Men s Sexual Health. Bell curve distribution. What is a normal libido? Everyone is different! Confused society. Hypoactive Sexual Desire Disorder

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1 Men s Sexual Health 1. Too little or loss of libido 2. Too much of a good thing Bell curve distribution Dr Margaret Redelman Medical sex therapist Sydney Men s Health Bondi Junction Society of Australian Sexologists Men s Sexual Health Symposium 2014 ASHA Conference What is a normal libido? Not a level playing field Media colouring of what is normal What does nature require 3 Everyone is different! Even though sexuality is an intrinsic part of us all, how we express it or deal with it depends on... own biology own psychological make-up own social milieu sexual experiences family of origin sex education religious or ethical expectations cultural norms access to erotica access to sexual partners 4 Confused society Hypoactive Sexual Desire Disorder 12-28% 1. Confusion about what is normal 2. Confusion about what is acceptable 3. Confusion about what is healthy 4. How to get the best for oneself sexually 5 Laumann et al. Sexual problems among women and men aged yr: prevalence and correlates identified in the Global Study of Sexual Attitudes and Behaviors Int J Impot Res 2005: 17;

2 Hypoactive sexual desire disorder HSDD (Desire discrepancy disorder) 1. Characterised by absence or notable decrease in frequency of sexual desire experience. 2. Decreased or absent sexual fantasies. 3. Decreased or absent initiatory sexual behaviour with self or partner. 4. Causing distress to patient. 1º & 2º 7 Etiology of HSDD 1. Genetic variant 2. Psychological a. Anger, anxiety, depression b. Relationship conflict c. Orientation issues d. Boring sex life e. Lazy lover syndrome 3. Medical a. Androgen deficiency b. Hyperprolactinemia c. Medication/antidepressants d. Chronic disease/cancer e. Aging f. Drug abuse 8 What effects overall sexual experience? Life stage Age Functionality of genitals Life events Impact of disease/medication Life stressors Communication skills Fatigue Longevity/quality of the relationship Partner characteristics Age Sexuality/Sexual function 9 Desire discrepancy disorder 2 person business In about 30% of couples, the male is the lower sex drive partner 10 1º HSDD very difficult to treat Biological History especially sexual development Masturbation history and style Intrapersonal and interpersonal dynamics Anger and withholding Medication effects Increase what works and decrease negatives Look after partner Acceptance 11 2º HSDD Most important step is the story Biology Relationship dynamics Depression &/disease, medication Impact of changes in male role Sexual script not met Madonna=whore=mother Boredom general & sexual Lazy lover syndrome Medical history, examination, tests 2

3 HSDD comorbidity / bi-directionality Testosterone ED 38% PE 28.2% DE 50% Isolated %.1% 1. Aging 1. Very small gradual annual decrease 2. No andropause 3. Considerable variability between men 2. Metabolic syndrome 3. Chronic conditions/illness/cancer Corona et al Risk factors associated with primary and secondary reduced libido in male patients with sexual dysfunction. J SexMed 2013;10: Sex Therapy Couples Therapy 1. Sex/relationship education 2. Stop pursuer/withdrawal cycles 2. Mind sex / Outercourse / Intercourse 3. Minimal participation sex 4. Masturbation 5. Sexual medication/supports/toys/erotica 6. Expand comfort zones 1. Venting and reframing in safe space 2. Show them their dances 3. Explain interpersonal relationship dynamics 4. Communication skills 5. Intimate and sexual language 6. Permission to practice patiently a more erotic script 16 Hypersexual behaviour Sexual addiction Normal biological variant Due to psychosocial factors Personal distress/anxiety Impairment in partner relationship Poor social skills Due to medical condition/medication Functional sexual impairment Sexual compulsivity Sexual impulsivity Out-of-control sexual behaviour Sexual sensation seeking Hypersexual behaviour Paraphilia-related disorder Spenhoff et al J Sex Med 2013;10: Hypersexual behaviour in an online sample of males: Associations with personal distress and functional impairment

4 DSM-5 Recurrent & intense sexual fantasies, sexual urges or sexual behaviours in association with diminished control, adverse consequences, or behaviour in response to dysphoric mood states and/or life events. Personal distress or impairment in social, occupational or other important areas of functioning. Behavioral specifiers mastubation, pornography consumption, sexual behviour with consenting adults, cybersex, telephone sex, sex venue visits Black et al characteristics of 36 subjects reporting compulsive sexual behavior. Am L Psychiatry 1997;154: % distressed by thoughts or behaviours Dysphoric affects Neuroticism/insecure attachment styles Pair-bonding dysfunction Marital separation Morbidity/mortality with STDs Financial stress 25% impact on their occupation 42% impact on marriage or relationship 47% felt behaviour adversely affected their social life Motivation to change High motivation to change associated with distress and loneliness Motivation discrepancy between one s goals and one s actual behaviour Not the behaviour or frequency that causes distress For many hypersexuality is not primarily a sexual pleasure-seeking strategy but a behaviour pattern serving other, nonsexual functions. These men often have a high level of ambivalence about the changes they wanted to make Once established A reinforcement pattern gains its own dynamic Can be difficult to control Puts these patients at high risk of losing self-respect and sense of integrity This is reinforced when partner is shocked and confused Management Multitude of programs and guru treatments Essential components Therapeutic alliance Readiness and determination of individual Addressing individual personality/psychopathology Addressing psychosocial/relationship issues Implementing good positive sexuality/sexual skills

5 Men s Sexual Health 1. Too little or loss of libido 2. Too much of a good thing Thank you hank you Margaret Redelman 25 5