{"id":1792,"date":"2020-09-10T15:35:11","date_gmt":"2020-09-10T15:35:11","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=1792"},"modified":"2022-07-26T20:07:06","modified_gmt":"2022-07-26T20:07:06","slug":"treating-sexual-dysfunction-disorders","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/treating-sexual-dysfunction-disorders\/","title":{"raw":"Treating Sexual Dysfunction Disorders","rendered":"Treating Sexual Dysfunction Disorders"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li style=\"font-weight: 400;\">Examine perspectives and treatments related to sexual dysfunction disorders<\/li>\r\n<\/ul>\r\n<\/div>\r\n<h2>Perspectives on Sexual Dysfunction Disorders<\/h2>\r\nThere are many factors that may result in a person experiencing sexual dysfunction. These may result from emotional or physical causes. Emotional factors include interpersonal or psychological problems, which can be the result of\u00a0depression, sexual fears or guilt, past sexual trauma, and sexual disorders,\u00a0among others.\r\n\r\nSexual dysfunction is especially common among people who have\u00a0anxiety disorders. Ordinary anxiousness can obviously cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as\u00a0panic disorder\u00a0commonly cause avoidance of intercourse and premature ejaculation.\u00a0Pain during intercourse is often a comorbidity of anxiety disorders among women. Therefore,\u00a0 clinicians are careful not to rule out the fact that there may be physiological causes of these dysfunctions as well.\r\n<h2>The Biological Model<\/h2>\r\n<p id=\"__p26\">Physical factors that can lead to sexual dysfunctions include the use of drugs, such as alcohol,\u00a0nicotine,\u00a0narcotics, stimulants,\u00a0antihypertensives,\u00a0antihistamines, and some psychotherapeutic drugs.\u00a0<span style=\"font-size: 1em;\">Excessive use of alcohol or use of other recreational drugs may cause sexual dysfunction, either by a direct effect on the penile neurovascular system or by causing increased secretion of prolactin, reduction in the production of testosterone, or both.\u00a0<\/span><span style=\"font-size: 1em;\">Many medications are commonly associated with sexual dysfunction, including diuretics, antipsychotics, antidepressants, benzodiazepines, buspirone, lithium, disulfiram, oral contraceptives, etc.<\/span><\/p>\r\n<span style=\"font-size: 1rem; text-align: initial;\">For women, almost any physiological change that affects the reproductive system\u2014<\/span>premenstrual syndrome<span style=\"font-size: 1rem; text-align: initial;\">, pregnancy, the postpartum period, and menopause\u2014can have an adverse effect on libido.\u00a0A common physiological culprit of anorgasmia is\u00a0menopause, where one in three women report problems obtaining an orgasm during sexual stimulation following menopause. <\/span>\r\n\r\n<span style=\"font-size: 1rem; text-align: initial;\">For men, diseases such as\u00a0cardiovascular disease,\u00a0multiple sclerosis,\u00a0kidney failure,\u00a0vascular disease, and\u00a0spinal cord\u00a0injury are the source of erectile dysfunction.\u00a0Historically attributed to psychological causes, new theories suggest that premature ejaculation may have an underlying neurobiological cause that may lead to rapid ejaculation.[footnote]Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977[\/footnote]<\/span>\r\n<h2>The Psychodynamic Model<\/h2>\r\nPsychological factors associated with sexual dysfunction can be divided into three categories: predisposing factors, precipitating factors, and maintaining factors. Predisposing factors include things like trauma, inadequate sexual information, disturbed family relationships, or insecurities. Precipitating factors include unreasonable or negative expectations, lack of harmony in the relationships, infidelity, or depression. Maintaining factors may include any of those same issues, just maintained over a longer time period.[footnote]Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977[\/footnote].\r\n<h2>The Sociocultural Model<\/h2>\r\nCultural and societal myths surrounding sex may also cause sexual dysfunctions. For example, some people erroneously learn that men always think about sex, the man should be the leader, penis size is important, couples must have frequent sex, or sex happens automatically. Other myths perpetuate about orgasms and when they happen, supposed dangers of masturbation, circumcision, and more.[footnote]Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977[\/footnote]\r\n\r\nIn the context of heterosexual relationships, one of the main reasons for the decline in sexual activity among these couples is the male partner experiencing erectile dysfunction. This can be very distressing for the male partner, causing poor body image, and it can also be a major source of low desire for these men. In aging women, it is natural for the vagina to narrow and become atrophied. If a woman has not been participating in sexual activity regularly (in particular, activities involving vaginal penetration) with her partner, if she does decide to engage in penetrative intercourse, she will not be able to immediately accommodate a penis without risking pain or injury. This can turn into a vicious cycle, often leading to female sexual dysfunction.