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Sexual problems are quite common Statistically, occur more frequently in:!Chapter 14– Younger women, older men!– People w/less education! Perception of sexual problems is subjective!– Not everyone experiencing a sexual problem isnecessarily distressed or sexually dissatisfied!Sexual Difficulties and SolutionsTypes of specific sexual difficulties In reality, these overlap considerably!!- problems w/desire and arousal can affectorgasm and vice versa!1) !Desire-phase difficulties!2) !Excitement/arousal-phase difficulties!3) !Orgasm-phase difficulties!4) !Dyspareunia! (pron. dis-puh-ROO-nee-uh)!– Painful intercourse!Excitement-phase difficulties1) Female Sexual Arousal Disorder:– EITHER:! Can’t physiologically become aroused (i.e. lubrication), or! Don’t feel aroused, even if physical responses are present!2) Persistent Sexual Arousal Disorder– Spontaneous, intrusive, and unwanted genital arousal inthe absence of sexual interest!– Uncomfortable tingling, throbbing, pulsating; notrelieved by orgasms--can last hours or days!Desire-phase difficulties1) Hypoactive sexual desire disorder (HSDD)!– Prolonged lack of interest in sexualactivity—even after trying toengage sexually with partner! It’s subjective—must cause distressfor individual and/or couple for HSDD to be diagnosed!– Contributing factors:! Life stress! Relationship problems! Depression and/or anxiety! History of sexual abuse or trauma! Side effects of medications!Excitement-phase difficulties (cont.)3) Male erectile disorder (ED)!– Consistent or recurrentinability to have or maintainan erection sufficient forsexual activity for 3 months!– Quite common! 1 in 5 men over age of20 experience ED! Incidence of ED increaseswith age (see graph)!!"# %&'#(%&'")* ,#-)./#0#12"&-/ #-%3! "# %&'()* '!"# %& '()*% ,-.(*!, &%)#',#)-.&/0'%12%'3)4'125&'1&2#(')67'! 8)#'&291') &:'*12%'()'3)4'; )*'2-)4%'%1&'.)(& %2 ('!# )!/ 0! 'Desire-phase difficulties (cont.)2) “Unmet” sexual desire!– 2005 Global Sex Survey: 41% of men and 29% ofwomen want sex more frequently !– Couples normally have some differences inpreferences re: sexual frequency (may go back & forth)! When these differences are significant source ofconflict or dissatisfaction in the relationship, couplecan have major difficulties!3) Sexual Aversion disorder: extreme andirrational fear of sexual activity!– Thought of sexual activity can induce intenseanxiety and panic!Orgasm-phase difficulties1) Female orgasmic disorder!– Absence, marked delay, or diminished intensity oforgasm--despite appropriate stimulation (usually clitoral)! Lack of orgasm during penetration is not a disorder!– Approx. 5-10% of adult women in U.S. !– More common among womenwho are younger, unmarried,and have less education!

Orgasm-phase difficulties2) Premature ejaculation!– The most common male sexual difficulty!– Pattern of ejaculations within 2 minutes and an inabilityto delay ejaculation, resulting in impairment of man’s orhis partner’s pleasure!– Approx. 20-30% of men!– Men w/P.E. experience rapidarousal and often ejaculatebefore reaching full sexual arousal; report lessenjoyment of orgasm than menw/o P.E.! Suggests physiological component!Why do we have sexual difficulties?Dyspareunia:Orgasm-phase difficultiesPain or discomfort during intercourse4) Faking orgasms– Usually discussed in reference to women,though some men also fake orgasms!– Reasons given: ! avoid disappointing or hurting their partners! get sex over with! need for partner Gay/Bi!Origins of sexual difficulties:physiological factors Vascular, hormonal, neurological problems! Poor general health, diet, and exercise! Physiological factors Cultural influences Individual factors Relationship factors- Not as common in men!- Problems w/foreskin!- Infection! Partner continues same method (presumably ineffective) ofstimulation, which he/she believes to be effective! Creates emotional distance during physical intimacy!Female!Heterosexual!MEN- More common in women!- Not enough lubrication!- Not fully aroused!- Hormones !– Can lead to vicious cycle !Table 14.3!Asked collegestudents, “Haveyou ever fakedan orgasm?”(%)!WOMEN– For example, body fat, especially around the abdomen,reduces testosterone levels in men, and men who are obeseare 90% morelikely14.4to have ED! Drug use!- Can occur in circ & uncirc.men!- Infection!- On glans—pain duringpenetration!- In urethra, prostate,seminal vesicles—painupon ejacuation!- Irritates vaginal walls!- Contraceptive irritation!- Sensitivity to spermicide,latex, or to a particular lube!- Deep pelvic pain!- Jarring of ovaries, ligaments!- Uterine infection or previoussurgery!– Peyronie’s disease: !– fibrous tissue and calciumdeposits in penis!Physiological factors (cont.)! ILLNESS Illness affects sexuality!– Pain & fatigue—no desire!– Damage to nerves, hormones, neurotransmitters, blood vessels,muscles—affects desire, arousal, orgasm! Diabetes:!