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Chapter 18

Psychology 2075 Chapter 18: Chapter 18 Sexual Disorders and Sex Therapy

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Psychology 2075
William Fisher

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Chapter 18 Sexual Disorders and Sex Therapy SEXUAL DISORDERS • Each disorder can be seen to vary along two dimensions: o A lifelong sexual disorder: always had that disorder (eg. The person has never had an orgasm) o An acquired sexual disorder: currently have the problem but didn’t have the problem in the past • A situational sexual disorder is a disorder that occurs in some situations but not in others – many sexual disorders are not absolute Disorders in Men Male Hypoactive Sexual Desire Disorder • Sexual desire or libido refers to an interest in sexual activity, leading the individual to seek out sexual activity or to be pleasurably receptive to it • The term hypoactive sexual desire disorder (HSDD) is used when an individual does not have spontaneous thoughts or fantasies about sexual activity o Sometimes termed inhibited sexual desire or low sexual desire • This disorder is diagnosed in men because in women, desire and arousal are often linked and thus part of the same disorder • See persistent or recurrent low or absent intereset in sex that is distressing to the individual • It is not uncommon for men to report problem with sexual desire: o 6% of young men and 41% of men over the age of 65 report this problem o but less than 2% of men meet the criteria for HSDD • the problem may not be the individual’s absolute level of sexual desire but a discrepancy between the partners’ levels o that is, if one partner wants sex considerably less frequently than the other, there is a conflict, even if neither partner is experiencing a sexual disorder = a discrepancy of sexual desire = a couple problem, not a sexual disorder Erectile Disorder • ED is the inability to have an erection or maintain one on almost all or all occasions • Also called erectile dysfunction or inhibited sexual excitement • Once called impotence but prefer not to use it due to negative connotations • ED can be generalized or situational • Occurs in fewer than 10% of men under 40 but then increases to 30% for those in their 60s • ED is the most common disorder among men who seek sex therapy Premature (Early) Ejaculation • Occurs when a man persistently has an orgasm and ejaculates sooner than desired during sexual activity with a partner and is significantly distressed about the problem • For penile-vaginal intercourse, ejaculation must occur within one minute following penetration o Specific time criteria have not been specified for other sexual activities • Definitions involve 3 parts: o Ejaculation that always or almost always occurs before or within one minute of vaginal penetration o The inability to delay ejaculation o Distress about the problem • Can be lifelong or acquired and situational or general • Kaplan believed that the key to defining rapid ejaculation is the absence of voluntary control of orgasm • Another good definition is self-definition, even if the man does not meet the criteria for a formal diagnosis: if a man finds that he has become greatly concerned about his lack of ejaculatory control or that it is interfering with his ability to form intimate relationships, or if a couple agree that it is a problem in their relationship, it is legitimate to seek professional assistance for these concerns • Estimated that between 1-3% of men will be diagnosed with premature ejaculation o However, many more men report poor ejaculatory control (24%) o Average time to ejaculation in a study was 8 minutes o But 7% in the study ejaculated in one minute, 17% in 2 minutes • In one study, early ejaculation was associated with lower sexual satisfaction for the men but not for their partners – and it was not associated with relationship satisfaction for either partner • In one study, the men reported the thoughts they used to delay ejaculation o Sex negative (thinking of an unattractive TV personality) o Sex positive (thinking we’re in no hurry, or visualizing a past episode of prolonged intercourse) o Nonsexual and negative (thinking of a sad event, unpaid debts) o Sex neutral (counting backwards from 100) o Sexually incongruous (thinking of your grandmother, reciting the Lord’s prayer) o Recommended to use the sex positive because it allows both partners to remain in the moment Delayed Ejaculation • Consistently (for a period of at least 6 months) unable to orgasm or orgasm is greatly delayed when engaging in sexual activity with a partner, even though he has a solid erection and has had more than adequate stimulation, and he is distressed about this • Most common version: unable of orgasm during intercourse but may be