Transcript EDGC 682 Counseling Issues In Sexuality

EDGC 682
Counseling Issues in Sexuality
Unit VI
Sexual Problems and Dysfunctions
Dean Owen, Ph.D., LPCC
Professor Emeritus
Department of Foundational and Graduate Studies in Education
Perhaps your performance anxiety wouldn’t be so
bad if you performed better.
Topics for discussion….
Sexual Desire Disorders
Sexual Arousal Disorders
Presentation material source: http://www.bbc.co.uk/health/physical_health/sexual_health/
Topics for discussion….
Erectile Dysfunction
Female Sexual Dysfunction
Impotence
Painful Intercourse
Premature Ejaculation
Vaginismus
Erectile
Dysfunction
Erectile Dysfunction is the repeated inability to get or
keep an erection firm enough for sexual intercourse.
Prevalence: Due to the sensitive nature of the
erectile dysfunction, it’s difficult to estimate
how many men it affects. However, recent
studies suggest:
10% of all men
22% of 40-year-old men and,
49% 70-year-old men may have the condition.
Causes and risk factors of
erectile dysfunction
The most common cause of
erectile dysfunction is damage to
the tissues, either the arteries,
nerves, muscles or fibrous tissue.
Physical diseases account for
around 70 per cent of cases of
erectile dysfunction.
The following conditions are most
related to this condition…..
Cardiovascular Disease
Problems with the blood supply
to the penis is by far the most
common cause of erectile
dysfunction, especially in older
men, smokers and those with
hypertension, - In fact erectile
dysfunction may often be the
first sign of serious heart or
blood vessel disease.
Diabetes
Kidney disease
Obesity
Central nervous system (CNS)
conditions such as multiple
sclerosis.
Hormonal problems, which include
for example an underactive thyroid
gland, or hypopituitarism after
head injury, brain hemorrhage or
tumour treatment.
Accidental trauma:
Physical injury to the
penis, spinal cord,
prostate, bladder or
pelvis
Collateral damage
resulting from prostate
or bladder cancer
surgery.
Common Medications may contribute to Erectile
dysfunction.
Antihypertensives (high blood pressure
meds)
Antihistamines
Antidepressants
Tranquilizers.
Recreational drug use, such as cocaine,
can also cause erectile dysfunction.
Psychological factors are the main factor in up to 20
per cent of cases, especially among younger men.
These include:
Stress / Anxiety
Psychological factors are the main factor in up to 20 per
cent of cases, especially among younger men. These
include:
Guilt
or
Depression
Psychological factors are the main factor
in up to 20 per cent of cases, especially
among younger men. These include:
Low Self Esteem
Psychological factors are the main
factor in up to 20 per cent of cases,
especially among younger men. These
include: Fear of sexual failure or
pregnancy
Symptoms of erectile dysfunction
The penis contains two chambers full of spongy
tissue called the corpora cavernosa. When a man
becomes sexually aroused impulses from the brain
and local nerves cause muscles in the corpora
cavernosa to relax, allowing blood to flow in and fill
the spaces within the tissue. This creates pressure in
the corpora cavernosa, making the penis expand. A
membrane called the tunica albuginea helps trap the
blood in the corpora cavernosa, thereby sustaining
erection.
Symptoms of erectile dysfunction
The erection is lost when the muscles contract
to stop blood flowing into the penis, and open
outflow channels. A successful, sustained
erection requires a sequence of events to
occur in a precise fashion. Anything which
disrupts this sequence can lead to problems
either getting, or keeping an erection.
Some men wake up with an erection or can
achieve one with masturbation but not with a
partner – this may indicate underlying
psychological causes rather than physical
disease.
Treatment and prevention
Step one….get a medical consult to rule out
physical or medical reasons….medical treatment
is indicated in about 70% of cases….
Step two: If the cause is likely to be psychological
then counseling may be helpful along with medical
treatment (drug therapy).
Drug therapy for erectile dysfunction
One drug in particular, sildenafil (‘Viagra’), has
become an international phenomenon since its launch
in the late 1990s because it’s one of the first drugs to
offer a relatively simple safe drug treatment that helps
the majority of men with erectile dysfunction – at
least 70 per cent report improved erections. The drug
does not directly give a man an erection but it works
by boosting the natural mechanism that leads to an
erection. When a man is sexually aroused, certain
tissues in his penis relax, allowing blood to flow in
and fill the penis. Viagra helps by elevating the levels
of the chemical that causes the tissues to relax. These
effects were discovered accidentally. The drug was
originally developed to improve blood supply to the
heart in angina sufferers.
