a)  Hypoactive sexual desire disorder
b)  Sexual  aversion disorder

• Sexual trauma - PTSD

a)  Male erectile disorder
b)  Female sexual arousal disorder

a)  Premature ejaculation
b)  Male orgasmic disorder
c)  Female orgasmic disorder

• Do not fit in with response cycle

a)  Dyspareunia - usually female
b)  Vaginismus

• Learned anxiety
• Constantly worried about performance

• Religious/sociocultural taboos on sexual feelings
• Marriage problems
• ETOH overuse
• Early psychosexual trauma

• Direct
• Symptomatic

• “Sensate Focusing”
• No intercourse (not for trauma patients)
• Controversy over surrogate partners

• “Start-stop” Technique
• “Squeeze Technique”

• “Paradoxical Instruction”
• Try not to have an erection during sensate focusing exercises
  

• Vacuum device which draws blood into the penis

• Education on female sexual anatomy
• Self-exploration exercises - vibrator, erotic pictures, etc.

• Fetishism from conditioning process
• Early sexual experiences  + unconventional stimulus
• Particularly masturbation
• Object/activity then discriminative stimulus for arousal

• Associated with physiological arousal

• From child only receiving love/attention after parents punish him?

• Reinforced (“cute”) for cross-dressing as child
• Sexual arousal vs. Relaxation
• “Femme” personality
• Parallel with Dissociative Identity Disorder?

• Masturbates looking at acceptable stimulus until ejaculation,
• Verbally describing his fantasies which are tape recorded
• Then 2 minutes after ejaculation, he masturbates to deviant stimulus
• And continues for 55 minutes
• Unless he becomes aroused
• At which point he switches back to the acceptable stimulus
• Repeated 3 times a week  for 1 month
• Working up heirarchy of deviant stimuli

• Deviant fantasy until arousal
• Then imagining the worst scenario

• Rehearses paraphiliac behavior in front of therapist and wife
• They observe and comment
• Used only when other techniques have failed