gender midterm.txt

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Emcalder
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gender midterm.txt
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2012-10-24 03:31:48
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gender sexuality
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    • sexual problem?
    • More emotionally based including degree of passion, types of communication, etc. ; complaints that encompass a broad spectrum of factors that are related to sexuality issues. (ex.: dissatisfaction with sexual frequency, sexual boredom, incompatibility with respect to sexual activity, lack of sexual fulfillment, etc.)
  1. sexual dysfunction?
    Physical or psychological impairments of one of the phases of sexual response ; impairments, either physical or psychological, that are of one of the three phases of the sexual response cycle. (ex. Erectile disorder, premature ejaculation, male orgasmic disorder, sexual aversion disorder, vaginismus, dyspareunia, HSDD, etc.)
  2. circular questioning
    Helps couples consider how the current sexual problem has affected their lives, and how family members or others have influenced the problem.

    Helps couples to externalize the problem and understand that they have power over the problem.
  3. 2 types of circular questioning
    2 types:

    • 1. Comparison and Classification
    • 2. Interventive Questions
  4. Role of Anxiety in Erectile Dysfunction and Premature Ejaculation
    Negative Cognitive Feedback Loop For many men, the sexual act is viewed as an evaluation of performance. This evaluation places men in the position of succeeding or failing, which means that a responsibility to perform can become unmanageable and cause anxiety.

    Anxiety about sexual performance is usually the most immediate cause of sexual dysfunction. In some cases, premature ejaculation is situational, influenced by external stressors such as family pressures, life crises, or work stress.
  5. Negative feedback loop
    • There is a demand for sexual performance…
    • Negative emotions (anxiety) leads to cognitive interference, which leads to

    anxiety, which leads to increased cognitive interference, which leads to

    were, ultimately, the individual avoids sex
  6. Strategies for Treating HSDD
    • Hormone Therapy
    • Medication Adjustment
    • Relationship Counseling
    • Sensate Focus
    • Couples’ Communication
    • Skill Building—using “I” statements
    • Psycho educational Training
    • Desensitization
    • Sexual Fantasy

    For men: Masturbation Training
  7. Treating HSDD via Reduce Response Anxiety
    Definition: Anxiety experience felt over not feeling enough desire, at all, or in sexual contexts. -Nearly universal amongst those suffering from Hypoactive Sexual Desire Disorder (HSDD)

    • -Therapist gives HSDD partner permission to feel only the desire he or she feels and not anything more
    • -Address fears of sexual intimacy
    • Fear of Exposure
    • Fear of Control
    • Fear of Anger
    • Fear of Rejection
    • Fear of Abandonment

    • Assign homework
    • Sensate Focus;
    • Non-Demand Intercourse -

    Therapist must be flexible -

    Reduce the impact on the relationship
  8. Sexual Response Cycle and the Domains for both female and male responses in the sexual response cycle
    Excitement: (“Turning the system ‘On’”) Fantasies about the sexual activity and the desire to have sexual activity

    Plateau: (Foreplay and intercourse leading up to orgasm) Subjective sense of sexual pleasure and accompanying physiological changes, such as lubrication in females and swelling of the external genitalia

    Orgasm: Peaking of sexual pleasure, with release of sexual tension and rhythmic contraction of the perineal muscles and reproductive organs


    Resolution: A sense of muscular relaxation and general well-being
  9. Major Physiological Changes During Each of the Four Phases of the Sexual Response Cycle WOMEN
    • Women: Excitement: Clitoris swells
    • Labia separates from vaginal opening
    • Lubrication begins
    • Breasts enlarge

    • Plateau: Orgasmic Platform forms
    • Clitoris withdraws under its hood

    • Orgasm: Orgasmic Platform contracts rhythmically 3-15 times
    • Clitoris remains retracted under its hood

    • Resolution: Clitoris descends and engorgement slowly subsides
    • Labia returns to unaroused size
  10. Major Physiological Changes During Each of the Four Phases of the Sexual Response Cycle MEN
    • Men: Excitement: Penis becomes erect
    • Testes elevate and engorge

    Plateau: Engorgement and elevation of testes becomes more pronounced

    • Orgasm: During emission phase, pooling of seminal fluid occurs
    • During expulsion phase, semen is expelled

    • Resolution: Erection is lost over a period of a few minutes
    • Testes descend and return to their normal size
  11. Inter system APPROACH
    Developed by Weeks as an approach that included these five areas:

    Individual/Biological/Medical: An individuals biology, medical status is one of many contributions to sexual issues. (medical conditions/disorders, medications, etc.)

    Individual/Psychological: Mental disorders and their symptoms can contribute to relational and sexual issues. Assess psychological makeup of each partner through the use of familial and sexual history taking. (personality disorders, depression, etc.)

