HOD DEPT OF PSYCHIATRY
DR RAKESH YADUVANSHI
MODERATORS
DR RAIES AHMED,AP,DEPT OF PSYCHIATRY
PRESENTED BY-
Dr Mohit Jindal(jr2)
OVERVIEW OF THE TOPIC
• 1-Introduction
• 2-Male Hypoactive Sexual Desire Disorder
• 3-Female Sexual Interest or Arousal Disorder
• 4-Male Erectile Disorder
• 5-Female Orgasmic Disorder
• 6-Delayed Ejaculation
• 7-Premature Ejaculation
• 8-Orgasmic Anhedonia
• 9-Sexual Pain Disorders
• 10-Treatment of Sexual Dysfunction
• 11-Summary
SEXUAL DYSFUNCTION- INTRODUCTION
• Sexuality is divided into the subjects of normal
sexuality, sexual dysfunction, paraphilias, and
gender dysphoria.
• Essential features of sexual dysfunctions are,
inability to respond to sexual stimulation, or the
experience of pain during the sexual act.
• Dysfunction can be defined by a disturbance in the
subjective sense of pleasure or desire usually
associated with sex, or by the objective performance.
• A/C to ICD-10, sexual dysfunction - a person’s
inability “to participate in a sexual relationship as
he or she would wish.”
• Sexual dysfunctions -frequently associated with other mental disorders, such
as depressive disorders, anxiety disorders, personality disorders, and
schizophrenia.
• In relationships, the sexually functional partner often reacts with distress or
anger due to feelings of deprivation or a sense that he or she is an
insufficiently attractive or adequate sexual partner.
MALE HYPOACTIVE SEXUAL DESIRE
DISORDER
• It is a deficiency or absence of sexual fantasies and desire for sexual activity
for a minimum duration of approximately 6 months.
• Men for whom this is a lifelong condition have never experienced many
spontaneous erotic/sexual thoughts.
• The prevalence of low desire is highest at the younger and older ends of the
age spectrum, with 2% of men ages 16 to 44 are affected by this disorder.
• 6 % of men of ages 18 to 24, and 40% of men ages 66 to 74, have problems
with sexual desire.
• Some men may confuse decreased desire with decreased activity - erotic
thoughts and fantasies are undiminished, but they no longer act on them due to
health issues, unavailability of a partner, or erectile disorder.
• Abstinence from sex for a prolonged period sometimes
results in suppression of sexual impulses.
• Loss of desire - an expression of hostility to a partner or
the sign of a deteriorating relationship.
• The presence of desire depends on several factors:
biologic drive, adequate self-esteem, the ability to accept
oneself as a sexual person, the availability of an
appropriate partner, and a good relationship in nonsexual
areas with a partner.
• Patient’s age, general health, any medication regimen,
and life stresses to be evaluated.
• Diagnosis is not made unless the lack of desire is a
source of distress to a patient.
DIAGNOSIS OF MALE HYPOACTIVE
SEXUAL DESIRE DISORDER
FEMALE SEXUAL INTEREST OR AROUSAL
DISORDER
• Women experiencing sexual dysfunction may experience either inability to
feel interest or arousal, and they may also have difficulty achieving orgasm
or experience pain.
• Decrease or paucity of erotic feelings, thoughts, or fantasies; a decreased
impulse to initiate sex; a decreased or absent receptivity to partner
overtures; or an inability to respond to partner stimulation.
• A subjective sense of arousal is often poorly correlated with genital
lubrication in both normal and dysfunctional women so, complaints of lack of
pleasure are sufficient for this diagnosis even when vaginal lubrication and
congestion are present.
• Alterations in testosterone, estrogen, prolactin,
and thyroxin levels occur in female sexual
arousal disorder.
• Antihistaminic or anticholinergic properties
decrease vaginal lubrication.
• Life stresses, aging, menopause, adequate
sexual stimulation, and general health to be
evaluated before making the diagnosis.
DIAGNOSIS OF FEMALE SEXUAL
INTEREST OR AROUSAL DISORDER
MALE ERECTILE DISORDER
• Historically called impotence.
• It describes the feelings of powerlessness, helplessness, and resultant low self-esteem
men with this dysfunction frequently suffer.
• Patient with this disorder has never been able to obtain an erection sufficient for insertion.
