• value in itself: self esteem depends on both fulfillment of need and self control
• improve well being of medically ill (improved relationship means better general health, even if sexual function unchanged)
• possibly reduce unintended pregnancy, STD, sexual aggression

• uncover specific sexual dysfunction
• address medical factors
• explore context of those medical factors (developmental and relational)
• provide resources for more complex help

• Permission (allows you to discuss concerns openly)- may I ask you some questions about your sexual life?
• Limited Information (explain sexual function)- tell them what the NEED to know
• Specific Suggestions
• Intensive Therapy (only if above not sufficient)

Any health care professional can do PLISS

• sexual aversion
• inhibited sexual desire
• pain during sex
• vaginismus
• problems of tumescence (weak/absent erection and absent/weak lubrication)
• problems of orgasm (premature, none, delayed)
• medical counseling vs. formal related more to complexity, severity of problem itself

• requires general biopsychosocial approach (usually requires formal therapy)
• begin by IDing roots
  • early parenting, attachment
  • maltreatment/abuse (conditioned fear)
  • cultural indoctrination
  • physical illness/injury
  • low anxiety threshold
  • complex interaction between fear/ anxiety and sexual interest/ responsiveness

• some lack natural desire (more in females)
• by itself, compatible with healthy attachment, work, fulfilled life
• imbalance between partners can make a problem out of what is otherwise normal for the individual
• if acquired (new onset, look for medical, substance, medication related probelms
• androgens often not helpful in women, safety not establishes

• infection
• physiological factors (lubrication, vaginismus)
• psychological inhibition of sexual response

• recognize psychological and reciprocal nature of problem
  • previously painful intercouse- anatomical probelm, rape, clumsy partner
  • negative sexual attitudes- guilt, dirt, sin
  • partner erectile dysfunction, coital frustration (vicious cycle)
• once couple enlisted in therapy, use graduated dilators

• delay orgasm often a medication effect (SSRI)
• in women, ginko may help, women can also learn to speed of their response (solitary sex); partner can help with non coital stimulation
• premature orgasm/ejaculation- male problem primarily (use of squeeze technique)

• may occur ONLY with vaginal intercouse
• may be result of internalized restriction against pleasure, loss of control
• may only occur in heterosexual intercouse or with a disliked partner (lack of trust)

Not essential for pleasure

• gradual stimulation, massage, touch
• do not try to achieve orgasm in early phases of tx
• female superior position
• Kegel exercises
• vibrators

• shame or need to concel sexual activity may have biological roots (ex: primate research shows when 2 go off to have sex, they go into a private place)
• guilt- cultural elaboration of shame

• sexual problems due to sociocultura, political, or economic factors
• sexual problems relating to partner and relationship
• sexual problems due to psychological factors
• sexual problems due to medical factors