Introduction to Human Sexuality Part II Chapter 17 Sexual Dysfunction and Treatment

CHAPTER 17 Chapter 17 Sexual Dysfunction and Treatment , AND EMERSON WOLFE , LEARNING OUTCOMES Apply the approach in analyzing sexual . Distinguish various sexual under the umbrella of the Compare and contrast treatment options for sexual and ways to outreach to diverse community members . INTRODUCTION Movies and music videos often depict characters engaging in romantic , passionate sexual activity without challenges or inhibitions . Reality is often very different and conversations around sexual difficulties are sometimes met with shame , reducing their frequency and silencing individuals . However , sexual impact the lives of about in Americans ( Crane , 2013 ) Instead of a model of sexual excitation and inhibition , further research has indicated that sexual arousal to internal ( thoughts , fantasies , etc . and external stimuli ( images , touch , etc . are based on individual traits , with some people being highly excitable while others experience reduced reactions ( et , 2019 ) Arguably , sexual arousal operates similarly to other emotions in which a thought or experience produces arousal . Some individuals are more while others are more methodical and calm in their reactions . Biological , social , and psychological processes intersect to produce individuals responses , and a similar process can be seen in terms of sexual responsiveness . Additionally , for some people experiencing sexual , other underlying causes may be factors as well , such as anxiety , sexual trauma , depression , etc . Terms have been developed , such as asexual , and more to explain how sexual attraction and sexual desire are complex processes . As with all human traits , sexual responsiveness exists on a continuum of possibilities rather than within a binary system in which sexual functioning equates health and a lack of sexual responsiveness equates disorder . At the same time , some people may want to be sexual and are distressed or experience relational difficulties when they face challenges . This unit will explore the role of distress and impairment as a requirement for diagnosis , and the importance of understanding underlying causes , the specific classifications of sexual ( also known as disorders of sexual function ) based on when they occur according to the sexual response cycle , the particular factors influencing sexual wellbeing for gender diverse individuals and sexual minorities , and sexual dysfunction treatments . 234

CHAPTER 17 235 DISTRESS AND IMPAIRMENT AS A DIAGNOSIS REQUIREMENT In the , sexual are defined as a clinically significant disturbance in a person ability to respond sexually or to experience sexual pleasure ( American Psychiatric Association , 2013 , 423 ) For some , sexual dysfunction has always been present whereas for others difficulties may develop later on in life . Additionally , individual differences may occur in which specific cause dysfunction to arise or dysfunction can be present in all sexual situations for some people as well . More on this will be covered shortly . However , distress is not present , then this is not considered a diagnosis . This is important because no one should be forced into being sexual if they do not want to be and sexual activity may be more distressing than not engaging in the behavior in some instances . Some people may have low sexual arousal or desire and are completely okay with this . Each person gets to decide their own unique sexual boundaries . Ifthey do want to engage in sexual behavior but experience challenges , then this is when therapy can be useful . In the case of diagnosis , symptoms will need to be present for a minimum of six months , be present in 75 or more sexual situations in a persistent or recurrent fashion , and have caused the individual clinically significant distress ( Mitchell et , 2016 ) and Underlying Causes Conducting a assessment in which relationship factors , personal , cultural and religious beliefs , body image , underlying health concerns , mental health , life stressors , and more can be explored to develop a comprehensive analysis of the many moving parts that may influence sexual wellbeing . For instance , conservative and stigmatized views regarding sexual behavior are associated with the development of sexual for individuals regardless of sexual orientation ( 2014 ) Mental health concerns , such as depression , anxiety , trauma , and more , can lead to the development of sexual difficulties ( 2018 ) Mitchell et al . 2016 ) found that individuals with one sexual dysfunction diagnosis , especially if experiencing a lack of interest or arousal disorder specifically , often met the criteria for additional sexual dysfunction diagnoses . Health concerns , such as high blood pressure , cancer , heart disease , may also have the side effect of impacting sexual responsiveness , interest , and maintaining arousal . Medications for physical health as well as mental health concerns can have side effects that cause changes to sexual functioning , leading to the development of sexual . Exploring these underlying causes can aid the client and therapist ( and medical doctor ) in understanding the best treatment plan moving forward . DISORDERS OF SEXUAL FUNCTION Sexual dysfunction is difficulty experienced by an individual or a couple during any stage of a normal sexual activity , including physical pleasure , desire , preference , arousal or orgasm . According to the , sexual dysfunction requires a person to feel extreme distress and interpersonal strain for a minimum of six months ( excluding substance or sexual dysfunction ) Sexual can have a profound impact on an individual perceived quality of sexual life . The term sexual disorder may not only refer to physical sexual dysfunction , but to as well this is sometimes termed disorder of sexual preference . A thorough sexual history and assessment of general health and other sexual problems ( if any ) are very important . Assessing performance anxiety , guilt , stress and worry are integral to the optimal management of sexual dysfunction . Many of the sexual that are defined are based on the human sexual response cycle , proposed by William Masters and Virginia Johnson , and then modified by Helen Singer Kaplan , a psychologist and psychiatrist by training , who viewed human sexual response as a triphasic phenomenon , consisting of desire , arousal , and orgasm .

