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Treatment of Sexual Disorders

The most common sexual problems for males are premature ejaculation and impotence. Premature ejaculation is orgasm occurring early in sex, cutting sexual activity short by eliminating the male's desire and ability to maintain an erection. Impotence (IMP-a-tence) is a male's inability to sustain an erection.

What are the two most common sexual problems for males? What is anorgasmia?

The most common sexual problem for females is anorgasmia, an inability to have orgasms. Both males and female may suffer from lack of desire, which may or may not be considered a sexual disorder. Many people are perfectly happy without sex. On the other hand, a sudden drop-off in sexual desire, within a relationship, may indicate a problem such as depression, hormonal imbalance, or dissatisfaction with the relationship.

Sexual difficulties occur occasionally in otherwise-normal people. If they are persistent and interfere with a normal sex life, their treatment may require therapy. The common problems listed above respond to simple therapies that work for the majority of people.

What are some causes of impotence?

The treatment for impotence depends on its underlying cause. Impotence can be caused by illness, disease, depression, drugs such as alcohol, or difficulties in the emotional side of a relationship. The discovery of a specialized valve system in the penis revealed that many cases of impotence are biological in nature, rather than psychological as doctors once assumed. Biological problems can be diagnosed by monitoring a male during sleep. If erection fails to occur during REM sleep, the cause of impotence is probably biological rather than psychological.

How did Viagra change the treatment of impotence?

Impotence becomes more common with old age, particularly in those with a long history of tobacco smoking. The drug Viagra, released in 1998, revolutionized treatment of impotence in older men. It works by improving blood circulation in the area of the penis, allowing the natural valve system to work again. Viagra and similar drugs are almost 100% effective in men who have not suffered damage to this system, if the cause of impotence is biological.

What are non-biological causes of impotence?

If impotence is not due to a biological disorder, it is usually the result of (1) not wanting to have sex, or (2) being anxious about performing well. To help re-direct attention to sensual interactions, rather than performance anxiety or expectations, a therapist is likely to suggest activities between partners that focus attention on delicate body sensations, such as mutual massage, hair-brushing, or back-scratching.

How is premature ejaculation treated?

Premature ejaculation occurs when a man comes to a sexual climax (and loses appetite for further activity) too soon during sexual activity. Premature ejaculation is commonly treated with the squeeze technique developed by Masters and Johnson. The woman brings the man close to orgasm then squeezes the tip of his penis. This does not hurt but makes the feeling of impending orgasm go away. Sometimes the man will partially lose his erection. Sexual stimulation is then resumed, but it is halted again before orgasm, and this pattern is continued until the man learns to recognize the sensations and obtain control over feelings of impending orgasm.

What was the stop-start technique?

The squeeze technique is a variation of the older stop-start technique of Semans (1956). Some leading sex therapists (such as Helen Singer Kaplan) prefer the stop-start technique to the Masters and Johnson technique. In the stop-start technique, the woman stimulates the man with her hand but stops before he has an orgasm and waits for him to begin losing his erection. Then she resumes stimulation, stopping again before orgasm. This continues until the man becomes familiar with, and able to control, the act of holding off the ejaculation reflex. Next the partners begin sexual activity using the woman-on-top position. When the man nears orgasm he informs the woman, who simply stops moving or lifts off. Gradually the couple develops better control and ability to sustain sex for a longer time.

How is anorgasmia commonly treated?

Anorgasmia is the inability of some women to have orgasm. The woman-on-top position is used in treating this disorder, too. In the top position a woman has far better control of movement and can produce more effective stimulation for herself. After a woman becomes orgasmic (capable of having orgasms) in this position, she may find orgasm becomes possible in other positions.

What are other possible causes of anorgasmia?

Sometimes anorgasmia is due to vaginismus: involuntary clenching of vaginal muscles due to tension and anticipated pain. Pain during intercourse may be caused by yeast infections or lack of lubrication. If sex is painful, then avoidance conditioning occurs. Stimuli associated with sex trigger fear and anxiety.

How is painful intercourse treated?

A woman who is tense and anticipating pain is not likely to feel aroused. If she nevertheless tries to have sex, she is unlikely to have normal vaginal lubrication. That aggravates the problem of pain and irritation during intercourse. To break the cycle of pain, fear, and lack of arousal, several things are necessary: a sensitive, understanding partner; treatment of any medical conditions such as yeast infections; and extra lubrication with a product designed for the purpose.

What therapy for anorgasmia did LoPiccolo and Lobitz develop?

LoPiccolo and Lobitz (1972) developed a therapy for anorgasmia. They suggested that the first step was for a woman to become comfortable with her own body and familiar with the sensations of orgasm. They recommended self-exploration, then masturbation, first alone and then with a partner, moving on to intercourse. Unfortunately, the recommendation for masturbation makes this treatment unacceptable in some cultures with traditional bans on the practice. However, the success rate for this treatment is good.

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