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22 state, their body image, health conditions, psychologic well-being and social, cultural or religious beliefs, as well as levels of personal hygiene [10] These partner-related conditions can cause various degrees of sexual function and disorders, and can lead to sexual aversion or avoidance For older women, the most signi cant in uences on their levels of sexual desire were attitudes about sexuality, including age, importance of sex, and education [11] It is common for women to cease sexual interest and intimacy when their partner is experiencing a sexual dif culty, such as erectile dysfunction [11] The anxiety caused by the vulnerability of physical intimacy can make some women very uncomfortable with their sexuality due to real or perceived body image problems, especially due to aging, health treatments, or eating disorders Some women see themselves as physically unattractive without their clothes on and thus avoid all aspects of sexual intimacy Sexual function and disorders are dynamic phenomena and reciprocal events When women experience sexual aversion disorder, avoidance of physical intimacy can impact the quality of the relationship With discrepancies of desire, one person in the relationship can get angry and act out against the other in non-sexual ways, creating a power struggle within the relationship This can then set up the woman to use sex as her power in the relationship and to completely avoid physical contact with her partner It is not uncommon for couples to learn about the power of sex in the relationship and how to use it in their favor or against their partner [1] Frequently, people in a sexual relationship confuse emotional intimacy with physical intimacy Within the power dynamics of an intimate relationship, sexual aversion disorder can be the result of some deep psychologic event or belief within the woman, a physical condition of the woman or her partner, or a perceptual problem within the relationship Regardless of the etiology, it can create a wedge within the relationship and become a source of distress for the woman and/or her partner Clinicians need to address the sexual history with the couple together and separately Frequently, one person may reveal perspectives and experiences that may not come out in the conjoint session Especially, if one person is really not turned on by the other for many reasons, it may be dif cult to address this in front of.

Table 125 Hard and Soft Reset Operational Implications TYPE OF RESET Hard GOOD NEWS Minimal memory requirement BAD NEWS Forces total refresh of table and potentially long reconvergence No effect on inbound

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the disease or treatment chosen, and psychologic or emotional changes due to the nature of the disease or disorder Women who have treatment for breast cancer often report a decrease in sexual function [5], which can result in voluntary avoidance of sexual intimacy Depending on the treatment choice this could be caused by a change in body image due to a mastectomy, to lymphedema, or due to lack of sensual response resulting from surgery, from the iatrogenic menopause secondary to chemotherapy, and or other treatment options [21] (see 26) Diabetes mellitus can cause women to have decreased genital sensation and lubrication and thus lead to female sexual disorders and eventually sexual avoidance Neither age, duration of diabetes, glycemic control, nor complications, predict the extent of sexual disorders in women [4] However, age is an independent predictor of sexual disorders Psychotropic medications, especially the serotonin-speci c reuptake inhibitors (SSRIs), tend to in uence tactile sensation and decrease orgasmic response [19] The decrease or even delay in orgasmic response can cause women to avoid sexual intimacy because it becomes unpredictable and requires a frustratingly longer sex-play Frequently, if the clinician is empathic and understanding of the woman s various health conditions, it is easier for her to talk about her loss of intimacy and closeness, and to open the hope and possibility of treatment Religious beliefs can in uence women s ability to enjoy sexual intimacy Some religious doctrines do not allow women to experience their sexuality with pleasure and prefer to focus on rigid role expectations about sexual intimacy, which creates the sex for procreation not recreation mindset [9] It is clear that if a woman has guilt about enjoying her sexual pleasure, which goes against her religious beliefs, she will also experience high levels of anxiety and this can cause unsatisfactory physical symptoms resulting in sexual avoidance.