1. health and fitness
2. disorders

Sex Differences and Defects
 Menstruation
 Circumcision
 Disorders of the Male Sex Organs
 Disorders of the Female Sex Organs
 Sexual Dysfunctions and Therapies
 Hormones
Sexual Dysfunctions and Therapies
• Statistical definition - an abnormal sexual
behavior is rare or not practiced by many people.
• Sociological approach - sexual behavior that
violates the norms of society.
• Psychological approach - criteria include
discomfort, inefficiency, and bizarreness.
• Medical approach - the Diagnostic and Statistical
Manual of Mental Disorders recognizes 8
paraphilias.
▫ A paraphilia is a recurring, unconventional sexual
behavior that is obsessive and compulsive.
Sexual Dysfunctions and Therapies
Normal-Abnormal Continuum:
• Normal and abnormal sexual behavior are not
two separate categories, but rather gradations on
a continuum.
• A mild, or even strong, preference for an object
is with the normal range of sexual behavior but
is abnormal if it becomes an extreme necessity.
Sexual Dysfunctions and Therapies
Sexual Dysfunctions and Therapies
Compulsive Sexual Behavior:
• A disorder in which the individual experiences
intense, sexually arousing fantasies, urges, and
associated sexual behaviors.
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Intrusive, driven, and repetitive
Lacking in impulse control
Often incur social and legal sanctions
Interfere with personal and occupational
functioning
▫ Create health risks
Sexual Dysfunctions and Therapies
• Fetishism is characterized by sexual fantasies,
urges, or behaviors involving use of nonliving
objects:
▫ to produce or enhance sexual arousal.
▫ with or in the absence of a partner.
▫ over a period of at least six months.
▫ causing significant distress.
Sexual Dysfunctions and Therapies
How do they start:
• Learning theory
▫ Fetishes result from classical conditioning, in
which a learned association is built between the
fetish object and sexual arousal and organism.
• Cognitive theory
▫ Fetishists have a serious cognitive distortion in
that they perceive a nonconventional stimulus as
erotic.
Sexual Dysfunctions and Therapies
Transvestism:
• Refers to dressing as a member of the other gender.
• Drag queens are male homosexuals that dress up
as women.
• Female impersonators are men who dress as
women, often as part of an entertainment job.
Transvestite fetishism refers to a heterosexual
man who dresses in female clothing to produce or
enhance sexual arousal.
• Transvestism is almost exclusively a male sexual
variation and is essentially unknown among women.
Sexual Dysfunctions and Therapies
• Sadist - a person who derives sexual
satisfaction from inflicting pain on another
person.
• Masochist - a person who derives sexual
satisfaction from experiencing pain.
• Sadomasochism (S-M) is a rare form of
sexual behavior, although in its milder forms is
probably more common than people think.
▫ Causes are not precisely known.
Sexual Dysfunctions and Therapies
• Bondage and discipline - use of physical or
psychological restraints to enforce servitude.
• Dominance and submission (D-S) - the use
of power consensually given to control the sexual
stimulation and behavior of the other person.
• Voyeur - a person who becomes sexually
aroused from secretly viewing nudes.
• Scoptophilia - a sexual variation in which the
person becomes sexually arouse by observing
others’ sexual acts and genitals.
Sexual Dysfunctions and Therapies
Exhibitionism:
• The person derives sexual pleasure from
exposing his genitals to others in situations
where this is clearly inappropriate.
• A man who exposes himself is considered
offensive, but a women who reveals most of her
breast is likely to be thought of as attractive.
• Causes of exhibitionism are not known.
Sexual Dysfunctions and Therapies
• Nymphomania (women) and Satyriasis (men)
▫ High level of sexual activity
▫ Excessive sex drive; person is apparently
insatiable.
▫ Leads to compulsive behavior; sexuality
overshadows all other concerns and interests.
Difficult to determine what is “excessive.”
▫ Terms are imprecise; couples may disagree.
• Especially difficult diagnosing women:
▫ One definition for men was seven or more orgasms per
week for six months, but this may not be abnormal for
multiorgasmic women, and hypersexual women may have
no orgasms.
Sexual Dysfunctions and Therapies
Asphyxiophilia:
• The desire to induce in oneself a state of oxygen
deficiency in order to create sexual arousal or to
enhance excitement and orgasm.
• People engage in asphyxiophilia in the belief that
arousal and orgasm are intensified by reduced
oxygen.
Sexual Dysfunctions and Therapies
Cybersex:
• Use of the Internet to access sexually
oriented materials, chat rooms, and
bulletin boards.
▫ Characterized by anonymity,
accessibility, and affordability.
▫ Can become compulsive, addictive,
paraphilic.
Sexual Dysfunctions and Therapies
• Troilism - or triolism, refers to three people
having sex together.
