Abnormal Psychology 3018 Sexual Dysfunction

Because in terms of sexuality, there is no such thing as ‘normal’ or ‘average’ and with or without a partner, we are all sexual beings.

… having sex or reproducing is a legitimate aspect of our wellbeing.

Sexual health is a state of physical, emotional, mental and social wellbeing relating to sexuality.

Sexual dysfunction is ‘the various ways in which an individual is unable to participate in a sexual relationship as he/she would wish’.

• Intimacy (loving and being loved; expressing mutual care).

• Loving relationships.

• Any type of sexual activity.

• Physical appearance.

It is about the emotional and physical needs that you have.

A sexual dysfunction is about being unable to participate in a sexual relationship/activity to the level that you desire (to the point that it is distressing).

1/2 of women.

1/3 of men.

One difficulty: 2/3

One new difficulty: 1/3.

Yes, people typically underreport these kinds of issues.

First of all, it is very hard to get people to participate, and typically these studies have small sample sizes.
Need to be very specific about the age group being studied, as the issues are age-related.
Need to know if the study was population-based vs. clinical or self-report vs. clinical interview.
Are the clinicians asking the ‘right’ questions, understanding the concepts?

Closed question: ‘are you sexually active?’

Open question: ‘how satisfied are you with your sexual life?’

The model focuses on genital response.

1. ‘Desire’ - the muscle tension, breathing, butterflies in stomach, changes in heart rate, preparing for sexual activity.

2. ‘Excitement’ - bodily changes intensify, engorged vagina and uterus, clitoris is sensitive, penis has erection.

3. ‘Orgasm’ - contractions, spasms of uterus/vagina walls, male ejaculation, testicles contract into the scrotum.

It is a very simplistic and linear model. It excludes other parts of intimacy, like emotional intimacy, relationship satisfaction.

It is a circular model. It begins with ‘Spontaneous Sexual Drive’ which can lead to seeking out ‘Sexual Stimuli’ or being receptive to ‘Sexual Arousal’.
The circular model is:
‘Sexual Stimuli’ –> ‘Sexual Arousal’ –> ‘Arousal and Sexual Desire’ –> ‘Emotional and Physical Satisfaction’ –> ‘Emotional Intimacy’ –> (back to the beginning).

It acknowledges how emotional intimacy, sexual stimuli, and relationship satisfaction can all affect the female sexual response.

The intimate aspect, the loving aspect.

No, ‘arousal’ can happen first and then ‘desire’ can come afterwards.

• A clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure.

• A minimum duration of 6 months.

• Symptoms must cause significant distress.

• Experienced on ALMOST all or ALL occasions of sexual activity (75 - 100%).

• Important to consider cultural values and age.

1. 1. Nature of the onset: lifelong vs. acquired.

2. 2. Context: generalised vs. situational.

3. 3. Severity: mild vs. moderate vs. severe (based on level of distress).

They are:

• Lifelong (present from the very first sexual experience).

• Acquired (had a period of normalcy and then an issue developed).

10%

They are:

• Generalised (e.g., does not experience sexual arousal in any context).

• Specific (e.g., experiences sexual arousal in one context but not the other).

Premature ejaculation. If the man ejaculates (after penetration has begun) -
60 seconds: mild.
30 seconds: moderate.
15 seconds: severe.

1. Desire.

2. Arousal.

3. Orgasm.

4. Pain.
   No, they were not gender specific.

Desire - 'Male hypoactive sexual desire disorder'.
Arousal - 'Erectile disorder'.
Orgasm - 'Delayed ejaculation' and 'Premature ejaculation'.

Desire & Arousal - 'Female sexual interest/arousal disorder'.
Orgasm - 'Female orgasmic disorder'.
Pain - 'Genito-pelvic pain/penetration disorder'.

The person who is asexual is not distressed by their lack of desire and therefore cannot be diagnosed. Someone with a desire disorder ARE distressed by their lack of desire.

• Persistent disinterest in sexual activity. | - The person is distressed by their lack of interest.

Overall prevalence: 7-33%.
Men: 8%.
Women: 55%.

A sexual desire disorder.

Women tend to have a lack of desire AND a lack of arousal. | Men tend to have a lack of desire but can still have arousal (physical response is normal).

Female Sexual Interest/Arousal Disorder:

• Interest/desire: a lack of, or significantly reduced, sexual interest in sexual activity and fantasising.