\r\n\r\nAccording to Emily Wentzell, American culture has anti-aging sentiments that have caused sexual dysfunction to become \"an illness that needs treatment\" instead of viewing it as the natural part of the aging process it is. Not all cultures seek treatment; for example, a population of men living in Mexico often accept erectile dysfunction as a normal part of their maturing sexuality.[footnote]Wentzell, Emily (2013). \"Aging Respectably by Rejecting Medicalization: Mexican Men's Reasons for Not Using Erectile Dysfunction Drugs\". Medical Anthropology Quarterly. 27 (1): 3\u201322. doi:10.1111\/maq.12013. PMID 23674320[\/footnote]\r\n<h3><span id=\"Female_sexual_dysfunction\" class=\"mw-headline\">Female Sexual Dysfunction<\/span><\/h3>\r\nSeveral theories have looked at female sexual dysfunction, from medical to psychological perspectives. Three social psychological theories include the self-perception theory, the overjustification hypothesis, and the insufficient justification hypothesis:\r\n<ul>\r\n \t<li>Self-perception theory: people make attributions about their own attitudes, feelings, and behaviors by relying on their observations of external behavior and the circumstances in which those behaviors occur.<\/li>\r\n \t<li>Overjustification hypothesis: when an external reward is given to a person for performing an intrinsically rewarding activity, the person's intrinsic interest will decrease.<\/li>\r\n \t<li>Insufficient justification: based on the classic\u00a0cognitive dissonance\u00a0theory (inconsistency between two cognitions or between a cognition and a behavior will create discomfort), this theory states that people will alter one of the cognitions or behaviors to restore consistency and reduce distress.<\/li>\r\n<\/ul>\r\nThe importance of how a woman perceives her behavior should not be underestimated. Many women perceive sex as a chore as opposed to a pleasurable experience, and they tend to consider themselves sexually inadequate, which in turn does not motivate them to engage in sexual activity.\u00a0Several factors influence a women's perception of her sexual life. These factors can include race, gender, ethnicity, educational background, socioeconomic status, sexual orientation, financial resources, culture, and religion.\u00a0Cultural differences are also present in how women view menopause and its impact on health, self-image, and sexuality. A study has found that African-American women are the most optimistic about menopausal life, Caucasian women are the most anxious, Asian women are the most inhibited about their symptoms, and Hispanic women are the most stoic.\r\n\r\nAbout one-third of the women experienced sexual dysfunction, which may lead to women's loss of confidence in their sexual lives. Since these women had sexual problems, their sexual lives with their partners became a burden without pleasure, and eventually, they may completely lose interest in sexual activity. Some of the women found it hard to be aroused mentally; however, some had physical problems. Several factors can affect female dysfunction, such as situations in which women do not trust their sex partners. The environment where sex occurs is crucial, since being in an extremely public or extremely private place may make some women feel uncomfortable. Inability to concentrate on the sexual activity due to a bad mood or burdens from work may also cause a woman's sexual dysfunction.[footnote]Kingsberg S.A. (2002). \"The impact of aging on sexual function in women and their partners\". <em>Archives of Sexual Behavior<\/em>. 31 (5): 431\u2013437. doi:10.1023\/A:1019844209233. PMID 12238611. S2CID 7762943[\/footnote]\r\n<h2>Treating Sexual Dysfunction Disorders<\/h2>\r\n<strong>Cognitive sexual therapy (CST)<\/strong> is a cognitive-behavioral integrative psychotherapy aimed specifically to address and treat SDs, articulating evidence-based clinical interventions to scientific understandings of human sexuality. In a\u00a0cognitive sexual therapy (CST) perspective, distorted sexual cognitions, allied to individuals' misinterpretations of sexual demands, directly affect emotional, physiological, and behavioral regulation in sexual situations. In this sense, restructuring central and intermediate cognitive processes is essential to foster the acquisition of sexual skills and to promote the development of a more adapted sexual repertoire. Thus, cognitions are understood as mediating factors to be modified, aiming sexual skills implementation and emotional regulation during sexual encounters.