Psychopathology
College 1 SEX(ual dysfunction)
Men’s Sexual Dysfunctions
Delayed Ejaculation (DE) a marked difficulty or inability to achieve desired ejaculation
o More common in men over 50, visual vc tactile
o Only 75% of men report always ejaculating during sexual activity
o Many theories regarding the aetiology of DE but with little empirical data to support any
particular theory
3 common factors associated with DE
1. Higher frequency of masturbation
2. Idiosyncratic masturbatory style
3. Disparity between the reality of sex with his partner compared to his preferred sexual
fantasy during masturbation.
In the clinical setting
o DE is often mistakenly diagnosed as ED
o Focus on pleasure instead of function
o Learn to focus attention on sexual stimuli
o Cognitive restructuring
o Suspend masturbatory activity temporarily
o Use condoms during masturbation?
o Check relationship
Erectile disorder (ED) failure to obtain or maintain erection during partnered sexual activities.
o Marked decrease in erectile rigidity
o More common in men over 50
o Most problems remit without professional intervention
o Medication and relational drugs
COBRA study association between erectile dysfunction and coronary artery disease. ED onset
occurred before CAD in 71% with a mean time interval of 25 months.
o Arterioscelerosis in coronary arteries arteriosclerosis in penile arteries.
Male Hypoactive Sexual Desire Disorder (MHSDD) persistent deficient or absent sexual thoughts,
fantasies or desires.
o 6% of younger 18-24 & 41% of older men 66-74 report problems with sexual desire;
persistent problem in only 1.8% of men
o Many men are often treated for different sexual diagnoses wile they are suffering from
HSDD.
o HSDD limited to a single partner is not SD but a relationship problem
o Sexual desire and sexual arousal are overlapping constructs since both depend on the ability
of an individual to process sexual information during sexual activity.
, o By the time that individuals reach middle and old age, there is a natural decline in sexual
desire, sexual capacity and the frequency of sexual behavior. So naturally MHSDD wil have a
higher prevalence in older men.
o Sufficient sexual stimulation is important for arousal to follow for women but also for men.
Long term relationship staat in relatie tot de sexual pleasure.
o Sexual feelings diminished during repeated erotic stimulation and increased with the
introduction of novel stimulation.
Side note on sexual pleasures in Long Term relationships
o Sex plays role in all phases of relationship to start, to stay
o Sexual desire is important to relationship satisfaction and stability low sexual desire
source of relational distress
o Most prevalent complaint in LT relations is low sexual desire
o Important to focus on the process, same as food lets look at sexual pleasure as flavor
o But sexual desire and sexual frequency zorgen not necessarily for relationship satisfaction
Premature Early Ejaculation persistent or recurrent pattern of ejaculation during partnered sexual
activity within 1 minute following penetration or before individual wishes it.
o 20-30% of men report concern about ejaculation speed 1-3% have persistent problem
Misschien is rapid ejaculation ook wel natuurlijk bij
dieren is sexual intercourse vaak heel snel.
Bijvoorbeeld chimpanzees duurt het maar 6 seconden.
Women’s sexual dysfunctions
Female Orgasmic Disorder delay, infrequency or absence of orgasm or reduced intensity of
orgasm sensation.
o RISK factors: abuse, partner with PE, poor communication
Prevalence
o Wide estimates of prevalence: 10-42%
o 10% never experience an orgasm
o 10% experience orgasm occasionally depending on the partner
, o 50% experience an orgasm during stimulation of the clitoris and penetration
o 30% experience orgasm during intercourse only
Likelihood of not having orgasm problems related to:
o Manual genital caressing
o Self-use of vibrator
o Perception that sex is important
o Early age of first orgasm
o Cunnilingus
o Orgasm by penile motion
Directed masturbation (Heiman en Meston) is about learning how to stimulate yourself by
learning about your own body in steps.
o 80% efficacy to obtain orgasm during masturbation in lifelong pre/anorgasmic women
o 20-60% efficacy to obtain orgasm during partnered sexual activity
o Psycho-sexual treatment.
