L22 - Sexual Dysfunctions

Question 1

In Australia, what percentage of women reported having one or more sexual difficulties?

Answer 1

66%

Question 2

In Australia what is the most common sexual dysfunction for women?

Answer 2

Diminished libido

Question 3

What are the key criteria that need to be met in the definition of sexual dysfunction?

Answer 3

• Clinically significant disturbance in a person’s ability to respond sexually or to experience sexual displeasure
• Causes significant distress
• Experienced on all or almost all occasions (75-100%)

Question 4

In the DSM-IV male and female sexual dysfunction was classified according to the desire, arousal and orgasm phases of the response cycles. What are the main changes from this in the DSM-5?

Answer 4

• DSM-IV 3 stage model (desire, arousal, orgasm) replaced by “gender specific dysfunction”
• It reflects a more circular model now
• For females: first 2 stages (desire & arousal) have been combined to form “female sexual interest/arousal disorder”
• Specifies for nature of the onset, context, and severity

Question 5

What are the 3 specifiers in the DSM-5 “gender specific dysfunctions” model?

Answer 5

1. Nature of onset (lifelong or acquired)
2. Context (generalised or situational, e.g. specific to particular simulation or partner)
3. Severity (mild, moderate, severe - based on level of distress)

Question 6

What is the defining feature/criteria of sexual desire disorder and is it more prevalent in men or women?

Answer 6

• Persistent disinterest in sexual activity & distressed by this lack of interest
• More prevalent in women (55% vs. 8%) –> most common female sexual dysfunction

Question 7

Erectile disorder (ED) is a male sexual arousal disorder. How is it characterised and what is its prevalence?

Answer 7

• Difficulty in obtaining OR maintaining an erection during sexual activity OR marked decrease in rigidity
• Prevalence: increases rapidly with age (1-10% <40 but 50-100% in men > 70)
• Up to 50% will have erectile difficulties at some stage

Question 8

What are the risk factors associated with erectile disorder (ED)?

Answer 8

Smoking, obesity, hypertension, diabetes.

Question 9

What are the main characteristics of female sexual arousal disorder?

Answer 9

• Difficulty attaining or maintaining adequate lubrication until completion of sexual act

Question 10

What is the prevalence of female sexual arousal disorder?

Answer 10

Prevalence rates uncertain due to high overlap with other female sexual disorders: 30-50%

Question 11

What are 2 male orgasmic disorders?

Answer 11

1. Delayed ejaculation

2. Premature ejaculation

Question 12

What are the characteristics associated with the male orgasmic disorder ‘delayed ejaculation’ and what is its prevalence in Australia?

Answer 12

• Maintains erection, but marked delay/inability to achieve ejaculation
• Usually with a partner (may be fine when masturbating)
• Prevalence: 4% (least common male sexual complaint)

Question 13

What are the characteristics associated with the male orgasmic disorder ‘premature ejaculation’ and what is its prevalence in Australia?

Answer 13

• Ejaculation with only minimal stimulation (<1 min after vaginal penetration)
• Prevalence: 8%

Question 14

What are the characteristics of female orgasmic disorder? What is the prevalence in Australia?

Answer 14

• Delay, infrequency, or absence of orgasm OR reduced intensity of orgasmic sensations
• Must be clinically distressed
• Can be situational
• Prevalence: approx 51%

Question 15

What is the cycle of pain in genito-pelvic pain/penetration disorder?

Answer 15

Body anticipates pain, fear/anxiety –> Body automatically tightens vaginal muscles –> Tightness makes sex painful, penetration may be impossible –> Pain reinforces/intensifies –> Body reacts by ‘bracing’ –> Avoidance of intimacy

Question 16

What are the limitations of prevalence rates of sexual dysfunctions?

Answer 16

• Different samples (clinical vs. non-clinical)
• Different measurements (self-report vs. clinical interview)
• Different definitions (lack of specificity)
• Re-conceptualisaiton of female sexual dysfunctions as circular rather than linear model

Question 17

What are psychological factors associated with causing sexual dysfunctions?

Answer 17

Cultural and religious beliefs, self-acceptance, body image, self-esteem, perfectionism, depression/anxiety/grief, attachment issues, past experiences, abuse/trauma history, inexperience, life stressors

Question 18

What are relational-interpersonal factors associated with causing sexual dysfunctions?

Answer 18

Attraction to partner, satisfaction with non-sexual aspects of relationship, unresolved interpersonal conflicts, inadequate stimulation, excessive focus on intercourse, excessive focus on orgasm, communication of needs, partner rejection, lack of partner

Question 19

What are physiological factors associated with causing sexual dysfunctions?

Answer 19

Age, illness, injury, disability, medications, substance use

Question 20

What are the features of organic erectile dysfunction vs. psychogenic erectile dysfunction?

Answer 20

• Organic: gradual, decrease in morning and nocturnal erections, no erections with masturbation, no loss of libido, presence of comorbid conditions
• Psychogenic: often sudden, preservation of morning/nocturnal erections, erection with masturbation, may be partner-specific, younger patients (<40)

Question 21

What are some environmental factors that can affect sexual dysfunction?

Answer 21

Lack of privacy, lack of time, physical discomfort

Question 22

What are the 4 areas of aetiology of sexual dysfunctions?

Answer 22

1. Biological/physical factors
2. Interpersonal factors
3. Psychological/psychosocial factors
4. Environmental factors

Question 23

What are some barriers to treating sexual dysfunctions?

Answer 23

• Patients unaware of available resources
• Lack of referral
• Lack of engagement
• Minimal attention to partners
• Treatments need more research

Question 24

What are some limitations of sexual dysfunction treatment research?

Answer 24

• Inadequate research methodology
• Limited treatment focus
• Paucity of studies

Question 25

What are some pharmacological treatments for female sexual dysfunction?

Answer 25

• Hormonal therapy (oestrogen, androgen)

- Sildenafil (viagra - but limited effectiveness)

Question 26

What are some treatments for female genito-pelvic pain/penetration disorder?

Answer 26

Kegel exercises, vaginal weights, vaginal lubricants, vaginal moisturiser, vaginal dilators

Question 27

What does the behavioural treatments “communicating skills training” for sexual dysfunction involve?

Answer 27

Communicating skills training - talking to partner about likes and dislikes, comforts and insecurities, how to communicate verbally/behaviourally in sex

Question 28

What are senate focused exercises in treating sexual dysfunctions?

Answer 28

• Focus on sensation of toughing your partner
• 3 weeks, very effective, not allowed to have sex
• Effective in treating female desire, arousal and orgasmic dysfunctions, and erectile disorders

Question 29

Which treatment is best for patients who are geographically isolated? Describe its main features.

Answer 29

Internet based treatment - personalised, interactive, online psycho-educational resource (e.g. cancer survivors) - 6 self-led online modules & tailored according to type of patient, gender, and sexualisation

Question 30

What are some medical treatments for male sexual dysfunctions?

Answer 30

• Viagra, Levitra, Cialis
• Penile injections
• Vacuum devices
• Penile prosthesis