\r\n\r\n<b>Sexual scripts<\/b>\u00a0are ideas of how males and females are supposed to interact with each other, including how each gender should behave in\u00a0sexual\u00a0or romantic situations. Being able to flexibilize sexual scripts and behaviors leads to better adaptation to physiological, environmental, and relational changes that negatively impact sexuality over the life cycle, contributing to booster sexual satisfaction even in the presence of sexual function disturbances. The focus of\u00a0cognitive sexual therapy (CST) interventions is to aid patients and partners towards the development of more flexible and adaptable sexual cognitions and behavioral patterns. CST could permit a regain in sexual function and satisfaction during and after treatment with psychotropic medication, lessen the negative impact of sexual adverse effects in quality of life and therefore, increase adherence and therapeutic effects of pharmacotherapy. Although the theoretical rationale supporting this proposal is evidence-based, feasibility, efficacy, treatment modalities, and procedural aspects of the intervention remain to be empirically tested.\r\n\r\n[caption id=\"\" align=\"alignright\" width=\"349\"]<img src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Old_couple_in_love.jpg\/220px-Old_couple_in_love.jpg\" alt=\"A woman touches a man's face. https:\/\/en.wikipedia.org\/wiki\/Sex_therapy\" width=\"349\" height=\"233\" \/> <strong>Figure 1<\/strong>. Sex therapy, at any age, often involves sensate-focused touching.[\/caption]\r\n<h2>Sex Therapy<\/h2>\r\n<b>Sex therapy<\/b>\u00a0is a strategy for the improvement of sexual function and treatment of\u00a0sexual dysfunction including premature ejaculation\u00a0or\u00a0delayed ejaculation,\u00a0erectile dysfunction, lack of sexual interest or arousal, and\u00a0painful sex. It includes dealing with problems imposed by atypical sexual interests (paraphilias); gender dysphoria\u00a0and being\u00a0transgender; highly overactive\u00a0libido\u00a0or\u00a0hypersexuality; a lack of sexual confidence; recovering from\u00a0sexual abuse, such as\u00a0rape or sexual assault; and sexual issues related to aging, illness, or disability.\r\n\r\nIt can include\u00a0sensate focus<strong>,<\/strong>\u00a0communication, and fantasy exercises as well as\u00a0psychodynamic therapy.\u00a0<b>Sensate focus<\/b>\u00a0is a\u00a0sex therapy\u00a0technique introduced by the\u00a0Masters and Johnson\u00a0team.\u00a0It works by refocusing the participants on their own\u00a0sensory perceptions\u00a0and\u00a0sensuality, instead of goal-oriented behavior focused on the genitals and penetrative sex. Sensate focus has been used to treat problems with body image, erectile dysfunction, orgasm disorders, and lack of sexual arousal.\r\n\r\nThe exercises are conducted by the couple at home between therapy sessions. Although the couple are nude and touching each other during the exercises, they are instructed to abstain from\u00a0sexual intercourse\u00a0during or close to the sessions.<sup id=\"cite_ref-3\" class=\"reference\"><\/sup>\u00a0Both participants are instructed instead to focus on their own varied\u00a0sense\u00a0experience, instead of focusing on performance or\u00a0orgasm.<sup id=\"cite_ref-5\" class=\"reference\"><\/sup>\u00a0Initially, the emphasis is on touching in a\u00a0mindful\u00a0way for oneself without regard for sexual response or pleasure for oneself or one\u2019s partner. In the second stage, they still abstain from intercourse and use touch to learn about their bodies and to identify what is pleasurable. Eventually, further stages lead again to intercourse, with the focus on learning about the partner's body.\r\n\r\nTaking about sex can be embarrassing for both the clinician and the patients, so it is important for the clinician to reassure the patient of confidentiality. Treatment plans will vary depending on the condition. For example, sexual desire disorders have no particular treatment plan and do not generally respond well to psychotherapy.[footnote]Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977[\/footnote] Some therapies, like treating vaginismus, include sex education and information to help the patient come to relax or to overcome negative preconceived notions about sex. Relaxation training may be helpful in these instances. Generally, several types of psychoterapies may be used in sex therapy, including psychodynamic, rational emotive therapy, CBT, or behavioral therapies such as systematic desensitization, and Masters and Johnson's behavioral therapy techniques (which focus on talk therapy with a couple making behavioral changes together that they work on as homework assignments following a therapy session).\r\n<div id=\"F1\" class=\"fig iconblock whole_rhythm clearfix\">\r\n<div class=\"figure\">\r\n<div id=\"sec2-13\" class=\"sec\">\r\n<div id=\"sec2-25\" class=\"sec\">\r\n\r\nThere are also pharmacological treatment options for some sexual dysfunctions, particularly erectile dysfunction and premature ejaculation. Lifestyle changes such as discontinuing smoking and drug or alcohol abuse can also help in some types of erectile dysfunction. Several oral medications like Viagra, Cialis, and Levitra have become available to help people with erectile dysfunction and have become first-line therapy. These medications provide an easy, safe, and effective treatment solution for approximately 60% of men. In the rest, the medications may not work because of the wrong diagnosis or chronic history. Another type of medication that is effective in roughly 85% of men is called intracavernous pharmacotherapy and involves injecting a vasodilator drug directly into the penis in order to stimulate an erection. This method has an increased risk of priapism if used in conjunction with other treatments and localized pain. Pelvic floor physical therapy has been shown to be a valid treatment for men with sexual problems and pelvic pain.