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Here are my lecture notes from my Human Sexuality class:
Sexual disorders/dysfunctions can interfere with satisfactory sexual relationships. To be classified as such, they have to be recurrent, persistent, and perceived as a problem. They are organized according to Kaplan's sexual response stages of desire, excitement and !@#$%^&.
I. Difficulties in the desire stage -- called sexual disorders -- are deeply rooted, involving psychological problems.
A. Hypoactive/inhibited sexual desire, more common in women, is a "shut down" of sexual systems. It leads to anxiety, depression, relationship problems and stress.
B. Sexual aversion is a phobic response, which can be caused by sexual trauma or pressure, negative parental attitudes, gender identity problems, or even poor body image and self-esteem.
In contrast to sexual disorders, sexual dysfunctions are more likely to be physiologically caused.
II. Excitement Stage.
A. Erectile dysfunction ("impotence") is organically caused about 80% of the time. It is more likely to be secondary rather than primary, but it can also be situational. Organic causes include fatigue, alcohol or other drugs, and various medical conditions (explain). A psychological factor is spectatoring (explain). If it is organic, there will be no nocturnal penile tumescence (NPT) (not in text, explain). Possible treatments include penile prostheses, suction or drugs like Viagra (explain).
B. Lubrication inhibition may be due to low estrogen levels or lack of foreplay.
C. Pain dysfunctions
1. Dyspareunia occurs with both men and women. In women, the hymen can be too thick, PC muscles too weak, episiotomy scars, drugs, lack of arousal, low hormone levels or sexual inhibitions (explain).
a. Peyronie's disease is a rare condition caused by excessive curvature of !@#$%^&.
b. Priapism is a prolonged painful erection.
c. Vaginismus involves PC contractions, which cause painful entry. It may be caused by fear, anxiety or previous pain, which leads to a conditioned response. It can be treated with dilators.
III. !@#$%^& Stage
A. Premature ejaculation needs to cause enough distress to be perceived as a problem (explain). This very common dysfunction is more likely to be perceived as a problem by women.
B. Inhibited ejaculation means the man can't ejaculate.
C. Delayed ejaculation is when the man takes extremely long (40+ minutes) to ejaculate.
D. An!@#$%^&ia ("frigidity") is when the woman rarely or never !@#$%^&s. Like the problems above, they can be primary, secondary or situational.
There are various ways of treating these problems.
I. Masters and Johnson use a cognitive-behavioral type of therapy. Problems seen as mainly caused by ignorance, bad methods or relationship problems. Pairs of therapists (one male and one female) treat as a couple, or if single, use sex surrogate. They take a case history, emphasize sensate focus, and don't cast blame on the individuals involved.
A. Erectile dysfunction is treated with repeated buildup and loss of erection, sensate focus and dealing with fears.
B. Premature ejaculation is treated with the squeeze technique or Seman's method (stop-start).
C. Inhibited ejaculation is helped by identifying pleasurable sensations.
D. An!@#$%^&ia is treated with sensate focus.
E. Vaginismus is treated with dilators or learning Kegels (explain).
II. Helen Singer Kaplan uses a psychosexual therapy which is similar to psychodynamic (psychoanalytic) therapy, seeking insight into the origins of anxieties and helping them face their feelings. This is more likely to be used with sexual disorders (contrast with dysfunctions).
III. PLISSIT model crosses over the previous two methods.
A. Permission gives the couple permission to accept their sexuality and reduce their guilt.
B. Limited Information involves explanations of sexual functioning as specifically related to their sexual problems.
C. Specific Suggestions involve asking them to perform specific exercises as "homework" like sensate focus and squeeze technique.
D. Intensive Therapy is used for disorders only (explain).
IV. Group therapy and self-help can also be effective.
When seeking therapy, sexual or otherwise, several questions need to be answered.
I. What are your goals for therapy?
II. Do you want therapy as individual, couple, group or a combination of these?
III. What characteristics do you want in a therapist (e.g., male or female)?
IV. What is the therapist's approach and training?
V. What fees will be charged?
I hope this helps a little more. Thanks for asking.
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