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COUNSELING WOMEN WITH SEXUAL DYSFUNCTIONS: AN OVERVIEW SOCIETY OF UROLOGICAL NURSES AND ASSOCIATES ANNUAL CONFERENCE FEBRUARY 25, 2012 Linda Weiner, MSW, LCSW Certified Diplomate in sex therapy, American Association of Sex Educators, Counselors & Therapists Diplomate in Sexology, American Board of Sexology Adjunct Professor, Brown School of Social Work, Washington University 7396 Pershing Avenue, St. Louis, MO 63130 314-588-8924 [email protected] www.sextherapiststlouis.com

Linda Weiner, MSW, LCSW

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COUNSELING WOMEN WITH SEXUAL DYSFUNCTIONS: AN OVERVIEW SOCIETY OF UROLOGICAL NURSES AND ASSOCIATES ANNUAL CONFERENCE FEBRUARY 25, 2012. Linda Weiner, MSW, LCSW Certified Diplomate in sex therapy, American Association of Sex Educators, Counselors & Therapists - PowerPoint PPT Presentation

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COUNSELING WOMEN WITHSEXUAL DYSFUNCTIONS:

AN OVERVIEW

SOCIETY OF UROLOGICAL NURSES AND ASSOCIATESANNUAL CONFERENCE

FEBRUARY 25, 2012

Linda Weiner, MSW, LCSWCertified Diplomate in sex therapy, American Association of Sex Educators, Counselors & Therapists

Diplomate in Sexology, American Board of SexologyAdjunct Professor, Brown School of Social Work, Washington University

 7396 Pershing Avenue, St. Louis, MO 63130

[email protected] www.sextherapiststlouis.com

I. Categories:

• DSMIV-TR Sexual Dysfunctions include:o Desireo Arousalo Orgasmico Pain Disorders

II. Etiology:• Sexual Dysfunctions can arise from:o Psychological

Family of Origin Early Negative Experiences Personality Trauma

o Relational Concernso Medical Issueso Drugs/Medicationso or a combination

III. Subtypes:

• Assessment includes a description of whether the condition has been:

o Lifelongo Acquired (onset)o Generalizedo Situational (context)

IV. Description of Disorders

1. Sexual Desire Disorders• Hypoactive Sexual Desire Disorder:

o Deficiency or absence of sexual fantasies and desire for sexual activity which causes distress or interpersonal difficulty, not due to a medical condition, another Axis I disorder, or drugs/meds.

• Sexual Aversion:o Avoidance of and phobic reaction to anticipation of

genital contact with a sexual partner causing distress not accounted for by another Axis I disorder.

2. Sexual Arousal Disorders

• Female Sexual Arousal Disorder:o Persistent or recurrent inability to attain or

maintain to completion of the sexual activity adequate lubrication/swelling response of sexual excitement.

o Distress; Not better accounted for by another diagnosis and/or lack of feelings of subjective pleasure. (check on this)

3. Orgasmic Disorders

• Female Orgasmic Disorder:o Persistent or recurrent delay or absence of

orgasm following a normal sexual excitement phase.

o Distress; No other Axis I cause.

4. Sexual Pain Disorders

• Dyspareuniao Recurrent or persistent genital pain

associated with intercourse.

o Distress; Not caused by vaginismus Lack of lubrication Another Axis I disorder Substance Medical condition

• Vulvodynia (a type of Dyspareunia)o Burning paino Swellingo Redness at the vulvor vestibule

inside the labia minora

• Vestibulodynia (a type of Dyspareunia)o Pain with touch to the vestibule

(where the outside of the skin meets the vagina)

• Vaginismuso Recurrent/persistent involuntary

spasm of the outer third of the vagina interfering with intercourse

o Distress; Not due to a general medical

condition No other Axis I cause

V. Intake Process in Counseling

• Assessment of Sexual Dysfunctions• Medical• Psychological• Relational• Societal/Cultural• Generalized/Situational• Onset• Individual and Couple Strengths and

Challenges

VI. Treatment Strategies

• Patient Educationo Educating patients about what is “normal”o Education about normal anatomyo Physiologic basis of sexual functioningo Lifestyle changes such as stress management,

exercise, relaxation and diet

VI.Treatment Strategies

• Medical and allied health practitioner coordination• Medications, hormones, hormone creams and

phosphodiesterase inhibitors

VI.Treatment Strategies

• Relationship and communication skills counseling and sensate focus

• Sex Therapy

VII. Definition of Sensate Focus

Sensate Focus is a hierarchy of structured touchingand discovery suggestions.

VIII. Rationale for the use of Sensate Focus

• Reduction of work, pressure, expectation, anxiety, negative conditioning • Reduces spectatoring or watching one’s experience, and teaches mindfulness• Reactivates the senses and builds sexual energy• Engenders feelings of closeness and intimacy• Builds feelings of closeness• Diagnostic and restorative

IX. Difficulties with the Concept of“pleasuring” in Sensate Focus

Sensate Focus I: Developed to address sexual dysfunctions, not to increase sexual competency and explore eroticism.

Sensate Focus II: Developed to encourage feedback about what feels good and what might be fun to explore.To give and receive information and pleasure to one anotherTo take greater risks and indulge themselves in playful, spontaneous, eyes wide open and erotic interactionsTo be their evolving sexual selves with one another with respect to their personalities, erotic interests and comfort zones

Meshing of touching for self with erotic feedback from partner keeping you on track! If you are touching them for self and they turn on, you’ll keep it going because it’s erotic to you!

X. The Masters & Johnson Protocol forSensate Focus

Sensate Focus InstructionsDescription – general

The “identified patient” initiates the touching 1-2x weekly for about 15-30 minutes. Clothing is optional at first. Clients are asked to non-verbally TOUCH FOR SELF, focusing on their sensations of temperature, texture and pressure, with no goal for arousal/response, using only hands and fingers. The partner being touched protects the touching partner by non-verbally communicating if something is physically or psychologically UNCOMFORTABLE. Both partners refocus on sensation when distracting thoughts impinge. Touch long enough to get over any discomfort (5-15 minutes), but not so long as to be tired or bored. Then switch. Begin in any comfortable position and change positions as you wish.

XI. The Modified Masters & JohnsonProtocol for Sensate Focus

Instructions for Clients: Sensate FocusNo intercourse, oral sex or mutual masturbation is suggested. If you choose to be sexual together – please take a “tea break” first.• Arrange for one hour of complete privacy when you are not exhausted.• Please limit alcohol/drug use unless discussed (sometimes Viagra, Cialis, Levitra suggested).• Set the mood for relaxation.• Clothing off, some lighting on.

XII. The Masters & Johnson Protocol for Sensate Focus

The General Sequence of Sensate Focus Suggestions is:• Breasts and genitals off limits• Breasts and genitals on limits, subsequently with oil, powder or lotion• Mutual touching; with hand riding• Clinical look• Partner astride, playing outside• Insertion without movement• Insertion with movement• Fantasy, variation and play (Sensate Focus II)

References

References, The Lost Art of Sensate Focus• Masters & Johnson Human Sexual Inadequacy• Thomas Maier, Masters of Sex• Staci Haines, The Survivor’s Guide to Sex• Linda de Villers & Heather Turgeon, The Uses and Benefits of “Sensate Focus” Exercises in Contemporary Sexuality, Vol 39, Nov 2005• David Schnarch, Constructing the Sexual Crucible• Shmulsy Boteach, The Kosher Sutra• Barry McCarthy, Rekindling Desire• Helen Singer Kaplan. The Illustrated Manuel of Sex Therapy, Second Edition