Springfield College Chapter 12 Sexual Dysfunction and Sex Therapy Paper Read Chapter 12: Sexual Dysfunction and Sex Therapy, read/watch Kentucky Bill Would

Springfield College Chapter 12 Sexual Dysfunction and Sex Therapy Paper Read Chapter 12: Sexual Dysfunction and Sex Therapy, read/watch Kentucky Bill Would Require Wife’s Permission Before Getting Viagra; FDA advisory panel recommends approval of ‘female Viagra’; The FDA is set to approve the “female Viagra”; and Critics say it’s a mistake, and New pill for boosting female libidos off to a slow start articles and provide an argument as to whether you are for or against this new pill for women, should the FDA have approved this pill?, what are your thoughts on the Kentucky Bill and what you took away from all 3 broadcasts and the articles. No Cover Page

Review the case studies of Mike and George.

What approach would you use to work with each of the scenarios?

Mike

A 24-year-old single man living with his girl friend (Dora) of four years reveals that he has an “unhealthy” sexual desire for teen age girls. He requests treatment to help “cure” him of this sexual interest. While not acting out his sexual desire, he has been secretly spending 3-8 hours per week hunting images of young girls on the internet. He acknowledges that his compulsion has hurt his relationship and his sex life. He is extremely ambivalent about his relationship but has not talked about his feelings openly with Dora. He has been avoiding sexual contact with Dora as well as having difficulty getting himself to the gym and other outside interests and activities. He states that his mood has been more depressed and he is anxious about his compulsion being revealed. He feels guilty, ashamed, and preoccupied.

George

George is a 49-year-old married man with a two-year-old boy. He has a history of alcohol addiction and cyber-porn addiction. Four years ago he was successfully treated for these addictions with a combination of in-patient, outpatient, and group psychotherapy. He is a writer and has taught English at a variety of local colleges. After three years of recovery from alcohol and cyber-porn addiction, he relapsed following his being laid off from his teaching position in an administration change. He has not begun drinking but is again “medicating” his anxiety by spending large chunks of time watching cyber-porn. He presented to treatment after becoming increasingly more agitated, depressed, ashamed and “fed-up” with himself.