• In acquired male erectile disorder, a man has successfully achieved penetration at some
time in his sexual life but is later unable to do so.
• In situational male erectile disorder, a man can have coitus in certain circumstances but
not in others; for example, he may function effectively with a sex worker but be unable to
have an erection when with his partner.
• Acquired male erectile disorder seen in 10 to 20 % of all men.
• Chief complaint of more than 50 % of all men treated for sexual disorders.
• Lifelong male erectile disorder occurs in 1% of men younger than age 35.
• Incidence of erectile disorder increases with age.
• 2 to 8% of the young adult , and much more common in older men.
• 20% of men fear erectile dysfunction before their first coitus; incidence of
actual erectile dysfunction during the first coitus is 8%.
• It can be organic or psychological or a
combination of both, but in young and middle-
aged men, the cause is usually psychological.
• A man may be unable to express a sexual impulse
because of fear, anxiety, anger, or moral
prohibition.
• In an ongoing relationship, the disorder may
reflect difficulties between the partners, mainly
when a man cannot communicate his needs or his
anger directly and constructively.
• Episodes of erectile disorder are reinforcing, with
the man becoming increasingly anxious before
each sexual encounter.
DIAGNOSIS OF ERECTILE DISORDER
OR FAILURE OF GENITAL RESPONSE
FEMALE ORGASMIC DISORDER
• Sometimes called inhibited female orgasm or anorgasmia.
• Defined as recurrent or persistent inhibition of female orgasm, as
manifested by the recurrent delay in, or absence of, orgasm after a normal
sexual excitement phase that a clinician judges to be adequate in focus,
intensity, and duration—in short, a woman’s inability to achieve orgasm by
masturbation or coitus.
• Women who can achieve orgasm by one of these methods are not necessarily
categorized as anorgasmic, although there may be some sexual inhibition.
• The woman may still present for treatment as her partner is distressed by her
apparent disinterest.
• Many women achieve orgasm during coitus by a combination of manual
clitoral stimulation and penile vaginal stimulation.
• A woman with lifelong female orgasmic disorder has never experienced orgasm
by any kind of stimulation.
• Acquired orgasmic disorder women has previously experienced at least one
orgasm, regardless of the circumstances or means of stimulation, whether by
masturbation or while dreaming during sleep.
• Women achieve orgasm more consistently with masturbation than with partnered
sex.
• Lifelong female orgasmic disorder -more common in unmarried women than
married women.
• Increased orgasmic potential in women older than 35 years of age may relate to
less psychologic inhibition, greater sexual experience, or both.
• The overall prevalence of female orgasmic disorder from all causes is estimated to
be 30%.
• Psychological factors associated with female orgasmic disorder include, fears of
impregnation, rejection by a sex partner, and damage to the vagina; hostility toward
men; poor body image; and feelings of guilt about sexual impulses.
• Some women equate orgasm with loss of control or with aggressive, destructive, or
violent impulses; they may express their fear of these impulses through inhibition of
arousal or orgasm.
• Nonorgasmic women may be otherwise symptom-free or may experience
frustration in a variety of ways; they may have such pelvic complaints as lower
abdominal pain, itching, and vaginal discharge, as well as increased tension,
irritability, and fatigue.
DIAGNOSIS OF FEMALE ORGASMIC
DISORDER
DELAYED EJACULATION
• Sometimes called retarded ejaculation, a man achieves ejaculation during
coitus with great difficulty, if at all .
• Problem is rarely present with masturbation but appears as a problem
during partnered sex .
• Man with lifelong delayed ejaculation has never been able to ejaculate
during partnered sexual activity,problem is most pronounced during coital
activity.
• Disorder is acquired if it develops after previously normal functioning.
• Incidence is much lower than the incidence of premature ejaculation/erectile
disorder.
• Prevalence is about 5 %.
• Increase in this disorder presenting to sex therapy programs antidepressant use ,
high use of Internet pornography may be explanation for this.
• Adolescent males who use porn sites frequently, before live sexual interaction,
donot develop neuronal synapses that will enable them to respond to usual
partnered interactions with sufficient pleasure to allow them to achieve climax.
• A man may come from rigid, puritanical background; he may perceive sex as
sinful and the genitals as dirty, and he may have conscious or unconscious incest
wishes and guilt. -This is how psychopathology affects
• In a few cases, attention-deficit/hyperactivity disorder may aggravate the condition.