Female Sexual Interest/Arousal Disorder absent/reduced interest/arousal related to sexual
activities, thought, cues, etc.
o Hard to delineate but persistent problem for relationships.
o Clinically FSAD:
Lack of genital arousal/response, lubrication, tingling, warmth
Subjective arousal lack of body sensations in the rest of the body
Risk factors:
Medical risk factors
Psychological inter- and interpersonal
o Sexual abuse and traumatic experiences
o Acute/chronic stress
o Self-focused attention
o Anxiety emotion dysregulation, avoidancetendencies
o Partners sexual problems
o Relationship problems
o Lack of sufficient stimulation/lack of intimacy
o Lack of privacy
o Culturel aspect
o Life time events as divorce, small children at home
Genito-pelvic pain/penetration disorder (GPPPD) difficulties with:
A) Vaginal penetration during intercourse
B) Pain during intercourse
C) Fear or anxiety about pain or penetration, or contraction of pelvic floor muscles during sex.
- 15% of women report some pain during intercourse
- Vaginismus and dyspareunia merged into GPPPD
, - A multidisciplinary approach within a biopsychosocial framework is necessary in most cases
Hypersexual disorder proposed diagnosis over a period of at least six months, recurrent and
intense sexual fantasies, sexual urges, and sexual behaviour in association with four or more of the
following:
1. Excessive time is consumed by sexual fantasies and by planning for and engaging in sexual
behavior
2. Repetitively engaging in sexual fantasies, urges and behavior in response to dysphoric mood
stages.
3. Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies,
urges and behavior.
4. Repetitively engaging in sexual behavior while disregarding the risk for physical or emotional
harm to self or others.
Fundamental treatment
Basic interventions that do not apply to each case but are interventions that can be used depending
and following a thorough BIO-PSYCH-SOCIAL assessment.
PLISSIT model permission, limited info, specific info, intensive therapy. Model voor het bepalen
van hoe ver een hulpverlener kan gaan over het bespreken en behandelen van seksuele problemen.
Via de genoemde 4 niveaus bied je hulp aan en je gaat pas verder in de hulp als het probleem niet op
te lossen is op het huidige niveau.
Therapist aided exposure
Sensate focus
- One partner ‘gives’ while the other
‘receives’ and gives feedback
- Initially no ‘sexual’ touching gradually
build up to touching genitals, orgasm and
intercourse.
- Gradual reawakening of sexual interest
with no performance anxiety to increase
awareness and appreciation of the sexual
stimulus.
- Is usually done with couples but can also
be done with solo-masturbation.
Self record of thought and alternative cognitions
College 1 SEX(ual dysfunction)
Men’s Sexual Dysfunctions
Delayed Ejaculation (DE) a marked difficulty or inability to achieve desired ejaculation
o More common in men over 50, visual vc tactile
o Only 75% of men report always ejaculating during sexual activity
o Many theories regarding the aetiology of DE but with little empirical data to support any
particular theory
3 common factors associated with DE
1. Higher frequency of masturbation
2. Idiosyncratic masturbatory style
3. Disparity between the reality of sex with his partner compared to his preferred sexual
fantasy during masturbation.
In the clinical setting
o DE is often mistakenly diagnosed as ED
o Focus on pleasure instead of function
o Learn to focus attention on sexual stimuli
o Cognitive restructuring
o Suspend masturbatory activity temporarily
o Use condoms during masturbation?
o Check relationship
Erectile disorder (ED) failure to obtain or maintain erection during partnered sexual activities.
o Marked decrease in erectile rigidity
o More common in men over 50
o Most problems remit without professional intervention
o Medication and relational drugs
COBRA study association between erectile dysfunction and coronary artery disease. ED onset
occurred before CAD in 71% with a mean time interval of 25 months.
o Arterioscelerosis in coronary arteries arteriosclerosis in penile arteries.
Male Hypoactive Sexual Desire Disorder (MHSDD) persistent deficient or absent sexual thoughts,
fantasies or desires.
o 6% of younger 18-24 & 41% of older men 66-74 report problems with sexual desire;
persistent problem in only 1.8% of men
o Many men are often treated for different sexual diagnoses wile they are suffering from
HSDD.
o HSDD limited to a single partner is not SD but a relationship problem
o Sexual desire and sexual arousal are overlapping constructs since both depend on the ability
of an individual to process sexual information during sexual activity.
, o By the time that individuals reach middle and old age, there is a natural decline in sexual
desire, sexual capacity and the frequency of sexual behavior. So naturally MHSDD wil have a
higher prevalence in older men.
o Sufficient sexual stimulation is important for arousal to follow for women but also for men.
Long term relationship staat in relatie tot de sexual pleasure.
o Sexual feelings diminished during repeated erotic stimulation and increased with the
introduction of novel stimulation.
