14B_Sexual Difficulties
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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
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)
Self-awareness
◦ knowledge of beliefs, needs, and how body
responds
◦ self-examination
◦ masturbation
Communication
Sensate focus
◦ touching & communicating without any goal less
pressure to perform
◦ focus on non-genital touch
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.
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.
Becoming orgasmic
◦ through self-stimulation
◦ vibrator use
Eros clitoral therapy device
◦ allow time, consider counseling
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.”
Dealing with vaginismus
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relaxation & self-awareness activity
gradual finger/dilator self-insertions
penile penetration
may require professional help
Strategies for delaying ejaculation
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more frequent ejaculation
“Come again”
change positions
communication slow down
Strategies for delaying ejaculation
◦ stop-start technique
stimulation to brink of orgasm
stop, wait for sensations to decrease
OR squeeze technique
training sessions required
woman above position most used
Strategies for delaying ejaculation
◦ medical treatment
small doses of antidepressants
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
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
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.
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
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
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
Therapeutic approaches
◦ psychosexual therapy
What happens in therapy?
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identify & clarify problems & goals
medical, sexual, relationship history
often given homework
NEVER includes sex with therapist
Selecting a therapist
◦ referral from trusted source
◦ ask about credentials, training, & experience
◦ interview: practicalities & "fit"