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SEXUAL DYSFUNCTION: WHAT YOU NEED TO KNOW - KwikMed.com This Report is intended to be a basic introduction into the types
of Female and Male Sexual Dysfunctions and their Therapies. This
report is in no means a substitute for proper counseling and guidance
by a licensed specialist in Sexual Dysfunction. If you have a Sexual
Disorder of any type we recommend that you contact your doctor and TYPES OF SEXUAL DYSFUNCTIONS Female: Male: Male & Female: Dysfunctions are classified by the time period of when and how they occur. It is important to try to define the classification of the dysfunction as closely as possible for better treatment of the problem. The classifications most commonly used are as follows: Life Long - the dysfunction has always been present Acquired - at some point the person was able to function without the dysfunction Situational - the dysfunction occurs in some situations and not others Generalized - the dysfunction occurs regardless of the situation
FEMALE DYSFUNCTIONS: Female Sexual Arousal Disorder (FSAD) is the inhibition of the
general arousal aspect of sexual response. The woman with FSAD does
not lubricate, her vagina does not expand, and there is no formation
of the orgasmic platform. She also typically does not feel erotic Like all the dysfunctions, FSAD may be life long or acquired. Life
long means that the woman has never been responsive to sexual stimulation.
Acquired means that at some point the women has been responsive
to sexual stimulation but is now unresponsive. But it can Some of the most common causes of this dysfunction are guilt and
hostility. Guilt usually involves an internal conflict between a
desire to enjoy sexual interaction and an unconscious fear of doing
so. Hostility often involves her specific partner. Helpful Products: _______________________________________________________________________ EXAMPLE: _______________________________________________________________________ Female Orgasmic Disorder is the impairment of the orgasmic component
of the female sexual response. It is important that this be separated
from FSAD. With Female Orgasmic Disorder, the woman may be very
sexually aroused but never reach orgasm. One women described it
as," it is like I build to a plateau and get stuck. I never
go further." Female Orgasmic Disorder can be either life long
or acquired, situational or generalized. Life long Female Orgasmic
Disorder (sometimes called anorgasmic or preorgasmic) is when the
woman has One extreme are the women who have never climaxed at all. Next
are women who require intense clitoral stimulation when they are
alone and not "disturbed" by a partner. Women who need
direct clitoral stimulation but are able to climax with their partners
fall into the It is important to recognize normal individual variation when attempting to label this particular dysfunction. One of the most common causes of Female Orgasmic Disorder is the sex-equals- intercourse model of thinking. This model sets intercourse and orgasm as the goal for sexual interaction. Having intercourse and orgasm as a goal leads to pressure which often prevents orgasm from occurring.(1) Also, hostility towards her partner can lead a woman to Female Orgasmic Disorder. If a woman is angry at her partner she may "withhold" her orgasm in an attempt to get back at him/her. Another cause of Female Orgasmic Disorder is ineffective sexual techniques. Sometimes the woman and/or her partner simply do not stimulate her effectively. Making love is not something we just "know," it is something we have to learn. Occasionally people simply do not know how to give or receive effective stimulation. Anxiety can also lead to ineffectual sexual techniques. Familial and/or religious teachings regarding sexuality sometimes cause the woman to avoid or actively discourage effective sexual stimulation. Helpful Products: Kama Crème(r) and (2) Crème(r) www.TerraceSpa.com or www.kwikmed.com Vaginismus. Vaginismus is an involuntary spasm of the vaginal entrance making intercourse impossible. This is generally thought to be a fairly rare dysfunction. However, an expanded definition of vaginismus includes difficult or uncomfortable penetration due to involuntary vaginal contractions. The cause of vaginismus is often a result of an aversive stimulus associated with penetration. Some of the more common aversive stimuli are traumatic sexual assaults, painful intercourse, and traumatic pelvic exam. Other causes can be pelvic disease and unconscious fear and/or guilt. MALE DYSFUNCTIONS: Erectile Dysfunction. Erectile dysfunction (ED) is the impairment
of the erectile reflex. The man is unable to have or maintain an
erection. Like other dysfunctions, erectile dysfunction can be either
life long or acquired, situational or generalized. Life long erectile
dysfunction is when a man has never had an erection. Acquired is
when a man has in the past had an erection but no longer is able
to have or maintain an erection either in certain situations or
at all. As a ED is more likely than the other dysfunctions to have a physical cause. Drugs (especially alcohol), diabetes, Parkinson's disease, multiple sclerosis, and spinal cord lesions can all be causes of erectile dysfunction. Erectile Dysfunction is one of the few sexual dysfunctions where
actual drug therapy can help. Viagra(r) therapy can help tremendously
with ED. There is great research and development by the major pharmaceutical
companies in this area. Already released in Europe and soon in the
United States similar medications to Viagra(r) are Uprima(r) by
Abbott(r) , Cialis(r) by Lilly(r) and Vardenafil(r) by Bayer(r).