    Dyadic/Couple Relationship: Systemic sex therapy treats the relationship as the client, while recognizing individual contributions. Unconscious collusion is expressed by one partner. (how individual problems occur within the couple)

    Family of Origin: How did these individuals learn about sex? What were the messages from parents? Abuse? (inter generational aspects of each person in the relationship)

    Society/Culture/History/Religion: Permissive societies versus conservative; Norms of society/community versus norms of couple
  12. Sensate Focus: There are 4 phases and goals in Sensate Focus
    Phase 1: Treatment begins by instructing couples to abstain from sexual intercourse. Several days later they may begin to engage in non-demanding caressing (sensual touching) through the use of sensate focus techniques. Couples learn to give and receive pleasure in a relaxed atmosphere away from the demands of sexual performance. Sensate focus activities serve to alleviate anxiety and obsessive thoughts that may have interfered with a man’s ability to perform.

    Phase 2: When anxiety has subsided and both partners are comfortable with exploring and giving pleasure to each other, the next step can be initiated. In this phase, couples focus on genital stimulation. This involved oral or manual pleasuring, or both.

    Phase 3: The final phase of sensate focus involves penile penetration into the vagina. For this step, couples begin with sensate focus and genital stimulation.

    Phase 4: Continued intercourse in stages.
  13. 9 Functions of Sensate Focus
    • 1. Help each partner become more aware of his or her own sensations
    • 2. Focus on one’s own needs for pleasure and worry less about the problem or the partner
    • 3. Communicate sensual and sexual needs, wishes, and desires
    • 4. Increase awareness of the partner’s sensual and sexual needs
    • 5. Expand the repertoire of intimate, sensual behaviors
    • 6. Learn to appreciate foreplay as a goal start rather than a means to an end
    • 7. Create positive relational experiences
    • 8. Build sexual desire
    • 9. Enhance the level of love, caring, commitment, intimacy, cooperation, and sexual interest in the relationship
  14. Appropriate Sensate Focus Activity:
    You will need to set aside about 20 minutes for the main part of this experience. During that 20 minutes, take turns touching each other in a sensual manner. The touch can resemble a gentle massage (of the specific body parts that were determined in the session). Each of you will have about 10 minutes. Rather than touching each other at the same time, please take turns. By taking turns you will be able to focus either on what you are feeling or what the other person would like to receive from you. The goal of this exercise is not to get sexually stimulated; however, if you happen to feel aroused, just take note of it.
  15. HYPOACTIVE sexual desire disorder
    (A)Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person’s life.

    (B)The disturbance causes marked distress or interpersonal difficulty.

    (C)The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g a drug of abuse, a medication) or a general medical condition.
  16. Sexual Aversion Disorder
    (A)Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner.

    (B)The disturbance causes marked distress or interpersonal difficulty.

    (C)The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction)
  17. Female Sexual Arousal Disorder
    (A)Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement.

    (B)The disturbance causes marked distress or interpersonal difficulty.

    (C)The sexual dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g a drug of abuse, a medication) or a general medical condition.
  18. Female/Male Orgasmic Disorder
    (A)Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Women exhibit wide variability in the type of intensity of stimulation that trigger orgasm. The diagnosis of Female Orgasmic Disorder should be based on the clinician’s judgment that the woman’s orgasmic capacity is less than would be reasonable for her age, sexual experience, and the adequacy of sexual stimulation she receives.

    (B)The disturbance causes marked distress or interpersonal difficulty.

    (C)The orgasmic dysfunction is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g a drug of abuse, a medication) or a general medical condition.
  19. Dyspareunia
    (A)Recurrent or persistent genital pain associated with sexual intercourse in either a male or a female.

    (B)The disturbance causes marked distress or interpersonal difficulty.

    (C)The disturbance is not caused exclusively by Vaginismus or lack of lubrication, and is not better accounted for by another Axis I disorder (except another Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g a drug of abuse, a medication) or a general medical condition.
  20. Vaginismus
    (A)Recurrent of persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse.

    (B)The disturbance causes marked distress or interpersonal difficulty.

    (C)The disturbance is not better accounted for by another Axis I disorder (e.g., Somatization Disorder) and is not due exclusively to the direct physiological effects of a general medical condition.
  21. Male Erectile Disorder
    (A) Persistent of recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate erection.

    (B)The disturbance causes marked distress or interpersonal difficulty

    (C)The erectile dysfunction is not better accounted for by another Axis I disorder (other than a Sexual Dysfunction) and is not due exclusively to the direct physiological effects of a substance (e.g a drug of abuse, a medication) or a general medical condition.
  22. Premature Ejaculation
    (A)Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. The clinician must take into account factors that affect duration of the excitement phase, such as age, novelty of the sexual partner or situation, and recent frequency of sexual activity.

    (B) The disturbance causes marked distress or interpersonal difficulty

    (C)The premature ejaculation is not due exclusively to the direct effects of a substance (e.g., withdrawal from opiods).

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