• Saliromania - disorder found mainly in men;
desire to damage or soil a woman or her clothes.
• Coprophilia - feces are important to sexual
satisfaction.
• Urophilia - urine is important to sexual
satisfaction.
Sexual Dysfunctions and Therapies
• Frotteurism (DSM-IV-TR) is identified as
sexual fantasies, urges, or behaviors involving
touching or rubbing one’s genitals against the
body of a nonconsenting person.
• Necrophilia - sexual contact with a dead
person.
• Zoophilia (bestiality) - sexual contact with an
animal.
Sexual Dysfunctions and Therapies
Diagnosing:
• Categories for diagnosis are not nearly as clear-cut as the
may seem
• Multiple diagnoses for one person are not uncommon.
Prevention of Sexual Variations:
• Difficult to do primary prevention.
• Interest in developing preventive programs targeting
children has increased.
• Analyze the components of sexual development:
▫ Gender identity
▫ Sexual responsiveness
▫ Formation of relationships with others
Sexual Dysfunctions and Therapies
• Hormonal treatment
▫ Use of drugs to reduce androgen production or
block effects of androgen.
• Psychopharmacological treatment
▫ Use of psychotropic medications
to influence psychological
functioning and behavior.
Sexual Dysfunctions and Therapies
Cognitive-Behavioral Therapies:
• Behavior therapy
• Social skills training
• Modification of distorted thinking
• Relapse prevention
Sexual Dysfunctions and Therapies
Skills Training:
• Programs may include:
▫ how to carry on a conversation
▫ how to develop intimacy
▫ basic sex education
• Sex surrogates interact socially and
sexually with the client and a
therapist.
Sexual Dysfunctions and Therapies
• Sexual disorder (sexual dysfunction) - a
problem with sexual response that causes
mental distress.
▫ Lifelong - present since the person became
sexual
▫ Acquired -the dysfunction appeared after a
period of normal functioning
Sexual Dysfunctions and Therapies
▫ Sexual desire (libido) - an interest in sexual
activity.
▫ Hypoactive sexual desire - when the person is
not interested in sexual activity.
▫ Discrepancy of sexual desire - when one
partner wants sex considerably less frequently
than the other.
Sexual Dysfunctions and Therapies
Sexual Aversion Disorder:
• Strong aversion to sexual interaction, involving
▫ anxiety,
▫ fear, or
▫ disgust
• Avoids any kind of genital contact with a
partner.
• Common in persons who have panic disorder.
Sexual Dysfunctions and Therapies
Female Arousal Disorder:
• Lack of response to sexual stimulation, including
lack of lubrication.
• Involves psychological and physiological
elements.
• Defined partly by a women’s sense that she does
not feel aroused despite adequate stimulation.
Sexual Dysfunctions and Therapies
Erectile Disorder:
• Lifelong erectile disorder -never been able to
have an erection that is satisfactory for intercourse.
• Acquired erectile disorder - now has difficulty
getting or maintaining an erection, but has had
sufficient erections at other times.
Male Orgasmic Disorder:
• Unable to have an orgasm or it is greatly delayed,
despite a solid erection and adequate stimulation.
• Far less common than premature ejaculation.
Sexual Dysfunctions and Therapies
Female Orgasmic Disorder:
• Lifelong orgasmic disorder - never experienced an
orgasm.
• Acquired orgasmic disorder - previously had
orgasms but no longer does so.
• Situational orgasmic disorder - orgasms in some
situations but not others.
▫ 24 percent of female respondents reported
difficulty in the last 12 months with having
orgasms.
▫ Female orgasmic disorder accounts for 25-35
percent of the cases of women seeking sex
therapy.
Sexual Dysfunctions and Therapies
Painful Intercourse:
• Dyspareunia - pain experienced during
intercourse.
• Vaginismus - spastic contraction of the
muscles surrounding the entrance to the vagina.
Sexual Dysfunctions and Therapies
Sexual Dysfunctions and Therapies
Causes:
• Physical causes include organic factors such as
disease and drugs.
• Diseases associated with the heart and circulatory
system are likely to be associated with the condition.
Hormonal Causes:
• Hypogonadism - an underfunctioning of the
testes, so that testosterone levels are very low.
• Hyperprolactinemia - excessive production of
prolactin.
Sexual Dysfunctions and Therapies
Premature Ejaculation:
• Premature ejaculation is more often caused by
psychological than physical factors.
▫ Physical factors such as a local infection or a
nervous system degeneration may be involved in
cases of acquired disorder.
Male Orgasmic Disorder:
• Most commonly associated with psychological factors.
• May be associated with a variety of medical or surgical
conditions, such as:
▫ multiple sclerosis
▫ spinal cord injury
▫ prostate surgery
Sexual Dysfunctions and Therapies
Female Orgasmic Disorder:
• Most cases are caused by psychological factors.