Side note on sexual pleasures in Long Term relationships
o Sex plays role in all phases of relationship to start, to stay
o Sexual desire is important to relationship satisfaction and stability low sexual desire
source of relational distress
o Most prevalent complaint in LT relations is low sexual desire
o Important to focus on the process, same as food lets look at sexual pleasure as flavor
o But sexual desire and sexual frequency zorgen not necessarily for relationship satisfaction
Premature Early Ejaculation persistent or recurrent pattern of ejaculation during partnered sexual
activity within 1 minute following penetration or before individual wishes it.
o 20-30% of men report concern about ejaculation speed 1-3% have persistent problem
Misschien is rapid ejaculation ook wel natuurlijk bij
dieren is sexual intercourse vaak heel snel.
Bijvoorbeeld chimpanzees duurt het maar 6 seconden.
Women’s sexual dysfunctions
Female Orgasmic Disorder delay, infrequency or absence of orgasm or reduced intensity of
orgasm sensation.
o RISK factors: abuse, partner with PE, poor communication
Prevalence
o Wide estimates of prevalence: 10-42%
o 10% never experience an orgasm
o 10% experience orgasm occasionally depending on the partner
, o 50% experience an orgasm during stimulation of the clitoris and penetration
o 30% experience orgasm during intercourse only
Likelihood of not having orgasm problems related to:
o Manual genital caressing
o Self-use of vibrator
o Perception that sex is important
o Early age of first orgasm
o Cunnilingus
o Orgasm by penile motion
Directed masturbation (Heiman en Meston) is about learning how to stimulate yourself by
learning about your own body in steps.
o 80% efficacy to obtain orgasm during masturbation in lifelong pre/anorgasmic women
o 20-60% efficacy to obtain orgasm during partnered sexual activity
o Psycho-sexual treatment.
Female Sexual Interest/Arousal Disorder absent/reduced interest/arousal related to sexual
activities, thought, cues, etc.
o Hard to delineate but persistent problem for relationships.
o Clinically FSAD:
Lack of genital arousal/response, lubrication, tingling, warmth
Subjective arousal lack of body sensations in the rest of the body
Risk factors:
Medical risk factors
Psychological inter- and interpersonal
o Sexual abuse and traumatic experiences
o Acute/chronic stress
o Self-focused attention
o Anxiety emotion dysregulation, avoidancetendencies
o Partners sexual problems
o Relationship problems
o Lack of sufficient stimulation/lack of intimacy
o Lack of privacy
o Culturel aspect
o Life time events as divorce, small children at home
Genito-pelvic pain/penetration disorder (GPPPD) difficulties with:
A) Vaginal penetration during intercourse
B) Pain during intercourse
C) Fear or anxiety about pain or penetration, or contraction of pelvic floor muscles during sex.
- 15% of women report some pain during intercourse
- Vaginismus and dyspareunia merged into GPPPD
, - A multidisciplinary approach within a biopsychosocial framework is necessary in most cases
Hypersexual disorder proposed diagnosis over a period of at least six months, recurrent and
intense sexual fantasies, sexual urges, and sexual behaviour in association with four or more of the
following:
1. Excessive time is consumed by sexual fantasies and by planning for and engaging in sexual
behavior
2. Repetitively engaging in sexual fantasies, urges and behavior in response to dysphoric mood
stages.
3. Repetitive but unsuccessful efforts to control or significantly reduce these sexual fantasies,
urges and behavior.
4. Repetitively engaging in sexual behavior while disregarding the risk for physical or emotional
harm to self or others.
Fundamental treatment
Basic interventions that do not apply to each case but are interventions that can be used depending
and following a thorough BIO-PSYCH-SOCIAL assessment.
PLISSIT model permission, limited info, specific info, intensive therapy. Model voor het bepalen
van hoe ver een hulpverlener kan gaan over het bespreken en behandelen van seksuele problemen.
Via de genoemde 4 niveaus bied je hulp aan en je gaat pas verder in de hulp als het probleem niet op
te lossen is op het huidige niveau.
Therapist aided exposure
Sensate focus
- One partner ‘gives’ while the other
‘receives’ and gives feedback
- Initially no ‘sexual’ touching gradually
build up to touching genitals, orgasm and
intercourse.
- Gradual reawakening of sexual interest
with no performance anxiety to increase
awareness and appreciation of the sexual
stimulus.
- Is usually done with couples but can also
be done with solo-masturbation.
Self record of thought and alternative cognitions