• In an ongoing relationship, acquired male delayed ejaculation disorder frequently
reflects interpersonal difficulties.
• The disorder may be a man’s way of coping with real or fantasized changes in a
relationship, such as plans for pregnancy about which the man is ambivalent, the loss
of sexual attraction to the partner, or demands by the partner for greater commitment
as expressed by sexual performance.
• In some men, the inability to ejaculate reflects unexpressed hostility toward a
woman.
• More common in men with obsessive-compulsive disorder (OCD) than others.
DIAGNOSIS OF DELAYED
EJACULATION
PREMATURE(EARLY) EJACULATION
• Men persistently or recurrently achieve orgasm and ejaculation before they wish to.
• Diagnosis occurs when a man regularly ejaculates before or within approximately 1 minute
after penetration.
• DSM-5 refers only to “vaginal penetration” in its diagnostic criteria, even though the disorder
can occur in gay men or those who do not engage in vaginal penetration for other reasons.
• Defn A/C DSM-5 - mild if ejaculation occurs within approx 30 seconds to 1 minute of
vaginal penetration, moderate if ejaculation occurs within approx15 to 30 seconds of vaginal
penetration, and severe when ejaculation occurs at the start of sexual activity or within
approximately 15 seconds of vaginal penetration.
• A difficulty with these specifiers involves time distortions, which patients make in both
overestimating and underestimating time from penetration to climax.
• Factors affecting the duration of the excitement phase of the sexual response,
such as age, the novelty of the sex partner, and the frequency of coitus are to
be considered.
• PME appears to be more common among college- educated men than among
men with less education.
• The complaint is likely related to their concern for partner satisfaction.
• PME is the chief complaint of about 35 to 40% of men treated for sexual
disorders.
• Difficulty in ejaculatory control can be associated with anxiety regarding the
sex act, with unconscious fears about the vagina, or negative cultural
conditioning.
• In young, inexperienced men, who have the problem, it may resolve in time.
• In ongoing relationships, the partner has a significant influence on a
premature ejaculaton, and a stressful marriage exacerbates the disorder.
• The focus of this diagnosis is on males, and data on premature female orgasm
are lacking.
• Rare case reports of spontaneous orgasms in women taking serotonergic
antidepressants are seen.
DIAGNOSIS OF PREMATURE (EARLY)
EJACULATION
ORGASMIC ANHEDONIA
• It is a condition in which a person has no physical sensation of orgasm, even
though the physiologic component (e.g., ejaculation) remains intact.
• Organic causes, such as sacral and cephalic lesions that interfere with afferent
pathways from the genitalia to the cortex, must be ruled out.
•
• Psychiatric causes- extreme guilt about experiencing sexual pleasure.
• These feelings produce a dissociative response that isolates the affective
component of the orgasmic experience from consciousness.
• In DSM-5 this would be diagnosed as an “other specified sexual dysfunction.”
SEXUAL PAIN DISORDERS
• Genito-Pelvic Pain/Penetration Disorder:-
• A/C DSM-5 -refers to one or more of the following complaints, of which any
two or more may occur together: difficulty having intercourse, genito-pelvic
pain, fear of pain or penetration, and tension of the pelvic floor muscles .
• These pain disorders were diagnosed as dyspareunia or vaginismus.
• These could coexist, or one could lead to the other and could understandably
lead to fear of pain with sex.
a)DYSPAREUNIA:-
• Dyspareunia is recurrent or persistent genital pain occurring before, during,
or after intercourse.
• Dyspareunia is related to and often coincides with vaginismus.
• Repeated episodes of vaginismus can lead to dyspareunia and vice versa; in
either case, we should rule out somatic causes, or lack of lubrication.
• 5% of women in North America report recurrent pain during intercourse.
• Chronic pelvic pain is a common complaint in women with a history of rape
or childhood sexual abuse.
• Painful coitus can result from tension and anxiety about the sex act that
causes women to contract their pelvic floor muscles involuntarily.
• The pain is real and makes intercourse unpleasant or unbearable.
• The anticipation of further pain may cause women to avoid coitus
altogether.
• If a partner proceeds with intercourse regardless of a woman’s state of
readiness, this aggravates the condition.