\r\n\r\nIn 2015, flibanserin was approved in the United States to treat decreased sexual desire in women. While it's effective for some women, it has been criticized for its limited efficacy, and many warnings and contraindications that limit its use. Women experiencing pain with intercourse are often prescribed pain relievers or desensitizing agents; others can be prescribed vaginal lubricants. Many women with sexual dysfunction are also referred to a counselor or sex therapist.[footnote]Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. <em>Indian journal of psychiatry<\/em>, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977[\/footnote]\r\n\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/460c1c7a-bd34-435a-ac39-8fd5e1990edf\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/9c69d81c-4dfa-4e6f-b973-4b0c654143df\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>cognitive sexual therapy (CST):<\/strong> a\u00a0cognitive-behavioral integrative psychotherapy aimed specifically to address and treat sexual dysfunctions\r\n\r\n<b>sensate focus:<\/b>\u00a0a sex therapy\u00a0technique that works by refocusing the participants on their own\u00a0sensory perceptions\u00a0and\u00a0sensuality, instead of goal-oriented behavior focused on the genitals and penetrative sex\r\n\r\n<b>sex therapy:<\/b>\u00a0a strategy for the improvement of sexual function and treatment of\u00a0sexual dysfunction\r\n\r\n<b>sexual scripts:<\/b> ideas of how males and females are supposed to interact with each other, including how each gender should behave in\u00a0sexual\u00a0or romantic situations\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li style=\"font-weight: 400;\">Examine perspectives and treatments related to sexual dysfunction disorders<\/li>\n<\/ul>\n<\/div>\n<h2>Perspectives on Sexual Dysfunction Disorders<\/h2>\n<p>There are many factors that may result in a person experiencing sexual dysfunction. These may result from emotional or physical causes. Emotional factors include interpersonal or psychological problems, which can be the result of\u00a0depression, sexual fears or guilt, past sexual trauma, and sexual disorders,\u00a0among others.<\/p>\n<p>Sexual dysfunction is especially common among people who have\u00a0anxiety disorders. Ordinary anxiousness can obviously cause erectile dysfunction in men without psychiatric problems, but clinically diagnosable disorders such as\u00a0panic disorder\u00a0commonly cause avoidance of intercourse and premature ejaculation.\u00a0Pain during intercourse is often a comorbidity of anxiety disorders among women. Therefore,\u00a0 clinicians are careful not to rule out the fact that there may be physiological causes of these dysfunctions as well.<\/p>\n<h2>The Biological Model<\/h2>\n<p id=\"__p26\">Physical factors that can lead to sexual dysfunctions include the use of drugs, such as alcohol,\u00a0nicotine,\u00a0narcotics, stimulants,\u00a0antihypertensives,\u00a0antihistamines, and some psychotherapeutic drugs.\u00a0<span style=\"font-size: 1em;\">Excessive use of alcohol or use of other recreational drugs may cause sexual dysfunction, either by a direct effect on the penile neurovascular system or by causing increased secretion of prolactin, reduction in the production of testosterone, or both.\u00a0<\/span><span style=\"font-size: 1em;\">Many medications are commonly associated with sexual dysfunction, including diuretics, antipsychotics, antidepressants, benzodiazepines, buspirone, lithium, disulfiram, oral contraceptives, etc.<\/span><\/p>\n<p><span style=\"font-size: 1rem; text-align: initial;\">For women, almost any physiological change that affects the reproductive system\u2014<\/span>premenstrual syndrome<span style=\"font-size: 1rem; text-align: initial;\">, pregnancy, the postpartum period, and menopause\u2014can have an adverse effect on libido.\u00a0A common physiological culprit of anorgasmia is\u00a0menopause, where one in three women report problems obtaining an orgasm during sexual stimulation following menopause. <\/span><\/p>\n<p><span style=\"font-size: 1rem; text-align: initial;\">For men, diseases such as\u00a0cardiovascular disease,\u00a0multiple sclerosis,\u00a0kidney failure,\u00a0vascular disease, and\u00a0spinal cord\u00a0injury are the source of erectile dysfunction.\u00a0Historically attributed to psychological causes, new theories suggest that premature ejaculation may have an underlying neurobiological cause that may lead to rapid ejaculation.