able to orgasm as a result of hand or mouth stimulation • Less common than premature ejaculation Disorders in Women Female Sexual Interest/Arousal Disorder • Lack of or significantly reduced sexual interest or arousal • The woman must experience at least three of the following persistent symptoms that cause clinically significant distress: o Lack of interest in sexual activity o Lack of sexual thoughts o Lack of desire as demonstrated by not initiating sex and not being responsive to initiations o Absent or reduced sexual excitement or pleasure in all or almost all sexual encounters o Absent or reduced response to sexual stimuli o Absent or reduced physiological response during all or almost all sexual encounters • This disorder cannot be due to psychological or relationship distress • Difficulties with arousal and lubrication are common, however most are not persistent and, particularly in older women, do not cause distress Female Orgasmic Disorder • Refers to women’s recurrent difficulty having an orgasm or reduced orgasm intensity during almost all sexual activity • The woman must be distressed about it • AKA: orgasmic dysfunction, anorgasmia, and inhibited female orgasm o Laypersons call it frigidity • A common pattern is situational orgasmic disorder • Younger women are more likely to report infrequent orgasms than are older women • Approximately 10% of women worldwide never experience an orgasm • DSM-5 explicitly states that women who need clitoral stimulation to reach orgasm should not be diagnosed with the disorder Genito-pelvic Pain/Penetration Disorder • Refers to any of four symptoms that typically occur together: difficulty having intercourse/penetration; marked genital and/or pelvic pain during penetration attempts (dyspareunia); fear of pain associated with vaginal penetration; and marked tension or tightening of pelvic floor muscles during attempts at vaginal penetration o The symptoms must occur for more than six months and must cause the woman significant distress • Can be situational or generalized, but more likely to be generalized • Dyspareunia decreases a women’s enjoyment of the sexual experience, frequently causes problem with arousal and orgasm, and may even lead one to avoid sexual situations • Some women experience reflexive muscle spasm of the outer third of the vagina = vaginismus • Although there is no equivalent male disorder in the DSM-5, men sometimes also experience pain during sex • Some argue that painful intercourse should be reclassified and treated as a pain disorder that interferes with sexual activity rather than a sexual disorder o Because women experience pain in other situations such as gynaecological exams and inserting tampons WHAT CAUSES SEXUAL DISORDERS? • Causes of most are understood from a biopsychosocial perspective Physical Causes • Physical factors, such as disease and drugs Erectile Disorder • Diseases associated with the heart and the circulatory system are particularly likely to be associate with erectile disorder • Any kind of vascular pathology can produce erection problems • ED is also associated with diabetes mellitus – circulation and peripheral nerve damage o Sometimes, ED is the earliest sign of diabetes • Hypogonadism – resulting in low testosterone – is also associated with ED • ED also associated with hyperprolactinemia in which there is excessive production of prolactin • Any disease or injury that damages the lower part of the spinal cord may cause ED (location of the erection reflex centre) • Some prostate surgery may cause ED Premature (Early) Ejaculation • More often caused by psychological than physical factors • However, for some men rapid ejaculation may be due to a malfunctioning of the ejaculatory reflexes – physiological hypersensitivity • A local infection, such as prostitis, may be the cause • Also degeneration in the related parts of the nervous system, which may occur in neural disorders (MS) • Explained by sociobiologists as selected for for survival Delayed Ejaculation • May be associated with a variety of medical or surgical conditions such as MS, spinal cord injury, and prostate surgery • Most commonly associated with psychological factors Female Orgasmic Disorder • May be caused by severe illness, general ill health, or extreme fatigue • Injury to spinal cord • Mostly caused by psychological factors Genito-pelvic Pain/Penetration Disorder • Disorders of vaginal entrance: irritated remnants of hymen, painful scar, infection of Bartholin’s gland • Disorders of the vagina: vaginal infections, allergic reactions, thinning of vaginal walls, scarring of the roof of the vagina • Pelvic disorders: pelvic infection such as PID, endometriosis, tumors, cysts, or tearing of the ligaments supporting the uterus • Dysfunction of the pelvic floor muscles: higher pelvic floor muscle