So much to think about from this weeks' presentation, with helpful information that extends to both couples with all ability levels, and parenting wisdom for all families. I specifically resonated with the PLISSIT acronym that was both in Binik and Hall's book and in the presentation. It reminds me of the stages of grieving in that processing traumatic events usually requires more than one step. I think beginning with permission to resume sex and to grieve changes also highlights the balance of life: persevering and moving forward while acknowledging and grieving the things that are lost to us.
I was especially drawn to the chapter regarding people with disabilities. During my undergrad, we spent a few different days exploring the world through the lens of people with physical disabilities. I spent a day in a wheelchair trying to access public spaces. We also played wheelchair basketball and amputee soccer. We spent a final day trying to navigate the world without vision. We learned a great deal about how accessible (or not accessible) our community was. We were also inspired athletes who had overcome physical disabilities who were white water rafting, skiing, playing basketball, and soccer. But we never talked about, nor did I consider, what sexuality or sexual intimacy would look like for these people. I do not know if I would have recognized my bias of viewing these people as asexual, but I am embarrassed by this oversight. I was so impressed by the very overt accomplishments and challenges these individuals had been able to overcome, but I had failed to see them as adults with very typical desires and sexual interests. Binik and Hall reported that PWD are the largest minority group in the US; it is vital that we view these people as just that: people. Such a small part of the wiki, but one of my favorite parts is the diagram for different sexual positions for individuals who use a wheelchair. It normalized the situation and presented the obstacle in a straightforward and easily surmountable manner.
Wednesday, March 25, 2015
Tuesday, March 10, 2015
Reflections about Orgasm Disorders
A few scattered thoughts regarding orgasm disorders:
From the presentation/wiki page:
I find it interesting that the prevalence of FOD is reported to be as high as 42%, but that number is not actually based on diagnosing orgasm issues with the DSM's FOD criteria. This inconsistency bugs me. Doctors do not diagnose broken bones by some arbitrary set of factors they decide on. Fractures are not diagnosed by "concepts", personal criteria, or according the the patient's complaint. If sex is going to be medicalized, then accurately medicalize it. The problem with quasi-medicalization is that facts, like 42% of women suffer from FOD, sound "legit" and people readily accept it as truth.
Likewise, I appreciated the snapshot of a google search for orgasmic disorder. It is telling to see what society views as both the causes and the "cures" for orgasmic disorders. I fear couples are going to be very disappointed when 10 new magical positions do not provide an instant cure.
Finally, I like the link/information about Standard Operating Procedures for treating FOD. I agree with McKenzie; while the title makes the information sound very stark, I feel like its a great concise starting point for thinking about starting points when working with women/couples with orgasm issues.
From the videos:
Tiffani, you encouraged us to look past the "cheese" and focus on what the couple was processing regarding the woman's vaginismus... but I was totally suckered in to the "cheese". I felt so much empathy for this couple; the woman especially was fighting against such powerful and reinforced negative messages about sex. I felt like the video was effective in suggesting just how distressing this condition can be for women; she talked about considering swerving her car into oncoming traffic to end her suffering. Low desire and arousal definitely causes tension in relationships, but the inability to have any intercourse at all seems likely to be even more stressful, heightening all those feelings of shame, guilt, inadequacy, and helplessness. The botox treatment is interesting, and I can see the appeal of an "instant" fix, or at least a jump start to the psychological work that needs to be done. It seems a little less practical however; I imagine the cost alone makes the procedure inaccessible to most women.
From the book:
I found the "three windows" approach an interesting framework for explaining the biopsychosocial information that would be helpful to collect when treating a woman with FOD. The current situation, the vulnerability of the client, and addressing health related factors seems like it would give a clinician a comprehensive starting point for assessing etiology of FOD in a client. Also, the diagram on page 103 expands upon this "three windows" concept, which really helps carry the framework from assessment to treatment. I am curious how often this structure is used by sex therapists, and if it proves to be as successful as it seems potentially to be.