<a class=\"footnote\" title=\"Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977\" id=\"return-footnote-1792-1\" href=\"#footnote-1792-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/span><\/p>\n<h2>The Psychodynamic Model<\/h2>\n<p>Psychological factors associated with sexual dysfunction can be divided into three categories: predisposing factors, precipitating factors, and maintaining factors. Predisposing factors include things like trauma, inadequate sexual information, disturbed family relationships, or insecurities. Precipitating factors include unreasonable or negative expectations, lack of harmony in the relationships, infidelity, or depression. Maintaining factors may include any of those same issues, just maintained over a longer time period.<a class=\"footnote\" title=\"Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977\" id=\"return-footnote-1792-2\" href=\"#footnote-1792-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a>.<\/p>\n<h2>The Sociocultural Model<\/h2>\n<p>Cultural and societal myths surrounding sex may also cause sexual dysfunctions. For example, some people erroneously learn that men always think about sex, the man should be the leader, penis size is important, couples must have frequent sex, or sex happens automatically. Other myths perpetuate about orgasms and when they happen, supposed dangers of masturbation, circumcision, and more.<a class=\"footnote\" title=\"Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977\" id=\"return-footnote-1792-3\" href=\"#footnote-1792-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/p>\n<p>In the context of heterosexual relationships, one of the main reasons for the decline in sexual activity among these couples is the male partner experiencing erectile dysfunction. This can be very distressing for the male partner, causing poor body image, and it can also be a major source of low desire for these men. In aging women, it is natural for the vagina to narrow and become atrophied. If a woman has not been participating in sexual activity regularly (in particular, activities involving vaginal penetration) with her partner, if she does decide to engage in penetrative intercourse, she will not be able to immediately accommodate a penis without risking pain or injury. This can turn into a vicious cycle, often leading to female sexual dysfunction.<\/p>\n<p>According to Emily Wentzell, American culture has anti-aging sentiments that have caused sexual dysfunction to become &#8220;an illness that needs treatment&#8221; instead of viewing it as the natural part of the aging process it is. Not all cultures seek treatment; for example, a population of men living in Mexico often accept erectile dysfunction as a normal part of their maturing sexuality.<a class=\"footnote\" title=\"Wentzell, Emily (2013). &quot;Aging Respectably by Rejecting Medicalization: Mexican Men's Reasons for Not Using Erectile Dysfunction Drugs&quot;. Medical Anthropology Quarterly. 27 (1): 3\u201322. doi:10.1111\/maq.12013. PMID 23674320\" id=\"return-footnote-1792-4\" href=\"#footnote-1792-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a><\/p>\n<h3><span id=\"Female_sexual_dysfunction\" class=\"mw-headline\">Female Sexual Dysfunction<\/span><\/h3>\n<p>Several theories have looked at female sexual dysfunction, from medical to psychological perspectives. Three social psychological theories include the self-perception theory, the overjustification hypothesis, and the insufficient justification hypothesis:<\/p>\n<ul>\n<li>Self-perception theory: people make attributions about their own attitudes, feelings, and behaviors by relying on their observations of external behavior and the circumstances in which those behaviors occur.<\/li>\n<li>Overjustification hypothesis: when an external reward is given to a person for performing an intrinsically rewarding activity, the person&#8217;s intrinsic interest will decrease.<\/li>\n<li>Insufficient justification: based on the classic\u00a0cognitive dissonance\u00a0theory (inconsistency between two cognitions or between a cognition and a behavior will create discomfort), this theory states that people will alter one of the cognitions or behaviors to restore consistency and reduce distress.<\/li>\n<\/ul>\n<p>The importance of how a woman perceives her behavior should not be underestimated. Many women perceive sex as a chore as opposed to a pleasurable experience, and they tend to consider themselves sexually inadequate, which in turn does not motivate them to engage in sexual activity.\u00a0Several factors influence a women&#8217;s perception of her sexual life. These factors can include race, gender, ethnicity, educational background, socioeconomic status, sexual orientation, financial resources, culture, and religion.\u00a0Cultural differences are also present in how women view menopause and its impact on health, self-image, and sexuality. A study has found that African-American women are the most optimistic about menopausal life, Caucasian women are the most anxious, Asian women are the most inhibited about their symptoms, and Hispanic women are the most stoic.