Kentucky Bill Would Require Wife’s Permission Before Getting Viagra: http://www.wbur.org/hereandnow/2016/02/17/kentucky-viagra-billFDA advisory panel recommends approval of ‘female Viagra’: https://www.washingtonpost.com/news/to-your-health/wp/2015/06/04/widely-varying-views-of-female-viagra-emerge-at-fda-hearing/?utm_term=.2fd9a59b8c5b
The FDA is set to approve the “female Viagra.” Critics say it’s a mistake: https://www.vox.com/2015/6/4/8732723/female-viagra-fda
A new pill for boosting female libidos off to a slow start: https://www.statnews.com/pharmalot/2015/11/17/pharmalot-addyi-female-libido/http://www.surrogatetherapy.org/
http://www.lehmiller.com/blog/2013/1/14/sex-surrogacy-the-hands-on-approach-to-sex-therapy.htmlhttp://sexability.org
Video: 17 min
https://youtu.be/gds2RvmCBKE 12
Sexual Dysfunction and Sex Therapy
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Chapter Outline
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Introduction 303
Causes of Sex Difficulties 303
Biological 303
Psychological 304
Social 306
Types of Sexual Dysfunction 308
Desire Problems 308
Arousal Problems 311
Orgasm Problems 311
Pain Disorders 312
Sex Therapy 313
Schools of Thought 313
Specific Treatments 318
Tips For Avoiding Sexual Difficulties 324
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The Psychology of Human Sexuality, First Edition. Justin J. Lehmiller.
© 2014 John Wiley & Sons, Ltd. Published 2014 by John Wiley & Sons, Ltd.
Lehmiller, Justin J.. The Psychology of Human Sexuality, John Wiley & Sons, Incorporated, 2014. ProQuest Ebook Central,
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Sexual Dysfunction and Sex Therapy
303
Introduction
[Sexual health is] a state of physical, emotional, mental and social well-being in relation to sexuality;
it is not merely the absence of disease, dysfunction or infirmity. Sexual health requires a positive and
respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be
attained and maintained, the sexual rights of all persons must be respected, protected and fulfilled.
World Health Organization (2012)
The above definition of sexual health will serve to guide our discussion in the final three chapters
of this book as we turn to the topics of sexual difficulties and their resolution (in this chapter) and
sexual coercion and violence (in Chapters 13 and 14). As this definition makes clear, sexual health
has biopsychosocial roots, which is why we will begin this chapter by discussing the biological,
psychological, and social factors that contribute to sexual dysfunction. Following that, we will
detail the most common sexual difficulties encountered in modern times and discuss their prevalence. The latter half of this chapter will delve into the topic of sex therapy, including coverage of
the various schools of thought in treating sex difficulties and some of the most common therapeutic techniques. As you might imagine, given the myriad factors that can generate sexual problems,
there is not one simple or singular approach to solving them. We will end the chapter with practical advice and suggestions for avoiding sexual difficulties in your own life.
Copyright © 2014. John Wiley & Sons, Incorporated. All rights reserved.
Causes of Sex Difficulties
When we talk about sexual dysfunction or sex difficulties, we are only talking about cases in
which a specific sexual issue persistently emerges (i.e., it is not a one-time thing) and creates distress at either the level of the individual or of the relationship. To clarify the importance of this
definition, consider someone who lacks sexual desire. Would you say that this person has a problem? Many people would say yes; however, keep in mind that some people are asexual. For asexual
individuals, their lack of desire is not personally distressing and they can go on to lead perfectly
satisfying and normal lives without sex. Thus, we must take care when labeling certain sexual attitudes and behaviors as inherently “dysfunctional” or “pathological” because subjective perceptions matter and our goal should not be to create problems where none exist.
It is also important to keep in mind that the absence of sexual dysfunction does not necessarily mean that someone is sexually healthy and satisfied. It is entirely possible to be free from
sexual problems, but to have less than satisfying sexual experiences (Basson et al., 2003). As
some of you may have found in your own life, simply having functional genitalia is not a guarantee of great sex. With that said, let us address the biopsychosocial factors that can contribute
to sexual problems.
Biological
There are numerous biological factors that can impair sexual function or cause pain during
sex, including the natural aging process, chronic illnesses, physical disabilities, sexually
transmitted infections (STIs), and drugs. As we get older, most of us will experience decreases
Lehmiller, Justin J.. The Psychology of Human Sexuality, John Wiley & Sons, Incorporated, 2014. ProQuest Ebook Central,
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Created from springfieldcollege on 2020-04-23 09:24:32.
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in sexual functioning because our bodies and hormone levels change. In addition, the older
we get, the more likely we are to develop chronic illnesses. These include diseases of the
cardiovascular and nervous systems, which are especially likely to interfere with sexual functioning. For instance, diabetes (a disease that progressively damages blood vessels and inhibits effective blood circulation) is a major contributor to male erectile dysfunction ( Johannes
et al., 2000). Diabetes can also contribute to female sexual difficulties by reducing blood flow
to the clitoris and vagina (Giraldi & Kristensen, 2010). In addition, multiple sclerosis (a disease that damages nerve fibers throughout the central nervous system, thereby disrupting
nerve impulses) often produces changes in genital sensitivity and may impact ability to reach
orgasm (Basson et al., 2010).
Various cancers are also linked to sexual problems, although it is sometimes the cancer
treatment that is more damaging to one’s sexuality than the cancer itself. For instance, surgical treatment for cancers of the breast, penis, and testicles tend to change the body in
very noticeable ways and often create body image issues. Likewise, surgery for prostate
cancer often results in erectile and ejaculatory difficulties (Vale, 2000), a fact that is not
