Discovering Human Sexuality 4e Chapter 14 Summary

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.
“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, infections, allergies, developmental malformations, 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 tension 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.
Women are more likely than men 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.
The causes of premature ejaculation, a very common male sexual disorder, are poorly understood. A man who ejaculates too soon may be helped by sex therapy exercises in which he learns to maintain his arousal at a medium level for extended periods of time. Premature ejaculation can also be treated with selective serotonin reuptake inhibitors (SSRIs).
Difficulty in reaching ejaculation or orgasm is fairly uncommon in men but may be caused by certain drugs, such 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 avoiding performance demands.
Many conditions can lead to problems with penile erection; these include smoking, use of alcohol and certain prescription 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 a PDE5 inhibitor (Viagra-type drug). The nondrug treatments available include vacuum devices and penile implants.
Excessive sexual desire or behavior (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 behaviors 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.
LGBT people may experience the same sexual difficulties as other people, but there are some concerns specific to sexual or gender minorities. Some gay people are in relationships with opposite-sex partners, which may make it difficult to engage in or enjoy sexual interactions. Internalized homophobia may impair sexual desire, pleasure, or performance. Anal penetration, widely practiced by gay men, can cause pain. Trans people may be unhappy with their genitals, and if they undergo sex-reassignment surgery, their new genitals may not perform as well as desired. LGBT-affirmative therapists are skilled in helping non-heterosexual men and women overcome problems of these kinds.