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sexual problem/ difficulty

One does not experience sexually what one could or would like to experience


Sexual dysfunction

When the sexual response is missing or diminished and when this goes along with sexual distress

19 %woman, 16 %men


The leading problems for women are

lack of interest in sex, an inability to experience orgasm, problems with psychological arousal (especially vaginal lubrication), and pain during sex.


For men

climaxing too early (premature ejaculation) is the leading problem, followed by anxiety about performance and a lack of interest in sex.


Sexual disorders can be primary, secondary, or situational.

• A primary disorder is lifelong.
• A secondary disorder is one that appears after some period of normal function.
• A situational disorder is one that appears in some circumstances but not others.

• For example, for situational disorder  premature ejaculation might occur during partnered sex but not during masturbation.


The causes of premature ejaculation are not well understood

learning or a dysfunction in certain receptors for the neurotransmitter serotonin.


when is what plausible

Psychological theories  most plausible in cases where premature ejaculation is situational.

Biological theories  may account better for lifelong premature ejaculation that affects a man in all circumstances.


Self-devised remedies:

• Masturbating to orgasm prior to partnered sex.
• Distracting himself during sex with irrelevant thoughts (such as doing mental arithmetic or imagining having sex with a person he’s not attracted to).
• Trying to bring his partner as close to orgasm as possible prior to coitus.
 Such remedies rarely work and they often prevent the man or his partner from having a rewarded sexual experience.


therapy treatment

stop start method
SSrIS (prozac, Paxil, Zoloft)=> Paroxetine(Paxil)

• It is taken as needed 1 to 2 hours before a sexual encounter.
• Several studies have found it to be efficacious and safe, though it does have a range of potential side effects.


Topical anesthetic

in the form of cream applied to the penis) can also be used to reduce sensitivity. This method is moderately effective in slowing ejaculation, but unless a condom is used, the anesthetic may also numb the woman’s vulva and vagina, impeding her ability to reach orgasm.


delayed (or absent) ejaculation

difficulty achieving or inability to achieve orgasm or ejaculation (male orgsamic disorder)
=> common estimates 3% to 8% of male population
As with premature ejaculation, delayed ejaculation can be a lifelong problem or it may be acquired at some point in adult life.
masturbation using a tight grip and vigorous strokes, or who masturbate by rubbing their penis against bedding or rough surfaces.

o This can leave men insensitive to the gentler stimulation that is likely to be experienced during coitus. o This interpretation is contested by others who argue that these men masturbate often and vigorously because they have such difficulty experiencing orgasm any other way.
• Alternatively, too much viewing of pornography could be the cause,
Delayed ejaculation can also follow some traumatic life event, such as a relationship crisis. Or perhaps the man’s thought processes during sex are so distracting or negative that they interfere with sexual arousal.


Treatment for delayed ejaculation

chnaging mans habits=>stopping mastrurbation,

sexual shame=> psychotherapy

biological causes, neurobiological damage, certain drugs( antidepressants)=> switching drug or adding a second drug


Erectile disorder (ED)

a recurrent inability to achieve an adequate penile erection or to maintain it through the course of the desired sexual behavior – if such inability causes distress to the man or difficulty between the man and his partner.

The condition may be partial or complete, and it may be a primary, secondary, or situational disorder.
Although ED can certainly occur in young men, it becomes much more common as men age  It affects about one-half of all men over the age of 60 and the majority of men who are 70 or older.