These new drugs will continue to help treat ED with different variations
of medications that will allow current Viagra(r) Helpful Products: Viagra, (soon to be released) Uprima(r) , Cialis(r) and Vardenafil(r) are all prescription medications. Herbal Products include Colossal. www.TerraceSpa.com or www.kwikmed.com ______________________________________________________________________ EXAMPLE: ______________________________________________________________________ It is certainly not uncommon for a man, after a few drinks of alcohol,
to experience erectile dysfunction. However, approximately 85% of
the cases of erectile dysfunction are psychogenic2. Anxiety seems
to be the most likely psychological cause of erectile dysfunction;
"the autonomic vascular reflexes which govern erection are
delicate and ______________________________________________________________________ EXAMPLE: _______________________________________________________________________ Another very common situation that occurs is for a man who has
had a few drinks of alcohol (which depresses the central nervous
system) to find it difficult to maintain an erection. The man in
this situation gets very concerned that next time he attempts to
be sexual he will "Impotence" Male Orgasmic Disorder. Male Orgasmic Disorder is an involuntary
inhibition of the male orgasmic reflex. As with the other dysfunctions,
the man can experience either life long or acquired, situational
or generalized Male Orgasmic Disorder. What constitutes a life long
dysfunction is controversial. One description is, never having been
able to ejaculate during a sexual involvement. (either heterosexually
or homosexually). Other sources have a similar Another type of Male Orgasmic Disorder is a milder form of Ejaculatory
Retardation (or Ejaculatory Incompetence) is relatively common and
has as excellent prognosis with sex therapy. In moderate forms of
this disorder the man can only ejaculate on masturbation when he
is alone. Men suffering from milder retardation can climax in the
presence of Acquired Male Orgasmic Disorder as a man with a history of normal ejaculatory functioning who now has an inhibition of his ejaculatory reflex. In its life long form, Male Orgasmic Disorder is fairly rare. In its acquired form this dysfunction is not uncommon. In fact the man who can withhold or "last-all-night" is envied. The myth is that he will be able to satisfy all women and thereby be sought after by these women. The man who is considerate of his partner is in reality more likely to experience mutual satisfaction than is the man who simply pounds away at his partner for an extended period of time. The cause of this dysfunction is rarely physical although it is sometimes confused with retrograde ejaculation. Retrograde ejaculation is when the man ejaculates into his bladder instead of out the urethra. More often than not, the cause is a traumatic sexual experience, strict religious upbringing, hostility, over control, or lack of trust. ________________________________________________________________________ EXAMPLE: ________________________________________________________________________ Premature Ejaculation. Exactly what constitutes premature ejaculation is unclear. "a man is considered to ejaculate prematurely if his partner wasn't orgasmic in at least 50 percent of their coital episodes(6)." Premature ejaculation occurred if the male did not have voluntary control over when he ejaculated(7) or "Persistent or recurrent ejaculation with minimal sexual stimulation or before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and frequency of sexual activity(8)." One of the best definitions of premature ejaculation is when a man is unable to exert reasonable voluntary control of his ejaculatory response and is unaware of erotic sensations leading to the point of inevitability. Although there is rarely a physical cause, occasionally there exists unusual nerve sensitivity around the opening of the penile glands and frenulum, which can lead to premature ejaculation. Some infections of the urethra and prostate, neglected gonorrhea and an overly tight uncircumcised foreskin have also been seen as possible causes of premature ejaculation. More commonly the man has not learned to pay attention to the sensory feedback that signals ejaculation. He has essentially taught himself to not pay attention to erotic sensation. Often men, in an effort to prolong the duration of intercourse, will distract themselves during sexual interaction. Some men think of mathematics or sports during intercourse. They believed that if they thought