Transcript Sexual Difficulties Wide ranging in both source and consequences Overview • Big numbers • The root of much anxiety • Many causes – physiological and psychological •

Sexual Difficulties
Wide ranging in both source and
consequences
Overview
• Big numbers
• The root of much anxiety
• Many causes – physiological and
psychological
• Male bias
• Hope for help
• Gender Roles expectations and Sex for
Procreation emphasis contribute
Physiological Causes
• A very complex collection of systems
• The first place to look
• Problems can arise from any one of three
areas:
1) Hormonal
2) Neurological
3) Circulatory
Chronic Illnesses
• Long standing, pathological conditions
affect us in many ways
• Associated pain, medications, fatigue and
loss of function interfere
The Looming Epidemic
• Diabetes – the pancreas fails to produce
adequate insulin
• Major source of male erectile problems
due to nerve and circulatory damage 50% of male victims, even retrograde
ejaculation
• Alcohol heightens
• Women affected also
A common crippler
• Arthritis – progressive inflammation of the
joints
• Pain, limitation of movement
• Little direct impact
• But tremendous blow to structures and
overall well-being
More chronic illnesses
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Cancer
Especially devastating, hitting all systems
Treatments worsen
Surgical procedures leave permanent
challenges
• Worse yet, can afflict reproductive systems
directly
• Multiple sclerosis, Strokes
Blindness/Deafness
• Little direct impact on sexual functioning
• Great effect on ability to communicate
(deafness) and perceive (blindness)
• Do other, intact, senses compensate?
How do we cope?
• Acknowledge great potential impact on
self-esteem?
• Acceptance
• Careful preparation
• Refashioning overall view of sexuality
• Exploration, innovation & patience
• Greater intimacy?
Medications
• A bigger and bigger problem every day
• Not always appreciated or even discussed
• Often alternative meds are available
• Psychiatric – (especially antidepressants)
cause reduced desire, arousal and
delayed or absent orgasm
• Antipsychotic and Tranquilizers also
Cultural Factors
• Childhood Negativity
Sex is sinful vs. infants “crave erotic
pleasure”(?)
Adults discourage this natural
expression
Guilt results
Parents model ambivalent attitudes
towards sexuality
The Double Standard
• Still prevalent – 2001 study
• Masters & Johnson – pressure on women to
deny their natural urges is “a major source of
women’s sexual dysfunction”
• Men must be eager, ever ready
capable of performing
no tenderness
all knowing
Gays and the Double Standard
• Already outside of cultural do’s and don’ts
• Immune to strict cultural expectations?
Culture and its Restricted View of
Sexuality
• What’s normal?
• Sex is traditional intercourse
• Problem – little focus on female
stimulation
• Huge $$ on Viagra while other aspects of
sexuality are ignored
Performance Anxiety
• Some feel that they have to live up to some
arbitrary societal standard rather than set their
own
• The shifting target (What about fun?)
Procreation
Simultaneous orgasm
Multiple orgasms
G spot ecstasy
Crushing Ramifications
• The vicious cycle
1) a mere temporary problem can cause
anxiety about the fear of “not living up" to
perceived standards
2) a pattern develops
3) self-blame & withdrawal follow
4) escape learning worsens situation
5) big problems result
Individual Problems
• Ignorance
often correlates with problems
Knowledge has the opposite effect
• Self Concept
relation between self confidence, sexual
satisfaction, and sexual problems
More Individual Factors
• Body Image
women are often scrutinized resulting in
self consciousness
accentuates dissatisfaction & negative
view of capability/desirability
men are given much more slack
Media/Entertainment Influence on
Body Image
• Models are skinnier and skinnier
• Is that what men really want?
• Backlash
Female athletes
Weight thresholds
Emotional Difficulties
• Depression, anxiety all impair sexuality
• Karen Horney’s victory
• Even beneath clinical levels, unhappiness,
dissatisfaction, exert negative influence
Sources of Emotional Problems
• Work, stress, death, war
• Inability to express feelings
• Fear of intimacy
• Normative male alexithymia
Sexual Abuse
• A breach of trust, consent
• Often causes problems
• Especially devastating for the young – a
failure to enjoy a normal pace of
development
• Classical conditioning at its worst and
most powerful
• Even 2 – 4 times more pelvic pain
Particular Disorders
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Hypoactive Sexual Desire
Most common problem for therapists
“Lack of appetite”
More women seem afflicted, but recently ..
Can be situational
Lifelong quite rare
Why aren’t they hungry?
• Often reflects unresolved relationship
issues
1) man is only affectionate if
intercourse will follow
2) poor communication/unresolved
conflicts
3) not enough love, romance, intimacy
4) sex as a duty
Erectile Dysfunction
• The persistent lack of an erection
sufficiently rigid for penetrative intercourse
• Formerly impotence – without power
• Label abandoned due to negative
connotations
• Duration – problem must persist for 6-12
months
More ED
• Two types
Acquired – of recent origin
Lifelong – never capable
• Viagra – first marketed in 1998
huge boost in public awareness
Why?
• Incidence skyrockets with increasing age
• But 58% of men in their 50’s?
• Age alone isn’t responsible, but conditions
associated with advancing age, such as:
diabetes
cardiovascular deficits
increased cholesterol
medications
Female Orgasmic Disorder
• Sufficient arousal, lubrication and
enjoyment but no climax
• Can snowball
• Anorgasmia – the absence of orgasm
• Generalized lifelong – never experienced
• Situational - varies
FOD II
• Most do not experience orgasm before 18
• 5-10% never
• But when asked about the last year, 24%
report
• Most likely to suffer:
the young
the uneducated
the unmarried
More FOD
• Self-help books and videos have helped
• And remember, it is normal to miss without
clitoral stimulation
Premature Ejaculation
• Ejaculating so rapidly that his and/or her
pleasure is impaired
• Often causes intense distress
• Worse yet, can be progressive
• For 29% of males it’s a chronic condition
Why so soon?
• Physiological factors appear to influence
• Common characteristics;
underestimate arousal
very excited by penile stimulation
ejaculate before full arousal
Dyspareunia
• Pain while engaging in intercourse
• Much more common for women
• But Peyronie’s disease is every man’s
nightmare
• 60% of women experience at some point
• Caused by many factors – multidisciplinary
approach works best
Vaginismus
• Involuntary spasmodic contractions of the
muscles of the outer third of the vagina
• Problems with any penetration – even
pelvic exam
• Often a conditioned response
Faking Orgasm
• 60% of females report they have done it at
least once
• 75% of these have done it more than 50
times
• 10% too many times to count
• Unlike other problems – a conscious
decision
Why do they lie?
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Want to get it over with
Poor communication
Limited knowledge
Hide troubled relationship
Need partner approval
“I started faking, and now I don’t know how
to stop!”
• Get counseling