236 EMERSON WOLFE , Response , Public domain , via ' a Commons The Masters and Johnson research team pioneered research into the nature of human sexual response and the diagnosis and treatment of sexual disorders and from 1957 until the . One of the most enduring and important aspects of their work has been the four stage model of sexual response , which they described as the human sexual response cycle and defined as Excitement phase ( initial arousal ) Plateau phase ( at full arousal , but not yet at orgasm ) Orgasm Resolution phase ( after orgasm ) Their model shows no difference between Sigmund Freud purported categories of vaginal orgasm and clitoral orgasm the physiological response was identical , even if the stimulation was in a different place . Masters and Johnson findings also revealed that men undergo a refractory period following orgasm during which they are not able to ejaculate again , whereas there is no refractory period in women this makes women capable of multiple orgasm . They also were the first to describe the phenomenon of the rhythmic contractions of orgasm in both sexes occurring initially in second intervals and then gradually slowing in both speed and intensity . The work of Masters and Johnson began in the Department of Obstetrics and Gynecology at Washington University in Louis and was continued at the independent research institution they founded in Louis in 1964 , originally called the Reproductive Biology Research Foundation and renamed the Masters and Johnson Institute in 1978 . In the initial phase of Masters and Johnson studies , from 1957 until 1965 , they recorded some of the first laboratory data on the anatomy and physiology of human sexual response based on direct observation of 382 women and 312 men in what they conservatively estimated to be complete cycles of sexual response . Their findings , particularly on the nature of female sexual arousal ( for example , describing the mechanisms of vaginal lubrication and debunking the earlier widely held notion that vaginal lubrication originated from the cervix ) and orgasm ( showing that the physiology of orgasmic response was identical whether stimulation was clitoral or

CHAPTER 17 vaginal , and , separately , proving that some women were capable of being ) dispelled many standing misconceptions . They jointly wrote two classic texts in the field , Human Sexual Response and Human Sexual inadequacy , published in 1966 and 1970 , respectively . Both of these books were and were translated into more than thirty languages . The team has been inducted into the Louis Walk of Fame . Additionally , they are the focus of a television series called Masters of Sex for Showtime based on the 2009 biography by author Thomas . Their research into the anatomy and physiology of sexual response was a springboard to developing a clinical approach to the treatment of sexual problems in a revolutionary manner . Prior to 1970 , when they described their treatment program to the world for the first time , sexual such as premature ejaculation , impotence , vaginismus , and female frigidity had been generally treated by ( psychotherapy or psychoanalysis with very low rates of success . Masters revolutionized things by devising a form of rapid treatment ( week ) psychotherapy always involving a couple , rather than just an individual , working with a therapist team that resulted in a success rate of more than 80 . This was strictly a talking therapy couples in their sex therapy program were never observed in sexual activity . A more modern day approach to sexual response is the Dual Control Model of arousal , which is described by Emily below One or more interactive elements has been excluded from this version of the text . You can view them online here ?