surprising given the important role of the prostate in male sexual functioning discussed in
chapter 3.
With respect to disabilities, spinal cord injuries are linked to erectile and ejaculatory difficulties
in men and often impair the ability to orgasm in women (Basson et al., 2010). Contrary to popular
belief, however, permanent sexual difficulties such as these do not necessarily diminish sexual
desire or make it impossible to have a satisfying sex life. Redefining what sex is and/or creating
secondary erogenous zones (see chapter 4) can help persons with physical disabilities develop and
maintain sexual relationships.
As discussed in chapter 11, untreated STIs such as chlamydia and gonorrhea can turn into pelvic
inflammatory disease in women, a condition that can lead to painful intercourse and impair ability
to orgasm. In addition, a number of drugs and medications have negative sexual side effects. As
discussed in previous chapters, antidepressants (namely SSRIs) tend to delay orgasm in men and
women because they keep serotonin in the brain longer. Other psychiatric medications such as
antipsychotics and tranquilizers also have neurological effects that can inhibit ability to reach
orgasm. Some blood pressure and allergy medications have been reported to have negative sexual
effects as well. Finally, as discussed in chapter 4, alcohol, tobacco, and other drugs can not only
create episodic sexual problems, but long-term use of these substances can generate chronic sexual dysfunction. For instance, chronic alcoholism is linked to problems with sexual desire, arousal,
and orgasm (Segraves & Balon, 2003). Likewise, men who smoke for years are at increased risk of
having erectile difficulties due to tobacco’s damaging effects on the body’s blood vessels. In addition, chronic use of cocaine, opiates, and other such drugs can inhibit sexual arousal and response
(Segraves & Balon, 2003).
Psychological
Some of the most common psychological causes of sexual dysfunction include distraction, previous
learning experiences, beliefs about sexual difficulties, body image, and mental illness. First, distraction often takes the form of spectatoring (Masters & Johnson, 1970), which involves over-thinking
or over-analyzing one’s own sexual performance while having sex. You can think of spectatoring
as the act of becoming a spectator to your own sexual activity by mentally stepping out of the
moment and evaluating how you are doing (e.g., Are you pleasing your partner? Could you be
Lehmiller, Justin J.. The Psychology of Human Sexuality, John Wiley & Sons, Incorporated, 2014. ProQuest Ebook Central,
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Figure 12.1 Both prescription and non-prescription drugs and medications can contribute to sexual problems.
©Sebastian Duda/123RF.COM.
doing a better job?). Over-thinking your sexual performance may create anxiety that reduces
arousal and likelihood of orgasm.
Second, past learning experiences have important implications for our sexual functioning. For
instance, people who grew up learning that sex is a shameful or sinful activity and women who
have been taught to think that they should not enjoy sex may end up thinking about these things
during the act, thereby dulling sexual response and pleasure. Likewise, people who have experienced traumatic sexual events in the past, such as rape, sexual assault, or childhood sexual abuse
may feel an aversion to sex or have post-traumatic stress, which can make sex thoroughly unenjoyable and perhaps impossible. In fact, a history of sexual abuse is often uncovered during sex
therapy for both women and men (McCarthy, 1990).
Third, our beliefs about sexual dysfunction are linked to our experiences with sexual problems.
For example, research has found that, at least among women, the more prevalent they believe
sexual difficulties to be, the lower their own sexual functioning is (Chang, Klein, & Gorzalka,
2013). These beliefs about higher prevalence may lead to monitoring oneself for sexual problems
or simply produce more anxiety and worry that one will develop a problem.
Fourth, poor body image and a lack of knowledge regarding your own body can contribute to
sexual problems. As discussed in Chapter 3, many women and men are dissatisfied with the size
and shape of their chest and genitals. This can create distress and anxiety that ultimately leads
people with poor body image to avoid sexual activity altogether (La Rocque & Cioe, 2011).
Alternatively, they may only have sex under very limited circumstances (e.g., at night with all
of the lights off or only while wearing a shirt). These restrictions have the added effect of reducing
sexual spontaneity and frequency. Also, when such persons do have sex, they may be preoccupied
with how they look or what their partner is thinking. With respect to sexual knowledge, a lack of
familiarity with one’s own genital anatomy, particularly among women, is sometimes implicated
in orgasmic difficulties.
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Figure 12.2 Spectatoring and other distractions during sex can make it difficult to maintain arousal and reach orgasm.
©ostill/123RF.COM.
Finally, mental illness (irrespective of whether one is receiving pharmacological treatment) is
linked to sexual dysfunction, but not always in the same way. For instance, affective disorders are
sometimes associated with low libido (as in the case of major depression), and other times with
hypersexuality (as in the case of bipolar disorder, at least when people are in the manic phase;
Dell’Osso et al., 2009). Additionally, psychotic disorders such as schizophrenia are associated
with several forms of sexual dysfunction. Certain mental disabilities are linked to sexual difficulties too; however, less is known about this because sexuality and sexual behavior are typically
ignored for this population. Many societies deem the mentally disabled unable to provide sexual
consent and, in some cases, these individuals may be institutionalized. Thus, sexual difficulties
among the mentally disabled have gone unstudied and unaddressed because these individuals
are often denied a sex life altogether.
On a side note, sometimes it is difficult to separate out biological causes from psychological
causes of sex difficulties because they frequently go hand-in-hand. For instance, coronary heart
disease is linked to erectile dysfunction ( Johannes et al., 2000). Part of this linkage is a result of
