Final

Question 1

Three categories of sexual dysfunction:

Answer 1

1. Sexual Dysfunction
2. Sexual Dissatisfaction
3. Sexual Deviation

Question 2

Prevalence of Sexual Dysfunction (based on gender)

Answer 2

Women = 43%

Men = 31 %

Question 3

Prevalence of sexual dysfunction in women

Answer 3

Hypoactive sexual desire disorder = 33.4%

Difficulty with orgasm = 24.1%

Pain during intercourse = 14.4%

Question 4

Causes of low sex drive in women

Answer 4

Vary.

Fatigue/stress from daily responsibilities

Psychological

Certain health conditions or medications (ex. mood stabilizers)

Depression/anxiety

Birth control pills

Question 5

Prevalence of sexual dysfunction in men:

Answer 5

Hypoactive sexual desire disorder = 15.8%

Erectile dysfunction = 34.8% (increases with age)

Premature ejaculation = 30%

Question 6

4 Types of Sexual Dysfunction

Answer 6

1. Disorders of Desire
2. Arousal Dysfunction
3. Orgasm dysfunction
4. Pain

Question 7

Disorders of Desire (male and female)

Answer 7

Hypoactive sexual desire disorder

Sexual aversion disorder

30% women, 15% men

Question 8

Most common psychological causes of disorders of desire:

Answer 8

Depression

Anxiety

Stress

Substance abuse

Fatigue

Question 9

Hypoactive sexual desire disorder

Answer 9

Persistent or recurrent deficiency (or absence) of sexual fantasies/thoughts and/or desire for or receptivity to sexual activity that causes personal distress (not just partner distress).

Lifelong or acquired (lifelong = more difficult to diagnose/treat)

Generalized or situational

Single or multiple etiologies

Question 10

Arousal Dysfunction (by gender)

Answer 10

Male erectile disorder

Female sexual arousal disorder

Question 11

Sexual Arousal Disorder

Answer 11

The persistent or recurrent inability to attain or maintain sufficient sexual excitement, causing personal distress.

May be expressed as a lack of subjective excitement, genital response (lubrication/swelling), or other somatic responses.

Question 12

Orgasm Dysfunction (by gender)

Answer 12

Male orgasmic disorder

Premature ejaculation

Female orgasmic disorder

Question 13

Orgasmic Disorder

Answer 13

The persistent or recurrent difficulty, delay in, or absence of attaining orgasm/ejaculation following sufficient sexual stimulation and arousal, causing personal distress.

Question 14

Pain

(Type of sexual dysfunction)

Answer 14

Dyspareunia

Vaginismus

Question 15

Dyspareunia

Answer 15

Recurrent or persistent genital pain associated with sexual intercourse.

Question 16

Vaginismus

Answer 16

Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration, causing personal distress.

Question 17

All 4 types of sexual dysfunction may be:

Answer 17

Lifelong/acquired

generalized/situational

psychological/combined factors

Question 18

Masters and Johnson (1970)

Answer 18

Crystallized cognitive/behavioral methods to treat sexualized problems.

Revolutionized treatment (like Viagra revolutionized pharmacology) - prior treatment for sexual disorders was long-term, multi-year psychotherapy or psychoanalysis with very low rates of success.

Birth of the field of sex therapy.

Question 19

Treatment created by Masters and Johnson

Answer 19

Devised a rapid (2 week) psychotherapy in couple, rather than individual, context, working with male/female therapist team - >80% success rate.

Strictly talking therapy (did not observe sexual activity).

Provide appropriate sex information, alleviate anxiety about sexual performance, and facilitate verbal/emotional/physical communication.

Still widely used today.

Revolutionary.

Question 20

Female Sexual Response Cycle (Basson)

Answer 20

Non-linear, intimacy-based model.

Female dysfunction (and desire) appears to have many causes and many dimensions, including biological, psychological, and interpersonal determinants that can aid or impede arousal.

Responsive rather than spontaneous (i.e. sexual stimuli). Begins with cognitive decision to engage in sexual activity (ex. listen to music, direct stimulation).

Goal of sexual activity = personal satisfaction, not necessarily orgasm, but can be physical or emotional

Question 21

Esther Perel on female eroticism

Answer 21

Diffuse, not localized in the genitals but distributed throughout the body, mind, and senses.

Tactile and auditory; linked to smell, skin, and contact.

Arousal is often more subjective than physical.

Desire arises on a lattice of emotion.

