textbook chapter 18

Male hypoactive sexual desire disorder

• Not interested in sexual activity that is distressing to the individual 

• Hard to define because there are many circumstances when this is okay 

• Common in men with anxiety about erections/ejaculation 

• Problem is not the individuals absolutel level of sexual desire but a discrepancy between partners levels

erectile disorder causes

• Diseases associated with heart and circulatory system

• Vascular pathology 

• Diabetes mellitus

• Hypogonadism: underfunctioning of testes

• Hyperprolactinemia: high prolactin

• Injury to spinal cord

• Severe stress or injury

• Prostate surgery

premature ejaculation remedies

• Doubling up on condoms

• Desensitizing creams

• Thinking of something else

premature ejaculation causes

• Mostly psychological factors

• Malfunctioning of ejaculagtory reflexes

• Physiological hypersensitivity 

• Prostatis 

• Genes for rapid ejacuation are hanging around from natural selection

delayed ejaculation

• Unable to orgasm

• Usually can with hand or mouth stimulation but not intercourse

delayed ejaculation causes

• Mostly psychological

• Multiple sclerosis

• Spinal cord injury

• Prostate surgery

female orgasmic disorder causes

• Mostly psychological

• Severe illness, general ill health, fatigue

• Injury to spinal cord

genito-pelvic pain/penetration disorder

• Any one of four symptoms that tyically occur together for more than 6 months

  • Difficulty having intercourse

  • Marked genital/pelvic pain during penetration

  • Fear of pain with vaginal pentration 

  • Marked tension or tightening of pelvic floor muscles during attempts of vaginal penetration

• Vaginismus: reflexive muscle spasm of the outer third of the vagina making penetration impossible

genito-pelvic pain/penetration disorder causes

• Disorders of vaginal entrance: scars, sexual assault, infection of bartholin glands

• Disorders of vagina: infections, allergic reactions, thinning of vagina walls

• Pelvic disorders: pelvic infections, tearing of ligaments

• Dysfunction of the pelvic floor muscles

drugs and sexual disorders

can cause sexual disorders

• Hormonal contraceptives

• High blood pressure meds

• Antidepressants

alc and sexual disorders

1. Short term pharmacological effects

2. Expectancy effects: many people have expectancy that alc will do stuff, so it does

3. Long term effects of chronic alcohol abuse: frequent sexual disorders

cannabis and sexual disorders

• Increases sexual desire and makes sexual interactions more pleasurable 

• High doses can have negative effects and lead to risky behaviours

• For women, low doses are associated with increased sexual desires 

illicit or recreational drugs and sexual disorders

• Cocaine enhances sexual experiences

  • Chronic use is bad for sex

  • Effect depends on means of administration: injection is best for this

• Amphetamines are associated with increased sexual desire and better control of orgasm

• Meth: people engage in risky sexual behaviours

• Opiates: supression effects on sexual desire and response

prescription drugs

• Tranquilizers and antidepressants improve sexual responding by improving mental states

• Antidepressants have sexual side effects

• Antihistamines reduce vaginal lubrication 

• Antihypertensive drugs cause erection problems

psychological causes

• Predisposing factors: things that happen in childhood that inhibit sexual response

• Maintaining factors: ongoing life circumstances that help explain why the problem continues

maintaining individual causes

• Myths and misinformation can be a source of sexual dysfunction

• Negative attitudes about sexual activity, ones body, partners body

• Anxiety during sex: caused by trauma, fear of failure

• Cognitive interference: thoughts that distract the person from focusing on the erotic experience 

  • Most people experience 1 nonerotic thought 

• Spectatoring: the person behaves like a spectator of their own sexual performance 

• Psychological distress: depression, ptsd etc

• Behavioural and lifestyle factors: smoking, alc, obesity

• Failure to engage in effective sexually stimulating behaviour

• Relationship distress: interfere with communication, closeness, arousal

predisposing factors

• Things that you learned in childhood like sex is dirty or something

• Persons first sexual act was traumatic 

• Child sexual abuse 

combined cognitive and physiological factors

• Women with sexual disorders were exposed to scary movie and then shown an erotic video and were told that their genitals showed a strong arousal response to it (false)

• This led them to have greater vaginal arousal responses in subsequent sessions

therapies for sexual disorders

behaviour therapy, cognitive behavioural therapy, mindfulness therapy, couple therapy, biomedical therapy

behaviour therapy

roots in learning theory, sex problems are resulting of prior learning and maintained by maintaining causes. Can be unlearned with new conditioning

• In vivodensitization: client is gradually led through exercises that reduce anxiety 

• Help clients learn about bodies and what they like

• Eliminate goal oriented sexual performance 

• Sensate focus exercises

• Simple education

CBT

• Cognitive restructuring: helping restructure thought patterns

• Helpful for women who distrust men

• Address cognitive interference

mindfulness therapy

• Focusing ones attention on experiences in the present moment in a calm, nonjudgemental way

• Helps people focus on their sexual experience

• Assigning exeercises first in non sexual situations and then sexual

• Increases concordance between sexual arousal and desire because it increases womens focus on their own sensations of arousal 

couples therapy

• Relationship is treated so partner can respond better to sexual problem 

5 part model in treating men with erectile disorder

1. Sexual and performance-anxiety reduction: sensate focus exercises

2. Education and cognitive intervention

3. Script assessment and modification

4. Conflict resolution and relationship enhancement: 

5. Relapse prevention therapy

stop start technique

 for men to increase control over timing of ejaculation

• Learns to identify sensations before ejaculation

• Partner stimulates the man to erection and then stops the stimulation before that point 

• Man loses erection

• Partner resumes

• And do this 3 or 4 times and then he can orgasm

masturbation

most effective for women with orgasm disorder

kegel exercises

 strengthen pubococcygeal muscle 

• Enhance arousal and facilitate orgasm

bibliotherapy and videotherapy

• Self helpbook or video 

biomedical therapies

• Viagra: facilitates physiological processes that produce erection, relaxes corpora cavernosa muscles allowing for blood flow. 

  • Temporary solution

  • Does not enhance sexual performance 

• Cialis: like viagra but lasts longer 

  • No impact on sperm production

• Testosterone treatments

• No drug for women

• Intracavernosal injection: injecting drug into corpora cavrnosa for erectile dysfunction 

• Suction devices: tube is placed over te penis and they pump you up 

• Surgical therapy:

  •  vestibulectomy can help women with pain

  • Penile prothesis helps with erectile disorder

criticims of sex therapy

• Medicalizes sexual disorders

• Goal oriented rather than pleasure oriented 

• Do not fit for people with disabilities