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Individual Differences and Relationship Conflicts - Expectations for Men
goal-oriented
Individual Differences and Relationship Conflicts - Expectations for Women
partner-oriented
with masturbation, men use ___ approach while women use ---
1 approach
different techniques
Relationship conflicts
Many couples (50%) have had, or eventually will have, sexual problems at some time in their relationship
Relationship solutions
Working together and talking about differences
Choosing properly trained and certified Marriage and Family Therapist
Sexual Therapy Techniques - Medical History
possible organic causes
Sexual Therapy Techniques - Sexual History
attitudes, behaviors, and partner reactions and involvement
Four types of sexual therapy
psychoanalysis
medical model
cognitive-behavior therapy
biopsychosocial approach
Psychoanalysis therapy
Long-term, intensive exploration of childhood causes for adult problems. Not commonly used today.
cognitive-behavioral therapy
Short-term, focusing on attitudes, beliefs and how they affect our behaviors.
psychosexual therapy
Insight into causes of the problems; successful with sexual aversion and low sexual desire.
medical model therapy
Looking for and treating organic causes for sexual problems
Sexuality educator
Teaches and trains about a range of topics related to sexual health, anatomy, etc
Sexuality counselor
Variety of professions ranging from medicine to clergy
sex therapist
Licensed mental health professions
ICD-10 Sexual Disorder
a clinically recognizable set of symptoms or behavior associated ... with distress and with interference with personal functions
APA Sexual Disorder
A heterogeneous group of disorders that are typically characterized by a clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure
Sexual problem criteria
one time occurrence
stress of life
common
most have problem at some point
problem with firsts
communication can help if it’s couple-related
Sexual disorder criteria
if the individual considers it to be one
some amounts of time (usually at least 6 months)
not the result of some other personal or interpersonal problem (depression)
issue occurs majority of the time
two views of dysfunction
medical
psychological
According to the DSM-5, Male Erectile Disorder will manifest at least one of three symptoms 75% to 100% of the time during sexual activity:
Marked difficulty in obtaining an erection during sexual activity
Marked difficulty in maintaining an erection until the completion of sexual activity
Marked decrease in erection rigidity
Persisted for approximately at least 6 months
Cause clinically significant distress in the individual
Medicalization of sexuality with viagra
originally used to treat heart issues, realized giving erection, now used for ED
sexual health
a state of physical, emotional, mental, and social well-being in relation to sexuality
positive and respectful approach to sexuality
free from coercion, discrimination, and violence
feelings toward ___ can affect sexual health
body
sexual anatomy
expression of sexual feelings
orgasm
masturbation
sexual intercourse
desire, arousal
Sexual problems you have heard from college students - Women
hard time orgasming
pain - lack of lubrication
inexperience
Sexual problems you have heard from college students - Men
Ejaculating too quickly - No lube
Inexperienced
No clit knowledge
No condom knowledge
Alcohol and erections
Erection
Sexual disorders in men
hypoactive sexual desire
erectile disorder
premature ejaculation
male orgasmic disorder
sexual pain disorder
Sexual disorders in women
Female Sexual Interest/Arousal Disorder
Female Orgasmic Disorder
Sexual Pain Disorders
causes of sexual disorders
organic/medical
psychological
sociocultural (relationship)
hypoactive sexual desire (lack of interest for 6 months)
primary: never had sexual interest
secondary or acquired
causes: organic (low T) or psychological (more common)
treatment: common reason for entering therapy but difficult to treat
medical vs biopsychosocial model
Causes of erectile dysfunction
80% are physical, do REM sleep test
circulatory problems, neurological disorders, prostrate surgery, low T, groin injuries
25% due to medications prescribed for other conditions (antidepressants and beta-blockers)
Smokers and drinkers
being overweight
What is erectile dysfunction?
persistent or recurrent inability to get or maintain erection adequate for satisfactory sexual performance
APA diagnostic criteria includes persistent (6months or more), causing distress or interpersonal relationship problems
nocturnal penile tumescence test
measures force and duration
several nights
sensate focus
non-demand mutual pleasure technique
couple learns how to touch and be touched
without worrying about performing or reaching a goal
premature ejaculation
Absence of reasonable voluntary control of ejaculation resulting in personal distress
Organic or psychological causes
solutions to premature ejaculation
masturbating several hours before intercourse
pause-squeeze technique
pelvic floor exercises
condoms or analgesic cream to reduce stimulation
other medications
counseling
male orgasmic disorder
delay or absence of orgasm following what is typically a normal sexual excitation phase
most common causes are psychological (fear, guilt, etc.)
bridge manuever
man masturbates alone and w/partner; partner stimulates to orgasm then quickly puts penis into vagina
dyspareunia
infections
peyronie’s disease
priapism
prolonged erection
benign coital cephalalgia
sex headache at start/after orgasm, usually in men
Four categories of sexual problems in women
sociocultural, political, economic factors
partner and relationship factors
psychological factors
medical factors
sexual interest/arousal disorder (most common for women)
persistent or recurrent deficiency of sexual fantasies/thoughts and/or desire for or receptivity to sexual activity, which causes personal distress
1/3 women
sexual aversion disorder
more severe
not in DSM-5
psychological and/or organic causes (women)
Sexually repressive upbringing, past sexual traumas, depression, some medications (esp. antidepressants), low testosterone (not common),coexisting sexual problem (such as painful coitus)
relationship issues (women)
Betrayal, dislike, fear of partner, partner’s abuse, partner’s negative patterns of communication, insufficient emotional intimacy
Treatments for desire
most difficult to treat and lowest success rate
self-help
communication, sex goals, novelty, non-sexual intimacy
self-expansion
broadening sense of self with your partner
engaging in new activity (going to a lecture, new site, exploring something new)
persistent sexual arousal disorder
Characterized by unrelenting, spontaneous, and uncontainable genital arousal, mostly in females.