• Arousal: difficulty attaining or maintaining adequate lubrication until completion of the sexual act.

Erectile Dysfunction (ED):

- Marked difficulty in obtaining OR maintaining an erection (until completion) of sexual activity, OR marked decrease in erectile rigidity.

About 50%, increases with age:

50 y/old: 50%.

60 y/old: 60%.

70 y/old: 70%.

80 y/old: 80%.

Psychogenic:

• sudden onset.

• situational.

• still have morning erections.

• erection when masturbating.

• partner specific?

• often present in younger patients.

Organic:

• gradual onset/deterioration.

• always.

• decrease in morning erection.

• no erection when masturbating.

• may be due to injury, trauma, disease, medication, or drug/alcohol use.

• Delayed ejaculation: maintains erection but with marked delay (or inability) to ejaculate (without wanting the delay). Experienced almost every time and will try to ejaculate for 20-25 minutes.
  (The least common male sexual complaint, around 4%).

• Premature ejaculation: ejaculation with only minimal stimulation (around 8%).

Female Orgasmic Disorder:
Marked delay/infrequency/absence of orgasm OR reduced intensity of orgasm.
It must be distressing, and can be situational.

Because women don't know their anatomy as well as men and sometimes don't know how to feel pleasure. They can learn how to properly stimulate themselves and eventually achieve orgasm.

Around 51%.

• Genito-Pelvic Pain/Penetration Disorder:
  Persistent/recurrent difficulties with -

• Vaginal penetration during intercourse.

• Fear or anxiety about pain.

• Tensing or tightening or the pelvic floor muscles.

If a woman experienced pain during sex, they might anticipate pain again and automatically tighten their muscles in fear. This creates more pain for the future sexual encounter.

The body anticipates pain, fear/anxiety -->
The body automatically tightens vaginal muscles -->
Tightness makes sex painful, penetration may be impossible -->
Pain reinforces/intensifies -->
Body reacts by 'bracing' -->
Avoidance of intimacy -->
(back to the start).

• Biological/Physical factors.

• Psychosocial factors.

• Environmental factors.

• Interpersonal factors.

Ageing, illness, disability, medications, substance use/abuse.

Cultural/religious beliefs, self-acceptance (identity/orientation), body image, depression/anxiety, life stressors, past experiences, inexperience, perfectionism/performance anxiety.

Attraction to partner, partner performance and technique, excessive goal orientation, relationship quality and conflict, routinisation/changes in role, lack of partner.

Lack of privacy, lack of time, physical discomfort.

• Pharmacotherapy: viagra (highly effective).

• Penile injections: inject muscle relaxing drug into erection chamber 30-45 minutes before sex.

• Vacuum devices.

• Penile prosthesis (inflatable): invasive surgery, remove the testes and put a machine in the scrotum. When squeezed can induce an erection.

Less focus: on restoring erection-dependant sexual practice. | More focus: on promoting sexual intimacy despite functional challenges.

• self-disclosure.

• emotional connection.

• shared interests.

• shared values.

• shared dreams.

• sensual massaging.

• genital caressing.

• mutual masturbation.

• outercourse.

• deep kissing.

• sex toys.

• oral sex.

• holding hands.

• hugging.

• physical touch.

• kissing.

• cuddling.

• Hormonal therapy (estrogen). | - Addyi ('pink pill', not effective for many and many side-effects).

• Kegel exercise and vaginal weights (strengthen the vaginal muscles).

• Vaginal lubricants.

• Vaginal moisturisers (insert a small tablet/pellet into the vagina 3 times a week to naturally restore lubrication in the vagina and vulva.

Vaginal dilator: a plastic/rubber tube that is used to stretch the vagina.

Female vacuum therapy: creates a gentle pulsating suction over the clitoris to increase the blood flow.

COMMUNICATION! Helps with understanding:

• likes/dislikes.

• comforts/insecurities.

• how to communicate verbally and behaviourally during sex.

• the underlying relationship issues that may impact sex.

Exercise 1: general body pleasuring (focus on sensation of touching partner).
Exercise 2: introducing genital body pleasuring in the absence of intercourse.

• non-goal-orientated physical intimacy (minimise performance pressure/anxiety and reduce spectatoring).

• enhance communication between partners about sensual and sexual experiences.

• effective in treating female desire, arousal and orgasmic dysfunctions and erectile disorders.