ED causes

• Behavioral/lifestyle factors (smoking, obesity)
• Medical conditions (diabetes)
• Drugs (antidepressants, recreational drugs)
• Injuries (spinal cord)
• Psychological factors(performance anxiety, depression, stress, relationship problems)
• Developmental issues (childhood trauma, religious taboos)

often its an interplay of physical and psychologic factors wich rein force each other

Psychological: relational, anxiety and inhibitions
Performance anxiety
Focus on the pleasure of the partner


ed treatment

lifestyle changes, switching drugs, cock ring , sex therapy, sensate-focus exercise
cognitive therapy=> overcome, misconceptions, reduces performance anxiety, resolving relationship issues

► viagra, injections, vacuum-pump, prothesis


ED dugs

viagra,Levitra, Cials, and Stendra.

highness responsiveness to nitric oxide=> the neurotransmitter responsible for penile erection , cannot respond if there is no nitric oxide


ED & nitrci oxide

What this means is that simply swallowing a Viagra tablet does not produce an erection – there has to be sexual excitation as well. And if the nerves are not active – if they have been destroyed in the course of prostate surgery, for example – then Viagra is unlikely to work, no matter how sexually excited the man may feel.


viagra in healthy individuals

In a study it was found that the drug was no different from the placebo in terms of the quality of the men’s erections or orgasms, but the men who took Viagra did experience a shorter refractory period after ejaculation before they could develop an erection again


vacuum construction system

a device that creates a partial vacuum , drawing blood to the erectile tissue


penile implant

• One kind s a semirigid plastic rod that keeps the penis permanently stiff enough for coitus.
o Relatively easy to insert but permanent erection may be difficult to conceal and therefore embarrassing in some circumstances.

• Another implant is hydraulic. It is filled from a reservoir that is implanted under the groin muscles. Pump and valves that control the filling and emptying are placed in the scrotum and can be accessed manually through the skin.
o It costs more and more prone to malfunction and the erect penis is usually not as long as it was originally. However, it is more discreet and produces a more natural-seeming erection.


hypoactive sexual desire disorder.

low or absent interest in sex , when the condition causes distress


hypoactive sexual desire disorder causes

asexuality, hormonal factors, a lack of attraction to partner , illness, disability, depression , or sex-negative attitudes


hypoactive sexual desire disorder treatment

psychotherapy, relationship counseling, or behavioral sex therapy.


dyspareunia In men

not listed in dsm 5, not common


In women, the three early processes of physiological arousal

vaginal lubrication, engagement of the vaginal walls, and clitoral erection.

These processes are often accompanied by psychological arousal – the feeling of sexual excitement.


treatment of female sexual arousal disorder

insufficient lubrication ( often after menopause)=> hormone treatment or over the counter lubrication

lack of clitoral erection( may be caused by disease that compromise blood vessels supplying genitals=> small pump (eros clitoral therapy device)= increases blood flow in clitoris and nearby structures

psychotherapy and sex therapy


causes dyspareunia in women

• Developmental malformations, intersexed conditions, or a persistent unbroken hymen.
• Scars from vaginal tearing during labor or from episiotomy, hysterectomy, sexual assault, or female circumcision.
• Vaginal atrophy (a thinning of the vaginal walls that occurs with aging).
• Acute or chronic infections or inflammation of the vagina, internal reproductive tract, or urinary tract, including several STIs and pelvic inflammatory disease.
• Vulvodynia – a poorly understood condition in which pain is experienced when the vulva is even lightly touched.
• Endometriosis.
• Allergic reactions to foreign substances, such as latex, spermicides, or soap.
• Insufficient genital arousal, especially insufficient vaginal lubrication.
• Vaginismus.



Some women have no obvious vaginal abnormalities, and yet they cannot experience coitus  Penetration of the vagina by the penis, or by any other object, is impossible on account of some combination of anxiety, pain, and pelvic muscle spasm

The usual explanation for why penetration is impossible in vaginismus is that the nearby muscles – either those of the vaginal walls or the entire musculature of the pelvic floor – go into a spasm, so the outer third of the vagina is tightly closed.


vaginusmus causes

Mental anticipation of pain is thought to be the main reason for the spasm, as if the body were conditioned to protect against penetration.
sex-negative attitudes, or early traumatic experience

a mix of psychotherapy and sex therapy are the currently favored options for treatment of vaginismus.



Some women experience considerable distress in their sex lives on account of a persistent difficulty in reaching orgasm ( rates low because many do not see it as distressful)