Question 22

Healthy Sex (Wendy Maltz)

Answer 22

Conscious, positive expression of our sexual energy in ways that enhance self-esteem, physical health, and emotional relationship.

Mutually beneficial and harms no one.

Requires five basic conditions be met: CERTS

Question 23

Sexual Energy (Wendy Maltz)

Answer 23

Powerful, natural force.

Potential to be channeled and experienced in either destructive or life-affirming ways.

Question 24

Healthy Sex CERTS Model (Wendy Maltz)

Answer 24

1. Consent
2. Equality
3. Respect
4. Trust
5. Safety

All five must basic conditions must be met to foster healthy sex.

Question 25

Therapist's Comfort Zone

Answer 25

Create a sex-friendly space free of judgment and moralizing where people can safely talk about their sexuality: Allow client to normalize when therapist conveys she is comfortable dealing with sexual issues. Allow clients to reveal fantasies, concerns - often for the first time Allows for greater creativity in the treatment room. Be aware of countertransferene - aligning with one partner, acknowledging own arousal/discomfort

Question 26

3 Dimensions of Assessment

Answer 26

1. Screening - may be the first screening by a professional 2. Incorporate ongoing practice in matter of fact manner 3. Specific requests for sex therapy = comprehensive sexual assessment

Question 27

Importance of biopsychosocial dimensional components to assessment

Answer 27

Sexual dysfunctions are often highly related to physical and psychosocial dimensions of an individual's life. Preventive treatment measure like sexual/senxual education would be more useful than only reproductive education. Optimal treatments require careful histories and have the ability to impact psychological and physiological sexual response. Sexualy is core human function but personal functioning remains a difficult topic to discuss for patients/physicians/therapists.

Question 28

Screening Assessment

Answer 28

Are you sexually active? Men, women, or both? Are you satisfied with quality and quantity of sexual activity in your life? Is this an area you would like more informaion on or to more fully explore?

Question 29

Assessment: Incorporating in ongoing practice

Answer 29

Contraindicated in presence of severe marital distress - marital therapy to pave the way for future treatment of sexual problem. Quality/quantity of sex and level of satisfaction *Meaning *of sex

Question 30

Comprehensive Sexual Assessment

Answer 30

Medical (thyroid disorder, depression, medications, menopause) Psychosocial (messages from family/media) Psychophysiological (which comes first: pain, dryness, erectile dysfunction, or loss of desire?)

Question 31

Psychosocial Evaluation | (in comprehensive assessment)

Answer 31

Couple and individual sessions (have each state what they think the other wants, Self-report questionnaires - expectations overt/covert (take-home) Clinical interviews (when is last time felt aroused/most desired): Couple - establish possible working relationship Individual - treatment plan with both

Question 32

Common male disorders

Answer 32

Premature/Delayed Ejaculation Erectile Dysfunction Disorders of Desire

Question 33

Common female disorders

Answer 33

Dyspareunia/Vaginismus Orgasmic Disorder Disorders of Desire

Question 34

Treating Premature/Delayed Ejaculation

Answer 34

Relaxation Response SSRI's Mindfulness - Fantasy Relationship Issues Squeeze Technique

Question 35

Squeeze Technique

Answer 35

Ejaculatory control is learned through a stop and go exercise. Stimulation of the penis until the man feels he will ejaculate unless stimulation stops. Stop simulation and the base of the penis is squeezed by the partner encircling it snugly with the thumb and forefinger. Stimulation is resumed when the ejaculatory impulse passes – usually after 10 seconds or more. After several sessions, regular intercourse may be tried without the squeeze technique. \>95% of men have learned to control ejaculation for five minutes or longer using this method. Goal = for the man to become accustomed to the feeling of delayed ejaculation.

Question 36

Treating Erectile Dysfunction

Answer 36

Focus on nonerotic stimuli Encourage positive reinforcement Decrease demands Encourage open, positive communication

Question 37

Treating Dyspareunia/Vaginismus

Answer 37

CRITICAL - Physical Examination Vaginal dilators Relaxation training Greater success with partner involvement

Question 38

Treating Orgasmic Disorder

Answer 38

Relaxation (sensate focus) Mindfulness of sensual pleasure Appropriate use of erotica/fantasy Masturbation Increase positive self-image Pelvic floor exercises

Question 39

Treating Disorders of Desire (Men & Women)