• Increase dyspareunia seen postmenopausally due to hormonally induced
physiologic changes in the vagina; but specific complaints of difficulty
having intercourse occur more often in premenopausal women.
• There is some increase in dyspareunia in the immediate postpartum
population, but it is usually temporary.
• Dyspareunia may present as any of the four complaints listed under genito-
pelvic pain/penetration disorder, and we would diagnose this as a genito-
pelvic pain/penetration disorder.
b)VAGINISMUS:-
• Vaginismus is a constriction of the outer third of the vagina due to involuntary
pelvic floor muscle tightening or spasm.
• It then interferes with penile insertion and intercourse.
• May occur during a gynecologic examination when involuntary vaginal constriction
prevents the introduction of the speculum into the vagina.
• Diagnosis is not made when the dysfunction is caused exclusively by organic factors
or when it is symptomatic of another mental disorder.
• Vaginismus may be complete; that is, no penetration of the vagina is possible,
whether by the penis, fingers, a speculum during a gynecologic examination, or even
if the woman tries to use the smallest size tampon.
• Many women who discover this when they become sexually active have
avoided the use of tampons previously.
• Penetration may be achieved with the smallest size speculum or little fingers.
In mild cases, the muscles relax after the initial difficulty with penetration,
and the woman can continue with sexual play, sometimes even with coitus.
• Vaginismus is less prevalent than female orgasmic disorder.
• It most often afflicts highly educated women and those in high
socioeconomic groups.
• Sexual trauma, such as rape, anticipation of pain at the first coital experience
may cause vaginismus.
• Strict religious upbringing in which the patient associates sex with sin is
frequent in these patients.
• Other women have problems in dyadic relationships; if women feel
emotionally abused by their partners, they may protest in this nonverbal
fashion.
• Women who have experienced significant pain in childhood due to surgical or
dental interventions become guarded about any breach of body integrity and
develop vaginismus.
• Vaginismus may present as any of the four complaints under genito-pelvic
pain/penetration disorder, and we should diagnose this as genito-pelvic
pain/penetration disorder.
TREATMENT OF SEXUAL
DYSFUNCTION
a)PHARMACOTHERAPY:-
i)Sildenafil and its congeners, oral phentolamine, alprostadil
and injectable medications.
ii)Other options- papaverine, prostaglandin E1, phentolamine,
or some combination of these; and transurethral alprostadil
(MUSE).
• Sildenafil is a nitric oxide enhancer that facilitates the inflow of blood to the penis
necessary for an erection.
• Takes effect about 1 hour after ingestion, and its effect can last up to 4 hours. Sildenafil
is not effective in the absence of sexual stimulation.
• Adverse events- headaches, flushing, and dyspepsia,Nonarteritic ischemic optic
neuropathy (NAION),hearing loss may also occur.
• Organic nitrates -not be taken with sildenafil, the combined action of the two
drugs can cause sudden, and sometimes fatal, drops in systemic blood pressure.
• Fails to produce an erection that is sufficiently rigid for penetration in about 50%
of men who have had radical prostate surgery or in those with long- standing
insulin-dependent diabetes.
• Ineffective in some instances of nerve damage.
• Oral phentolamine and apomorphine are not FDA approved at present but have
proved useful as potency enhancers in men with minimal erectile dysfunction.
• Phentolamine reduces sympathetic tone and relaxes corporeal smooth muscle.
• Adverse events -hypotension, tachycardia, and dizziness, nausea,vomitting
• Apomorphine effects the autonomic nervous system and result in
vasodilation that facilitates the inflow of blood to the penis.
• Alprostadil:
• Injectable and transurethral forms of alprostadil act locally on the penis
and can produce erections in the absence of sexual stimulation.
• Alprostadil contains a naturally occurring form of prostaglandinE-vasodilating
agent.
• Alprostadil can be given by direct injection into the corpora cavernosa or by
intraurethral insertion of a pellet through a cannula-firm erection within 2 to 3 mins
after administration may last as long as 1 hour.
• Adverse effects of injections- penile bruising and changes in liver function test
results, infrequent and reversible
• Hazardous effects- priapism and sclerosis of the small veins of the penis.
• Transurethral alprostadil - burning sensations in the penis.
• A cream incorporating alprostadil exists for female sexual arousal disorder.
• Vaginally applied phentolamine mesylate, an α-receptor antagonist, can increase
vasocongestion and a subjective sense of arousal.
