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14: Sexual Function Difficulties, Dissatisfaction, Enhancement, and Therapy
14: Sexual Function Difficulties, Dissatisfaction, Enhancement, and Therapy
© 2019 McGraw-Hill Education. All rights reserved. Authorized only for instructor use in the classroom. No reproduction or
further distribution permitted without the prior written consent of McGraw-Hill Education.
Main Topics
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Sexual Function Difficulties: Definitions,
Types, and Prevalence
Sex problems are normal and typical.
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Defining Sexual Function Difficulties:
Different Perspectives
Standard medical diagnostic classification is found in the
American Psychological Association’s DSM-5, using the terms
sexual dysfunction and sexual disorders.
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The Diagnostic and Statistical Manual of
Mental Disorders
APA’s DSM-5 definition of sexual dysfunction:
a clinically significant disturbance in a person’s ability to respond
sexually or to experience sexual pleasure.
All dysfunctions require the symptoms to be present for at least 6
months, unless caused by substance or medication use, and cause
significant distress.
APA further notes that sexual response and function occur as an
interaction of biological sociocultural, and psychological factors.
DSM-5 largely reflects a psychiatric model, the heterosexual
context, and a linear sequence of desire, arousal, orgasm, and so
on.
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Table 1 DSM-5 Sexual Dysfunctions/Disorders
Dysfunction/disorder Description
Female sexual interest/arousal disorder. Absent/reduced sexual thoughts, fantasies, initiation,
and receptivity, and absent/reduced arousal and
pleasure during sexual activity.
Male hypoactive sexual desire disorder. Persistence or absence of sexual thoughts, fantasies,
and desire for sexual activity.
Erectile disorders. Difficulty with erections during partnered sexual
activity.
Female orgasmic disorders. Difficulty in experiencing orgasms or reduced intensity
of orgasms during sexual activity.
Premature (early) ejaculation. Experiencing “early” ejaculation following vaginal
penetration.
Delayed ejaculation. Marked delay in or inability to ejaculate, usually
during partnered sexual activity.
Genito-pelvic pain/penetration disorder. Difficulties related to genital and pelvic pain and
vaginal penetration during intercourse.
Substance/medication-induced sexual A specific substance presumed to cause the sexual
dysfunction. dysfunction.
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@2019 McGraw Hill Education. source: American Psychiatric Association (APA), Diagnostic and Statistical Manual of Mental Disorders, 5th ed. (DSM-5). Arlington, VA: 2013.
A New View of Women’s Sexual Problems
Note: Percents are rounded; hence, the total may exceed 100%.
Access the text alternative for these images. 14-10
@2019 McGraw Hill Education. Source: Adapted from Herbenick et al., 2010.14a.
Figure 3 Percentage of Self-Reported Sexual
Function Difficulties in the Past 12 Months Among
U.S. Adults Aged 18 to 59, by Gender and Age
A Finnish study of 2,650 adults found that feelings of sexual desire decreased as
the individual aged and as a relationship continued through the years. Note the
slight upward trend for women around age 45 to 49, before resumed decrease
in interest.
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@2019 McGraw Hill Education. Source: Kontula, 2009.
Figure 5 Percentage of Finnish Adults Who
Indicated That If They Could Choose Freely They
Would Like to Have Intercourse at Least Twice a
Week
Feelings of sexual desire decrease as a relationship continues through the years. Here,
note the steady decrease in interest among women as the relationship duration
increases, while for men, interest decreases around 6 to 9 years into the relationship,
increases again at around 10 to 19 years, and then decreases steadily thereafter.
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@2019 McGraw Hill Education. Source: Kontula, 2009.
Disorders of Sexual Desire
DSM-5 diagnoses:
Female sexual interest/arousal disorder.
Male hypoactive sexual desire.
Erectile disorder.
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Orgasmic Disorders
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Physical Causes of Sexual Function Difficulties
and Dissatisfaction
Until recently, researchers believed most sexual function
difficulties and dissatisfaction were almost exclusively
psychological in origin.
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Physical Causes in Men
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Psychological Causes of Sexual Function
Difficulties and Dissatisfaction (2 of 2)
Various conflicts within the self can contribute.
For example, among gay men, lesbian women, and bisexual
individuals, internalized homophobia: self-hatred because of
one’s homosexuality.
Sources of severe difficulties include childhood sexual abuse,
adult sexual assault, and rape.