about what was happening he would not "last." This is the exact opposite of what needs to occur. Another possible cause is conditioning. Men often train themselves to ejaculate as soon as possible for fear of being discovered. One man spoke of his adolescent masturbatory practices as follows: _________________________________________________________________________ EXAMPLE: _________________________________________________________________________ The man in the above story had taught himself to ejaculate quickly. This learning did not go away simply because he no longer worried about getting caught. He had conditioned himself to not pay attention to his sensory feedback while learning how to ejaculate as soon as possible. DYSFUNCTION OF EITHER MALE OR FEMALE: Inhibited Sexual Desire (ISD). Although this is, strictly speaking, not a sexual dysfunction, it is a disorder that can severely disrupt the sexual relationship of a couple. ISD is the persistent and pervasive inhibition of sexual desire or “a lack of sexual appetite”(9). ISD is present if there is both a low rate of sexual activity and
a subjective lack of desire for sexual activity; desire here includes
sexual dreams and fantasies, attention to erotic material, awareness
of wishes for sexual activity, noticing attractive potential partners, Hypoactive Sexual Desire Disorder is the persistent lack of sexual
fantasies and desire for sexual activity. The clinician, taking
into account factors that affect sexual functioning, such as age,
sex, and the context of the person’s life, makes the judgment
of deficiency or The problem with the above description is the lack of a relationship context. To deal with this the added Sexual Aversion Disorder," a persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner.(11)” Both physical and psychological factors contribute to ISD. Physical causes include: hormone deficiencies; depression; stress; alcoholism; kidney failure; and chronic illness. Psychological causes include: relationship problems, e.g. power struggles, conflict, hostility; sexual trauma, e.g. rape; major life changes, death of a family member, childbirth, geographic relocation; and associating negative memories with sexual interaction. People who are angry, fearful, or distracted are usually not desirous of sexual intimacy. ______________________________________________________________________ EXAMPLE: His story - We simply don't make love anymore. She seems to never be interested. I guess she's just not interested in me. I don't know what to do. She says she finds me attractive but when I suggest we `go to bed' she finds some reason not to. Her story - I don't know. I just am not interested anymore. There is always something else that needs to be done. When I finally get to bed I want to sleep. ______________________________________________________________________ Two major changes had occurred in their lives in the last three years. First, they had a child and second he had gained about 80 pounds since their child was born. Not only did she find him unattractive, but she also believed that mothers were not to be sexual. The result was that she shut off her sexual desire so as to not have to deal with either. RELATIONSHIP BETWEEN MALE AND FEMALE DYSFUNCTIONS: Erectile Dysfunction / Female Sexual Arousal Disorder: Both are conditions, which are caused by inhibition of the vasocongestive phase of the sexual response. For both there is a failure to respond to erotic stimulation. The man does not achieve an erection and the female does not lubricate. For both it is possible to experience either dysfunction without affecting the orgasmic response. Male Orgasmic Disorder / Female Orgasmic Disorder: In both there is a specific inhibition of the orgasmic phase of the sexual response. It is also possible to experience either dysfunction without affecting the arousal phase of sexual response. Premature Ejaculation / Premature Ejaculation has no female counterpart. Vaginismus / Vaginismus has no male counterpart Now What? I have a problem and I need help. Below are some basics on how sex therapy can work. Sex Therapists have their own technique in treating Sexual Dysfunction. It is important to discuss these issues with your Doctor and have them recommend a licensed Sex Therapist for treatment. It will make your sexual life much fuller and rewarding. SEX THERAPY: THE BASICS In general sex therapy is a combination of psychotherapy and prescribed
sexual/sensual experiences designed to teach a couple sexual functioning
under conditions not likely to induce anxiety or performance fears.
