Sexual Dysfunctions:

Biphasic Model

• Masters and Johnson (1980)
• DSM 3

• 7 disorders- biphasic Model for sexual

  dysfunction.

  Two periods during arousal where things can go wrong

  ·         Arousal phase disorders

  ·         Orgasmic phase disorders

   

  
  

Sexual Dysfunctions:

Triphasic Model

• Helen Singer Kaplan
• DSM 3R
• 9 disorders- Triphasic
• arousal, orgasmic, and Desire phase
• desire phase: sexual aversion disorder, hypoactive sexual desire.

• o    50% of couples have listed disorders

  o    45% have something other than what is listed in the DSM: they have no interest in getting sex

  
  

   

  
  

   

Hypoactive Sexual Desire Disorder

Psycogenic:

Problems:

• psychological
•  lack of emotional closeness
•  lack of tunneling
• you don't feel your relationship is fair
• power struggles
• talk yourself out of sex
• expecting passion to lead to sex
• partner's perception of why you are having sex and they aren't the same

(in regards to sexual dysfunction)

Primary 

vs. 

Secondary

You've always had the disorder

vs

Situational, you just acquired it or you have certain circumstances

Psycogenic: in the mind

Organic: physical 

Desire Phase Disorders:

Sexual Aversion Disorder

Aversion to and active avoidance of sex with a partner.

Pscogenic:

• a vow
• high anxiety 
• sexual abuse/rape

Arousal/Excitement Phase Disorders:

Female Sexual Arousal Disorder

There is desire to have sex, but inadequate lubrication-swelling response to sexual excitement.

• 14% of  women
• Causes:
  • lack of tunneling
  • body image disorders
  • menopause
  • hormone disorders
  • anxiety problems

Can not attain or maintain an adequate erection.

• Organic:
  • 50% is caused organically
  • Prostate issues
  • Multiple sclerosis
  • Spinal cord injury
  • Alcohol/drug abuse over time
  • varicocele: varicose vein in penis or scrotum
• Psychogentic:
  • 50%  are psychogentic
  • stress/anxiety
  • spectatoring
  • worried about pleasing partner
  • Primary: sexual abuse
• How to test if it is psycho. or organ. :
  • strain gauge test: see if penis becomes erect while asleep then it's psycho
• How to treat:
  • exercise 
  • Pump: 60-90%  it works successful in getting
  • Viagra : 80-90% of men this works for
  • Yohimbine: herbal, bark from west Africa, may no even work
  • Testostrone: in men with low sex drive
  • Apomorphine: affects hypothalamus like antidepressants
  • Papaverine: penis shot, 80% of men can get erection first FDA approved medication, 

  •  Penile Implants:

    
    

    Semirigid: always hard

    Inflatable cylinders: that replace the spongy tissues, salt water in the belly

     

     

    
    

    
    

    
    

     

Orgasmic Phase Disorders:

Female Orgasmic Disorder

Delay or absence of orgasm following normal sexual excitement 

• 30% of all
• Majority of women with this disorder it is caused by Psychogentic reasons
• often because it is a social dogma
• primary:15% , often never masturbated, probably religious, never had orgasm before
• secondary:15%, it's just situational
• Treatment:
  • 1st work with women alone, help them to create a treasure map, warm bath where they touch themselves, don't start with vibrators
  • 3rd week 20% a woman will have generally had an orgasm
  • 4th week 20% more will have orgasm
  • 5-6 weeks she'll bring the guy (or mother) to the session
  • 15% of women have orgasm with intercourse alone

Orgasmic Phase Disorders:

Male Orgasmic Disorder 

 Delay or absences of orgasm following normal sexual excitement. Cannot ejaculate in partner

Causes:

• A great deal of pressure when masturbate, vagina doesn't present enough, leading to a lack of stimulation
• Fear of pregnancy
• Need for multiple layers of stimulation

Ejaculation with minimal sexual stimulation before the person  or partner desires.

three ways of defining:

1. Anyone that comes in less than one min. 
2. Kaplan: Absence of voluntary control
3. Master/Johnson: Not long enough for partner to come at least half the time

• This is the most common male sexual disorder
• Psychogenic: often they simply don't pay attention, they are new to sex and don't think about having to suppress their climax
• Treatments:
  • squeeze tip, or lightly tug scrotal sack
  • Start and stop technique: 
    • 5weeks
    • come close to orgasm
    • deflate 50%
    • come close to orgasm
    • deflate 50%
    • finishes
  • theory PC muscle is tight, they come sooner, need to learn to relax the PC

Pain Disorders:

Dyspareunia

Pain Disorders:

Vaginismus

Part's of the Autonomic nervous system:

Parasympathetic: is active during the build up to sex, active before climax

Sympathetic: activated for/during orgasm, if they kick into soon you won't be able to finish

ex: Spectatoring: I hope I  stay hard and down they go

Sexual Assault

Sexual Assault: forced sexual contact that does not necessarily include penile-vaginal intercourse, but could be included rape

Sexual Coercion

• broader term than rape or sexual aggression
• including arguing, pleading, and cajoling, as well as force and the threat of force

Rape

• Stranger: 26%
• Friend/acquaintance:44%
• Intimate:30%
• date rape hints:
  • alcohol abuse is huge 
  • invade personal space  
  • woman doesn't respond
  • male rapes

• Stranger: 16%
• Intimate: 30%
• Friend/Acquaintance: 44%
• Date rape:
  • alcohol abuse
  • violation of personal space
  • no correction of violation
  • rape

• 28+ STD's
• % of adolescents/young adults w/ STI's is5x that of people over 
• greatest risk of STI's is15-25 who have more than 1 partner a year
• 65 million in the US living with viral STI

Can be cured with medication, mostly antibiotics

• Syphilis: 
  • least common today 
  • cured by penicillin
• Gonorrhea:
  •  one of the most frequent 
  • untreated leads to Pelvic Infalmmatory Disease (PID) 
  • 80% of women w/ this are asymptomatic
  • the majority of men have symptoms, mainly epididymitis: urethral discharge and pain when urinating
  • 20-25% of women have untreated get PID and 
    • 20% of these women have pelvic pain
    • 10% have ectopic pregnancies
• Chlamydia:
  • 10% of college students have this
  • 80% of women are asymptomatic 
  • 25% of male are asymptomatic

Viral STI's:

Herpes 

1in 5 Americans affected- no cure

• Herpes I cold sores
• Herpes II genital herpes

Viral STI's:

HPV

• HPV: Human Papillomavirus: 
  • 100+ strains of HPV
  • 30 are sexually transmitted  
  • 10% may lead to genital warts  and may add to cervical and or genital cancer
  • many men carry it are asymptomatic
  • there are no tests to measure HPV
  • Men:  symptomatic w/ warts on the shaft, corona, base of penis

Viral STI's:

Hepatitis

Viral STI's:

HIV/AIDS

Acquired Immune Deficiency Syndrome

• 6-10 weeks after infection blood tests reveal HIV antibodies present
• final stage: T cells below 500,thus opportunistic diseases are life threatening

• 30% no sexual training
• 56% had minimal training
• 11% adequate training
• 01% excellent

• Lack of info
• Depression
• Anxiety

Sex Therapy

Vs.

Psycho Therapy

ST: focus on the behavior you want to change and is much shorter

PT: over all help and takes a life time

• 31% of men: premature ejaculation
• 43% of women low sex drive, orgasmic disorder, pain disorder

•  self disclosure: your personal experience helps the patient to feel closer to you
• Paradoxical intent: a assignment that will have the opposite response
• introduce humor