Task 2 What’s wrong with me?
Low desire, erectile dysfunctions, she has burning pain, asexuality, hypersexuality (he is masturbating
a lot)
The main way exam; clinical cases; what could cause this problem? How do we treat this? Don’t need
to now the prevalence rates. You need to explain it as if you would explain it to your patients.
Asexuality and hypersexuality; try to explain in a few sentences what the problem is here is.
Book chapter 14 is list of possible dysfunctions. Articles is the focus, the most important part.
Chapter 14 Sexual Disorders
Terms
- Sensate focus = a form of sex therapy that involves graduated touching exercises
- Premature ejaculation = ejaculation before the man wishes, often immediately on
commencement of coitus. Also called rapid ejaculation.
- Stop-start method = a sex therapy technique for the treatment of premature ejaculation that
involves alternating between stimulating and not stimulating the penis.
- Delayed ejaculation = difficulty achieving or inability to achieve orgasm and /or ejaculation.
Also called male orgasmic disorder.
- Erectile disorder (ED) = a persistent inability to achieve or maintain an erection sufficient to
accomplish a desired sexual behaviour such as coitus to orgasm.
- Penile implant = an implanted device for treatment of erectile disorder
- Hypoactive sexual desire disorder = low or absent interest in sex, when this condition causes
distress
- Dyspareunia = pain during coitus
- Female sexual arousal disorder = lack of insufficiency of physiological sexual arousal in
women
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, - Sexual interest / arousal disorder = lack of interest in sex or insufficient sexual arousal, when
it causes distress
- Persistent genital arousal disorder = long-lasting physiological arousal in women,
unaccompanied by subjective arousal or pleasure
- Vulvodynia = painful sensitivity of the vulva to touch
- Vaginismus = inability to experience coitus due to spasm of the muscles surrounding the
outer vagina combined with pain, or fear of pain
- Vaginal dilator = a plastic cylinder used to enlarge the vagina or to counteract vaginismus
- Anorgasmia = difficulty experiencing or inability to experience orgasm. In women, also called
female orgasmic disorder
- Coital alignment technique (CAT) = a variation of the man-above position for coitus that
increases clitoral stimulation
- Kegel exercises = exercises to strengthen pelvic floor muscles, with the aim of improving
sexual function or alleviating urinary leakage
- Discrepant sexual desire = the situation in which one partner in a relationship has much
more interest in sex than the other
- Hypersexuality = excessive sexual desire or behaviour
- Sex addiction = the idea that a person may be addicted to sexual behaviour by a mechanism
similar to that of substance addiction
- Compulsive sexual behaviour = sexual behaviour perceived subjectively as involuntary and
diagnosed as a symptom of a compulsive disorder. Also called obsessive-compulsive sexual
disorder.
Summary
- Sexual disorders are common.
o Among women, the most frequent problems are lack of interest in sex, difficulty
experiences orgasm, and a lack of vaginal lubrication.
o Among men, the most common problems are premature ejaculation, anxiety about
performance and a lack of interest in sex.
- Sexual disorders are clinical problems requiring treatment only if they cause distress.
Treatment may involve some combination of drugs, psychotherapy, and sex therapy
exercises. Sensate-focus exercises are commonly recommended.
- The causes of premature ejaculation, a very common male sexual disorder, are poorly
understood. A man who ejaculates prematurely may be helped by sex therapy exercises in
which he learn to maintain himself at a medium level of arousal for extended periods of
time. Premature ejaculation can also be treated with SSRIs.
- Difficulty in reaching ejaculation or orgasm is fairly uncommon in men but may be causes by
certain drugs as SSRIs. It may be treated by changing or adding drugs or by sensate-focus
exercises in which the man and his partner progressively explore each other’s bodies while
avoidance performance demands
- Many conditions can lead to problems with penile erection; these include smoking, use of
alcohol and certain prescriptions or recreational drugs, diabetes, cardiovascular disease,
spinal cord injury, and prostate surgery. Among psychological factors that may impair erectile
function, performance anxiety is probably the most important. Treatment of erectile
disorder can include alleviation of the underlying disorder, psychotherapy, or the use of
Viagra-type drug. The nondrug treatments available include vacuum devices and penile
implants.
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, - ‘Female sexual arousal disorder’ refers to difficulties with vaginal lubrication or engorgement
or with clitoral erection. Insufficient lubrication is common, especially after menopause; it
can be dealt with by the use of lubricants. Hormone replacement often restores physiological
arousal in postmenopausal women. Sex therapy exercises may be helpful.
- In women, painful coitus (dyspareunia) can result from a wide variety of biological causes,
including insufficient lubrication, scars, and vaginal atrophy. It can often be treated by
correction of the underlying condition.
- In vaginismus, coitus is impossible because of some combination of pelvic muscle spam and
pain or fear of pain. It is treated by psychotherapy and sex therapy exercises including the
use of vaginal dilators.
