1

Female Sexual Dysfunction

2
Sex Myths
Masturbation causes hairy palms, insomnia, impotency, lack of
concentration, and blindness.
The bigger the penis, the better.
Men can instantly produce an erection on demand, while women turn
on much more slowly.
If we didn't have intercourse, we didn't have sex.
Having good sex should come as naturally as breathing.
The proper way for a woman to orgasm is through penis-vagina sex.



3
Sexual Response Cycle
Sexual Desire
Sexual Arousal
Orgasm
4
DSM-IV
Causes personal distress or interpersonal difficulty
Symptoms persistent and recurrent
Types:
lifelong vs. acquired
generalized vs. situational
psychological, organic, or combined causes
5
Hypoactive Sexual Desire Disorder
What is low desire?
Prevalence rates (Laumann et al., 1999)
age
marital status
education
race


6
Hypoactive Sexual Desire Disorder
Causes:
Physiological factors:
Hormones
neurotransmitters
CNS
Psychological factors:
daily hassles
high stress
relationship issues


7
Hypoactive Sexual Desire Disorder
Relationship issues:
conflict
attraction
sexual compatibility
sexual skill
desired level of intimacy
power dynamics
Guilt
Psychological disorders

8
Hypoactive Sexual Desire Disorder
Treatment
rule out physiological causes
couple problem
address beliefs
communication issues
affection

9
Sexual Aversion Disorder
A form of anxiety
history of sexual abuse/assault
Treatment: address underlying anxiety
10
Female Sexual Arousal Disorder
Psychological & physiological components
Prevalence
age
marital status
education
race

11
Female Sexual Arousal Disorder
Causes:
physiological
hormones
neurotransmitters
SNS activation (Meston, 1996)
touch sensation (Frohlich, 1999)
psychological
anxiety (Barlow)
performance demand (Laan, 1993)
expectancies (Palace, 1995)

12
Female Sexual Arousal Disorder
Psychological causes continued: similar causes as HSDD
Relationship issues:
conflict
attraction
sexual compatibility
sexual skill
desired level of intimacy
power dynamics
Guilt
Psychological disorders
13
Female Sexual Arousal Disorder
Viagra?
EROS-CTD
Couples counseling to address psychological issues
14
Female Orgasmic Disorder
Delayed or absent orgasm following normal sexual excitement
age
sexual experience
degree of sexual stimulation
lifelong vs. acquired; generalized vs. situational
Prevalence:
age
marital status
education
race
15
Female Orgasmic Disorder
Causes:
physiological
Lack of SNS activation (Meston, 1996)
psychological:
distraction
discomfort about sex
guilt
endorse sex myths
negative attitudes about masturbation

16
Female Orgasmic Disorder
Treatment
education
self-exploration
directed masturbation
couple exploration
Success rates up to 90% (Heiman & Meston, 1998)

Becoming Orgasmic, by Julia Heiman
17
Pain Disorders: Dyspareunia
Pain associated with sexual intercourse
Adequate vaginal lubrication?
Pain syndrome or sexual problem?
Descriptors:
location
quality
elicitors
course
intensity
meaning
18
Pain Disorders: Dyspareunia
Causes:
anatomical
pathological
iatrogenic
psychological
Abnormalities in pain sensation (Pukall, 2000)
Treatment:
multidisciplinary
cognitive-behavioral therapy:
systematic desensitization
couples counseling
19
Vaginal Dilators
20
Pain Disorder: Vaginismus
Involuntary spasm of vaginal musculature interfering with intercourse
Generalized vs. sexual problem
Prevalence
Causes:
medical conditions (23-32%)
family background
sexual trauma (40%)
Treatment:
cognitive behavioral therapy
beliefs
education
muscle exercises, vaginal dilation