The assumption is that if a couple experiencing a Under no circumstances should sex therapy begin before all possible physical causes are ruled out. Although in most cases of physical causation there exists a psychological component, the physical cause must be addressed before sex therapy can begin. Although the approaches are different, they are also similar. All place importance on creating a treatment plan that is specific to the couple and the dysfunction. All the approaches believe that sex therapy needs to be flexible enough to adjust to information brought up by the therapy itself. It is not uncommon for a couple to acknowledge old issues they have been denying for years. Often sex therapy needs to be postponed until the issue that is acknowledged takes the focus. ________________________________________________________________________ EXAMPLE: ________________________________________________________________________ SENSATE FOCUS Most, if not all, sex therapy employs a version of sensate focus. To begin sex therapy, couples are told that there are two major restrictions: intercourse, and orgasm. Sensual Focus I. The couple touches and explores their partner's body minus the genitals and breasts. The focus of this exercise is for the one touching to learn about his/her partner's body. They are not to guess what their partner wants, they are to do the touching on the basis of what interests them. The one being touched is to be silent, expressing only that which is uncomfortable. Sensual Focus II. This is a change in focus, with the one touching
doing so for his/her partner's pleasure. The genitals and breasts
are still avoided. The emphasis is on communication of what is pleasurable.
Often the "hand-riding" technique is employed at this Sensual Focus III. This includes the genitals and breasts. The couple is instructed to include the genitals and breasts but not to the exclusion of the rest of their partners body. In fact they should not spend more time in any single area. Even though the genitals are included at this point, the partners are reminded that orgasm and intercourse are still off limits. Sensual Focus IV. This includes mutual touching. At this stage the couple, instead of taking turns touching each other, begin mutual touching. This not only increases the sensual pleasure, but it also brings the "exercises" closer to a more natural interaction. From this point on the exercises vary depending on the treatment plan for the particular couple undergoing sex therapy. This is where the most variation among the approaches begins. Not only is there variation between the approaches, but also between therapists employing the same approach. SEXUAL THERAPY FOR SPECIFIC DISORDERS: EXAMPLES Female Sexual Arousal Disorder: The treatment strategy is to provide
a situation where there is no pressure or anxiety. The woman must
allow herself to experience sensations she has suppressed for usually
a long time. After Sensate Focus I-IV, the couple is assigned non-demand
coitus. The couple is instructed to include intercourse in their
regular exercises, if and only if, it seems right at the time. Intercourse
is not the goal. If either perceives intercourse has become the
goal they are instructed to stop and continue Sensate Focus Once they have included intercourse into their regular exercises,
they are told that orgasm is now all right as long as it does not
become a goal. In other words, if orgasm happens, fine, but if it
does not, that is fine too. If either begins to feel that they are
striving for Female Orgasmic Disorder. The treatment strategy is to provide
an environment where the woman can experience maximum stimulation
with minimum inhibition. The woman is instructed to find a time
when she can be alone and is unlikely to be disrupted. She will
explore her body and masturbate to orgasm. She should not force
orgasm but she should not fight it either. Sometimes people need
help resolving guilt and shame regarding masturbation. Once she
is able to experience an orgasm with masturbation, her partner is
instructed, as part of their normal exercises, to concentrate on
her clitoris. She will need to Although this exercise is provided to enable a woman to experience orgasm with intercourse, orgasm should never become a goal of sexual interaction. It places undue pressure on both partners. Also it should not be assumed from this exercise that experiencing an orgasm through intercourse is better in any way than experiencing an orgasm by other means. Vaginismus. The treatment strategy for vaginismus consists of extinguishing the conditioned vaginal spasms. Typically after Sensate Focus III, the woman begins attempted insertion of her finger while alone. Although there are several reactions to this exercise, one typical reaction is that she has no trouble inserting her finger. Another common reaction is that it is not possible for her insert her finger. Although the treatment for the two reactions is different, we still may be dealing with a phobia of intercourse and or penetration. In the first case, the phobia may only occur during penile penetration, whereas in the second case the phobia occurs with any penetration. This fear will need to be addressed prior