Psychology 2075 Chapter Notes - Chapter 18: Conflict Resolution, Scrotum, Vardenafil

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Chapter 18: Sexual Disorders and Sex Therapy
Whether we define something as a sexual disorder is affected by the social and cultural context
in which we live
Most of us have at one time or another a sexual problem that went away without treatment
oIt is normal
Until the 1960s, the only available treatment was long-term psychoanalysis which was costly and
not very effective
In 1970 Human Sexual Inadequacy by Masters and Johnson brought in new understanding and
treatment for sexual disorders
Sexual Disorders
Sexual Disorders problems with sexual response that cause a person mental distress
oListed in the DSM-5
oA person can have more than one disorder
oAlthough each disorder corresponds to different aspects of the sexual response cycle, in
all disorders the person is not able to respond sexually or feel sexual pleasure because of
the disorder and experiences distress because of it
oThe DSM-5 also includes substance / medication induced sexual dysfunction
Lifelong Sexual Disorder a sexual disorder that has been present since the person began
sexual functioning
Acquired Sexual Disorder a sexual disorder that develops after a period of normal
Situational Sexual Disorder a person has the disorder in some situations but not in others
Many sexual disorders are not absolute
oThey mar occur with one partner but not another or in one situation but not another
Sexual disorders can occur with a partner of the same or other gender
Disorders in Men
Male Hypoactive Sexual Desire Disorder there is a lack of interest in sexual activity (inhibited
sexual desire or low sexual desire)
The person does not have spontaneous thoughts or fantasies about sexual activity and is not
interested in it
Diagnosed in men because in women desire and arousal are often linked and thus part of the
same disorder
Defined by a persistent or recurrent low or lack of sexual thoughts or fantasies and low or absent
interest in sex that is distressing to the person
Responsive Desire when people begin to feel desire after their partner initiates or after the sex
It is not uncommon for men to report problems with sexual desire
oLess than 2% of men meet the criteria for a diagnosis of HSDD
Men who experience anxiety about erection or ejaculation may lose interest in sex
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It could also be the case that the problem is not the person’s absolute level of sexual desire but a
discrepancy between the partner’s levels
Discrepancy of Sexual Desire a sexual problem in which the partners have considerably
different levels of sexual desire
oIf one partner wants sex less frequently than the other partner does
oNot a sexual disorder, just a couple problem
Erectile Disorder the inability to have or maintain an erection on almost all or all occasions
Occurs in fewer than 10% of men under 40
oIncreases to about 30% of men in their 60s
Erectile disorders is the most common of the disorders among men who seek sex therapy
oParticularly since the introduction of Viagra
Premature (Early) Ejaculation the man ejaculates too soon and feels he cannot control when he
o1. Ejaculation that always or almost always occurs before or within one minute of vaginal
o2. The inability to delay ejaculation
o3. Distress about the problem
In extreme cases, ejaculation may take place so soon after erection that it happens before
penetration can occur
oIn other cases, the man is able to delay the orgasm to some extent but not as long as he
would like or not long enough to meet his partner’s preferences
Kaplan believes the real problem is that the man has no control over when he orgasms
About 24% of men report having a problem with climaxing too early
Female partners are less likely to see the timing of ejaculation as a problem
oOnly 10% of the partners felt the man has a problem compared with 24% of the men
oEarly ejaculation was associated with lower sex satisfaction for the men but not for their
oWas not associated with relationship satisfaction for either partner
Men have developed (mostly ineffective) home remedies for dealing with PE
oDoubling up on condoms and using desensitizing creams
oThoughts  sex negative (thinking of someone unattractive), sex positive (we’re in no
rush), nonsexual and negative (thinking of a sad event), sex neutral (counting backward
from 100) and sexually incongruous (thinking about your grandma)
Most common for men to do this
Of these options, the sex-positive is recommended because it allows both patterns
to remain in the moment
Delayed Ejaculation the man cannot have an orgasm or the orgasm is greatly delayed even though he
has an erection and has had a great deal of sexual stimulation
In the most common version, the man is incapable of orgasm during intercourse but may be able
to orgasm as a result of hand or mouth stimulation
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Far less common than premature ejaculation
oLess than 1% would meet the criteria for a diagnosis
More common among men over 50 than among younger men
Disorders in Women
Female Sexual Interest / Arousal Disorder  the woman’s sexual interest or arousal is significantly
The women must experience at least 3 of the following symptoms
oLack of interest in sexual activity, lack of sexual thoughts, lack of desire as demonstrated
by not initiating sex with a partner and not being responsive to the partner’s initiations,
absent or reduced sexual excitement or pleasure in all sexual encounters, absent or
reduced response to sexual stimuli, absent or reduced physiological response during
sexual encounters
Rates increase as women get older
A discrepancy of sexual desire between members of the couple is not sufficient to diagnose this
Difficulties with arousal and lubrication are common
oHowever, most are not persistent and it may not cause distress
These problems become frequent among women during and after menopause
oAs estrogen levels decline, vaginal lubrication decreases
Female Orgasmic Disorder the woman is unable to have an orgasm or experiences orgasms that are
less intense
A common pattern is situational orgasmic disorder in which the woman orgasms in some
situations but not others
Common disorder among women
Younger women are more likely to report infrequent orgasms than are older women
Approx. 10% of women never experience an orgasm in their lifetime
21% of Canadian women report that they do not usually have an orgasm during intercourse
oThese women don’t necessarily have a disorder
Because it is so common, the DSM-5 states that women who need clitoral stimulation to reach
orgasm should not be diagnosed with this disorder
Often the woman who orgasms as a result of hand or mouth stimulation but not penile thrusting
is simply having orgasms when she is adequately stimulated and not having them when she is
inadequately stimulated
Genito-Pelvic Pain / Penetration Disorder any one of the 4 symptoms that typically occur together
related to genital pain during actual or attempted intercourse
4 symptoms
oDifficulty having intercourse / penetration
oDyspareunia  Marked genital or pelvic pain during penetration attempts
oFear of pain associated with vaginal penetration
oMarked tension or tightening of the pelvic floor muscles during attempts at vaginal
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