Transcript 14B_Sexual Difficulties

© Robert J. Atkins, Ph.D.
◦ Occurs when the cells of the lining of the uterus are
disrupted, and often grow outside the uterus within
the abdominal cavity.
◦ Symptoms
 Deep pelvic pain, painful menstruation, painful sex,
abdominal pain when walking
 Laparoscopic surgery
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Symptoms
Inability to climax at least half the time.
Treatment
Self and partner education on what is enjoyable
Use of a vibrator
Direct manual stimulation of the clitoris during
intercourse.
Female initiated movements
(Woman on top position)
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Self-awareness
◦ knowledge of beliefs, needs, and how body
responds
◦ self-examination
◦ masturbation
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Communication
Sensate focus
◦ touching & communicating without any goal  less
pressure to perform
◦ focus on non-genital touch
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Cultural values and masturbation
Fig. 16.1 The process of sensate focus, whereby partners sensually explore each other’s
body, can contribute to the mutual enhancement of a couple’s sexual enjoyment.
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Masturbation with partner present
◦ to learn what feels good & teach partner
◦ to allow sexual release
◦ for women learning to experience orgasm with
partner
◦ to resolve male erectile difficulties
Fig. 16.3 Masturbating in the presence of a partner can be an effective way for an individual
to indicate what kind of touching she or he finds arousing.
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Becoming orgasmic
◦ through self-stimulation
◦ vibrator use
 Eros clitoral therapy device
◦ allow time, consider counseling
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Experiencing orgasm with a partner
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sexual assertiveness important
masturbation in presence of partner
sensate focus activity
techniques to increase arousal
Fig. 16.4 The back to chest position for genital sensate focus.
Fig. 16.5 The use of an electric vibrator for clitoral stimulation during coitus.
Fig. 16.1 Facilitating Orgasm: Complete the Sentence, “In addition to getting specific physical
stimulation, I have often done the following to help me reach orgasm during sex with a
partner.”
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Dealing with vaginismus
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relaxation & self-awareness activity
gradual finger/dilator self-insertions
penile penetration
may require professional help
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Strategies for delaying ejaculation
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more frequent ejaculation
“Come again”
change positions
communication  slow down
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Strategies for delaying ejaculation
◦ stop-start technique
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stimulation to brink of orgasm
stop, wait for sensations to decrease
OR squeeze technique
training sessions required
woman above position most used
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Strategies for delaying ejaculation
◦ medical treatment
 small doses of antidepressants
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Dealing with erectile dysfunction
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reduce anxiety (most common cause)
restore confidence with success
sensate focus or stop-start
final phase of treatment is intercourse
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Dealing with erectile dysfunction
◦ medical treatment
 Viagra: takes effect < 3 hours, requires physical
stimulation, effect may depend on quality of
relationship
 newer drugs: Levitra and Cialis
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Dealing with erectile dysfunction
◦ mechanical: suction pump, Rejoyn
◦ surgical treatment
 semi-rigid or inflatable implants
 may alter sensations during erection
 microsurgical vascular repairs
Fig. 16.6 An inflatable penile prosthesis.
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Reducing male orgasmic disorder
behavioral approach used
sensate focus without ejaculation
ejaculation by any means
manual or oral stimulation by partner, to
ejaculation
◦ coital ejaculation
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Some suggestions same as other
dysfunctions
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encourage erotic responses
reduce anxiety
enhance sexual experiences
expand repertoire of activities
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Multifaceted intervention may be required
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goal = modify inhibited impulses
explore underlying relationship problems
often requires long-term professional help
medical treatment; testosterone supplementation
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The PLISSIT model of sex therapy
◦ 1st level = permission to engage or not in specific
sexual behaviors
◦ 2nd level = limited information corrected
◦ 3rd level = specific suggestions offered
◦ 4th level = intensive therapy
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Therapeutic approaches
◦ psychosexual therapy
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What happens in therapy?
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identify & clarify problems & goals
medical, sexual, relationship history
often given homework
NEVER includes sex with therapist
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Selecting a therapist
◦ referral from trusted source
◦ ask about credentials, training, & experience
◦ interview: practicalities & "fit"