<\/p>\n<p>About one-third of the women experienced sexual dysfunction, which may lead to women&#8217;s loss of confidence in their sexual lives. Since these women had sexual problems, their sexual lives with their partners became a burden without pleasure, and eventually, they may completely lose interest in sexual activity. Some of the women found it hard to be aroused mentally; however, some had physical problems. Several factors can affect female dysfunction, such as situations in which women do not trust their sex partners. The environment where sex occurs is crucial, since being in an extremely public or extremely private place may make some women feel uncomfortable. Inability to concentrate on the sexual activity due to a bad mood or burdens from work may also cause a woman&#8217;s sexual dysfunction.<a class=\"footnote\" title=\"Kingsberg S.A. (2002). &quot;The impact of aging on sexual function in women and their partners&quot;. Archives of Sexual Behavior. 31 (5): 431\u2013437. doi:10.1023\/A:1019844209233. PMID 12238611. S2CID 7762943\" id=\"return-footnote-1792-5\" href=\"#footnote-1792-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/p>\n<h2>Treating Sexual Dysfunction Disorders<\/h2>\n<p><strong>Cognitive sexual therapy (CST)<\/strong> is a cognitive-behavioral integrative psychotherapy aimed specifically to address and treat SDs, articulating evidence-based clinical interventions to scientific understandings of human sexuality. In a\u00a0cognitive sexual therapy (CST) perspective, distorted sexual cognitions, allied to individuals&#8217; misinterpretations of sexual demands, directly affect emotional, physiological, and behavioral regulation in sexual situations. In this sense, restructuring central and intermediate cognitive processes is essential to foster the acquisition of sexual skills and to promote the development of a more adapted sexual repertoire. Thus, cognitions are understood as mediating factors to be modified, aiming sexual skills implementation and emotional regulation during sexual encounters.<\/p>\n<p><b>Sexual scripts<\/b>\u00a0are ideas of how males and females are supposed to interact with each other, including how each gender should behave in\u00a0sexual\u00a0or romantic situations. Being able to flexibilize sexual scripts and behaviors leads to better adaptation to physiological, environmental, and relational changes that negatively impact sexuality over the life cycle, contributing to booster sexual satisfaction even in the presence of sexual function disturbances. The focus of\u00a0cognitive sexual therapy (CST) interventions is to aid patients and partners towards the development of more flexible and adaptable sexual cognitions and behavioral patterns. CST could permit a regain in sexual function and satisfaction during and after treatment with psychotropic medication, lessen the negative impact of sexual adverse effects in quality of life and therefore, increase adherence and therapeutic effects of pharmacotherapy. Although the theoretical rationale supporting this proposal is evidence-based, feasibility, efficacy, treatment modalities, and procedural aspects of the intervention remain to be empirically tested.<\/p>\n<div style=\"width: 359px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" src=\"https:\/\/upload.wikimedia.org\/wikipedia\/commons\/thumb\/d\/d6\/Old_couple_in_love.jpg\/220px-Old_couple_in_love.jpg\" alt=\"A woman touches a man's face. https:\/\/en.wikipedia.org\/wiki\/Sex_therapy\" width=\"349\" height=\"233\" \/><\/p>\n<p class=\"wp-caption-text\"><strong>Figure 1<\/strong>. Sex therapy, at any age, often involves sensate-focused touching.<\/p>\n<\/div>\n<h2>Sex Therapy<\/h2>\n<p><b>Sex therapy<\/b>\u00a0is a strategy for the improvement of sexual function and treatment of\u00a0sexual dysfunction including premature ejaculation\u00a0or\u00a0delayed ejaculation,\u00a0erectile dysfunction, lack of sexual interest or arousal, and\u00a0painful sex. It includes dealing with problems imposed by atypical sexual interests (paraphilias); gender dysphoria\u00a0and being\u00a0transgender; highly overactive\u00a0libido\u00a0or\u00a0hypersexuality; a lack of sexual confidence; recovering from\u00a0sexual abuse, such as\u00a0rape or sexual assault; and sexual issues related to aging, illness, or disability.<\/p>\n<p>It can include\u00a0sensate focus<strong>,<\/strong>\u00a0communication, and fantasy exercises as well as\u00a0psychodynamic therapy.\u00a0<b>Sensate focus<\/b>\u00a0is a\u00a0sex therapy\u00a0technique introduced by the\u00a0Masters and Johnson\u00a0team.\u00a0It works by refocusing the participants on their own\u00a0sensory perceptions\u00a0and\u00a0sensuality, instead of goal-oriented behavior focused on the genitals and penetrative sex. Sensate focus has been used to treat problems with body image, erectile dysfunction, orgasm disorders, and lack of sexual arousal.<\/p>\n<p>The exercises are conducted by the couple at home between therapy sessions. Although the couple are nude and touching each other during the exercises, they are instructed to abstain from\u00a0sexual intercourse\u00a0during or close to the sessions.