- Many women have problems with orgasm. Some have never experienced it, and some do
not experience it during partnered sex or during coitus. A biological cause for orgasmic
disorder cannot usually be identified. Sex therapy for anorgasmia may include a program of
directed masturbation or sensate-focus exercises. A woman may be helped to experience
orgasm during partnered sex or coitus by adding effective clitoral stimulation, trying different
positions, or extending the duration of the sexual interaction. It may also be helpful to
address relationship problems.
- Excessive sexual desire or behaviour (hypersexuality) in either sex can be caused by
neurological damage, various mental illnesses, or certain drugs. Hypersexuality may include
frequently repeated and seemingly involuntary involvement in masturbation, partnered sex,
pornography use, telephone sex, and the like. Such behaviours may be classed as compulsive
disorders, and like other such disorders, they often respond well to SSRIs. The use of the
term ‘sex addiction’ to describe these conditions is controversial.
- Women are more likely than man to experience a lack of interest in sex. Sex hormone levels
strongly influence sexual desire. Women who are distressed by a lack of sexual desire may be
helped by treatment with estrogens, androgens, or a combination of the two, but androgen
treatment can cause unwanted or harmful side effects. Sex therapy may help people with
low desire ‘let go’ of thought patterns that interfere with sexual pleasure, such as a
perceived obligation to ensure their partner’s satisfaction. Lack of sexual desire has to be
evaluated in a broad context which includes not just medical problems but also
psychological, relationship, and socioeconomic issues.
Nederlandse boek uit samenvatting
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, Gezien de hoge mate van comorbiditeit dient naast de aanmeldingsklacht ook expliciet aandacht te
zijn voor andere klachten/problemen binnen de seksuele responscyclus. Drie kernpunten over
seksuele disfuncties bij vrouwen:
- Bij vrouwen is er weinig samenhang tussen de sterkte van genitale opwindingsrespons en
de mate van ervaren seksuele opwinding.
- Bij vrouwen is de context (omgevingsfactoren en sfeer) van de seksuele stimulatie van groot
belang voor de beleving van seksuele gevoelens
- Comorbiditeit met andere seksuele disfuncties komt bij vrouwen veel voor
STOORNISSEN IN HET SEKSUEEL VERLANGEN
Verminderd seksueel verlangen (Hypoactive Sexual Desire Disorder) is een aanhoudend of
recidiverend gebrek aan seksuele fantasieën en verlangen naar seksuele activiteit.
Het is belangrijk om ‘verminderd seksueel verlangen’ te differentiëren van seksuele aversie. Bij geen
zin gaat het vooral om het ontbreken van iets dat wel na te streven is. Bij seksuele aversie zijn het
vooral de negatieve emoties (bijvoorbeeld walging, angst) die maken dat een vrouw een seksuele
situatie probeert te vermijden.
Moderne motivatietheorieën stellen dat motivatie het resultaat is van een samenspel tussen de
gevoeligheid van het responssysteem en prikkels die in de omgeving aanwezig zijn. Volgens deze
opvatting is zin het resultaat van een emotionele reactie op bepaalde prikkels. Zin in seksualiteit gaat
niet vooraf aan opwinding, maar is een gevolg van of gaat samen met opwinding. Je krijgt zin omdat
je met seks bezig bent. De voorwaarden voor het opgang brengen van een seksueel proces zijn
volgens de auteur:
- Er moet een intact seksueel systeem zijn dat seksueel responderen mogelijk maakt
- Er moeten (seksuele) stimuli zijn die het seksuele systeem kunnen activeren
- Er moet de mogelijkheid zijn om over te gaan tot seksuele activiteit
Als aan één van deze voorwaarden niet of onvoldoende gedaan is, komt het seksuele proces niet op
gang of wordt het afgebroken.
Regan et al. Vonden dat mannen en vrouwen beiden het seksueel verlangen ervaren als een toestand
van gemotiveerd zijn om een doel te bereiken. Mannen zien de seksuele activiteit als doel op zich,
terwijl vrouwen vaker ‘emotionele intimiteit. Betrokkenheid en liefde, als doel noemen.
Door Basson is een specifiek seksueel responsmodel voor vrouwen ontworpen (zie taak 1). Naast
behoefte aan intimiteit zijn voor vrouwen ook andere uitgangspunten van seksuele activiteit
mogelijk. Het model benadrukt dat zin het resultaat is van de verwerking van seksuele stimuli.
Hoewel het individu in de verschillende modellen centraal staat, speelt de relatie met de ander wel
een belangrijke rol in de toename/afname van verlangen in seks met de partner. In behandeling van
problemen met seksueel verlangen wordt ook aandacht geschonken aan de relatie.
Etiologie
Somatische factoren = aanwijzingen dat het seksueel verlangen zou verminderen wanneer de
hoeveelheid oestrogenen en androgenen afneemt, zoals in de postmenopauze.
Onderzoeksbevindingen zijn niet eenduidig.
Psychische factoren = Grote verscheidenheid van psychische factoren (bijv. depressie) kan aan de
basis liggen van de klachten geen zin/ verminderde zin. Vaak komt verminderd seksueel verlangen
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