Sexual disorders affect up to 43 of women and 31 of men ( Paik , Rosen , 1999 ) Sexual disorders are often difficult to diagnose because in many cases the dysfunction occurs at the partner level ( one or both of the partners are disappointed with the sexual experience ) rather than at the individual level . The sexual described in the include delayed ejaculation , erectile disorder , female orgasmic disorder , female sexual disorder , disorder , male hypoactive sexual desire disorder , premature ( early ) ejaculation , sexual dysfunction , other specified sexual dysfunction , and unspecified sexual dysfunction . See descriptions below .

233 EMERSON WOLFE , Disorder Description Male hypoactive sexual desire disorder ( Persistent or recurrently deficient sexual or erotic thoughts , fantasies , and desire for sexual activity . Female sexual arousal disorder A complete lack of or significant reduction in sexual interest or sexual arousal . It is diagnosed with three or more of the following symptoms are manifested . These include the absence of an interest in sexual activity or a decided reduction and an absence of fantasizing or even thinking sexual or erotic thoughts . Erectile disorder Female orgasmic disorder Recurrent inability to achieve or maintain an adequate erection during partnered sexual activities . A significant change in orgasm such as delay , reduction of intensity or cessation . Delayed ejaculation ( DE ) Persistent difficulty or inability to achieve orgasm despite the presence of adequate desire , arousal , and stimulation . Premature ( early ) ejaculation Persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within about one minute following vaginal penetration and before the individual wishes it . pain ! Difficulty having intercourse and feeling significant pain upon penetration . penetration disorder Sexual A condition in both men and women in which patients have difficulties with sexual desire , arousal , orgasm due to a side effect of certain medications ( legal or illicit ) Other specified sexual dysfunction , and Used when symptoms ofa sexual dysfunction are present and cause significant distress or impairment , but do not meet full unspecified sexual criteria for any of the other disorders . dysfunction Prevalence of Sexual Dysfunction in Men and Women . This chart shows the percentage of respondents who reported each type of sexual difficulty over the previous 12 months . Sexual arousal disorders Sexual arousal disorders were previously known as frigidity in women and impotence in men , though these have now been replaced with terms . Impotence is now known as erectile dysfunction , and frigidity has been replaced with a number of terms describing specific problems that can be broken down into four categories as described by the American Psychiatric Association Diagnostic and Statistical Manual of Mental Disorders lack of desire , lack , pain during intercourse , and lack of orgasm . For both men and women , these conditions can manifest themselves as an aversion to , and avoidance of , sexual contact with a partner . In men , there may be partial or complete failure to attain or maintain an erection , or a lack of sexual excitement and pleasure in sexual activity . Hypoactive sexual desire disorder ( is considered a sexual dysfunction and is characterized as a lack or absence of sexual fantasies and desire for sexual activity , as judged by a clinician . For this to be regarded as a disorder , it must cause marked distress or interpersonal difficulties and not be better accounted for by another mental disorder , a drug ( legal or illegal ) or some other medical condition . A person with will not start , or respond to their partner desire for , sexual activity . affects approximately 10 of all women in the United States , or about million women . There are various . can be general ( general lack of sexual desire ) or situational ( still has sexual desire , but lacks sexual desire for current partner ) and it can be acquired ( started after a period of normal sexual functioning ) or lifelong ( the person has always had sexual desire . In the , was split into male hypoactive sexual desire disorder ( and female sexual arousal disorder ( The has characterised the diagnostic features of male hypoactive sexual desire disorder ( as males experiencing deficient or no erotic fantasies and desire for sexual activity for a period of at least months . The level of deficiency in patients is determined by who take factors such as age and environment of the individual into account which may affect the sexual functioning . The manifestation