to initiation of the deconditioning exercises. The deconditioning exercises consist of insertion of progressively larger objects. Typically these exercises begin with the woman alone to avoid pressure. Once she is comfortable with insertion, her partner is brought into the process. Usually he/she begins by inserting one finger during their normal sensate exercises. When she is comfortable he/she will insert two fingers. The first penile penetration should be done cautiously. The man should lubricate his penis and she should guide him. He should not thrust. He should remain within her vagina for a short time then withdraw. After this initial insertion, slow thrusting can be included. Communication is essential. If at any time the woman begins to experience fear, the couple should stop and he should withdraw. Male Erectile Disorder. The basic treatment strategy for male erectile disorder is to provide the man with a non-pressured, highly stimulating interaction. In most cases following the sensate focus exercises previously outlined will re-establish the erectile response. Occasionally the man and/or couple are so anxious about regaining a lost erection that they will need to experience his being able to regain an erection. This can be facilitated by the "squeeze" technique. In this technique the tip of the penis is squeezed. The result is a partial loss of erection, which is usually regained with gentle stimulation. After the couple has gone through Sensate Focus I-IV, they will include intercourse but maintain the orgasm restriction. Intercourse is included as a natural part of their regular exercises. Next the orgasm restriction is lifted. It is important they not put orgasm as the goal. If orgasm happens as a natural part of their interaction, great, if not that is great too. Couples need to learn that sexual interaction without intercourse and/or orgasm can be stimulating, fun, and satisfying. Male Orgasmic Disorder. The treatment strategy for male orgasmic disorder is to desensitize the inhibitory factors to his ejaculatory reflex. The most common is the situational retarded ejaculator, a man who ejaculates under certain situations. The treatment focuses on these situations, which are typically masturbation while alone. Next the man would masturbate to ejaculation in the presence of his partner. Having his partner stimulate him to ejaculation would follow this. Once the man feels comfortable with this, his partner would stimulate him to ejaculatory inevitability and then quickly insert his penis into her vagina. If the couple were a gay couple that chooses to include anal intercourse in their lovemaking, the same procedure could be employed. Premature Ejaculation. The treatment strategy for premature ejaculation is to provide the man with non-pressured stimulation, which focuses on his perception of the accompanying sensation. As the couple begins to work through Sensate Focus III, He will be taught the "squeeze" technique. “The woman puts her thumb on the frenulum of the penis and places her first and second fingers just above and below the coronal ridge on the opposite side of the penis. A firm, grasping pressure is applied for about four seconds and then abruptly released”(12). The man will be instructed to find a time when he is not likely to be disturbed. He will masturbate, paying attention to the sensations he is experiencing. Before reaching ejaculatory inevitability he is to stop stimulation and employ the squeeze technique. After about four seconds, or when the sense of ejaculation diminishes, he again begins to masturbate. He should repeat this four times before allowing ejaculation. Once he feels comfortable with his control, his partner is taught the procedure and follows the same process. Typically his partner will include the use of oil or cream in this exercise before attempting intercourse. The same procedure will be followed during intercourse as was followed during masturbation. A slight variation on the squeeze technique is to squeeze at the base of the penis instead of the tip. This allows the man to maintain insertion while employing the squeeze. The pressure should always be front to back and never side to side. Inhibited Sexual Desire (ISD). The treatment strategy for ISD usually requires more extensive psychotherapy to uncover the underlying causes. It is not uncommon to begin the sensate focus exercises only to put them on hold after a session or two due to what they have uncovered. Once the underlying causes are dealt with the sensate focus exercises seem to be very useful in reestablishing sexual desire. 1. What qualities do you find physically attractive in another
person? Products to help Erective Dysfunction are available at: www.TerraceSpa.com or www.kwikmed.com The health information contained herein is for educational purposes only and is not intended to replace discussions with a healthcare provider. All decisions regarding patient care must be made by a healthcare provider, who will consider the unique characteristics of the patient.12 Masters and Johnson (1988) ________________________________________________________________________ 1 Helen Singer Kaplan (1975)
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