general cardiovascular problems, but it is also the case that having a heart attack makes people
anxious about future sexual activity because they are afraid of getting “too worked up.” Thus, a
given sexual dysfunction can have more than one cause, with biological and psychological factors
often being intimately intertwined.
Social
Last but not least, there are several social variables than can generate sexual difficulties. First,
ineffective communication about sex both in and out of the bedroom is correlated with lower
sexual satisfaction (Babin, 2013). This makes sense because if you fail to tell you partner what
Lehmiller, Justin J.. The Psychology of Human Sexuality, John Wiley & Sons, Incorporated, 2014. ProQuest Ebook Central,
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you like or what feels good, then you may not receive the stimulation you need in order
to maintain arousal and to reach orgasm. Second, relationship problems such as unresolved
conflict and anger often reduce desire for partnered sexual activity (Brotto, 2010a), which has a
tendency to breed further relationship problems. Third, the way the partners in a relationship
view sex can affect partners’ performance and satisfaction. For example, as noted in chapter 10,
couples who are actively trying to have a baby sometimes put too much performance pressure
on one another, which may create anxiety and arousal problems. Also, couples who turn sex
into a chore or duty, or whose sex lives become very routine (e.g., a couple who only has sex
on Tuesdays and only in the missionary position) may risk reducing their enjoyment. Lastly,
cultural and religious factors are extremely important to take into account because they may
dictate certain prohibitions when it comes to seeking out and experiencing pleasure from sex.
For example, it is well known that East Asian cultures tend to have more conservative attitudes
toward sex than European cultures. Research finds that persons of East Asian descent tend to
report lower sexual desire and functioning than their European counterparts, at least partly
because they report feeling more guilt about pursuing and enjoying sexual activity (Brotto,
Woo, & Gorzalka, 2012).
As the above discussion makes clear, sexual dysfunction is a biopsychosocial phenomenon.
For even more information on the biopsychosocial factors associated with sexual dysfunction,
see Table 12.1. One theory that attempts to integrate all of these influences is the dual control
model (Bancroft, Graham, Janssen, & Sanders, 2009). The idea behind this model is that underlying sexual arousal and behavior are two important brain mechanisms: an excitatory system
and an inhibitory system. Activation of the excitatory system promotes sexual arousal and
activity, whereas activation of the inhibitory system suppresses it. Having two separate systems is thought to be adaptive. For instance, the excitatory system is important for ensuring
that reproduction happens, whereas the inhibitory system may be useful for helping to maintain harmonious interpersonal relationships by suppressing the impulse to have sex with our
friends’ romantic partners.
Table 12.1 Factors Associated with Risk of Sexual Dysfunction in the National Health and Social Life Survey
Emotional problems and stress were correlated with experiencing arousal and desire disorders in both
men and women, as well as painful intercourse in women.
In men, poor physical health was linked to greater risk for premature ejaculation, erectile dysfunction,
and low sexual desire. In women, poor health was only linked to painful sex.
Being sexually touched before puberty was linked to arousal disorders in both men and women, as well
as desire disorders and premature ejaculation in men.
Women who were previous victims of sexual assault were more likely to experience arousal disorders.
Men who reported having forced themselves on a woman before were more likely to experience erectile
dysfunction.
Having previously had an STI was associated with lower sexual desire among women.
Having had an abortion was unrelated to female sexual dysfunction.
Masturbation frequency was unrelated to sexual difficulties in both men and women.
Source: Laumann, Paik, & Rosen (1999).
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It is theorized that both systems are influenced by biopsychosocial factors. For example, some
people may be biologically “hardwired” to have one system be more active than the other. At the
same time, however, activation of these systems is also affected by our previous learning experiences (e.g., have your previous sexual experiences been rewarding or punishing?) and by cultural
factors (e.g., does your culture believe that sexual responses should be controlled and hidden away?).
When one system becomes disproportionately active, no matter whether it is a result of biological, psychological, or social factors, sexual difficulties are more likely to occur. For example, higher
excitatory activity may lead to compulsive and risky sexual behavior or premature orgasm, whereas
higher inhibitory activity may lead to difficulties with sexual desire or with becoming and staying
aroused. As you can see, the dual control model may be useful for understanding the origins of a
wide range of sexual dysfunctions.
Copyright © 2014. John Wiley & Sons, Incorporated. All rights reserved.
Types of Sexual Dysfunction
At this point, we will turn to a discussion of specific sexual difficulties. Research on sexual difficulties has historically been heterosexist and made the assumption that everyone fits into the gender
binary. As some evidence of this, many of the diagnostic criteria for sexual difficulties emphasize
problems with penile–vaginal intercourse and there is typically little, if any coverage of sexual
problems among individuals who are transgendered. However, anyone can experience sexual dysfunction, regardless of their sexual orientation, gender identity, or specific sexual practices. As a
result, we will attempt to describe sexual difficulties here at a broader level than you might see
elsewhere, without making too many assumptions about people’s sexual identities and practices.
Below, we will describe sexual dysfunction according to four distinct classes: problems with
desire, arousal, orgasm, and painful intercourse. Please note that the…
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