به نام خدا - PowerPoint Presentation

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به نام خدا

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Biological characteristic of sexual experience :

Changes in genitalia

Heightened awareness of pleasurable erotic sensation

Changes in subjective state (sexual excitement )Slide3

Genital responses :

Depend on specific local vascular mechanism Slide4

Sexual excitement Slide5

Neuropsychology of emotions :

Whether

conscious

feeling follow bodily changes / vice versa ?Slide6

Information processing

Cognitive processes that attend to the sexual meaning of what is happening by focusing on external events & relating them to memory ,internal processes such as imagery ,/perceptions bodily changes that have sexual meaning Slide7

Arnold`s conceptualization

:

Emotions are generated by an

unconscious,implicit

evaluation of a stimulus

Is followed by

a tendency to act

in a particular way (action tendency )

Is followed by

peripheral responses

Finally

conscious experience Slide8

Emotion system :

Gray (1994 )has proposed three fundamental emotion system :

1)

Behavioural

approach system (

BAS

)

2)Fight /flight system

(F/FLS

)

3)

Behavioural

inhibition system (

BIS

)

The

first two involve action

(approach for reward or fight /flight to avoid punishment )

The third involves inaction accompanied

dy

increased arousal & attention ,as away of coping with threat Slide9

Arousal mechanisms are relevant to all three of Gray`s emotional system

General arousal (activates individual in a non-specific way )

Specific arousal (prepares the body for specific types of action )Slide10

Orgasm:

Orgasm is often regarded as the goal of sexual activity

Conclusion ,pleasure & reduction of tension associated with it are important

reinforcers

in the learning of sexual

behaviourSlide11

Orgasmic manifestations :

1)Intense feeling of pleasure ,ecstasy

2)Some degree of altered consciousness with reduced awareness & information processing

3)Specific sensation ,typically felt in the genital regions but spreading through the body

4) Muscle contractions

5)Other non genital changes

A post-orgasmic state in which the above manifestations return to a non-aroused state Slide12

Orgasmic manifestations are similar in M&W

except seminal emission ,refractory period

Slide13

Types of female orgasm:

freud`s

doctrine

clitoral stimulation in order to experience orgasm is a sign of immaturity ,a failure of the clitoral-vaginal transfer that signal sexual maturity

Kinsey et al (1953)

pointing to the insensitivity to touch of the vaginal wall in contrast to clitoris & labia minor they underestimated importance of pressure as a vaginal stimulus Slide14

Continuse

Masters &

johnson

(1966)

either direct /indirect stimulation of clitoris is always

necessery

for orgasm & physiological changes

coclusion

that instead of two types of orgasm

( clitoral & vaginal )there was only one

Bentler

&

peerler

(1979)

siger

(1973)

found difference between two type (

vulval

& uterine)Slide15

Vulval

orgasm depend on clitoral stimulation and manifested by vaginal contractions

Uterine experience is characterized by more marked emotional reactions , by

apnoea

& without vaginal contraction

with a refractory period Slide16

The recent report of differences in post-orgasmic PRL levels in both women & men when comparing orgasms from masturbation & those from

seual

interaction with one`s partner Slide17
Slide18

Sexual dysfunction :

Correlated with sexual physiological response

Essential feature of sexual dysfunctions is inhibition in one /more of the phase

A disturbance in the sexual response cycle Slide19

orgasmic disorders

Lifelong or acquired

generalized or situational

psychological

Medical

combined psychological and medical factorsSlide20

Premature Ejaculation:

common male sexual problem

Masters and Johnson (1970) diagnosed a man with PE if he could not delay ejaculation long enough

for his partner to reach orgasm 50% of the timeSlide21

Etiology of PE

Biological/Physiological :

_

range exists among men in their ejaculatory speed(nerve latency time )

91% of men with lifelong PE had a first relative with

lifelong PE ,

Waldinger

et al. (1998)

_ neurotransmitter

Serotonin

_ Physical illnesses

_ Pharmacologic side effect

opioids

, alcohol

cold medications

PsychologicalSlide22

Psychological :

emotional issues :

1) Anger

2) frustration,

3) low self-confidence, mistrust,

4) negative body image

5)psychosocial stress associated with financial difficulties, occupational problems

