study guide

Sexual Dysfunctions

Definition

• Problems with sexual responses in one or more of the first three phases of the human sexual response cycle.

Types

• Lifelong type: struggle with sexual dysfunction for most of their lives.

• Acquired type: normal functioning that preceded the disorder.

• Generalized type: dysfunction present in all sexual situations.

• Situational type: dysfunction tied to particular situations.

Human Sexual Response Cycle

• Desire Phase: interest in or urge to have sex, sexual fantasies, sexual attraction to others.

• Excitement Phase: changes in the pelvic region (penis erection, swelling of clitoris and labia, vaginal lubrication), general physical arousal, increases in heart rate, muscle tension, blood pressure, and respiration.

• Orgasm Phase: sexual pleasure peaks and sexual tension is released as pelvic muscles contract rhythmically; for men, semen is ejaculated; for women, the outer third of vaginal walls contract.

• Resolution Phase: return to baseline.

Major Dysfunctions Characteristics

Desire

• Male hypoactive sexual desire: lack of interest in sex and little sexual activity; physical responses may be normal, they may enjoy sex.

• Female sexual interest/arousal disorder: lack of interest in sexual activity, generally involves the excitement phase.

Excitement

• Male erectile disorder (ED): persistent inability to attain or maintain an erection during sexual activity.

• Female arousal disorder (frigidity): repeated inability to maintain proper lubrication or genital swelling during sexual activity; often co-occurs with desire or orgasmic disorders.

Orgasm

• Premature ejaculation: orgasm and ejaculation within one minute of beginning sexual activity and before the man desires ejaculation.

• Delayed ejaculation: repeated inability to ejaculate or very delayed ejaculation after sexual activity.

• Female orgasmic disorder: persistent inability or delay to reach orgasm or experiencing orgasms of very low intensity.

Sexual Pain Disorders

• Genito-pelvic pain/penetration disorder.

  • Vaginismus: involuntary contraction of the outer third of the vagina; severe cases prevent intercourse.

  • Dyspareunia: vaginal or pelvic pain during sexual intercourse.

Common Causes of Sexual Dysfunctions

• Social/cultural: gendered attitudes and expectations, lack of information, trauma, fears, attitude, stress, mood.

• Biological: effects of diseases, injury, or substances/prescribed medications, hormonal abnormalities (prolactin, testosterone, estrogen), excessive serotonin and dopamine activity.

Treatment

• Modern sex therapy techniques include:

  • Assessing and conceptualizing the problem (medical examination and sex history assessment).

  • Assigning “mutual responsibility” for the issue (both partners share the problem).

  • Education about sexuality (increase knowledge regarding physiology and techniques).

  • Emotion identification (express upsetting emotions affecting arousal and enjoyment).

  • Attitude change (examining and changing problematic beliefs).

  • Elimination of performance anxiety and spectator role (exercises to reduce performance demands).

  • Increasing sexual and general communication skills.

  • Changing destructive lifestyles and marital interactions.

  • Addressing physical and medical factors.

Sexual Paraphilias

Distinction among Different Paraphilias

• Fetishistic disorder: intense sexual urges, fantasies, or behaviors involving a nonliving object.

• Transvestic disorder: dressing in opposite sex clothes for sexual arousal.

• Exhibitionistic disorder: arousal from exposing genitals in public.

• Voyeuristic disorder: sexual desire to observe others undressing or having intercourse; may involve acting on these desires.

• Frotteuristic disorder: fantasies or behaviors involving touching and rubbing against a nonconsenting person.

• Pedophilic disorder: sexual activity with a child, usually prepubescent or early pubescent.

• Sexual masochism disorder: fantasies or behaviors of being humiliated or made to suffer.

• Sexual sadism disorder: fantasies or behaviors involving the psychological or physical suffering of a victim.