Task 2 Flashcards

1
Q

sexual problem/ difficulty

A

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

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2
Q

Sexual dysfunction

A

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

19 %woman, 16 %men

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3
Q

The leading problems for women are

A

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

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4
Q

For men

A

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

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5
Q

Sexual disorders can be primary, secondary, or situational.

A
  • 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.

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6
Q

The causes of premature ejaculation are not well understood

A

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

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7
Q

when is what plausible

A

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.

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8
Q

Self-devised remedies:

A

• 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.

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9
Q

therapy treatment

A

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.
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10
Q

Topical anesthetic

A

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.

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11
Q

delayed (or absent) ejaculation

A

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.

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12
Q

Treatment for delayed ejaculation

A

chnaging mans habits=>stopping mastrurbation,

sexual shame=> psychotherapy

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

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13
Q

Erectile disorder (ED)

A

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.

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14
Q

ED causes

A
  • 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

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15
Q

ed treatment

A

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

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16
Q

ED dugs

A

viagra,Levitra, Cials, and Stendra.

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

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17
Q

ED & nitrci oxide

A

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.

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18
Q

viagra in healthy individuals

A

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

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19
Q

vacuum construction system

A

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

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20
Q

penile implant

A

• 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.

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21
Q

hypoactive sexual desire disorder.

A

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

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22
Q

hypoactive sexual desire disorder causes

A

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

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23
Q

hypoactive sexual desire disorder treatment

A

psychotherapy, relationship counseling, or behavioral sex therapy.

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24
Q

dyspareunia In men

A

not listed in dsm 5, not common

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25
Q

In women, the three early processes of physiological arousal

A

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

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

26
Q

treatment of female sexual arousal disorder

A

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

27
Q

causes dyspareunia in women

A
  • 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.
28
Q

vaginusmus

A

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.

29
Q

vaginusmus causes

A

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.

30
Q

anorgasmia

A

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)

31
Q

anorgasmia causes & treatment

A

caused by drugs, especially by antidepressants and antihypertensive drugs. Such cases can usually be treated by adjusting dosage, switching drugs, or adding another drug to counteract the effect.

medical conditions / especially this ebringing neurological damage ( diabetes or multiple sclerosis ) can interfere with orgasm , menopause, anatomy of vulva

the coital alignment technique (CAT),

32
Q

Discrepant sexual desire

A

when the levels of sexual activity desired by two partners are very different.

33
Q

hypersexuality.

A

Excessive sexual desire or behavior spend several hours each day engaged in masturbation, reading or viewing pornography, participating in sex-related online chat rooms, using commercial phone sex services, seeking casual sex partners in bars, cruising the streets for prostitutes, or having anonymous sex with multiple partners in bathhouses or sex clubs.

Hypersexuality may include frequently repeated and seemingly involuntary involvement in masturbation, partnered sex, pornography use, telephone sex, and the like.

  • They often feel that they have lost control of their own behavior.
  • These activities may take over their lives as to destroy their careers and marriages and expose them and their partners to HIV and other sexually transmitted infections.
  • A form of addiction preferred phrase is compulsive sexual behavior.

can follow the use of certain drug, brain injury , dementia (pathological)

psychological => causes of childhood sexual abuse or inculcated shame

SSRIs are the most common used drug for therapy
Such behaviors may be classed as compulsive disorders, and like other such disorders, they often respond well to SSRIs. The use of the term “sex addiction” to describe these conditions is controversial

34
Q

lack of sexu desire in woman is not always a problem

A

undesired for sex increases with age

ESTROGEN OR ANDROGEN TREATMENT MAY IMPROVE SEXUAL DESIRE IN WOMEN

The levels of these hormones drop when levels of body fat are very low as well as after menopause. In these circumstances, sexual desire often declines or disappears

sex therapy might also help

35
Q

adminsiatratin testoretsorn in women with low sexual desire

A

Administration of testosterone (via transdermal patches or implants) has been reported to increase interest in sex in women who are menstruating normally, in women who have low sexual desire as a side effect of treatment with antidepressants, and in women who are menopausal because they have had their ovaries removed.