<sup id=\"cite_ref-3\" class=\"reference\"><\/sup>\u00a0Both participants are instructed instead to focus on their own varied\u00a0sense\u00a0experience, instead of focusing on performance or\u00a0orgasm.<sup id=\"cite_ref-5\" class=\"reference\"><\/sup>\u00a0Initially, the emphasis is on touching in a\u00a0mindful\u00a0way for oneself without regard for sexual response or pleasure for oneself or one\u2019s partner. In the second stage, they still abstain from intercourse and use touch to learn about their bodies and to identify what is pleasurable. Eventually, further stages lead again to intercourse, with the focus on learning about the partner&#8217;s body.<\/p>\n<p>Taking about sex can be embarrassing for both the clinician and the patients, so it is important for the clinician to reassure the patient of confidentiality. Treatment plans will vary depending on the condition. For example, sexual desire disorders have no particular treatment plan and do not generally respond well to psychotherapy.<a class=\"footnote\" title=\"Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977\" id=\"return-footnote-1792-6\" href=\"#footnote-1792-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a> Some therapies, like treating vaginismus, include sex education and information to help the patient come to relax or to overcome negative preconceived notions about sex. Relaxation training may be helpful in these instances. Generally, several types of psychoterapies may be used in sex therapy, including psychodynamic, rational emotive therapy, CBT, or behavioral therapies such as systematic desensitization, and Masters and Johnson&#8217;s behavioral therapy techniques (which focus on talk therapy with a couple making behavioral changes together that they work on as homework assignments following a therapy session).<\/p>\n<div id=\"F1\" class=\"fig iconblock whole_rhythm clearfix\">\n<div class=\"figure\">\n<div id=\"sec2-13\" class=\"sec\">\n<div id=\"sec2-25\" class=\"sec\">\n<p>There are also pharmacological treatment options for some sexual dysfunctions, particularly erectile dysfunction and premature ejaculation. Lifestyle changes such as discontinuing smoking and drug or alcohol abuse can also help in some types of erectile dysfunction. Several oral medications like Viagra, Cialis, and Levitra have become available to help people with erectile dysfunction and have become first-line therapy. These medications provide an easy, safe, and effective treatment solution for approximately 60% of men. In the rest, the medications may not work because of the wrong diagnosis or chronic history. Another type of medication that is effective in roughly 85% of men is called intracavernous pharmacotherapy and involves injecting a vasodilator drug directly into the penis in order to stimulate an erection. This method has an increased risk of priapism if used in conjunction with other treatments and localized pain. Pelvic floor physical therapy has been shown to be a valid treatment for men with sexual problems and pelvic pain.<\/p>\n<p>In 2015, flibanserin was approved in the United States to treat decreased sexual desire in women. While it&#8217;s effective for some women, it has been criticized for its limited efficacy, and many warnings and contraindications that limit its use. Women experiencing pain with intercourse are often prescribed pain relievers or desensitizing agents; others can be prescribed vaginal lubricants. Many women with sexual dysfunction are also referred to a counselor or sex therapist.<a class=\"footnote\" title=\"Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977\" id=\"return-footnote-1792-7\" href=\"#footnote-1792-7\" aria-label=\"Footnote 7\"><sup class=\"footnote\">[7]<\/sup><\/a><\/p>\n<\/div>\n<\/div>\n<\/div>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_460c1c7a-bd34-435a-ac39-8fd5e1990edf\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/460c1c7a-bd34-435a-ac39-8fd5e1990edf?iframe_resize_id=assessment_practice_id_460c1c7a-bd34-435a-ac39-8fd5e1990edf\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_9c69d81c-4dfa-4e6f-b973-4b0c654143df\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/9c69d81c-4dfa-4e6f-b973-4b0c654143df?iframe_resize_id=assessment_practice_id_9c69d81c-4dfa-4e6f-b973-4b0c654143df\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>cognitive sexual therapy (CST):<\/strong> a\u00a0cognitive-behavioral integrative psychotherapy aimed specifically to address and treat sexual dysfunctions<\/p>\n<p><b>sensate focus:<\/b>\u00a0a sex therapy\u00a0technique that works by refocusing the participants on their own\u00a0sensory perceptions\u00a0and\u00a0sensuality, instead of goal-oriented behavior focused on the genitals and penetrative sex<\/p>\n<p><b>sex therapy:<\/b>\u00a0a strategy for the improvement of sexual function and treatment of\u00a0sexual dysfunction<\/p>\n<p><b>sexual scripts:<\/b> ideas of how males and females are supposed to interact with each other, including how each gender should behave in\u00a0sexual\u00a0or romantic situations<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-1792\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Sonja Ann Miller for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Sexual Dysfunction. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_dysfunction#Causes\">https:\/\/en.wikipedia.org\/wiki\/Sexual_dysfunction#Causes<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Sexual Desire Disorders. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_dysfunction#Sexual_desire_disorders\">https:\/\/en.wikipedia.org\/wiki\/Sexual_dysfunction#Sexual_desire_disorders<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Sex Therapy. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sex_therapy\">https:\/\/en.wikipedia.org\/wiki\/Sex_therapy<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Sensate focus. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sensate_focus\">https:\/\/en.wikipedia.org\/wiki\/Sensate_focus<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-1792-1\">Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977 <a href=\"#return-footnote-1792-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-1792-2\">Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977 <a href=\"#return-footnote-1792-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-1792-3\">Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977 <a href=\"#return-footnote-1792-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-1792-4\">Wentzell, Emily (2013). \"Aging Respectably by Rejecting Medicalization: Mexican Men's Reasons for Not Using Erectile Dysfunction Drugs\". Medical Anthropology Quarterly. 27 (1): 3\u201322. doi:10.1111\/maq.12013. PMID 23674320 <a href=\"#return-footnote-1792-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-1792-5\">Kingsberg S.A. (2002). \"The impact of aging on sexual function in women and their partners\". <em>Archives of Sexual Behavior<\/em>. 31 (5): 431\u2013437. doi:10.1023\/A:1019844209233. PMID 12238611. S2CID 7762943 <a href=\"#return-footnote-1792-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-1792-6\">Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. Indian journal of psychiatry, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977 <a href=\"#return-footnote-1792-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><li id=\"footnote-1792-7\">Avasthi, A., Grover, S., &amp; Sathyanarayana Rao, T. S. (2017). Clinical Practice Guidelines for Management of Sexual Dysfunction. <em>Indian journal of psychiatry<\/em>, 59(Suppl 1), S91\u2013S115. https:\/\/doi.org\/10.4103\/0019-5545.196977 <a href=\"#return-footnote-1792-7\" class=\"return-footnote\" aria-label=\"Return to footnote 7\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":9,"template":"","meta":{"_candela_citation":"[{\"type\":\"original\",\"description\":\"Modification, adaptation, and original content\",\"author\":\"Sonja Ann Miller for Lumen Learning\",\"organization\":\"Lumen Learning\",\"url\":\"\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Sexual Dysfunction\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Sexual_dysfunction#Causes\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Sexual Desire Disorders\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Sexual_dysfunction#Sexual_desire_disorders\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Sex Therapy\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Sex_therapy\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Sensate focus\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Sensate_focus\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"}]","CANDELA_OUTCOMES_GUID":"36b5348d-5db8-4e18-835a-a1c6fc0c8957, 9433dfb9-6fa6-49a0-b30b-a97e288bc80b","pb_show_title":"on","pb_short_title":"","pb_subtitle":"","pb_authors":[],"pb_section_license":""},"chapter-type":[],"contributor":[],"license":[],"class_list":["post-1792","chapter","type-chapter","status-publish","hentry"],"part":150,"_links":{"self":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1792","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters"}],"about":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/types\/chapter"}],"author":[{"embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/users\/29"}],"version-history":[{"count":31,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1792\/revisions"}],"predecessor-version":[{"id":7581,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1792\/revisions\/7581"}],"part":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/parts\/150"}],"metadata":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapters\/1792\/metadata\/"}],"wp:attachment":[{"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/media?parent=1792"}],"wp:term":[{"taxonomy":"chapter-type","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/pressbooks\/v2\/chapter-type?post=1792"},{"taxonomy":"contributor","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/contributor?post=1792"},{"taxonomy":"license","embeddable":true,"href":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/wp-json\/wp\/v2\/license?post=1792"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}