به نام خدا

1. به نام خدا

2. Biological characteristic of sexual experience : • Changes in genitalia • Heightened awareness of pleasurable erotic sensation • Changes in subjective state (sexual excitement )

3. Genital responses : • Depend on specific local vascular mechanism

4. Sexual excitement

5. Neuropsychology of emotions : • Whether conscious feeling follow bodily changes / vice versa ?

6. 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

7. Arnold`s conceptualization : • Emotions are generated by an unconscious,implicitevaluation of a stimulus • Is followed by a tendency to act in a particular way (action tendency ) • Is followed by peripheral responses • Finally conscious experience

8. 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

9. 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 )

10. 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 behaviour

11. 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

12. Orgasmic manifestations are similar in M&W except seminal emission ,refractory period

13. 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

14. 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)

15. 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

16. 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

18. 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

19. orgasmic disorders Lifelong or acquired generalized or situational psychological Medical combined psychological and medical factors

20. 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 time

21. 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 • Psychological

22. 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

23. Treatment : • Medical : SSRIs ( paroxetine , sertraline , fluoxetine ) TCAs ( ciomipramin ) Neurololeptics topical anesthesia (lidocaine cream ) PDE5 inhibitor agents • PE Exercises

24. PE Exercises : • Help man learn to tolerate increasing levels of stimulation • control of his ejaculatory reflex _ sensate focus exercises _ stop–start method _ squeeze technique

25. 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 difficulty

26. 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

27. Etiology • Intergenerational • individual • relationship

28. 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)

29. 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 disorders

30. 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 men

31. Assessment • psychological • relational • social • medical history

32. 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 partner

33. clear understanding of the nature of the sexual dysfunction • assess the frequency of orgasm • the situation in which anorgasmiaoccurs 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 therapy

34. 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 behavior

35. 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

36. three interrelated treatment strategies: • communication exercises • sensate focus exercises • and guided fantasy

37. 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

38. 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?

39. 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?

40. 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 pattern

41. 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.

42. Some women may have difficulty accepting themselves as sexual persons and may experience a high level of guilt in association with their sexual functioning

43. . Men may experience guilt in association with sexual expression, but this guilt is accompanied by a lack of emotional involvement in the actual relationship

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