Drug therapy for erectile dysfunction
In a small number of cases, people who have taken
sildenafil have complained of headaches, flushing
and stomach-ache. It can also cause some visual
problems, including an increased sensitivity to light,
blurred vision or an inability to tell the difference
between blue and green. Men who are already taking
medicines that contain nitrates, such as nitroglycerine (usually for angina or heart disease), are
strongly advised not to use Viagra as this is
dangerous and may result in a heart attack.
Other similar drugs are tadalafil (‘Cialis’)and
vardenafil (‘Levitra’).
Drug therapy for erectile dysfunction
Penile injections: The injection of drugs such as
alprostadil directly into the tissues of the penis to
trigger an erection was more common before the
advent of new drugs such as sildenafil. The drugs
relax muscles and increase blood flow to create an
erection. They are also available as pellets to insert in
to the urethra (the opening at the tip of the penis).
Vacuum Devices: These work by creating a partial
vacuum around the penis, which draws blood into the
organ. The devices have three components: a plastic
cylinder, into which the penis is placed; a pump,
which draws air out of the cylinder; and an elastic
band, which is placed around the base of the penis to
maintain the erection after the cylinder is removed
and during intercourse.
Drug therapy for erectile dysfunction
Surgery: There are different types of surgery.
Implanted devices, known as prostheses, can restore
erection in many men. These can come in different
forms. For instance, paired rods can be inserted into
the corpora cavernosa to enable the user to manually
adjust the position of the penis. Alternatively,
inflatable cylinders can be inserted inside the penis
and expanded using pressurized fluid. In some cases
doctors may attempt to repair blockages in damaged
arteries. However, this usually only works if the
blockages are not widespread.
Life style changes
There are a number of things you can do yourself to
reduce your risk of erectile dysfunction. These
include :
Stop smoking if you smoke (smoking damages the
arteries and can reduce blood supply to the penis).
Lose weight if you are overweight.
Deal effectively with stress and anxiety – try
meditation, counselling, exercise.
Moderate your alcohol consumption.
Avoid street drugs.
Take regular exercise (this improves your
cardiovascular health).
Female Sexual
Dysfunction
Female Sexual
Arousal Disorder
(FSAD)
An estimated 40% of women
suffered from sexual problems
in the past year. The difficulties
have arisen from both physical
and psychological factors.
This female equivalent of
impotency is known as female
sexual arousal disorder (FSAD).
When men and women become sexually aroused,
their genitals become engorged with blood. In women
this normally results in:
Enlargement of the clitoris and surrounding tissues
(comparable to a male erection)
Secretion of vaginal lubrication
Relaxation and widening of the vaginal opening to
permit intercourse
FSAD patients have the desire to have sex but their
genital area fails to respond in the normal way,
making sex painful or impossible.
Causes of female sexual dysfunction
FSAD can result from an underlying medical condition,
such as high blood pressure or diabetes. It can also be
caused by irritations, infections and growths in the
vaginal area, or reactions to contraceptive devices.
Medications used to treat high blood pressure, peptic
ulcers, depression or anxiety and cancer may also cause
problems.
Another factor is the physical, hormonal and emotional
changes that occur during or after pregnancy, while
breastfeeding or, very importantly, during and after the
menopause.
Causes of female sexual dysfunction
FSAD is also often linked to psychological causes.
These can include:
Inadequate or ineffective foreplay
Depression
Poor self-esteem
Sexual abuse
Feelings of shame or guilt about sex
Fear of pregnancy
Stress and fatigue
Symptoms of female sexual dysfunction
The symptoms of sexual dysfunction can include lack
of sexual desire, an inability to enjoy sex, insufficient
vaginal lubrication or a failure to achieve an orgasm
even if sexually aroused.
Women who suffer from female orgasmic disorder
(FOD) are unable to achieve orgasm despite being
sufficiently aroused to have sex.
Symptoms of female sexual dysfunction
Women differ from men in that orgasm is a learned, not
automatic, response. 5-10% of women never have an orgasm
through any type of sexual activity - a condition called
anorgasmia.
Anorgasmia is most often the result of sexual inexperience,
performance anxiety or past experiences, such as sexual
trauma or a strict upbringing, that have led to an inhibition of
sexual response.
FOD is a problem only if it has a negative effect on the
satisfaction of a woman or her partner.
