Abnormal Psychology

Gender and Sexual Disorders 511

Some women with arousal disorders use PDE-5 inhibitors because these med-

ications have an analogous effect on the clitoris. However, PDE-5 inhibitors are

most effective with women who—for medical reasons—have reduced blood fl ow to

the clitoral area, which leads to decreased physical arousal (Berman et al., 2001).

Critics point out that prescribing this type of medication for a woman will not im-

prove sexual functioning when the problem is with her relationship, not her body

(Bancroft, 2002).

At least in some cases, PDE-5 inhibitors (and the medicalization of treatment

more generally) may actually produce sexual problems. For example, consider a

middle-aged man with erectile dysfunction who is given Viagra and resumes sexual

intercourse with his postmenopausal wife. However, his wife cannot maintain ade-

quate lubrication or interest during intercourse given her husband’s (now) extended

erections. In this situation, according to DSM-IV-TR, she may be viewed as hav-

ing sexual arousal disorder, but this “disorder” may only exist because her partner

is taking medication to counter effects of aging. Many researchers and clinicians

maintain that in such cases the woman does not have a disorder, although she may

have a relationship problem (Basson et al., 2001).

Targeting Psychological Factors: Shifting Thoughts,

Learning New Sexual Behaviors

Two types of treatment directly target psychological factors: Sex therapy, which

provides specifi c guidance and techniques to treat sexual problems, and psychologi-

cal therapies—such as CBT or psychodynamic therapy—which address feelings and

thoughts about oneself and others and how they may relate to sexual problems.

One of the main goals of treatments that directly target psychological factors re-

lated to sexual dysfunctions is to educate patients about sexuality and the human

sexual response. Another goal is to help patients develop strategies to counter nega-

tive thoughts, beliefs, or attitudes that may interfere with sexual desire, arousal, or or-

gasm (Carey & Gordon, 1995). For instance, during sexual activity, some people are

preoccupied with nonsexual thoughts that prevent them from reaching full arousal

or orgasm. These nonsexual thoughts might be work-related worries, thoughts about

household tasks that need to be done, or worries that someone will interrupt the sex-

ual encounter. Cognitive treatment may involve teaching a patient how to fi lter out

such thoughts and (re)focus on the sexual interaction. The therapist might encourage

the patient to apply standard cognitive methods (see Chapter 4) to sexual encounters,

such as problem solving (“You could turn the phone off”) or cognitive restructuring

(“Are you likely to think of a solution to your work problem while making love? If

not, you can let your mind focus on the physical sensations you are experiencing”).

In addition to addressing very specifi c sex-related thoughts and feelings, the

treatment may also address the patient’s view of himself or herself. Sometimes

the sense of being dysfunctional or inadequate generalizes from the sexual realm to

the whole self, and the individual with a sexual dysfunction comes to have low self-

esteem and self-doubts generally. In such cases, the therapy may use cognitive and

behavioral methods (see Chapter 4), to address the thoughts and feelings of being

inadequate in multiple spheres of life.

Behavioral treatment typically involves “homework.” Depending on the nature

of the problem, the homework may be completed by the patient or by the patient

and his or her partner together. Homework for women with female orgasmic disor-

der (as well as other sexual dysfunctions) may include masturbation in order to learn

more about what sensations and fantasies facilitate arousal and orgasm (Meston

et al., 2004). For many patients, a fi rst step is to begin to (re)discover pleasurable

sensations through specifi c homework exercises. In the beginning of behavioral treat-

ment, homework may include sensate focus exercises,which are designed to increase

awareness of pleasurable sensations, but preclude orgasm. Such exercises may pro-

hibit genital touching, intercourse, or orgasm; rather partners take turns touching

other parts of each others’ bodies so that each can discover what kinds of stimula-

tion feel most enjoyable (Baucom et al., 1998; LoPiccolo & Stock, 1986).

Sensate focus exercises

A behavioral technique that is assigned

as homework in sex therapy, in which an

individual or couple seeks to increase

awareness of pleasurable sensations that do

not involve genital touching, intercourse, or

orgasm.

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