From the presentation/wiki page:
I find it interesting that the prevalence of FOD is reported to be as high as 42%, but that number is not actually based on diagnosing orgasm issues with the DSM's FOD criteria. This inconsistency bugs me. Doctors do not diagnose broken bones by some arbitrary set of factors they decide on. Fractures are not diagnosed by "concepts", personal criteria, or according the the patient's complaint. If sex is going to be medicalized, then accurately medicalize it. The problem with quasi-medicalization is that facts, like 42% of women suffer from FOD, sound "legit" and people readily accept it as truth.
Likewise, I appreciated the snapshot of a google search for orgasmic disorder. It is telling to see what society views as both the causes and the "cures" for orgasmic disorders. I fear couples are going to be very disappointed when 10 new magical positions do not provide an instant cure.
Finally, I like the link/information about Standard Operating Procedures for treating FOD. I agree with McKenzie; while the title makes the information sound very stark, I feel like its a great concise starting point for thinking about starting points when working with women/couples with orgasm issues.
From the videos:
Tiffani, you encouraged us to look past the "cheese" and focus on what the couple was processing regarding the woman's vaginismus... but I was totally suckered in to the "cheese". I felt so much empathy for this couple; the woman especially was fighting against such powerful and reinforced negative messages about sex. I felt like the video was effective in suggesting just how distressing this condition can be for women; she talked about considering swerving her car into oncoming traffic to end her suffering. Low desire and arousal definitely causes tension in relationships, but the inability to have any intercourse at all seems likely to be even more stressful, heightening all those feelings of shame, guilt, inadequacy, and helplessness. The botox treatment is interesting, and I can see the appeal of an "instant" fix, or at least a jump start to the psychological work that needs to be done. It seems a little less practical however; I imagine the cost alone makes the procedure inaccessible to most women.
From the book:
I found the "three windows" approach an interesting framework for explaining the biopsychosocial information that would be helpful to collect when treating a woman with FOD. The current situation, the vulnerability of the client, and addressing health related factors seems like it would give a clinician a comprehensive starting point for assessing etiology of FOD in a client. Also, the diagram on page 103 expands upon this "three windows" concept, which really helps carry the framework from assessment to treatment. I am curious how often this structure is used by sex therapists, and if it proves to be as successful as it seems potentially to be.
Wednesday, March 4, 2015
Thoughts about Desire and Arousal...
As a co-author of the wiki-page, I am quite familiar with the information on the page. Likewise, preparing for the presentation resulted in careful reading of the applicable chapters as well as what felt like a mind-numbing amount of articles. You Tube also offers no shortage of videos about arousal and desire... although one side note: trying typing "Male Desire Disorder" or anything of the like. I found that MOST videos were still about females. A frustrating discovery, and a poignant example of our societal thought that men don't have a "problem" with desire; that is, after all, the cornerstone of their masculinity. As Tiffani pointed out, the void of male desire dysfunction is not actually true in the clinical world. I wonder what it feels like for a man who is struggling with low sexual desire; it cannot help to also feel like a social outlier because of it.
One topic that bubbled to the surface of most readings, which I hope we did an adequate job representing on our wiki-page, is the importance of the initial assessment. As an emerging therapist, I think it could be easy to jump too quickly to trying to solve the "problem". If all focus is steered to desire and sexual functioning, the approach will become very medicalized, and is likely miss relational and psychological factors contributing to low desire. Listening for clues in the client's sexual history, current relationship status, and any secrets they have not disclosed to their partner, are much more likely to highlight the etiology of a specific case of desire dysfunction.
One topic that bubbled to the surface of most readings, which I hope we did an adequate job representing on our wiki-page, is the importance of the initial assessment. As an emerging therapist, I think it could be easy to jump too quickly to trying to solve the "problem". If all focus is steered to desire and sexual functioning, the approach will become very medicalized, and is likely miss relational and psychological factors contributing to low desire. Listening for clues in the client's sexual history, current relationship status, and any secrets they have not disclosed to their partner, are much more likely to highlight the etiology of a specific case of desire dysfunction.
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