CHAPTER 17 239 of personal distress due to the disorder in the absence of disorders , significant relationship stress , other forms of stress and other medical conditions distinguishes . As with , it can also be subdivided into the lifelong , acquired , situational and distress severity can be classified as either mild , moderate or severe . Female sexual disorder is defined as the lack of or significantly reduced sexual with at least three of the following interest in sexual activity thoughts or fantasies initiation of sexual activity , and typically unreceptive to a partner attempts to initiate sexual during sexual activity in almost all or all ( 75 100 ) sexual encounters ( in identified situational or , if generalized , in all ) sexual arousal in response to any internal or external erotic cues ( written , verbal , visual ) genital or sensations during sexual activity in almost all or all ( 75 100 ) sexual encounters ( in identified situational or , if generalized , in all ) Masters and johnson were the first to conduct research on the sexual responsiveness of older adults , finding that given a state of reasonably good health and the availability of an interested and interesting partner , there was no absolute age at which sexual abilities disappeared . While they noted that there were specific changes to the patterns of male and female sexual responses with aging for example , it takes older men longer to become aroused and they typically require more direct genital stimulation , and the speed and amount of vaginal lubrication tends to diminish with age as well they noted that many older men and women are perfectly capable of excitement and orgasm well into their seventies and beyond , a finding that has been confirmed in based epidemiological research on sexual function in the elderly . Men with erectile disorder can not attain or maintain an erection during sexual activity that is sufficient to allow them to initiate or maintain sexual activity . The erectile dysfunction or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection ofthe penis . There are various underlying causes , such as damage to the which prevents or delays erection , or diabetes as well as cardiovascular disease , which simply decreases blood flow to the tissue in the penis , many of which are medically reversible . The causes dysfunction may be psychological or physical . Psychological erectile dysfunction can often be helped by almost anything that the patient believes in there is a very strong placebo effect . Physical damage is much more severe . One leading physical cause of ED is continual or severe damage taken to the . These nerves course beside the prostate arising from the sacral plexus and can be damaged in prostatic and colorectal surgeries . Diseases are also common causes of erectile dysfunction especially in men . Diseases such as cardiovascular disease , multiple sclerosis , kidney failure , vascular disease and spinal cord injury are the source of erectile dysfunction . Due to its embarrassing nature and the shame felt by sufferers , the subject was taboo for a long time , and is the subject of many urban legends . Folk remedies have long been advocated , with some being advertised widely since the . The introduction of perhaps the first pharmacologically effective remedy for impotence , trade name Viagra ) in the 19905 caused a wave of public attention , propelled in part by the of stories about it and heavy advertising . It is estimated that around 30 million men in the United States and 152 million men worldwide suffer from erectile dysfunction . However , social stigma , low health literacy and social taboos lead to under reporting which makes an accurate prevalence rate hard to determine . Orgasm disorders Female orgasmic disorder refers to the inability to obtain orgasm in women . The woman enjoys sex and foreplay and shows normal signs of sexual arousal but can not reach the peak experience of orgasm . Male orgasmic disorder refers to a delay in or absence of orgasm following a normal phase of excitement and an adequate

