Exam 4

Question 1

History of Approaches to Sexual Dysfunction

Answer 1

Starts

Question 2

1786

Answer 2

Sir John Hunter reports first treatment of erectile failure

Question 3

1789: Sir John Hunter

Answer 3

Sends couples with unconsummated marriage, due to erectile dysfunction, to his secluded cabin, and FORBADE sexual contact.
- Unable to follow instructions.

Question 4

1789: Sir John hunters solution?

Answer 4

• Remove the individual from anxiety (AKA. put in secluded cabin)
• Couple returned saying that they were not able to follow the instructions.
• Engineer a situation that anxiety can be lessened to the point where sexual function returns.

Question 5

1890-1900: Kraft-Edbing

Answer 5

“Psychopathia Sexualis”

Question 6

Kraft-Edbing: “Psychopathia Sexualis”

Answer 6

• Appallingly Victorian
• Psychopathia Sexualis is what he considered as perversions.
• His recommendation was to hot iron the clitoris of a masturbator.
  ( people is insane asylums would publicly engage in masturbation or same sex sexual activity)

Question 7

1930-1965: Fruendian Psychoanalysis, Psychodynamic approaches

Answer 7

• Sexual problems are SYMPTOMS of unconscious conflict.
• Do NOT treat symptoms- identify and provide insight into their underlying unconscious conflictual basis.
  ( bring it into conscious)

Question 8

Freud and Rapid Ejaculation?

Answer 8

Possibly due to unconscious view of castration.

Question 9

1965-1990: Masters and Johnson

Answer 9

• Pragmatic, brief, symptom focused, behavioural therapy.

- Sexual problems are learned behaviours that are amenable to learned solutions.

Question 10

Masters and Johnson: Obstetrician and Gynaecologist

Answer 10

• Asked to study prostitutes

- Began recording for lab studies- what their bodies were doing and how to repair problematic sexual function.

Question 11

Masters and Johnsons Contribution:

Answer 11

• Appropriate for era with little understanding of sexual dysfunction.
• View that sexual function proceeds unless their anxiety, spectating, and ignorance.
• Get people to approach anxiety situation without provoking anxiety and spectating, it should no longer hinder sexual function.

Question 12

Masters and Johnson Treatment ideology?

Answer 12

Treatment: Symptom focused

• Worked well
• Not well involved in neurology and vascular basis in ageing men.

Question 13

1990-200: Sex versus Marital and Relationship Therapy- Disorders of sexual Desire : HELEN KAPLAN

Answer 13

• Notice that most patients don’t have orgasmic erectile, and pain problems ( they lack DESIRE)

Question 14

1990-2019: Development of Pharmacotherapy

Answer 14

Sildenafil, tadalafil, vardenafil; flibanserin.

Drug therapy: thought that alpha blocker might be related to penile erection.

Question 15

The sexual Response Cycle : Male and Female

Answer 15

Masters and Johnsons: Conceptualize that men are understanding of their diagnosis of sexual dysfunction.
Modern day approach:
- People can have disorders of sexual desire.
- They might have problems with arousal.
- They may also have orgasmic problems.
- May experience coital pain
( All are looked at in both masters and Kaplans work)

Question 16

Hypoactive Sexual Desire Disorder(HSDD) (woman)

Answer 16

Persistent or recurrent deficiency ( or absence) of sexual fantasies and desires for or receptivity to sexual activity. (* Female sexual interest and arousal disorder)
“Hypo” means low - this person has low sexual desire. ( don’t initiate and not receptive)

Question 17

Sexual Dysfunction Vs. Sexual Concern:

Answer 17

• The disturbance must cause marked distress or interpersonal difficulty.
• Must not be better accounted for by effects of a psychiatric disorder, medical disorder, or substance, or marked relationship difficulty.
• Must persist 6 months or more and must occur on all or almost all sexual encounters.

Question 18

Sexual Arousal Disorder (woman)

Answer 18

Absent or reduced sexual arousal, genital sensations, excitement or pleasure during sexual activity.

Question 19

Female Orgasmic Disorder

Answer 19

Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase.

Question 20

Dyspareunia (woman)

Answer 20

Recurrent or persistent genital pain associated with sexual intercourse ( Outlet, deep)

Question 21

Outlet Dyspareunia (woman)

Answer 21

Pain, not lubricated enough, yeast infection.

Question 22

Deep Dyspareunia (woman)

Answer 22

Pain, b/c more underlying tissues.

Question 23

Vaginismus

Answer 23

Recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal penetration with penis, finger, tampon, or speculum is attempted.

Question 24

Vulvodynia

Answer 24

Vulvar and vestibular “burning” or cutting type of pain; may be provoked or unprovoked.
*Genital-pelvic pain/penetration disorder.

Question 25

Prevalence of Sexual Dysfunction: Sexual Problems and Distress in United States Women

Answer 25

- Desire disorder is MOST FREQUENT. - Arousal: Common - Orgasmic: Not common * * All Peak in women during or near menopause and all decline after menopause. - Prevalence increases and distress decreases after menopause.

Question 26

London ON ob-Gyn Waiting Room Series (woman):

Answer 26

47%- sexual desire lower than like 22%- partners being lower than liked. 23% - couples distressed because of sex. **There are no negation training regarding sexual desire and frequency of sexual intercourse.

Question 27

London ON waiting room serious (woman): Arousal and lubrication problems, lack of orgasm, painful intercourse:

Answer 27

- Arousal or lubrication problems: 28% - Lack of orgasm: 35% - Painful intercourse:24%

Question 28

Sexual Dysfunction Problems:

Answer 28

- Almost 80% had one or more of the dysfunction problems . | - Only 16% discussed it with a physician.

Question 29

Diagnosis of Male Sexual Dysfunctions: Hypoactive Sexual Desire Disorder (HSDD)

Answer 29

- Persistent or recurrent deficiency (or absence) sexual fantasies and desire for sexual activity.

Question 30

Sexual Arousal Disorder (male)

Answer 30

Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection.

Question 31

Orgasmic Disorder

Answer 31

- Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. - Persistent or recurrent delay in, or absence of orgasm following a normal sexual excitement phase. (cum too fast or not at all)

Question 32

Dyspareunia

Answer 32

Recurrent or persistent genital pain associated with sexual intercourse (e.e., Pyronies Disease- curvature of the penis - fibrous/painful penile eraction)

Question 33

Prevalence of male sexual dysfunction? HSDD

Answer 33

18-19 : 14% 30-39: 13% 40-49: 15% 50-59: 17%

Question 34

Prevalence of Male Sexual Dysfunction: ED ( trouble achieving or maintaining an erection)

Answer 34

18-19: 7% 30-39: 9% 40-49: 11% 50-59: 18%

Question 35

Prevalence of Male Sexual Dysfunction: Rapid Ejaculation

Answer 35

18-19: 30% 30-39: 32% 40-49: 28% 50-59: 31%

Question 36

Prevalence of Male Sexual Dysfunction: Unable to orgasm

Answer 36

18-19: 7% 30-39: 7% 40-49: 9% 50-59: 9%

Question 37

Often interrelated diagnoses

Answer 37

Desire + arousal - eg., orgasm phase problem could be the case that their primer problem is coital pain or lack of arousal. - Often adaptions to partner's sexual Dysfunction.

Question 38

Lifelong vs. Acquired

Answer 38

- if its always been there, it would be very different in comparison