Disorders of sexual dysfunction

Question 1

Definition of sexual health

Answer 1

“Enjoyment of the sexual activity of one’s choice, without causing or experiencing physical or emotional harm.”

Question 2

List the 4 classifications of sexual disorder (DSM IV)

Answer 2

• Sexual desire Disorders:
• Hypoactive sexual desire disorder – involves a loc or loss of interest in initiating sex and little desire to see stimulation
• Sexual aversion disorder – an aversion, avoidance or dismissal of sexual prompts or sexual contact. It may be life-long or acquired following sexual or physical abuse or trauma.
• Sexual Arousal Disorders:
• Female sexual arousal disorder – failure to achieve & progress through the stages of normal sexual arousal. Adequate lubrication, the ballooning of the vagina and pulling up of the uterus will not occur without sexual arousal.
• Male erectile disorders
• Orgasmic Disorders
• Female orgasmic disorder – a delay or absence of orgasm after normal female arousal.
• Male orgasmic disorder
• Premature ejaculation
• Sexual Pain Disorders
• Dyspareunia – marked by genital pain before, during or after intercourse.
• Vaginismus - involuntary contraction of the muscles around the vagina as a response to attempted penetration. The contraction makes penetration painful or impossible.

Question 3

Drugs that reduce libido and orgasm

Answer 3

Psychiatric medications (all ↓ libido & orgasm)

• TCA
• MAO I
• SSRIs
• Lithium

Non-psychiatric medications

• antiHT – beta blockers, methyl dopa
• diuretics
• antiparkinsonian
• anticholinergics
• antihistamines
• cimetidine
• steroids
• oestrogen

Recreational drugs

• alcohol
• marijuana

Question 4

Causes of vulval pain:

Answer 4

• vulvitis or vulvovaginitis from infection
• vulval vestibulitis – with severe pain to touch
• vulvodynia – condition of persisting pain of unknown aetiology possibly related to post viral infection sensitivity or psychological fears, that may overlap with vestibulitis
• urethritis
• atrophic vulvitis
• inadequate lubrication
• irritants such as spermicides, detergents, scents, dyes or sweat.

Question 5

The Study of Women’s Health Across the Nation (SWAN) was a longitudinal study of more than 3000 multiethnic American women followed through the menopause transition.

What were the major changes in sexual functioning that occurred with the menopause?

Answer 5

1. an increase in vaginal and pelvic pain with sexual intercourse
2. a decrease in sexual desire

However, there was no significant difference in arousal, emotional satisfaction or physical pleasure.

Question 6

Summary of the use of testosterone

Answer 6

Testosterone has been researched for use in hypoactive sexual desire and there is some evidence to suggest that using a testosterone patch increases sexual desire slightly for some women. Testosterone decreases in the menopause/primary ovarian failure etc.

Question 7

Who to consider testosterone for:

Answer 7

naturally or surgically menopausal women who report low sexual desire that causes personal distress;

women who have decreased libido after starting an SSRI;

older premenopausal women.