• Flibanserin - FDA-approved to increase desire in women.
Other Pharmacologic Agents:
• IV methohexital sodium assists with desensitization therapy.
• Antianxiety agents for tense patients.
• The side effects of antidepressants, in particular the SSRIs and tricyclic drugs,
have been used to prolong the sexual response in patients with premature
ejaculation.
• This approach is particularly useful in patients who are refractory to behavioral
techniques.
• Topical anesthetic creams - decrease the intravaginal ejaculation latency time (IELT) in
cases of premature ejaculation.
• Antidepressants - patients who are phobic of sex ,post traumatic stress disorder
following rape.
• Trazodone -improves nocturnal erections.
• Bromocriptine treats hyperprolactinemia, which is frequently associated with
hypogonadism and any associated sexual dysfunction, in such patients, it is necessary to
rule out pituitary tumors.
• Aphrodisiacs; ginseng root and yohimbine.
• Yohimbine -α-receptor antagonist,cause dilation of the penile artery, American
Urologic Association does not recommend its use to treat organic erectile dysfunction.
• Recreational drugs-cocaine, amphetamines, alcohol, and cannabis, are
considered enhancers of sexual performance- benefit because of their
tranquilizing, disinhibiting, or mood-elevating effects, consistent or prolonged
use of any of these substances impairs sexual functioning.
• Dopaminergic agents ( L-dopa and bromocriptine) may increase libido and
improve sex function.
• Bupropion has dopaminergic effects and has increased sex drive in some
patients.
• Selegiline, MAOI, is selective for MAOB and is dopaminergic- improves
sexual functioning in older persons.
b)HORMONE THERAPY:
• Androgens increase the sex drive in women and men with low testosterone
concentrations.
• Women may experience virilizing effects, some of which are irreversible (e.g.,
deepening of the voice).
• In men, prolonged use of androgens- hypertension and prostatic enlargement.
• Testosterone- most effective when given parenterally;effective oral and transdermal
preparations are available.
• Women using estrogens- replacement therapy or contraception may report
decreased libido; in such cases, a combined preparation of estrogen and
testosterone is given.
• Forms of locally delivered estrogen—vaginal rings, vaginal creams, and vaginal
tablets— provide alternate administration routes to treat women with arousal problems
or genital atrophy.
• Tablets, creams, and rings do not increase circulating estrogen levels, so, given to
patients with breast cancer with arousal problems.
• Estrogens and progesterone are antiandrogens -used to treat compulsive sexual
behavior in men, usually in sex offenders.
• Clomiphene and tamoxifen are antiestrogens, and stimulate gonadotropin-releasing
hormone (GnRH) secretion and increase testosterone concentrations, thereby
increasing libido.
• Women treated for breast cancer with tamoxifen report an increased libido. However,
tamoxifen may cause uterine cancer.
c)MECHANICAL TREATMENT
• Vacuum pumps are mechanical devices that patients without a vascular
disease can use to obtain erections.
• Vacuum draws blood to the penis and kept there by a ring at the base of the
penis.
• EROS has been developed to create clitoral erections in women.
• EROS is a small suction cup that fits over the clitoral region and draws blood
into the clitoris -treats female sexual arousal disorder.
• Vibrators used to stimulate the clitoral area have been successful in treating
anorgasmic women.
d)OTHER SOMATIC TREATMENTS:-
i) Male Prostheses:-
• Penile prosthetic devices -for men with inadequate erectile responses who are
resistant to other treatment methods or who have medically caused deficiencies.
• The two main types of prostheses are :-
(1) a semi-rigid rod prosthesis that produces a permanent
erection that can be positioned close to the body for
concealment
(2) an inflatable type that is implanted with its reservoir and
pump for inflation and deflation.
ii)Vascular Surgery:-
• When vascular insufficiency is present due to atherosclerosis or other
blockages, bypass surgery of penile arteries may help in selected cases.
PSYCHOSOCIAL TREATMENTS
i)DUAL-SEX THERAPY:
• In dual-sex therapy, when a dysfunctional person is in a relationship, the couple must be
treated.
• Sexual problem reflects other areas of disharmony or misunderstanding in the relationship so
that the entire relationship is treated, with emphasis on the sexual functioning of the partners.
• Roundtable session in which a male and female therapy team clarifies, discusses, and works
through problems with the couple.