240 EMERSON WOLFE , degree of stimulation . Male orgasmic disorder is most often situational . The male may have an issue reaching orgasm with a certain partner , but not through masturbation . Male orgasmic disorder includes a delayed ejaculation ( very rare ) or ( more commonly ) premature ejaculation . One of the most common sexual in men is premature ejaculation . It is not possible to exactly specify what defines premature , but if the man ejaculates before or immediately upon insertion of the penis into the vagina , most will identify the response as premature . Most men diagnosed with premature ejaculation ejaculate within one minute after insertion ( 2003 ) Premature ejaculation is one ofthe most prevalent sexual disorders and causes much anxiety in many men . Orgasm disorders , specifically , present as persistent delays or absence of orgasm following a normal sexual excitement phase in at least 75 of sexual encounters . The disorder can have physical , psychological , or pharmacological origins . antidepressants are a common pharmaceutical culprit , as they can delay orgasm or eliminate it entirely . A common physiological culprit is menopause , where one in three women report problems obtaining an orgasm during sexual stimulation following menopause . Sexual pain disorders disorder ( is a new diagnosis included in the edition of the Diagnostic and Statistical Manual of Mental Disorders ( which merged the revised definitions of both female sexual ( painful sex ) and vaginismus ( involuntary vaginal muscle spasms ) At least one of the following persistent or recurrent criteria characterizes ( difficulties with vaginal penetration during intercourse , pain during vaginal intercourse or penetration attempts , fear or anxiety associated with pain or vaginal penetration , or ( tightness of the pelvic floor muscles during attempted vaginal penetration . One or more of these symptoms have to be present for at least months and must cause clinically significant distress . can be classified as either lifelong or acquired and , depending on the level of distress as mild , moderate or severe . The fusion and under a new classification and set of criteria was due to the significant overlap in clinical presentation , and exceeding difficulties to distinguish between the two reliably . The prevalence of has not been ascertained due to the novel criteria set . Reported prevalence rates in the general population vary between and 25 for and and for vaginismus . Prevalence estimates are heterogeneous due to , varying diagnostic criteria , assessment methods , study design , and sample characteristics . The burden of suffering associated with and linked conditions such as and provoked is high as symptoms have a detrimental impact on physiological and psychological health , and relational . is chronic pain in the vulva , the area on the outside of a woman genitals . It is usually described as a sensation of burning , stinging , itching or rawness . is chronic pain and discomfort that occurs in the area around the opening ofthe vagina , inside the inner lips of the vulva . This area is known as the vestibule . One or more interactive elements has been excluded from this version of the text . You can view them online here on .

CHAPTER 17 241 has been shown to have a negative effect on the women overall quality of life , with 60 of women reporting that the disorder compromised their ability to enjoy life . Moreover , it has been linked to depression and anxiety disorder . symptoms are often with a wide range of other sexual and reduced sexual behavior . Many women with also experience problems when using tampons or during gynecological examinations . has been shown to contribute to declines in and feelings of femininity and is associated with a negative body and genital . It can pose a considerable burden on a couples relationship , especially ifthey would like to have children . Sexual and the Community As you can see from the previous section of the reading going over the classifications of the sexual , much of the research and language centers the experiences of and straight individuals . The particular contextual factors that influence the sexual functioning of gender diverse individuals and sexual minorities deserve specific attention . Sexual Functioning and Gender Diversity and ( 2018 ) found that transgender individuals who desired care , such as hormones surgery , and received these services experienced increases in sexual satisfaction and sexual wellbeing . Individuals who desired services but were unable to receive them reported less body satisfaction and less sexual satisfaction . People who did not desire transition services were the most satisfied with their bodies and with their sexual behaviors . Thus , the role of body satisfaction can be seen as having an impact on sexual functioning and satisfaction . Body satisfaction was somewhat more important to the transgender women participants in relation to their sexual wellbeing than the transgender men participants as a whole . This research is important to understand that some transgender individuals may desire hormones surgeries more than others and that body satisfaction plays an important role in sexual functioning ( 2018 ) Unfortunately , research is lacking regarding the experiences of , gender , and gender individuals . Sexual Functioning and Sexual Minorities Li et al . 2019 ) found that internalized stigma and shame related to sexual orientation was associated with less sexual satisfaction in the study of participants who identified as men who have sex with men ( both gay and bisexual men were included together ) If the participants perceived the neighborhood in which they lived to be accepting of their sexual orientation , then this was correlated with higher levels of sexual satisfaction as well . This indicates that internalized and social stigma may have an impact on some individuals sexual wellbeing . et al . 2012 ) found no significant statistical difference between the incidence of sexual between men who have sex with men and straight men . The same factors that increased the chance of sexual in straight men , such as increasing age , underlying health concerns , urinary tract issues and lack of a consistent , stable romantic relationship , impacted men who have sex with men as well ( et , 2012 ) Stereotypes exist regarding lesbian sexual behaviors and desire in which the term bed death derives , meaning that after a few years of being in a relationship , lesbians will no longer engage in sexual behaviors with each other ( 2014 , 2691 ) However , the reality lies in how women are socialized to be more passive regarding sex causing them to initiate less frequently . Understanding the influence of gender socialization and sexual scripts in the lives of lesbian women can be helpful instead . For instance , and ( 2014 ) found that the biggest factor in influencing the development of sexual in both straight and lesbian women was internalizing the sexual desire and pleasure are sins .