Treatments for female sexual dysfunction
There is currently inconclusive research suggesting the
efficacy of using the anti-impotence drug sildenafil
citrate (Viagra) to treat sexual disorders in women by
increasing blood flow to the sexual organs and thereby
increasing physical stimulation in the area.
Some studies suggest that it may help but others have
demonstrated no effect at all. Perhaps the most positive
results have been in trials with women suffering from
multiple sclerosis…
Treatments for female sexual dysfunction
Women who suffer from vaginal dryness often respond
to low dose hormonal creams to promote natural
vaginal secretions as well as the use of lubricants.
The use of Kegel exercises, which help to develop the
muscles around the outer portion of the vagina that are
involved in pleasurable sensations have also been
suggested by sex therapists.
Treatments for female sexual dysfunction
Psychological counseling can also play an important
part in treating women with sexual problems, as can
coaching in sexual foreplay and stimulation techniques.
The key is education, changing
inhibitory belief patterns and
encouraging gentle, loving, and
sensitive interactions with a caring
partner…..coaching in how
“pleasure” and “be pleasured”…..
Painful Intercourse
(dyspareunia)
Causes of dyspareunia
The most common cause of painful
intercourse is the lack of sufficient
arousal with its attendant physical
responses. When a women's body is
ready for sex, the vagina expands both
lengthways and widthways. While this
is happening, it becomes moist and
lubricated to avoid any friction. The
vagina wasn't designed to be penetrated
in its unaroused state.
Causes of dyspareunia
If full arousal is achieved there are still a number of
conditions that can cause this condition. These can
include:
Childbirth - it's quite common for women to suffer
some discomfort after childbirth, particularly if there
was an episiotomy (a cut to make delivery easier).
Menopause - intercourse may be more painful during
the menopause as lower estrogen levels cause a
thinning of the vaginal wall and loss of natural
lubrication.
Causes of dyspareunia
Urinary infections – cystitis or vaginal irritations
such as thrush, vaginitis and genital may also be a
cause of soreness.
Sensitivity to condoms, contraceptive creams or
lubricants – This is relatively rare but does occur.
The problem with pain is that it blocks sexual arousal,
which causes further pain. Many women find that
they're caught up in a pain cycle - having experienced
painful intercourse before, they fear more pain which
blocks arousal, causing more pain and so the cycle
continues.
Causes of dyspareunia
Pain experienced in the lower abdomen or to one side
requires an immediate referral for a gynecological
evaluation to rule out the following conditions...
Endometriosis,
Prolapse
Ovarian cysts,
Fibroids or,
Pelvic inflammatory disease (PID).
Causes of dyspareunia
Another possible cause is uterine retroversion, a
natural condition where the womb tilts towards the
back of the pelvis. In all these conditions, clients are
encouraged to try different coital positions which may
be more comfortable.
Premature
Ejaculation
What is premature ejaculation?
This is one of the most common sexual problems in
men. It's particularly common in younger men when
sexual activity is relatively new, and for any man
who's with a new sexual partner, since under these
circumstances the level of sexual excitement is very
high.
When premature ejaculation becomes a problem, men
suffer with performance anxiety. They worry about
ejaculating prematurely, it happens, and they find
themselves in a downward spiral.
Treatments for premature ejaculation
Sex therapists recommend a few straightforward
techniques to prevent or delay ejaculation. You can
practice these on your own or with your partner:
Take a deep breath as you feel your climax
approaching. This will briefly switch off the
ejaculation reflex.
The squeeze technique involves squeezing below the
tip of your penis when the climax is imminent for 10
to 20 seconds.
Treatments for premature ejaculation
It helps to think about something boring at the same
time to take your mind off more exciting things.
During foreplay or intercourse, stopping and starting
sexual stimulation helps to lengthen the time taken to
reach climax, and can be combined with the squeeze
technique.
If you keep practicing and stay relaxed, you should
find that the problem disappears.
Vaginismus
What is vaginismus?
Vaginismus is a psychological
condition that manifests itself in
a powerful physical response in
which the muscles surrounding
the vaginal opening go into
involuntary spasm and prevent
penetration.
The condition is one that
can generally be treated
quickly and very easily
once the dynamics of the
condition are understood.
2
1
The body anticipates pain;
fear and anxiety may
contribute
6
The body automatically
tightens vaginal muscles
3
Cycle of Pain
Avoidance of intimacy and
a lack of desire may
develop
Tightness makes
penetration painful or
even impossible
4
5
Body reacts by bracing
more on an ongoing
basis
Pain reinforces and
intensifies the reflex
response.
