sexual dysfunction difficulty functioning adequately while having sex paraphilic disorders when sexual arousal occurs in the context of inappropriate objects individuals incidence of masturbation is the largest gender difference in sexuality women have broader more general patterns of arousal than men both straight and lesbian women can become aroused from both male and female sexual stimuli the vast majority of people engage in heterosexual vaginal intercourse in the context of a relationship with one partner women s sexuality is more influenced by the environment and less influenced by genetics than men genes account for 34 39 of homosexual behavior in men and only 18 19 in women women are more likely to change their sexual identities over time than men one of the possible causes of diff sexual orientations could be exposure to diff hormones in utero 3 aspects of assessing sexual behavior 1 in person interviews supported by paper questionnaires 2 medical evaluation to rule out medical conditions or medicines that may be contributing to sexual problems 3 psychophysiological assessment to measure physiological aspects of sexual arousal SEXUAL DYSFUNCTION DISORDERS specify if lifelong acquired generalized situational are they being adequately stimulated rule out use of substances that impair sexual functioning medical conditions medications that impair sexual functioning abusive relationships relationship distress considerations religion how might religious background influence beliefs about sex body image history of abuse partner relationship factors and communication partner s health psychological state symptoms must persist for at least 6 months and happen at least 75 of the time many men w sexual dysfunctions believe in myths about sex it is very common to have more than one sexual dysfunction many biological factors including physical and medical conditions can cause sexual dysfunctions neurological diseases vascular disease cardiovascular disease chronic illness indirectly fear of physical exercise b c of heart attack etc prescription meds like SSRIs esp Prozac cocaine heroin alcohol suppresses CNS cigarettes and more in normally functioning adults anxiety or performance demand increases sexual arousal sexual situations result in a positive affect they are not distracted by nonsexual stimuli and they have a good idea of how aroused they are in those w sexual dysfunction anxiety or performance demand decreases arousal sexual situations result in a negative affect they are distracted by nonsexual stimuli and they do not have an accurate sense of how aroused they are they underreport their arousal some reasons why people may develop sexual dysfunction they learned early in life that sexuality can be negative and threatening they were sexually assaulted they sexually assaulted someone they are really stressed they don t love their partner anymore they aren t self confident they are sexually inexperienced and unwilling to try new things in bed script theory of sexual functioning says that we all operate by following scripts that reflect social and cultural expectations and guide our behavior for example in India wet dreams are looked down upon as a depletion of physical and mental energy and as a result tons of men in India are really concerned about wet dreams and also present with premature ejaculation treatments are based on the basic sex therapy treatment developed by Masters and Johnson partners build up very slowly from kissing and touching to sexual intercourse helps reestablish arousal sensate focus focus on sensations and nondemand pleasuring pleasuring without having the demand of intercourse it is a psychosocial intervention education about sex and eliminating performance anxiety one treatment that is effective for lots of people with sexual dysfunction disorders is education about the basic sexual response cycle and intercourse overall treatment strategy of choice is a combo of psychological and drug treatment Sexual Desire Disorders problems with the desire and or arousal phase of the sexual response cycle for men the prevalence increases with age and for women it decreases with age 1 8 prevalence in 16 45 year old men probably more common in women treatment for both genders reeducation and communication phases of traditional sex therapy education about normative sex stuff therapy with both partners in relationship and possibly the addition of masturbatory training and exposure to erotic material male hypoactive sexual desire disorder little or no interest in sexual activity that causes significant distress in the individual absent reduced masturbation and sexual fantasies female sexual interest arousal disorder little or no interest in sexual activity that causes significant distress in the individual absent reduced masturbation and sexual fantasies Sexual Arousal Disorders erectile disorder problem is with arousal not desire 8 of men will have some problems with erection in their first sexual experience but that isn t erectile disorder and doesn t mean they ll have persistent difficulties extremely common after age 60 60 of men in their 60s and over have it most common treatment is Viagra most men do get an erection with the drug but most aren t satisfied with the results which suggests a need for additional drug or psychological treatment CBT tends not to be the best long term solution vasodilating drugs like papaverine or prostaglandin are injected directly into the penis when the man wants to have intercourse and produce an erection however it is somewhat painful and ppl don t tend to use it for a long time penile prostheses are sometimes used implantation of a semirigid silicone rod or the implantation of a small pump into the scrotum that can force fluid into an inflatable cylinder that produces an erection can be bent into correct position however surgical implants fall short of restoring presurgical sexual functioning or assuring satisfaction in most patients vacuum device therapy creates a vacuum in a cylinder placed over the penis and produces an erection it s awkward but it is less intrusive than the other things and does produce satisfactory erections compared to other sexual dysfunctions many more men will seek treatment for erectile disorder treatment squeeze technique woman stimulates partner s penis or man stimulates own penis and then squeezes area joining head and shaft reducing arousal man develops sense of control over arousal and ejaculation