• The four-way sessions require active participation by the patients.
• Therapists and patients discuss the psychological and physiologic aspects of sexual
functioning, and therapists have an educative attitude.
• Therapists suggest specific sexual activities for the couple to follow in the
privacy of their home.
• Aim is to establish or reestablish communication within the partner unit.
• Treatment is short term and is behaviorally oriented.
• Perspective can interrupt the couple’s destructive pattern of relating and can
encourage improved, more effective communication.
• Sexual inadequacy often involves a lack of information, misinformation, and
performance fear.
• Initially, the therapist prohibits intercourse, and the couple learns to give and receive
bodily pleasure without the pressure of performance or penetration.
• At the same time, they learn how to communicate nonverbally in a mutually
satisfactory way, and they learn that sexual foreplay is an enjoyable alternative to
intercourse and orgasm.
• During the sensate focus exercises, the couple receives reinforcement to reduce
anxiety.
• If either partner becomes sexually excited by the exercises, the other is encouraged to
bring them to orgasm by manual or oral means.
• Couple should sequentially try various positions for intercourse, without
necessarily completing the act, and to use varieties of stimulating techniques before
they proceed with intercourse.
• Psychotherapy sessions follow new exercise period, problems and
satisfactions, both sexual and in other areas of the couple’s lives, are
discussed.
• Gradually, the couple gains confidence and learns to communicate, verbally
and sexually.
• Dual-sex therapy is most effective when sexual dysfunction exists apart from
other psychopathology.
• Difficult treatment cases involve couples with severe marital discord.
• Desire disorders are particularly challenging to treat.
ii)SPECIFIC TECHNIQUES AND EXERCISES:-
• In vaginismus, a woman is advised to dilate her vaginal opening with her fingers or
with size-graduated dilators.
• Dilators can also treat cases of dyspareunia.
• Specially trained physiotherapists can assist the treatment by helping the patients to
relax their perineal muscles.
• In premature ejaculation, the squeeze technique can raise the threshold of penile
excitability- man or the woman stimulates the erect penis until feeling the earliest
sensations of impending ejaculation.
• At this point, the partner forcefully squeezes the coronal ridge of the glans,
diminishing the erection and inhibiting ejaculation.
• A variant of the exercise is the stop-start technique developed by James H.
Semans, in this woman stops all stimulation of the penis when the man first
senses an impending ejaculation without squeezing.
• Sex therapy -most successful in the treatment of premature ejaculation.
• A man with a sexual desire disorder or male erectile disorder can masturbate
to prove that full erection and ejaculation are possible.
• Delayed ejaculation is managed initially by extravaginal ejaculation and then
by gradual vaginal entry after stimulation to a point near ejaculation.
• In lifelong female orgasmic disorder, the woman is directed to masturbate,
sometimes using a vibrator.
iii)BEHAVIOR THERAPY:-
• Initially designed for the treatment of phobias but are now used to treat other problems as well.
• Behavior therapists assume that the patient learns sexual dysfunction as maladaptive
behavior, which causes them to fear sexual interaction.
• Therapists set up a hierarchy of anxiety-provoking situations, ranging from least threatening
(e.g., the thought of kissing) to most threatening (e.g., the thought of penile penetration).
• Therapist enables the patient to master the anxiety through systematic desensitization, which
inhibits the learned anxious response by encouraging behaviors antithetical to anxiety.
• The patient first deals with the least anxiety-producing situation in fantasy and progresses by
steps to the most anxiety-producing situation.
• Assertiveness training can help teach patients to express sexual needs openly and without fear.
• Patient receives exercises in assertiveness, given in conjunction with sex
therapy, and they are encouraged to make sexual requests and to refuse to
comply with requests perceived as unreasonable.
• Sexual exercises prescribed for patients to perform at home, and the therapist
teaches to start with those activities that have proved most pleasurable and
successful in the past.
• Couples who regularly practice assigned exercises appear to have a much
higher success than do more resistant couples or those whose interaction
involves sadomasochistic or depressive features or mechanisms of blame and
projection.
• Younger couples tend to complete sex therapy more often than older couples.
• Couples whose interactional difficulties center on their sex problems, such as
inhibition, frustration, or fear of performance failure, are also likely to respond
well to therapy.
iv) MINDFULNESS:-
• Cognitive technique - helpful in the treatment of sexual dysfunction.