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Sexual Function Enhancement
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Developing Self-Awareness (1 of 2)
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Developing Self-Awareness (2 of 2)
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Intensifying Erotic Pleasure
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Table 2 Percentage of Sexually Satisfied Men and Women
Versus Those Dissatisfied Who Indicated They Had Done
Different Activities in the Past Year to Improve Their Sex
Life
Acts of Sexual Variety Past Year (% Yes) Sat. Men Dis. Men Sat. Women Dis. Women
At least one of us got a mini-massage or backrub 72% 48% 68% 40%
Talked about or acted out our fantasies 40% 14% 37% 16%
Had anal intercourse 25% 10% 26% 14%
Had sexual contact in a public place 23% 6% 19% 6%
Videotaped our sex or posed for pictures in the nude 15% 5% 13% 5%
Invited another person into bed with us 6% 2% 3% 2%
Participants were asked, “Have you done any of the following in the past year to improve your sex life? If so, select all
that apply.”
Participants provided their answers on a 7-point Likert scale: 1 = very dissatisfied, 7 = very satisfied. For this table,
dissatisfied represent answers 1 to 3 combined and satisfied as 5 to 7 answers combined. 14-27
source: Adapted from Frederick D. A., Lever, J., Gillespie, B. J., and Garcia, J .R., “What Keeps Passion Alive? Sexual Satisfaction Is Associated With Sexual Communication, Mood Setting,
@2019 McGraw Hill Education. Sexual Variety, Oral Sex, Orgasm, and Sex Frequency in a National U.S. Study,” The Journal of Sex Research, vol. 54, no. 2, February 2017, 186–201.
Table 3 Percentage of Sexually Satisfied Men and
Women Versus Those Dissatisfied Who Indicated They
and Their Partner Had Talked About Sex in Any of These
Ways
Communication Past Month (% Yes) Sat. Men Dis. Men Sat. Women Dis. Women
I asked for something I wanted in bed 51% 28% 42% 15%
One of us praised the other about something they did in bed 50% 12% 56% 14%
My partner asked for something they wanted in bed 37% 8% 50% 21%
One of us asked for feedback on how something felt 34% 13% 33% 12%
One of us called/emailed to tease about doing something sexual 33% 11% 40% 14%
One of us gently criticized how the other did something in bed 7% 7% 7% 7%
Participants were asked, “In the past month, have you and your partner talked about sex
in any of these ways? Please select all that apply.”
Participants provided their answers on a 7-point Likert scale: 1 = very dissatisfied, 7 =
very satisfied. For this table, dissatisfied represent answers 1 to 3 combined and satisfied
as 5 to 7 answers combined.
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source: Adapted from Frederick D. A., Lever, J., Gillespie, B. J., and Garcia, J .R., “What Keeps Passion Alive? Sexual Satisfaction Is Associated With Sexual Communication, Mood Setting,
@2019 McGraw Hill Education. Sexual Variety, Oral Sex, Orgasm, and Sex Frequency in a National U.S. Study,” The Journal of Sex Research, vol. 54, no. 2, February 2017, 186–201.
Treating Sexual Function Difficulties (1 of 6)
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Table 4 Strategies to Cope With Sexual
Difficulties
Explore ways to change the situation.
One could end the current relationship and seek to begin another, or look for ways to resolve the
problem psychologically or medically (e.g. erection-enhancing drugs).
Amend your goals to fit the circumstances.
One could take a flexible perspective toward the importance of sex by focusing more on other
relationship aspects and other priorities.
One could lower expectations by accepting a trade-off between having a relationship with a person
one loves and experiencing the perfect physical sexual experience.
A person could expect to have “good sex” less often.
One could adapt flexible definitions of “good-enough” sex by shifting from perceiving excitement as
most important to considering intimacy as the most important.
Live with a gap between one’s sexual goals and the circumstances.
One could perceive one’s experience as normal and favorably compare one’s experience with other
persons.
One could avoid thinking about the problem, initiating sexual relationships, and experiencing sexual
activity.
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@2019 McGraw Hill Education. source: Mitchell, R., King, M., Nazareth, I., & Wellings, K., “Managing Sexual Difficulties: A Qualitative Investigation of Coping Strategies,” The Journal of Sex Research, vol. 48, 2001, 325–333.
Treating Sexual Function Difficulties (2 of 6)
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Treating Sexual Function Difficulties (3 of 6)
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Treating Sexual Function Difficulties (4 of 6)
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Treating Sexual Function Difficulties (5 of 6)
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Final Thoughts?
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