Female Sexual Dysfunction
Sex Myths
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Masturbation causes hairy palms, insomnia, impotency, lack of concentration,
and blindness.
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The bigger the penis, the better.
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Men can instantly produce an erection on demand, while women turn on much
more slowly.
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If we didn't have intercourse, we didn't have sex.
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Having good sex should come as naturally as breathing.
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The proper way for a woman to orgasm is through penis-vagina sex.
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Sexual Desire
Sexual Arousal
Orgasm
Sexual Response Cycle
DSM-IV
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Causes personal distress or interpersonal difficulty
Symptoms persistent and recurrent
Types:
– lifelong vs. acquired
– generalized vs. situational
– psychological, organic, or combined causes
Hypoactive Sexual Desire Disorder
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What is low desire?
Prevalence rates (Laumann et al., 1999)
– age
– marital status
– education
– race
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Causes:
– Physiological factors:
• Hormones
• neurotransmitters
• CNS
– Psychological factors:
• daily hassles
• high stress
• relationship issues
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Relationship issues:
– conflict
– attraction
– sexual compatibility
– sexual skill
– desired level of intimacy
– power dynamics
• Guilt
• Psychological disorders
• Treatment
– rule out physiological causes
– couple problem
– address beliefs
– communication issues
– affection
Sexual Aversion Disorder
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A form of anxiety
history of sexual abuse/assault
Treatment: address underlying anxiety
Female Sexual Arousal Disorder
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Psychological & physiological components
Prevalence
– age
– marital status
– education
– race
• Causes:
– physiological
• hormones
• neurotransmitters
• SNS activation (Meston, 1996)
• touch sensation (Frohlich, 1999)
– psychological
• anxiety (Barlow)
• performance demand (Laan, 1993)
• expectancies (Palace, 1995)
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Psychological causes continued: similar causes as HSDD
– Relationship issues:
• conflict
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attraction
sexual compatibility
sexual skill
desired level of intimacy
power dynamics
– Guilt
– Psychological disorders
Female Sexual Arousal Disorder
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Viagra?
EROS-CTD
Couples counseling to address psychological issues
Female Orgasmic Disorder
Delayed or absent orgasm following normal sexual excitement
– age
– sexual experience
– degree of sexual stimulation
– lifelong vs. acquired; generalized vs. situational
• Prevalence:
– age
– marital status
– education
– race
• Causes:
– physiological
• Lack of SNS activation (Meston, 1996)
– psychological:
• distraction
• discomfort about sex
• guilt
• endorse sex myths
• negative attitudes about masturbation
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Treatment
– education
– self-exploration
– directed masturbation
– couple exploration
– Success rates up to 90% (Heiman & Meston, 1998)
Becoming Orgasmic, by Julia Heiman
Pain Disorders: Dyspareunia
• Pain associated with sexual intercourse
– Adequate vaginal lubrication?
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Pain syndrome or sexual problem?
Descriptors:
– location
– quality
– elicitors
– course
– intensity
– meaning
Pain Disorders: Dyspareunia
Causes:
– anatomical
– pathological
– iatrogenic
– psychological
Abnormalities in pain sensation (Pukall, 2000)
Treatment:
– multidisciplinary
– cognitive-behavioral therapy:
• systematic desensitization
• couples counseling
Pain Disorder: Vaginismus
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Involuntary spasm of vaginal musculature interfering with intercourse
Generalized vs. sexual problem
Prevalence
Causes:
– medical conditions (23-32%)
– family background
– sexual trauma (40%)
• Treatment:
– cognitive behavioral therapy
• beliefs
• education
• muscle exercises, vaginal dilation