Is he mentally ill?

Lack of desire or interest/aversion to sex, increasing in frequency over past generation

Hypoactive Sexual Desire Disorder—little or no interest in sex, absence of fantasies

• More common among women
• Hard to define low desire, difficult to treat successfully
• Often brought in by other member in couple
• Causes
• Bio—testosterone deficiencies, thyroid, diabetes, medication for hypertension, CA, heart, and others
• Psych—anxiety, fatigue, lifestyle

Sexual Aversion Disorder—phobia or panic level

• May be related to a hx of erectile problems in men; also to rape or sexual abuse

Previously called impotence and frigidity

• Previously called impotence and frigidity

• Male erective disorder—

• Situational vs. generalized; primary vs. secondary
• Performance anxiety—big cause; also depression, s-e, etc.
• 10% of men experienced erectile problem in last 12 mos—varies with age
• 50-80% are due to organic factors—vascular problems, diabetes, spinal cord injury
• Exercise, wt loss, lower cholesterol all improve sexual functioning

• Female sexual arousal disorder—both subjective arousal and lubrication

• 19% of women have problems with lubrication
• often goes with other sexual disorders like HSDD
• usually situational
• more commonly has psych causes—anger and resentment toward partner, sexual trauma, anxiety, guilt, ineffective stimulation
• but physical causes also possible—vascular damage, decreased estrogen

Male orgasmic disorder—cannot have orgasm even when highly aroused and had a great deal of stimulation

• Male orgasmic disorder—cannot have orgasm even when highly aroused and had a great deal of stimulation

• 8% in last year –not necessarily dx
• most often is limited to intercourse
• bio causes-MS or neuro condition, side effect of meds, ETOH abuse
• also psy causes—hostility, anxiety, guilt

• Female orgasmic disorder

• 24% of women in last 12 mos
• accts for 25-35% of cases of female sex tx
• may be related to education, also to spectatoring

• Premature ejaculation—hard to define—but too rapid to permit selves or partner to enjoy sex fully.

• Def varies--<30 sec, <1min, or no voluntary control

Dyspareunia—painful coitus

• Dyspareunia—painful coitus

• 14% women, 3% men
• In women, most common cause—lack of lubrication
• Can also be caused by allergies to spermicides etc., vaginal infections, STDs, PID
• Psych causes—guilt, anx, sex trauma
• In men—genital infections, smegma

• Vaginismus—involuntary contraction of the pelvic muscles that surround outer 1/3 of vaginal barrel.

• Intercourse is painful or impossible.
• 12-17% of women seeking sex tx.
• Not conscious.
• Not bio based.

Always have a physical first!

• Always have a physical first!

• Poor general health is related to most of these problems.

• Alcohol—interplay of expectancy and actual effects

• Cocaine—can decrease sexual desire, cause erectile or orgasmic dis.

• Vascular problems

• Cultural influences—cultures that have more negative attitudes toward sex have more dysfunctions

• Ineffective sexual techniques

• Irrational beliefs

• Performance anxiety

• Sexual trauma

• Sexual orientation

5 goals

• 5 goals

• 1) change self-defeating beliefs and attitudes
• 2) teach sexual skills
• 3) enhance sexual knowledge
• 4) improve sexual communication
• 5) reduce performance anxiety

• Therapy usually involves both partners

• Bio tx also available—viagra

• Sensate focusing

• Masters and Johnson—pioneered behavioral tx—focus on problem beh, not cause

• Cognitive-behavioral tx—teach script flexibility—novelty is good

• Need to make sure that relationship out of bed is a good one
• Restructure negative thoughts—all or none thinking

• Evaluation –success varies by dx—vaginismus 80%; premature ejaculation 90%; HSDD—most difficult to treat successfully

• Tx works best when couples are motivated and get along well in other areas

Two types of substance disorders in three classes (alcohol; sedative-hypnotics, opioids)

• Two types of substance disorders in three classes (alcohol; sedative-hypnotics, opioids)

• About 9.4 % of US adults meet criteria in a year

• Abuse—person uses a drug to the extent that he/she is often intoxicated and fails to meet obligations; no physiological dependence

• To dx—1 of
• Failure to fulfill major obligations
• Exposure to physical dangers such as operating machinery or driving drunk
• Legal problems
• Persistent social/interpersonal problems

• Dependence—aka addiction—physio dependence—tolerance and withdrawal sx

• Tolerance—greater and greater to achieve same effect
• Withdrawal—cramps, restlessness, even death—both psych and phys
• 3 of the following to dx
• Tolerance
• Withdrawal or taking drug to avoid withdrawal
• Uses more or more often than intended
• Tried and unable to reduce use
• Lots of time in obtaining or recovering from substance
• Use continues despite phys problems causes or worsened
• Activities given up or reduced b/c of use