242 EMERSON WOLFE , THEORIES AND TREATMENT OF SEXUAL Sexual have a variety of causes . In some cases the primary problem is biological , and the disorder may be treated with medication . Other causes include a repressive upbringing in which the parents have taught the person that sex is dirty or sinful , or the experience of sexual abuse ( Hood , 1992 ) In some cases the sex problem may be due to the fact that the person has a different sexual orientation than he or she is engaging in . Other problems include poor communication between the partners , a lack of sexual skills , and ( particularly for men ) performance anxiety . It is important to remember that most sexual disorders are temporary they are experienced for a period of time , in certain situations or with certain partners , and then ( without , or if necessary with , the help of therapy ) go away . It is also important to remember that there are a wide variety of sex acts that are enjoyable . Couples with happy sex lives work together to find ways that work best for their own styles . Sexual problems often develop when the partners do not communicate well with each other , and are reduced when they do . One or more interactive elements has been excluded from this version of the text . You can view them online here ?

SEXUAL AROUSAL DISORDERS . File Contrary to popular belief , sexual arousal disorder is not always caused from a lack of sexual arousal . Possible causes of the disorder include psychological and emotional factors , such as depression , anger , and stress

CHAPTER 17 243 relationship factors , such as conflict or lack medical factors , such as depleted hormones , reduced regional blood flow , and nerve damage and drug use . The lack of sexual arousal may be due to a general lack of sexual desire or due to a lack of sexual desire for the current partner ( situational ) A person may always have had no or low sexual desire or the lack may have been acquired during the person life . Certain medications like may be a contributing factor . Treatment depends on the cause of the disorder . Hormone therapy or a enhancing medication , like Viagra , may be appropriate . formerly ) is being studied in clinical tests to increase sexual desire in women . In 2014 , the company developing the drug , announced the beginning ofa Phase clinical trial to determine its effectiveness . sold under the trade name , is a medication approved for the treatment of women with hypoactive sexual desire disorder ( DISORDERS INVOLVING ORGASM The condition is sometimes classified as a psychiatric disorder . However , it can also be caused by medical problems such as diabetic neuropathy , multiple sclerosis , genital mutilation on either gender , complications from genital surgery , pelvic trauma ( such as from a straddle injury caused by falling on the bars of a climbing frame , bicycle or gymnastics beam ) hormonal imbalances , total hysterectomy , spinal cord injury , cauda syndrome , uterine , childbirth trauma ( vaginal tearing through the use of forceps or suction or a large or unclosed episiotomy ) and cardiovascular disease . Primary is a condition where one has never experienced an orgasm . This is significantly more common in women , although it can occur in men who lack the ( bulbocavernosus ) reflex . Women with this condition can sometimes achieve a relatively low level of sexual excitement . Frustration , restlessness , and pelvic pain or a heavy pelvic sensation may occur because of vascular engorgement . On occasion , there may be no obvious reason why orgasm is unobtainable . In such cases , women report that they are unable to orgasm even if they have a caring , skilled partner , adequate time and privacy , and an absence of medical issues which would affect sexual satisfaction . About 15 of women report difficulties with orgasm , and as many as 10 of women in the United States have never climaxed . Only 29 ofwomen always have orgasms with their partner . Secondary is the loss of the ability to have orgasms ( as opposed to primary which indicates a person who has never had an orgasm ) Or loss of the ability to reach orgasm of past intensity . The cause may be alcoholism , depression , grief , pelvic surgery ( such as total hysterectomy ) or injuries , certain medications , illness , estrogen deprivation associated with menopause , or rape . Orgasmic dysfunction is more prevalent in younger and less sexually experienced women . Primary ( is found in about of women and is less common than secondary ( acquired ) Research has shown that almost ofwomen have concerns about their sexual relationships . In a study in America 43 of the 1749 women interviewed reported experiencing in the past year events such as a lack of interest in sex , inability to achieve orgasm and trouble lubricating compared with 31 of men . Many factors affect orgasmic function , age , education , job , folklore ( taboos ) religious beliefs , drugs , psychological disorders and gynecological surgery . Sexual dysfunction causes many problems for couples some researchers found that up to 67 of divorces are related to sexual disorders . It seems that counseling and education in sexual behavior is the most effective treatment for sexual dysfunction . Disorder Regarding the broad symptom profile of , its etiology and maintenance can be best explained by a framework considering a wide range of interdependent , psychological , social ,