• May be caused by physical factors, such as:
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A severe illness
General ill health
Extreme fatigue
Injury to the spinal cord
Dyspareunia:
• Painful intercourse in women is often caused by organic factors:
▫ Disorders of the vaginal entrance
▫ Disorders of the vagina
▫ Pelvic disorders
• Painful intercourse in men can often be caused by a variety of organic
factors:
▫ For an uncircumcised man, poor hygiene may be the cause.
▫ Prostate problems may cause pain on ejaculation.
Sexual Dysfunctions and Therapies
• Some drugs may have side effects that cause sexual disorders.
• Effects of alcohol vary considerably.
Marijuana:
• Many respondents report that marijuana increases sexual
desire
• Chronic users report decreased sexual desire.
Cocaine:
• Said to increase sexual desire
• Chronic use is associated with
▫ loss of desire
▫ orgasmic disorders
▫ erectile disorders
Sexual Dysfunctions and Therapies
Stimulants:
• Stimulant drugs such as amphetamines are associated with
increased sexual desire, but in some cases, orgasm becomes
impossible or difficult.
• People high on crystal methamphetamine (ice) have a
tendency to engage in risky sexual behaviors.
Opiates:
• Opiates or narcotics such as:
▫ Morphine
▫ Heroin
▫ Methadone
have strong suppression effects on sexual desire and response.
• Long-term use of heroin leads to decreased testosterone levels
in males.
Sexual Dysfunctions and Therapies
Psychiatric Drugs:
• Psychiatric drugs alter functioning of the central
nervous system which, in turn, affects sexual
functioning.
• Some antidepressants are associated, in both
men and women, with
▫ arousal problems
▫ delayed orgasm problems
Sexual Dysfunctions and Therapies
Sexual Dysfunctions and Therapies
Psychological Causes:
• Immediate causes - various things that happen in the
act of lovemaking itself that inhibit the sexual response.
• Prior learning - things people learned earlier
(childhood, adolescence, earlier adulthood), which now
inhibit their sexual response.
• Cognitive interference - thoughts that distract the
person from focusing on erotic experience.
• Spectatoring - when the person behaves like a judge of
his or her own sexual performance.
• Failure of the partners to communicate - one of
the more important and immediate causes of sexual
disorders.
Sexual Dysfunctions and Therapies
• Emotional factors such as depression, anger,
sadness, and anxiety can interfere with sexual
responding.
• Behavioral or lifestyle factors such as
smoking, alcohol consumption, and obesity all
are associated with higher rates of sexual
disorders.
Sexual Dysfunctions and Therapies
Sexual Dysfunctions and Therapies
• Interpersonal factors
▫ Disturbances in a couple’s relationship.
▫ Anger or resentment toward one’s
partner.
▫ Fear of intimacy can cause a person to
draw back from a sexual relationship
before it becomes truly fulfilling.
Sexual Dysfunctions and Therapies
• Behavior therapy - eliminates goal-oriented
sexual performance.
▫ Sensate focus exercises - gradually
increase the sexual component as the
couple successfully complete assignments.
• Couple therapy
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Sexual and performance anxiety reduction
Education and cognitive intervention
Script assessment and modification
Conflict resolution and relationship enhancement
Relapse prevention training
Sexual Dysfunctions and Therapies
• Stop-start technique - used in the treatment
of premature ejaculation.
• Kegel exercises - strengthen the
pubococcygeal muscle (PC muscle) along the
sides of the vagina.
• Bibliotherapy - using self-help books to treat a
disorder.
Sexual Dysfunctions and Therapies
• Viagra (sildenafil), Cialis (tadalafil), and Levitra
(vardenafil)
▫ treat erectile disorders
▫ do not seem to cause priapism (an erection that
won’t go away)
• Intrinsa, a testosterone patch for post
menopausal women experiencing low sexual
desire, is in clinical trials.
Sexual Dysfunctions and Therapies
• Suction devices
▫ A tube is placed around the penis until a
reasonably firm erection is present.
▫ Can be helpful in combination with
cognitive-behavioral couple therapy.
• Surgical therapy
▫ The inflatable penis involves implanting
a prosthesis into the penis.
▫ This is radical treatment that should be
reserved for cases that have not been cured
by sex or drug therapy.
Sexual Dysfunctions and Therapies
Sexual Dysfunctions and Therapies
Sexual Dysfunctions and Therapies
• Masters and Johnson reported a failure rate of
about 20 percent, which implied a success rate of 80
percent.
• There is a lack of carefully controlled studies that
investigate the success of various therapies
compared with other therapies.
• Disorders may be given a quick fix with drugs while
the patient’s anxieties and relationship problems are
ignored.
• We must be sensitive to the values expressed in
labeling something as being, or someone as having,
a “disorder.”