orgasmic disorders

Changes in genitalia
Heightened awareness of pleasurable erotic
Changes in subjective state (sexual excitement )
Depend on specific local vascular mechanism
Whether conscious feeling follow bodily
changes / vice versa ?
Cognitive processes that attend to the sexual
meaning of what is happening by focusing on
external events & relating them to memory
,internal processes such as imagery
,/perceptions bodily changes that have sexual
Emotions are generated by an
unconscious,implicit evaluation of a stimulus
Is followed by a tendency to act in a particular
way (action tendency )
Is followed by peripheral responses
Finally conscious experience
Gray (1994 )has proposed three fundamental
emotion system :
1) Behavioural approach system (BAS )
2)Fight /flight system (F/FLS)
3) Behavioural inhibition system (BIS )
The first two involve action (approach for reward
or fight /flight to avoid punishment )
The third involves inaction accompanied dy
increased arousal & attention ,as away of coping
with threat
Arousal mechanisms are relevant to all three of
Gray`s emotional system
General arousal (activates individual in a nonspecific way )
Specific arousal (prepares the body for specific
types of action )
Orgasm is often regarded as the goal of sexual
Conclusion ,pleasure & reduction of tension
associated with it are important reinforcers in
the learning of sexual behaviour
1)Intense feeling of pleasure ,ecstasy
2)Some degree of altered consciousness with
reduced awareness & information processing
3)Specific sensation ,typically felt in the genital
regions but spreading through the body
4) Muscle contractions
5)Other non genital changes
A post-orgasmic state in which the above
manifestations return to a non-aroused state
Orgasmic manifestations are similar in M&W
except seminal emission ,refractory period
freud`s doctrine
clitoral stimulation in order to experience
orgasm is a sign of immaturity ,a failure of the
clitoral-vaginal transfer that signal sexual
Kinsey et al (1953)
pointing to the insensitivity to touch of the
vaginal wall in contrast to clitoris & labia minor
they underestimated importance of pressure as
a vaginal stimulus
Masters & johnson (1966)
either direct /indirect stimulation of clitoris is
always necessery for orgasm & physiological
coclusion that instead of two types of orgasm
( clitoral & vaginal )there was only one
Bentler & peerler (1979) siger (1973)
found difference between two type (vulval &
Vulval orgasm depend on clitoral stimulation
and manifested by vaginal contractions
Uterine experience is characterized by more
marked emotional reactions , by apnoea &
without vaginal contraction
with a refractory period
The recent report of differences in postorgasmic PRL levels in both women & men
when comparing orgasms from masturbation
& those from seual interaction with one`s
Correlated with sexual physiological response
Essential feature of sexual dysfunctions is
inhibition in one /more of the phase
A disturbance in the sexual response cycle
Lifelong or acquired
generalized or situational
combined psychological and medical factors
common male sexual problem
Masters and Johnson (1970) diagnosed a man with
PE if he could not delay ejaculation long enough
for his partner to reach orgasm 50% of the time
Biological/Physiological :
_ range exists among men in their ejaculatory speed(nerve latency
time )
91% of men with lifelong PE had a first relative with
lifelong PE , Waldinger et al. (1998)
_ neurotransmitter
_ Physical illnesses
_ Pharmacologic side effect
opioids , alcohol
cold medications
emotional issues :
1) Anger
2) frustration,
3) low self-confidence, mistrust,
4) negative body image
5)psychosocial stress associated with financial
difficulties, occupational problems
6)death of a significant other may be factors
Medical :
SSRIs ( paroxetine , sertraline , fluoxetine )
TCAs ( ciomipramin )
topical anesthesia (lidocaine cream )
PDE5 inhibitor agents
PE Exercises
Help man learn to tolerate increasing levels of
control of his ejaculatory reflex
_ sensate focus exercises
_ stop–start method
_ squeeze technique
persistent or recurrent delay in, or absence of,
orgasm following a normal sexual excitement phase
during sexual activity that the clinician, taking
into account the person’s age, judges to be adequate
in focus, intensity, and duration,” and it causes
“marked distress or interpersonal difficulty
persistent or recurrent delay in, or
absence of, orgasm in a female following a
normal sexual excitement phase
during sexual activity that the clinician judges
to be adequate in focus, intensity and duration
Difficulties in the process of socialization during
development of misconceptions about sex
negative attitudes toward sexual pleasure
problems with sexual orientation or gender identity
sexual abuse during childhood
experiences or attitudes during adolescence (women)
sexual attitudes
McCabe (2005) demonstrated that performance
anxiety was associated with high levels of
stress, levels of fatigue, sexual identity, health
mood disorders
quality of the relationship
McCabe and Cobain (1998) found that
relationship factors were strongly associated
with sexual dysfunction for women but not as
strongly for men
medical history
Kelly, Strassberg, and Turner (2006) found that
there were behaviorally assessable differences
in the communication pattern of couples
experiencing female anorgasmia when
compared with functional couples ,specially
the negative interactional dynamics of blame
and lack of recepitivly to interactions by their
assess the frequency of orgasm
the situation in which anorgasmia occurs whether
whether anorgasmia is primary or secondary
if anorgasmia is partial or complete,
and the length of time the problem has been in
question the woman and her partner on why she is
seeking treatment at this point in time & what
expectations or goals she has for therapy
important factors :
performance anxiety
The communication training included:
exercises for active and passive listening,
verbalization and reflection of feeling
productive conflict management
assertive behavior
woman’s past failure to achieve orgasm
who regards her orgasmic response as an
assurance of his or her own competence
Fear of rejection or feelings of obligation
toward the partner
communication exercises
sensate focus exercises
and guided fantasy
improve the quality of the marital relationship
develop and explore emotional responses
(address all aspects of the relationship, both
sexual and nonsexual)
Both partners were instructed to share their
· What do I like best about us as partners
and how does that make me feel?
· How do I feel about differences between
us in desire for sexual contact?
communication exercises continued to encourage the
development of the emotional side of the woman by
exploring her reaction to the program and sharing this
reaction with her partner
For example, when partners were physically
exploring their responses to body massage and genital
one of the communication questions was,
How do I feel when you caress me intimately?
What body feelings occur?
The Masters and Johnson (1970) sensate focus
program was outlined in therapy and
implemented at home by the client
The program was commenced two weeks after the
commencement of therapy
exercises comprised nongenital and then genital
pleasuring and, finally, intercourse in a gradual
use of sexual fantasy is an important aspect of
purpose of sexual fantasy seems to be different
for men and women
fantasies need to be aimed at enhancing the
acceptance of oneself as a sexual person.
Some women may have difficulty accepting
themselves as sexual persons and may
experience a high level of guilt in association
with their sexual functioning
. Men may experience guilt in association with
sexual expression, but this guilt is accompanied
by a lack of emotional involvement in the actual
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