Treatment of orgasm disorder in women with the digital S-ONapp method

Abstract

Objectives: The present body of work presents a case study addressing the development of sexual behaviors in a patient with primary anorgasmia in order to reduce emotional distress manifested by guilt, embarrassment and performance anxiety, as well as learning new sexual patterns to increase pleasure and sexual satisfaction. Specifically, we sought to create a positive attitude toward sexuality as part of mental health and increase self-confidence in expressing one's sexuality. Reaching orgasm by the patient was not a stated goal, not to accentuate the distress, but the development of sexual behaviors aimed to increase the duration and intensity of arousal and more frequent manifestation of sexual desire, designed to create the conditions for its occurrence. Method: This is a case study on a 44-year-old patient, during 20 sex therapy sessions of 1 hour each, for 22 weeks, May-September 2021. Assessment methods for Axis I and Axis II, anamnesis and clinical observation, structured, semi-structured and unstructured clinical interviews (Delcea C., 2021) and investigation of medical, family, sexual, socio-cultural, and psycho-social history (individual completion) - MCMI III psychometric tests (Millon), Scale of Anxiety Hamilton, HRSA (SEC), PDA Affective Distress Profile, Opris D., Macavei B. (SEC), YSQ-S3 Short Form Cognitive Questionnaire (SEC), DAS Dysfunctional Attitude Scale Beck A., Weissman A. ( SEC); For sexual testing: Genogram of excitatory stimuli, (Delcea C., 2021), FSFI Female Sexual Function Index, Rosen M. 2000, FSDS Female Sexual Distress Scale, Derogatis, 2019, FOS Female Orgasm Scale, McIntyre, Smith, 2019, ORS The Orgasm Rating Scale, Mah K., Binik, 2019, MISSA Multiple Indicators of Subjective Sexual Arousal, Mosher DL, 2019- SISES Sexual Inhibition / Excitation Scale, (Milhausen RR 2019). Methods used in sex therapy intervention (face to face): to identify stimuli of pleasure, arousal and sexual relaxation, having as source the partner's body we used the Genogram of excitatory stimuli, the technique of anticipating excitatory stimuli and the technique of defocusing irrelevant stimuli. (Delcea C., 2021). Sensate focus and directed masturbation to identify individual arousal stimuli, and self-monitoring through journals. 3. Cognitive restructuring of dysfunctional cognitions. 4. Progressive desensitization, in the construction and practice of new exciting sexual behaviors. 6. Psychoeducation. 7. Relaxation techniques (eg breathing, mindfulness). Results: Following the standard psychological assessment, the patient has no Axis I and II emotional disorders, and no history of sexual abuse. The MCMI profile shows a person without clinical personality disorders, but a very high level of Distress (PDA), present cognitive schemas, Negativism and Need for approval that outlines a possible anxious predisposition, as well as present dysfunctional attitudes of medium level, considered as predispositions for depression. Sexual testing with the score sc = 19 FSDS scale, (Derogatis, LR 2002) The sexual distress scale in women shows that the patient has a high level of stress that positively correlates with the existence of sexual dysfunction, manifested by feelings of shame, guilt , inadequacy, and average sexual satisfaction. From the 2 orgasm measurement scales, FOS (McIntyre - Smith, 2019) and ORS (Mah K., Binik, Y., 2019) there is a lack of experience of orgasm by the subject, throughout life and an increased dissatisfaction. The FSFI Scale Index of sexual functioning in women (Rosen R., 2000) shows the same difficulty in experiencing orgasm in the context in which sexual desire exists and the level of arousal is high, from the subjective assessment of the patient. Sexual desire - 4.2; Excitation - 5.1; Lubrication - 4.2; Orgasm - 1.2; Sexual satisfaction - 4.4; Disappearance - 0.9 (maximum = 6.0). The genogram of excitatory stimuli shows an insufficient register of excitatory stimuli on the partner's body, 4 out of 8 (face, chest and arms) and an absent register of excitatory physical stimuli having as source its own body, absent fantasies, unique, poor and repetitive scenarios. Conclusions: This is a patient without mental disorders with clinical significance, with predispositions for the installation of anxiety and depression, high level of distress. There is a poor sexual history and reduced and inadequate arousal. Absent fantasies, absent masturbation, dysfunctional cognitions about sex, "sex is unknown, forbidden, dangerous", register of excitatory stimuli on one's own absent body, and reduced for the partner's body, sexual pattern during predominantly passive sexual intercourse, on receiving pleasure, focused on the partner's body. There is a lack of development of arousal stimuli and consequently sexual behaviors maintain orgasm dysfunction.