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

• 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

• 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?

• 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