– Nerve damage and circulatory problems affect arousal & desire! Cancer !– Treatment can damage nerves, blood vessels,hormones, and cause nausea, pain, fatigue!– See table! Strokes:!– Brain tissue can be destroyed from blockedblood flow to brain or bleeding in brain!– Can affect desire, arousal, mobility!Physiological factors(cont.)!MEDICATIONS Over 200 prescription and OTC medications have negativeeffects on sexuality--not always mentioned by doctor! Psychiatric medications!– Antidepressants, antipsychotics, tranquilizers: can reduce desire,arousal, orgasm! Antihypertensive medications (treat high b.p.)!– Can interfere w/desire, arousal, and orgasm! Other medications!– Prescription and OTC gastrointestinal,antihistamine medications caninterfere w/desire, arousal, erection!Physiological factors(cont.)!DISABILITIESCultural influences Have widely varying effects on sexual responsiveness! One example: spinal cord injury! Negative childhood learning! Effect of spinal cordinjury on erectiondepends onlocation of injuryalong spinal cord! Sexual double standard!– Parents’ attitudes toward sex, level of affection!– Labeling sex as sinful or shameful can contribute tosexual difficulties later in life!– Research: equality of gender roles is associated withgreater sexual satisfaction in men & women!– Opposing sexual expectations for women and mencreate problems! Men feel that they should want sex all the time, that asking forguidance from their partner isn’t ‘manly’! Women may learn to be sexually restrained for fear of beinglabeled a ‘slut,’ resulting in less exploration of their sexuality,not asking their partner for what they want!

Individual factorsCultural influences (cont.) How comfortable are we with our bodies?! Narrow definition of “sex”!– Idea that ‘real’ sex penile-vaginal intercourse leads toinadequate clitoral stimulation for women, placesunrealistic burden on intercourse!– When problems occur, too much focus is often placedon issues of erection problems, when emotional orrelationship problems are very often the root cause! Performance anxiety!– Usually, anxiety about not being able to achieve erectionor orgasm!– Leads to vicious cycle where anxiety about repeatproblems causes problems next time!Individual factors—self imagethen!– Awareness of our bodies and how we receivepleasure minimizes future sexual difficulties! Sexual abuse & assault!– 17% of women and 12% of men were sexually abusedbefore adolescence!– 17.6% of women and 3% of men have been raped orwere the victim of attempted rape!– Increases likelihood of sexual difficulties later in life,affecting self-esteem, desire, arousal, and orgasm!now! Emotional problems!– Anxiety, depression, and stress have a strongnegative effect on sexuality!Relationship factors Body image & self-esteem strongly affect sexuality!– Affects majority of women; many women feel sexuallyinhibited b/c they are uncomfortable with their bodies!– Media images of women have gotten further andfurther from the average size of women! Early 1980s: average model weighed 8% less than theaverage American woman; today, it’s 23% less!– Men are increasingly affected as well! Male models/stars typically have no visible body hair andare getting ‘beefier’! Porn gives men unrealistic idea of normal penis size!Sexual enhancement/Sex therapy Self-awareness!– Becoming well-acquaintedwith our sexual anatomy!– Experimenting withmasturbation to learnsexual response!Individual factors (cont.) Self-image! Unresolved resentments, trust issues, disrespectfor partner! One partner feels pressured! Ineffective communication ! Anxiety !– about unwanted or desired pregnancy!– about contracting or transmitting an STI! Problems accepting one’s sexual orientation!– Homosexuals who fear societal or familial disapprovalabout being gay may attempt to live in heterosexualrelationships despite their lack of desire for other sex!Sexual enhancement/Sex therapy (cont.) Sensate focus– Prescribed by therapists for several sexual difficulties!– Also helpful to increase intimacy in general!about Communication!– Using strategies described in Chp. 7 to improvecommunication about sexual activities!– Learning how to tell or show partner what isdesired, what type of stimulation is effective!Solutions!– Principles of the technique:! Non-goal-oriented physical intimacy!– Takes the pressure off “performance” and orgasm! Focus on sensation of touching your partner! Exploring sensual touching beyond the genitals! Discovering whether aspects of intimacy bring up anyfeelings of discomfort!Specific suggestions for women Becoming orgasmic: first alone!– First: body exploration, genital self-exam, Kegels!– Then: self-stimulation exercises (as described in Chp. 8)!– Vibrators can help women experience orgasm forthe first time so she knows what it feels like! After a few vibrator-assisted orgasms, helpful toreturn to manual stimulation--easier for a partnerto replicate!