36
Q

the dam 5

A

comprised major changes in the classification of sexual disorders, particularly for female sexual disorders.
DSM 1& 2 did not even include sexual disorder

37
Q

dsm 4 critique

A
  • An overemphasis on genital response.
  • Inadequate acknowledgement of relationships and partner factors.
  • The lack of any defined severity or duration criteria.
38
Q

dem 5 classification of sexual disorders

A

a group of disorders that are typically characterised by a clinically significant disturbance of a person ability to sexually respond

they must persist for at least 6 months and musst be experienced on 75% -100% of sexual encounters

female arousal disorder and HSDD were deleted
a new disorder came - Femal sexual interest / arousal disorder

39
Q

– Female Sexual Interest/Arousal Disorder (FSIAD)

A

1) Absent/reduced interest in sexual activity.
2) Absent/reduced sexual/erotic thoughts or fantasies.
3) No/reduced initiation of sexual activity and typically unresponsive to a partner’s attempts to initiate.
4) Absent/reduced sexual excitement/pleasure during sexual activity on all or almost all… sexual encounters.
5) Absent/reduced sexual interest in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual).
6) Absent or reduced genital or nongenital sensations during sexual activity on all or almost all… sexual encounters.

The criteria allow for the fact that there is variability in how sexual interest/arousal problems may be expressed. However, others have expressed concern that the new criteria will mean that some women who would have met criteria for DSM-4 diagnosis would no longer do so and would be excluded from treatment

40
Q

Attempts to gain FDA approval for testosterone patches (Intrinsa) and transdermal testosterone gel (Libigel) for menopausal and postmenopausal women with HSDD

A
  • Intrinsa was rejected due to concerns over safety risks outweighing the efficiency  However, the European Medicines Agency approved it as a treatment for HSDD in women with surgically induced menopause.
  • Libigel was not approved because of poor clinical efficacy data.
41
Q

Mindfulness-based therapies (MBT) for treating sexual dysfunctions

A

MTB could be effectively used in the treatment of female sexual dysfunction, specifically to improve sexual arousal/desire and satisfaction and to reduce sexual dysfunction associated with anxiety and negative cognitive schemas
1) Purposeful and conscious directing of attention to the current experience.
2) Inclusion of benevolence, compassion, and acceptance.
=> has a lot in common with sensate focus (focus on your and your partners needs)

Mindfulness techniques proved to be efficient in the improvement of mental condition (among other things, through reduction of anxiety and tension) in the course of other disorders.

42
Q

primary

A

pain has always been there

43
Q

secondar y

A

the pain has developed after a period of time without pain

44
Q

complaint ?

A

A. What is the problem?
B. Primary, secondary (gradually or suddenly)? C. Generalized, situational

Are there circumstances in which a complete sexual respons is
possible?
* Nightly responses
 * Masturbation
* Other partners

Situational: what are the preconditions to have pleasurable and satisfying sex??

45
Q

searching for reasons

A

-Start with open questions “What brought you here?”

Closed questions to make the complaint more concrete

Biological, psychological and social factors
– Family of origin
– Sexual development
– Relationship/relationship-history
– Personality
– Background: work, hobby, religion, life circumstances
– Previous treatment
– Tabacco/drugs/medication
– Observations
46
Q

sexual desire discrepancy

A

SDD: when two partners in an intimate relationship desire different levels or a different frequency of sexual activity (Zilbergeld & Ellison, 1980)

Sexual desire in a relationship -> relative, dyadic concept

SDD as inevitable in LT relationship -> SD fluctuates over time and contexts, normal variation, decline with relationship length (Baumeister & Bratslasvsky, 1999; Sims & Meana, 2010)

SDD does not necessarily cause distress and require treatment

47
Q

SDD what helps ?

A

Psycho-education, giving permission to talk, normalization

Reframe as couple problem

Normal experience in LT-relationships -> ↘ Distress and learn to cope

Develop realistic expectations -> Good Enough Sex Model (Metz & McCarthy, 2007): Desire for and quality of sex may vary from day to day

48
Q

specific devices to break routine & help SDD

A

Communication skills training -> openly talk about sexual wishes. Reduced arousability or specific preferences?