Can experience spontaneous orgasms that do not resolve arousal. The person's arousal is not linked to sexual desire.
Can lead to on going physical pain, stress, and psychological difficulties due to an inability to carry out everyday tasks.
Sexual syndrome that takes joy out of life
Female orgasmic disorder
persistent or recurrent inability of a woman to have an orgasm (climax or sexual release) after adequate sexual arousal, and sexual stimulation, which causes personal distress
Associated with older women, less assertive women, can be primary, secondary, or situational (partner-or action based)
Only half of women are distressed by failure to orgasm
genito-pelvic pain/penetration disorders
dyspareunia (pain during sex)
vaginismus (involuntary spasms of muscles surrounding vagina cause full/partial closure)
noncoital pain disorder
postcoital dysphoria
sadness, irritability, and anxiety after sex
33% women, 12-34% men
Cross-cultural perspectives on sexual therapy
western, middle-class values
sex for physical pleasure
men and women are equal partners
Northern Africa and Middle East sexual attitudes
restrictive, patriarchal, sexual attitudes
Latin countries sexual attitudes
male-oriented sexual regimehi
Hindu and Buddhist sexual attitudes
emphasize unity, harmony, and spiritual growth
female genital mutilation
any procedure involving partial removal or total removal or deliberate injury to the female genitals for non-medial reasons
NO HEALTH BENEFITS
CULTUAL CUSTOM based on limiting female sexual behavior
illegal in the US still routinely performed in some African countries
Where does FGM occur?
300 million women
0-4 years, almost always before 15 years
1/2 population live in Indonesia, Egypt, and Ethiopia
84.5% report complications
hypersexuality
No DSM-5 category
Sexual compulsion aka sexual addiction
Recurrent failure to control the behavior and/or continuation of behavior despite significant harmful consequences
Engage in sex (or masturbation) compulsively to reduce anxiety; usually finding little or no emotional satisfaction
compulsive sexual behavior
a disorder in which the individual experiences intense sexually arousing fantasies, urges, and associated sexual behavior
Not in DSM – 5
3-5% - hypersexuality
3% - 20 or more hours per week online sex
ICD – 11 (International Classification of Diseases)
Classified as an impulse control behavior like gambling and kleptomania
Types of treatment
therapy
cognitive behavioral therapy
acceptance and commitment therapy
medications
support groups
12 step programs
sex addicts anonymous
sexaholics anonymous
NoFap - online community
Porn addiction
An addiction model of compulsive sexual activity with concurrent use of pornographic material, despite negative consequences to one's physical, mental, social, or financial well-being.
Neither the DSM-5 nor the ICD-11 classify pornography as a mental disorder or addiction.
problematic internet pornography viewing
viewing of Internet pornography that is problematic for an individual due to personal or social reasons, including excessive time spent viewing pornography instead of interacting with others.
sexual dysfunction in younger men ( < 40Y)
Sharp increase
10 – 20% organic
More often psychological
Increased rise in ED, orgasmic disorder, low sexual arousal
Porn-Induced Erectile Dysfunction
gender differences in porn (women)
often watch with partner
watch soft porn; couples porn
report higher levels of intimacy
gender differences in porn (men)
often watch alone
watch sex acts without context
report lower levels of intimacy
associative learning
When a user has conditioned his sexual arousal to Internet pornography, sex with desired real partners may register as “not meeting expectations” (negative reward prediction) resulting in a corresponding decline in dopamine.
Combined with the inability to click to more stimulation, this unmet prediction may reinforce an impression that partnered sex is less salient than Internet pornography use.
It is possible that if a susceptible Internet pornography user reinforces the association between arousal and watching other people have sex on screens while he is highly aroused, his association between arousal and real-life partnered sexual encounters may weaken.
Treatments by Many Different Types of Professionals
medical doctors
family practitioners
OB-GYNS
psychotherapists
marriage-family
cognitive-behavioral
sex therapists
O-shot
Marketed as the orgasm shot, or O-Shot, treatment involves injecting the clitoris, labia, and G-spot with platelets — a substance in your blood that contains healing proteins called growth factors —extracted from your own blood.
There’s currently very little research on the O-Shot, and no scientifically proven evidence that it can improve your sex life.
sex surrogate
A sex surrogate is a person who helps others over come social and sexual issues through hands-on intimacy
The surrogate engages with the client in a physical, intimate way to build their sexual confidence and make them more comfortable with emotional and physical intimacy
The legal status of surrogate partners is undefined in most of the United States and most countries around the world, according to the IPSA. This means that there are generally no laws regulating the profession.
sex surrogacy experiment
(1985), director Kirby Dick weaves a fascinating study of the curious role of a sex surrogate in the then-new discipline of sexual therapy.
Maureen Sullivan and two of her clients agreed to have the entire progression of their therapy taped.
Newly divorced man
25 year old grad student