Answer 39

Education Sensate Focus - sensual awareness Appropriate exposure to erotica/sexual aids Explore relationship to sex/erotic mind Hormonal (estrogen/testosterone) screening (female issues not as related to plumbing)

Question 40

Sensate Focus: Stage I

Answer 40

Weeks 4-6 First few weeks couples take turns non-genital touching to establish awareness of sensations. Person touching does so on basis of what interests them or person being touched can "guide"

Question 41

Sensate Focus: Stage II

Answer 41

Weeks 7-9 (longer as needed) Expanded to breasts and genitals. Emphasis on physical sensations, not sexual response - no intercourse Take turns "hand riding" as a means of nonverbal communication

Question 42

Sensate Focus: Stage III - IV

Answer 42

Weeks 10+ Mutual touching Female on top w/out insertion Progress to tip of penis, moving back if anxious Full intercourse

Question 43

Sensate Focus: Assessment

Answer 43

Weeks 1-3

Question 44

Current Trends in Sex Therapy

Answer 44

1. Medicalization of sexual dysfunction 2. Esther Perel's notion of erotic intelligence 3. Jack Morin's peak erotic experiences and core erotic themes 4. Mind/Body Approaches (6th sense = interoception, pleasure-centered somatic tx; Dan Siegel's Mindsight = 7th sense)

Question 45

Medicalization of sexual dysfunction

Answer 45

Current trend. Aim to change person's physiological response. Historic focus on male erectile disorder, more recently on premature ejaculation in men and sexual arousal/desire in women

Question 46

Medically speaking, sexual issues fall into three general categories:

Answer 46

1. Nerve suppy 2. Blood flow 3. Hormones

Question 47

Esther Perel's notion of erotic intelligence

Answer 47

Meaning of sex: What does sex mean to you? How is sex treated in your family? What are the important events that shaped your sexuality? What would you like to experience most with your partner sexually, and what are you most afraid of?

Question 48

Jack Morin's Erotic Equation

Answer 48

Current Trend Attraction + Obstacles = Excitement (flames of passion) Unpredictability, spontaneity, and risk are where eroticism resides.

Question 49

Privacy vs. Secrecy

Answer 49

Emotional connection can dampen desire when closeness becomes an obligation. Threat to separateness = basis of all attractions Need connection without terror of obliteration. Need separateness without terror of abandonment.

Question 50

Sex as source of shame vs. self--affirmation

Answer 50

When our innermost desires are revealed and are met by our loved one with acceptance and validation, the shame dissolves, and it becomes an experience of profound empowerment and self-affirmation.

Question 51

Most feared challenge of erotic/sexual intimacy (+shield):

Answer 51

May be most fearsome intimacy because it is all-encompassing. Reaches the deepest places inside of us and involves disclosing aspects of ourselves that are invariably bound up with shame and guilt. When we express our yearnings, we risk humiliation and rejection. Shield: many prefer workable, utilitarian type sex (that often leaves them feeling bored or dead inside)

Question 52

Encouraging Change

Answer 52

Clarify goals and motivations Nurture self-worth Embrace uncertainty Acknowledge and mourn your losses Practice mindfulness using your senses Risk the unfamiliar Integrate your discoveries

Question 53

Mind/Body Approaches = The sensuality solution

Answer 53

Gestalt therapy - focus on experience over performance, what is happening now Growth model = treatment + enrichment Mind and body as two-way street

Question 54

Important issues that influence women's sexual well-being:

Answer 54

Self-image Relationships Psychological health Social connectedness Cultural expectations (All intertwined) Physiology plays into it for a very small percentage

Question 55

Jack Morin's peak erotic experiences

Answer 55

Current Trend As fulfilling as they are arousing. Factors: 1. Firsts (new activities, settings, partners) and surprises 2. Idyllic settings/features 3. Extensions and restrictions of time 4. Knowledge of memorability factors that contribute to one’s arousal can help cultivate conditions for more fulfilling sex.

Question 56

5 Personal Responses most mentioned for Peak Experiences (Morin)

Answer 56

1. Sensual and orgasmic intensity 2. Reduced inhibitions 3. Validation given and received 4. Mutuality and resonance (synchronicity) 5. Transcendence of personal boundaries

Question 57

Investigate peak turn-ons to understand core erotic themes (Morin)

Answer 57

Current Trend 1. Most memorable real-life encounters – two specific that were the most intensely arousing in your entire life? Describe them in as much detail as possible. 2. Ideas about what made these encounters so exciting?