Nov 1 Topic 12Sexual dysfunctions: things that go wrong. There are 3 types of sexual dysfunctions based on a combination of work of master and johnson and Helen singer. - Having sex to orgasm sequence- 1. Disorder of desire (2Manefiestations)o Inhibited sexual desires. One of the partners simply are not really interested in sex.  “Hyposexualty” o Non inhibited Hypersexuality Have sex all the time to the point where it disrupts his or her entire life. o Disorder of desire is hardest to treat cause of definitional problems.o Real hypo and hyper sexuals are at the extremes of the distributiono Those with inhibited sexual desires can go without sex, but the problem occurs when mismatch occurs between that person and the partner who does want to have sex. o If both partners are uninterested in sex then there is no problem. o When dealing with sexual dysfunctions, the patient, or the client is not one individual, the client is the sexual relationship.o Female hypersexual= nymphomaniac Emperor Claudius wife was nymphomaniaco Male hypersexual= sateriatist o Treatment for female disorder of desire is letting things happen.- 2. Disorder of arousalo These dysfunctions can be primary, meaning individual always had this fromthe beginning. Or it could be secondary that at some time early one they were functional but now they are not. o Erectile failure: inability to achieve erection (male)o This concept developed by Masters and Johnsons This was a learning problem. 50 percent of erectile dysfunction is physical while the rest is psychological.  They argued that in normal life there will be times even for young men when they cant have an erection The probable causes are: fatigue, distraction, worry, alcohol. For most men, when this happens, a good night sleep helps get rid of the problem.  Males often obsess about the problem, and they engage in the activity which masters and Johnson called spectatoring.- Watched to see if it comes up, but if they worry, then it wont come up. Object of treatment is to unlearn the bad habit and to release reflexactivity ( to relearn the correct way) Women have problem of lubrication, but now we have whole line ofproducts to take care of that. (KY)  Major concern with using a lubricant is oil based vs. water based. Always use water base because oil base can harvest diseases.o Orgasmic dysfunction: (female) – anatomical, males can be turned on by anything (visual cues). For females, getting turned on is a physical matter with direct stimulation in the right places.  For females, reaching orgasm is the main problem. The therapy will involve a set of exercises designed to allow the female to just feel.  Disorder of orgasm is much less in males. There are males who erecteasily, but simply have difficulty in achieving orgasm. - Solved by increasing general other stimulation (pain,) Females don’t have refractory periods so they can keep orgasming. For males, major problem is premature ejaculation: if ejaculation occurs 2 minutes of more after penis is inserted in vagina, then it is normal. - COMMON dysfunction in males. - The most treatable of all dysfunctions Women is called preorgasm.- Therapy will involve letting things go and letting things happen.  Males: penis can be bent and it hearts during penetrations Females: Vaginismis: reflex contraction of the muscle around vaginawhich squeezes it down, making orgasm painful if not impossible. - Can be cause from total fear.- Treatable and successful- 3. Situation Disorder: self-masturbation is no problem, but when a partner comes along, it becomes a problem. o Or if you have no problem with one partner, but you have problems with another partner. Good sex is sensing what your body is doing. Taking turns while one partner feels while other is stimulating. Adult play. Has no object in itself except pleasurable feeling. It is amoral as long as both are voluntarily doing. Activation of pleasure in the brain. “Sexual dysfunctions is for whatever reason, we have learned the BAD sexual habits which make the whole activity non pleasurable. The object of sex therapy is to get rid of the bad habits to unlearn and relear (to gain new habits) which will allow things to occur” Masters and JohnsonSex is a reflex as long as right parts are stimulated. Orgasm is a pleasurable buildup of tension followed by a release of that tension which is even more pleasurable.Within 20 seconds the male will erect, female will lubricate. But it needs appropriate stimulation of clitoris. All therapy will involve the use of a model. The “PLISSIT” model. Represents a series of attempts to deal with sexual problems. P: Permission Giving, very difficult for women than men. For a long time in western civilization, women were considered to be insatiable. The more insatiable they were, the more they conflicted with church and they had to be more suppressed. - In some societies, the hack off clitoris so that women will not become permiscuous after marriage. L: LimtedI: Information : Education function. If your dealing with sexual problem, the permission giving may be enough, and you can stop, but one may be ignorant about things so you get the education. S: SpecificS: Suggestions: This is the learning part. Therapist gives homework I: Intensive T: Therapy: If SS fails, then you do this. Masters Johnsons clients were either married or paired off in long term relations who didn’t have problems other than their sex life problems, so they were screened carefully. They would treat couples, and not individuals. They added that the therapist need to be a couple. (one male and 1 female) so that each member of patient couple would have someone of same sex to talk