Theories and treatment of sexual dysfuctions

1. Theories and
Treatment of
Sexual
Dysfunctions

2.  Biopsychosocial perspective
 A comprehensive assessment-
1. A physical exam
2. Psychological testing
including client’s partner, if appropriate.
 must assess use of substances- not only drugs
and alcohol, but also all medications, including
psycho-therapeutic ones.

3. BIOLOGICAL PERSPECTIVE
 Erectile disorder- strong biological component.
 In 1970s, Masters and Johnson – virtually all men
(95 percent) with erectile disorder(ED) had
psychological problems-
 Anxiety
 Job stress
 Boredom with long term sexual partners
 Other relationship difficulties
 new and more sophisticated assessment
devices sensitive to the presence of
physiological abnormalities.

4.  Health care professionals- more than half the
cases of erectile disorder attributable to-
 Physical problems of vascular ,neurological, or
hormonal nature.
 Impaired functioning caused by drugs, alcohol
, and smoking.

5. MEDICATIONS
 prescription drugs Vigra, Levitra and Cialis.
phosphodiesterase(PDE) inhibitors.
 increasing blood flow to penis during sexual
stimulation.
 Reasons for these medications being appealing-
1. Much less invasive
2. Much less awkward
 work when accompanied by the experience of sexual
excitement

6.  The hormonal changes takes place with the climacteric , the
gradual loss of reproductive potential occurs in men and women
.
 Changing estrogen levels can lead to number of physical
symptoms that affect sexuality, including vaginal dryness and
gradual shrinking of vaginal size and muscle tone.
 Women also experience a decline in free testosterone , but it is
not clear whether this decline is related to changes in sexual
desire and satisfaction
 Variety of chronic diseases also interfere with a women's sexual
desire and response
 - including diabetes , spinal cord injury , multiple sclerosis ,
hypothyroidism and the aftermath of cancer surgery involving
the uterus.
 Medications that act on the serotonin and dopamine systems
also interfere with sexual responsiveness in women.

7.  Treatment of female sexual interest / arousal disorder
 It involves hormonal replacement therapy , estrogen
cream applied directly to the vagina , and testosterone
therapy .
 Doctors may also give women a PDF inhibitor , but it
efficacy remains undemonstrated

8. Genito - pelvic pain / penetration disorder presents a
different set of challenges.
The physical symptoms can come from a variety of
sources , including disturbances in the muscle fibers in the
pelvic area .
The best approach to this disorder is to be multifaceted ,
 Including application of corticosteroids and physical
therapy to promote muscle relaxation and improved
blood circulation . clinicians also use electrical nerve
stimulation to relive the individual's pain .
 Prescribe pharmacological agents such as Amitriptylene
and Pregabalin .

9. PSYCHOLOGICAL PERSPECTIVES
 Associations between sexual stimuli and
pleasurable feelings also pay an important role .
 In case of erectile disorder , man's belief in the "
macho myth " of sexual infallibility.
 Their belief in this myth makes them prone to
developing dysfunctional thoughts

10.  Both men and women- negative “sexual self-schemas” such
as feeling unloved, inadequate, and unworthy- transfer onto
sexual situations- causing anxiousness when they feel that
their inability to achieve an orgasm- cause the partner to
become tired.
 Underlying feature of men and women with sexual
dysfunction- incompetence in sexual situations

12.  The quality of the relationship- contributes to sexual
dysfunction- particularly for women- whose sexual desires
is sensitive to interpersonal factors, including the
frequency for positive interactions.
 Researchers are also discovering the cognitive factors
involved in genito-pelvic pain/penetration disorder that
compound the physical causes and having low levels of
self-efficacy.

13.  The core treatment- involving disturbances of arousal and
orgasm- follow the principle of Masters and Johnson
(1970).
 That is- Treating both partners in a couple, reducing the
anxiety about sexual performance, and the development of
specific skills such as sensate focus.
 sensate focus- method of treating sexual dysfunction in
which the interaction is not intended to lead the orgasm, but
to experience pleasurable sensations during the phases
prior to orgasm.

14.  This procedure reduces couple’s anxiety levels until
eventually they are able to focus not on their feelings of
inadequacy but instead on the sexual encounter itself.
 Clinicians may also teach the partners to masturbate or to
incorporate methods or sexual stimulations other than
intercourse, such as clitoral stimulation alone.

15.  Therapists are increasingly using principles derived from
cognitive- behavioral therapy that restructure the
individual’s thoughts that can inhibit sexual arousal and
desire.
 Both partners may also promote their interpersonal
communication and have more positive intimate
experiences.
 For sexual pain disorders, cognitive- behavioral therapy
doesn’t seem to be effective, but is most beneficial when
integrated with muscle relaxation, biofeedback and
education.