244 EMERSON WOLFE , cultural , and relational factors as well as critical life events . According to the model , including worrying about losing control of one body , genital incompatibility , and pain are crucial in maintaining and reinforcing pain and associated symptoms , by leading to fear and in sexual situations , or complete avoidance of sexual intimacy . Beyond individual aspects , relationship dynamics such as dyadic communication and stress coping , as well as partners responses have been shown to have profound influence on symptoms . To an appreciable extent , has also been found to concur with male partners sexual . Due to the nature of , a multidimensional integrative treatment approach is needed that targets not only difficulties with vaginal penetration , pain , anxiety , and muscle tightness associated with sexual intercourse but also sexual satisfaction and couple dynamics . Psychological interventions for vaginismus and include strategies such as pain management , systematic desensitization , cognitive restructuring , exercises , sensate focus , and mindfulness . Only few interventions , however , have been empirically tested so far . Ofthese trials , only few studies have applied randomized controlled trial ( design , most of them with only small sample sizes . Findings ofthese indicate that psychological treatments can result in significant improvement of intercourse penetration ability , decrease in pain during intercourse , and higher levels of sexual functioning . However , none of these studies targeted all symptoms of . SEX THERAPY Sex therapy is a strategy for the improvement of sexual function and treatment of sexual dysfunction . This includes sexual such as premature ejaculation or delayed ejaculation , erectile dysfunction , lack of sexual interest or arousal , and painful sex . It includes dealing with problems imposed by atypical sexual interests ( gender dysphoria and being transgender highly overactive libido or , a lack of sexual confidence , recovering from sexual abuse , such as rape , sexual assault , and sexual issues related to aging , illness , or disability . One or more interactive elements has been excluded from this version of the text . You can view them online here on . It can include sensate focus , communication , and fantasy exercises as well as psychodynamic therapy . Sensate focus is a sex therapy technique introduced by the Masters and Johnson team . It works by refocusing the participants on their own sensory perceptions and sensuality , instead of behavior focused on the genitals and penetrative sex . Sensate focus has been used to treat problems with body image , erectile dysfunction , orgasm disorders , and lack of sexual arousal . The exercises are conducted by the couple at home , between therapy sessions . Although the couple are nude and touching each other during the exercises , they are instructed to abstain from sexual intercourse during or close to the sessions . Both participants are instructed instead to focus on their own varied sense experience , instead of focusing on performance or orgasm . Initially , the emphasis is on touching in a mindful way for oneself without regard for sexual response or pleasure for oneself or one partner . The second stage increases the touch options to include breasts . Sensation and gathering information about the