• The patient focuses on the moment and maintains an awareness of sensations
—visual, tactile, auditory, and olfactory —that he or she experiences in the
moment.
• The aim is to distract the patient from “spectatoring” (watching him or
herself) and center the person on the sensations that lead to arousal or orgasm.
• This shift in focus allows patients to become immersed in the pleasure of the
experience and remove themselves from self-judgment and performance
anxiety.
v)GROUP THERAPY:
• Helps to examine both intrapsychic and interpersonal problems in patients with
sexual disorders.
• Provides a strong support system for a patient who feels ashamed, anxious, or
guilty about a particular sexual problem.
• Members share the same problem, such as premature ejaculation; members may all
be of the same sex with different sexual problems, or groups composed of both
men and women experiencing sexual problems.
• An adjunct to other forms of therapy or the prime mode of treatment.
• Groups organized to treat a particular dysfunction are usually behavioral in
approach.
• Group gives opportunity to gather accurate information, offers consensual
validation of individual preferences, and enhances self- esteem and self-
acceptance.
• Techniques, as role-playing and psychodrama, may be used in treatment.
• Groups are not indicated for couples when one partner is uncooperative, when
a patient has a severe depressive disorder or psychosis, when a patient finds
explicit sexual audiovisual material repugnant, or when a patient fears or
dislikes groups.
vi)HYPNOTHERAPY:-
• Hypnotherapists focus specifically on the anxiety-producing situation—that is, the sexual
interaction that results in dysfunction.
• Successful use of hypnosis enables patients to gain control over the symptom that has been
lowering self-esteem and disrupting psychological homeostasis.
• The patient’s cooperation is first obtained and encouraged during a series of nonhypnotic
sessions with the therapist.
• During this time, the therapist assesses the patient’s capacity for the trance experience.
• Focus of treatment - symptom removal and attitude alteration.
• Patient develops alternative means of dealing with the anxiety-provoking situation, the
sexual encounter.
• Therapist teaches relaxation techniques for use before sexual relations.
• With these methods to alleviate anxiety, the physiologic responses to sexual
stimulation can more readily result in pleasurable excitation and discharge.
• The therapy helps to remove psychological impediments to vaginal
lubrication, erection, and orgasms so that normal sexual functioning ensues.
vii)ANALYTICALLY ORIENTED SEX THERAPY:-
• Some therapists combine sex therapy with psychodynamic psychotherapy.
• Therapy occurs over a extended period than usual - allows learning or relearning
of sexual satisfaction under the realities of patients’ day-to-day lives.
• The material and dynamics that emerge in patients in analytically oriented sex
therapy are the same as those in psychoanalytic therapy, such as dreams, fear of
punishment, aggressive feelings, difficulty trusting a partner, fear of intimacy,
oedipal feelings, and fear of genital mutilation.
• The combined approach of analytically oriented sex therapy is used by the general
psychiatrist, who carefully judges the optimal timing of sex therapy and the ability
of patients to tolerate the directive approach that focuses on their sexual
difficulties.
SUMMARY
• Sexual dysfunction - a person’s inability “to participate in a sexual relationship as
he or she would wish.”
• Male hypoactive sexual desire disorder-deficiency or absence of sexual
fantasies and desire for sexual activity for a minimum duration of approximately 6
months.
• Female Sexual Interest/Arousal Disorder-Decrease or paucity of erotic feelings,
thoughts, or fantasies; a decreased impulse to initiate sex; a decreased or absent
receptivity to partner overtures; or an inability to respond to partner stimulation.
• Male Erectile Disorder- describes the feelings of powerlessness, helplessness,
and resultant low self-esteem men with this dysfunction frequently suffer.
• Female Orgasmic Disorder-recurrent or persistent inhibition of female
orgasm, as manifested by the recurrent delay in, or absence of, orgasm after a
normal sexual excitement phase that a clinician judges to be adequate in focus,
intensity, and duration.
• Delayed Ejaculation-a man achieves ejaculation during coitus with great
difficulty, if at all .
• Premature Ejaculation-when a man regularly ejaculates before or within
approximately 1 minute after penetration.
• Orgasmic Anhedonia-a person has no physical sensation of orgasm, even
though the physiologic component (e.g., ejaculation) remains intact.
• THANK YOU