Physical Causes of Vaginismus
Medical Conditions
Urinary tract infections (UTIs) or urination
problems, yeast infections, sexually
transmitted disease, endometriosis, genital
or pelvic tumors, cysts, cancer, pelvic
inflammatory disease, eczema, psoriasis,
vaginal prolapse, etc.
Physical Causes of Vaginismus
Childbirth
Pain from normal or difficult vaginal
deliveries and complications, c-sections,
miscarriages, etc.
Physical Causes of Vaginismus
Age related changes
Menopause and hormonal changes, vaginal
dryness / inadequate lubrication, vaginal
atrophy
Physical Causes of Vaginismus
Temporary Discomfort
Temporary pain or discomfort resulting
from insufficient foreplay, inadequate
vaginal lubrication, etc.
Physical Causes of Vaginismus
Pelvic Trauma
Any type of pelvic surgery, difficult pelvic
examinations, or other pelvic trauma
Physical Causes of Vaginismus
Abuse
Physical attack, rape, sexual/physical abuse
or assault
Non-Physical Causes of Vaginismus
Fear
Fear or anticipation of intercourse pain, fear
of not being completely physically healed
following pelvic trauma, fear of tissue
damage (ie. "being torn"), fear of getting
pregnant, concern that a pelvic medical
problem may reoccur, etc.
Non-Physical Causes of Vaginismus
Anxiety or Stress
General anxiety, performance pressures,
previous unpleasant sexual experiences,
negativity toward sex, guilt, emotional
traumas, or other unhealthy sexual emotions
Non-Physical Causes of Vaginismus
Partner Issues
Abuse, emotional detachment, fear of
commitment, distrust, anxiety about being
vulnerable, losing control, etc…
Non-Physical Causes of Vaginismus
Traumatic Events
Past emotional/sexual abuse, witness of
violence or abuse, repressed memories
Non-Physical Causes of Vaginismus
Childhood Experiences
Overly rigid parenting, unbalanced
religious teaching (ie."Sex is BAD"),
exposure to shocking sexual imagery,
inadequate sex education
Non-Physical Causes of Vaginismus
No cause
Rarely the condition arises without any
logical explanation at all.
What is vaginismus?
Some women will have had the condition all
their adult lives, for others it may have
occurred after a trauma or in a particular
relationship. Either way, vaginismus can have
a devastating effect on quality of life. Not
only do they find it more difficult to enjoy
love-making, but the inability to be penetrated
makes the decision to start a family very
difficult.
Causes of vaginismus
There are many causes, though none are
physical. If you've suffered painful
intercourse in the past, then vaginismus may
be an unconscious response to avoid more
pain.
Broadly speaking, the common psychological
causes can be split into three categories:
1. Personal issues with sex
2. Previous traumatic experiences with sex
3. Relationship problems
Causes of vaginismus
Personal issues about sex. Some women are
brought up believing it’s a bad and dangerous
thing. There may have been very powerful
cultural or religious taboos that left you with
feelings of guilt or shame whenever you felt
any sexual desire. Puberty may have been
associated with feeling dirty or embarrassed
or if there was inadequate sex education.
Women can grow up feeling that it's
physically impossible to be penetrated.
Causes of vaginismus
Previous traumatic experiences. If, at any
stage in your life, you've experienced a
traumatic incident associated with your
sexuality or your genital area, you may have
developed vaginismus as a protective
response to further hurt. For some,
vaginismus comes in the aftermath of a rape
or sexual abuse. Contact a rape crisis center or
clinic for help and advice if you have been
raped or sexually assaulted recently or in the
past.
Causes of vaginismus
Relationship problems. There may be
unresolved anxieties between you and your
partner that may be causing or at least
contributing to the problem. If you're unhappy
about something in your relationship, talk it
through and try to resolve the issue.
The American Association of Sexuality Educators,
Counselors and Therapists (AASECT) is a not-for-profit,
interdisciplinary professional organization. In addition to
sexuality educators, sexuality counselors and sex therapists,
AASECT members include physicians, nurses, social
workers, psychologists, allied health professionals, clergy
members, lawyers, sociologists, marriage and family
counselors and therapists, family planning specialists and
researchers, as well as students in relevant professional
disciplines. These individuals share an interest in promoting
understanding of human sexuality and healthy sexual
behavior.
Source: http://www.aasect.org/default.aspx
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