CHAPTER 17 245 partner body is still encouraged and intercourse and touching of the genitals is still forbidden . The participants then use a technique of placing their hand over their partner hand in order to show what they find pleasurable in terms of pace and pressure . Learning about the partner body is still the goal rather than pleasure . Further stages gradually touching of breasts and genitals , then intercourse . Orgasm is never the focus . Cognitive Sexual Therapy therapy is recognized by its efforts in developing and providing psychotherapeutic interventions to various kinds of psychological and interpersonal problems , being this ideological standpoint a trigger to continuous actualization of its theory and practice . Cognitive sexual therapy ( is a integrative psychotherapy aimed specifically to address and treat , articulating clinical interventions to scientific understandings of human sexuality . In a perspective , distorted sexual , allied to individuals of sexual demands , directly affect emotional , physiological and behavioral regulation in sexual situations . In this sense , restructuring central and intermediate cognitive processes is essential to foster the acquisition of sexual skills and to promote the development of a more adapted sexual repertoire . Thus , are understood as mediating factors to be modified , aiming sexual skills implementation and emotional regulation during sexual encounters . Sexual Scripts are ideas of how males and females are supposed to interact with each other , including how each gender should behave in sexual or romantic situations . Being able to sexual scripts and behaviors leads to better adaptation to physiological , environmental and relational changes that negatively impact sexuality over the life cycle , contributing to booster sexual satisfaction even in the presence of sexual function disturbances . The focus of interventions is to aid patients and partners towards the development of more flexible and adaptable sexual and behavioral patterns . could permit a regain in sexual function and satisfaction during and after treatment with psychotropic medication , lessen the negative impact of sexual adverse effects in quality of life and therefore , increase adherence and therapeutic effects of pharmacotherapy . Although the theoretical rationale supporting this proposal is , feasibility , efficacy , treatment and procedural aspects of the intervention remain to be empirically tested . Additional Resources From Sexual Medicine Treating Low Libido in Women ( Adams , 201 ) From Medicine gender from sex in sexual dysfunction ( 2020 ) LICENSES Clinical Perspectives in Abnormal Psychology by Sonja Ann Miller is licensed under Creative Commons BY Lumen Learning ( 2020 ) Abnormal psychology . Retrieved from Adaptations Reformatted . Added learning objectives . Modified content for language , application to subject and cohesion . Updated sources . All Rights Reserved Tracy Marks ( 2019 , January ) Why antidepressants kill your sex drive and what to do about it Video . License All Rights Reserved . License Terms Standard YouTube license . 2012 , July 12 ) What happens in a sex therapy session ?

Psychology of sex Video .

246 EMERSON WOLFE , License All Rights Reserved . License Terms Standard YouTube license . 2016 , February 12 ) Confidence and joy are the keys to a great sex life Video . University of Nevada . License All Rights Reserved . License Terms Standard YouTube license . Ohio State Medical Center ( 2016 , October 24 ) The importance of early treatment for erectile dysfunction Video . License All Rights Reserved . License Terms Standard YouTube license . Pelvic Health and Rehabilitation Center ( 2020 , December 29 ) vaginismus the difference Video ?

License All Rights Reserved . License Terms Standard YouTube license . REFERENCES American Psychiatric Association . 2013 ) Diagnostic and statistical manual of mental disorders ( 2018 ) Women sexual dysfunction associated with psychiatric disorders and their treatment . Women Health . Li , Remble , 2019 ) Stigma on the streets , dissatisfaction in the sheets is minority stress associated with decreased sexual functioning among young men who have sex with men ?

The Journal of Sexual Medicine , 16 ( Miller , A . 2020 ) Clinical perspectives in abnormal psychology . Lumen Learning . Retrieved from Mitchell , Jones , Johnson , Graham , Datta , Field , Mercer , 2016 ) Estimating the prevalence of sexual function problems The impact of morbidity criteria . Journal of Sex Research , 53 ( 2018 ) Sexual experiences in transgender people The role of desire for interventions , psychological , and body of Sex Marital Therapy , 44 ( 2014 ) Dysfunctional sexual beliefs A comparative study of heterosexual men and women , gay men , and lesbian women with and without sexual problems . of Sexual Medicine , 11 ( Sack , 2019 ) The role control mechanisms in the regulation of sexual behavior . Archives of Sexual Behavior , 48 ( 2012 ) Erectile dysfunction and premature ejaculation in men who have sex with men . The Journal of Sexual Medicine ,