Broaden sexual repertoire. Sex is more than penetration -> ↑ sexual pleasure instead of frequency

Tune, balance, compromise -> wish list or wish box

Sensate focus: sexual touch, communication, sex as mutual
responsibility

Homework assignments: Schedule occasions for intimacy => challenge myth of spontaneous desire. Active search for sexual stimulation

49
Q

hypersexuality ( sex compulsion)

A

Especially men

Trapped in a sexual pattern

Inability to stop, lack of control Despite negative consequences For individual and environment

it is not an addiction
Strong demand on the therapist
=> must help to stop and control the addic=on

Therapist takes the lead, patient is dependen

50
Q

treating hypersexulaity

A

Limit addiction:
• Qualitative porn
• Thoughtful (mindful) masturbation

Self-image: (small) positive acts (non-relational and later relational)
Relationship-therapy: coping with sadness, anger, loss of confidence

51
Q

arousal problems

A

for example erectile disfunction

52
Q

erectile disfunction causes

A

Physical: vascular, neurological, medicines
Physical examination: nightly erections
► viagra, injections, vacuum-pump, prothesis

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

53
Q

premature ejaculation

A

sexual contact hastily, under pressure, fast lifestyle
No control over reflex

focus on own sensations + controlling point-of-no-return

Resolutions
(stop-start, squeeze technique, medication: SSRI/dapoxetine)

54
Q

Deep dyspareunia

& superficial

A

deep pain

< somatic treatment (endometriosis) or switch position

55
Q

dypareunia & vagninusmu

A

Contraction of pelvic floor muscles

56
Q

dyspareunia/ vaginiuzsm etiology

A
Etiology:
– Fear of pain for first sexual contact
– Relational problem
– Physical(bladerinfectioons,fungal infections,episiotomy ,too agressive intimate hygiene)
– Fear of pain(unaroused intercourse)
57
Q

coping with sexual pain

A

Avoidance sexual activity (intimacy)

Persistence: continue with intercourse despite pain Alternative sexual activities (but don’t feel normal)

58
Q

dyspareunia biological teratment

A

Pharmaceutical treatment: anesthetic cream (lidocaïne), corticoseroïdcream, interferon injections and lubricants

Biofeedback-training of the pelvic floor muscles

Lasertherapy or operation: vestibulectomy

59
Q

multimodal Treatment of dyspareunia ( cognitive aspect)

A

Validating that the pain is real

Exploring treatment expectations and setting treatment goals (own need for
help, partner, relationship?)

Clinical interview -> patient and/or couple’s medical, psychosexual and pain history + identify the factors that may contribute to pain and pain-related distress

Clinical examination in which the women can observe via a handheld mirror

Psycho-education about the vicious circle of pain and the relation between
negative thoughts, feelings and pain

60
Q

multimodal treatment (physicall)

A

Pelvic floor therapy & dilators (relaxation)

 Pain stop (stopping with any activity that causes genital pain) to uncouple the
association between sex and pain

Engage in penetrative sex only when being sexually aroused enough because lubrication and relaxed pelvic floor muscles will make penetration more comfortable

Schedule sex to disrupt avoidance of intimacy -> Sensate focus exercises to practice touching and communicating about sex

Expanding their sexual repertoire (+ associations sex and pain; expect pleasure instead of pain)

61
Q

psychological treatment for dyspareunia

A

act & mindfulness

Non-judgemental moment-to-moment awareness -> learning to de-
center thoughts and feelings and focus attention on bodily sensations
– Decouple physical pain from emotional and cognitive experience
– Mindfulness often integrated in CBT protocols

Act - how to live a valued life despite pain

62
Q

treatment for sexual problem

A

Combine biological treatment, with psychotherapy and relationship therapy

Even in case of biological cause -> psychological factors determine coping with the dysfunction, excacerbation and maintenance of the problem

Sexual problem has an influence on and is influenced by the partner => impact on emotion regulation within the couple
(might think of taking the couple in as a therapist , take them in together ir seperate,discuss how to involve the partner

therapist taking innovative to talk about sex might act as permission