6)death of a significant other may be factors

Slide23

Treatment :

Medical :

SSRIs (

paroxetine

,

sertraline

,

fluoxetine

)

TCAs (

ciomipramin

)

Neurololeptics

topical anesthesia (

lidocaine

cream )

PDE5 inhibitor agents

PE ExercisesSlide24

PE Exercises :

Help man learn to tolerate increasing levels of stimulation

control of his ejaculatory reflex

_ sensate focus exercises

_ stop–start method

_ squeeze techniqueSlide25

Delayed ejaculation

persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity that the clinician, taking

into

account the person’s age, judges to be adequate in focus, intensity, and duration,” and it causes “marked distress

or interpersonal difficultySlide26

Inhibited female orgasm

persistent or recurrent delay in, or

absence of, orgasm in a female following a normal sexual excitement phase

during sexual activity that the clinician judges to be adequate in focus, intensity and duration

Slide27

Etiology

Intergenerational

individual

relationshipSlide28

Intergenerational Influences

Difficulties in the

process of socialization

during childhood

development of

misconceptions about sex

negative attitudes

toward sexual pleasure

problems with

sexual orientation

or gender identity

sexual abuse

during childhood

experiences or attitudes

during adolescence (women)Slide29

Individual Influences

sexual attitudes

McCabe (2005) demonstrated that performance anxiety was associated with high levels of

anorgasmia

stress, levels of fatigue, sexual identity, health

mood disordersSlide30

Relationship Factors

quality of the relationship

McCabe and Cobain (1998) found that relationship factors were strongly associated

with sexual dysfunction for women but not as strongly for menSlide31

Assessment

psychological

relational

social

medical history Slide32

Kelly,

Strassberg

, and Turner (2006) found that there were behaviorally assessable differences

in the

communication pattern

of couples

experiencing female

anorgasmia

when compared with functional couples ,specially

the negative interactional dynamics of

blame

and lack of

recepitivly

to interactions by their partnerSlide33

clear understanding of the nature of the sexual dysfunction

assess the

frequency

of orgasm

the

situation in which

anorgasmia

occurs whether

whether

anorgasmia

is

primary or secondary

if

anorgasmia

is

partial or complete

,

and the

length of time

the problem has been in place.

question the woman and her partner on why she is seeking treatment at this point in time & what

expectations or goals

she has for therapySlide34

Treatment:

important factors :

communication

performance anxiety

The communication training included:

exercises for active and passive listening, verbalization and reflection of feeling

productive conflict management assertive behaviorSlide35

Performance Anxiety:

woman’s past failure to achieve orgasm

who regards her orgasmic response as an

assurance

of his or her own

competence

Fear of

rejection

or feelings of

obligation

toward the partner Slide36

three interrelated treatment strategies:

communication exercises

sensate focus exercises

and guided fantasySlide37

Communication Exercises :

improve the quality of the marital relationship

develop and explore emotional responses

(address all aspects of the relationship, both sexual and nonsexual)

Both partners were instructed to share their feelings Slide38

Examples of early questions

· What do I like best about us as partners

and how does that make me feel?

· How do I feel about differences between

us in desire for sexual contact?Slide39

communication exercises continued to encourage the development of the emotional side of the woman by exploring her reaction to the program and sharing this reaction with her partner

For example, when partners were physically

exploring their responses to body massage and genital stimulation

one of the communication questions was,

How do I feel when you caress me intimately?

What body feelings occur?

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Sensate Focus Exercises:

The Masters and Johnson (1970) sensate focus program was outlined in therapy and

implemented at home by the client

The program was commenced two weeks after the commencement of therapy

exercises comprised

nongenital

and then genital

pleasuring and, finally, intercourse in a gradual

patternSlide41

Fantasy:

use of sexual fantasy is an important aspect of

therapy

purpose of sexual fantasy seems to be different for men and women

fantasies need to be aimed at enhancing the acceptance of oneself as a sexual person. Slide42

Some women may have difficulty

accepting

themselves as sexual persons and may

experience a high level of guilt in association with their sexual functioningSlide43

. Men may experience guilt in association with

sexual expression, but this guilt is accompanied

by a lack of emotional involvement in the actual

relationshipSlide44

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