tone; lower vaginal flexibility; higher mucosal sensitivity; lower muscle strength Drugs Alcohol • Either: o Short-term pharmacological effects o Expectancy effects o Long-term effects of chronic alcohol abuse: ED, orgasmic disorder, and loss of desire • At high dosage levels, alcohol acts as a depressant and sexual arousal is markedly suppressed in both men and women Illicit or Recreational Drugs • There is widespread belief that weed has aphrodisiac properties o Surveys indicate people report increases in sexual desire and that it makes it more pleasurable o Chronic users report decreased sexual desire o In community studies, weed is associated with orgasmic disorder • Effects of cannabinoids (active drugs in weed) depend on gender o In women, low doses of cannabis are associated with increased sexual desire and sexual pleasure ▪ Possible that cannabis boosts the production of androgens in women o At higher doses though, cannabis creates sexual problems o In men, moderate doses appear to increase sexual desire while at the same time creating erectile problems • Among drug users, cocaine is reported to be one of the drugs of choice for enhancing sexual experiences o It is said to increase sexual desire, enhance sensuality, and delay orgasm o Chronic use, however, is associated with loss of sexual desire, orgasmic disorders, and ED o Effects also depend on the means of administration ▪ Problems occur most in those chronic injectors • Stimulant drugs, amphetamines, are associated with increased sexual desire and better control of orgasm in some studies • Opiates such morphine, heroin, and methadone, have strong suppression effects on sexual desire and response Prescription Drugs • Psychiatric drugs (drugs to treat psychological disorders) may affect sexual functioning • Most function on the central nervous system, which can in turn affect sexual functioning • Drugs to treat schizophrenia may cause delayed orgasm or dry orgasm in men • Tranquilizers and antidepressants often improve sexual responding by improving the person’s mental state – but there may be negative effects o Many antidepressants are associated with desire, arousal, and delayed orgasm in men and women o Sometimes prescribed to treat premature ejaculation • Some of the antihypertensive drugs can cause erection problems in men • Some medication used to treat epilepsy appear to cause erection problems and decreased sexual desire o But epilepsy itself is associated with these problems Psychological Causes • Predisposing factors are people’s prior life experiences • Maintaining factors are ongoing life circumstances, personal characteristics, and characteristics of love making that help explain why the problem continues Maintaining Individual Causes • Myths or misinformation can be a sources of sexual dysfunction • Negative attitudes about sexual activity, one’s own body, or one’s partner’s body can be a source of sexual dysfunction o Researchers in BC found that sex guilt – feeling that one is violating proper sexual conducts – is associated with lower sexual desire in women, and sex guilt accounts for why South Asian women tend to report lower sexual desire than Euro-Canadian women • Anxiety during sexual activity can be a source of sexual disorders o Anxiety may be caused by negative or traumatic experiences in the past, such as child sexual abuse o Anxiety can also result from fear of failure – fear of not being able to perform o Anxiety can block sexual response in some people • Cognitive interference refers to thoughts that distract the person from focusing on the erotic experience – the problem is one of attention o Research asked students about the non-erotic thoughts they had during their most recent sexual encounter that took away from their sexual experience ▪ More than 90% of participants reported having at least one such non-erotic thought ▪ The thoughts most often related to performance concerns, concerns related to external consequences (STIs) and emotional consequences (eg. For relationship), and body image ▪ Men are more likely to have thoughts related to performance and the women more likely about body image o Spectatoring is one kind of cognitive interference (Masters and Johnson) ▪ The person behaves like a spectator or judge of his own sexual performance o David Barlow studied men with and without sexual disorders (dysfunctionals and functionals) ▪ He found that they respond very differently to stimuli in sexual situations ▪ Anxiety (induced by the threat of being shocked) increases the arousal of functional men, but decreases the arousal of dysfunctional men ▪ Demands for performance increases the arousal of functionals, but are distracting to and decrease arousal in dysfunctionals ▪ Dysfunctionals consistently underestimate the
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