L22 - Sexual Dysfunctions Flashcards
In Australia, what percentage of women reported having one or more sexual difficulties?
66%
In Australia what is the most common sexual dysfunction for women?
Diminished libido
What are the key criteria that need to be met in the definition of sexual dysfunction?
- 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%)
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?
- 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
What are the 3 specifiers in the DSM-5 “gender specific dysfunctions” model?
- Nature of onset (lifelong or acquired)
- Context (generalised or situational, e.g. specific to particular simulation or partner)
- Severity (mild, moderate, severe - based on level of distress)
What is the defining feature/criteria of sexual desire disorder and is it more prevalent in men or women?
- Persistent disinterest in sexual activity & distressed by this lack of interest
- More prevalent in women (55% vs. 8%) –> most common female sexual dysfunction
Erectile disorder (ED) is a male sexual arousal disorder. How is it characterised and what is its prevalence?
- 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
What are the risk factors associated with erectile disorder (ED)?
Smoking, obesity, hypertension, diabetes.
What are the main characteristics of female sexual arousal disorder?
- Difficulty attaining or maintaining adequate lubrication until completion of sexual act
What is the prevalence of female sexual arousal disorder?
Prevalence rates uncertain due to high overlap with other female sexual disorders: 30-50%
What are 2 male orgasmic disorders?
- Delayed ejaculation
2. Premature ejaculation
What are the characteristics associated with the male orgasmic disorder ‘delayed ejaculation’ and what is its prevalence in Australia?
- 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)
What are the characteristics associated with the male orgasmic disorder ‘premature ejaculation’ and what is its prevalence in Australia?
- Ejaculation with only minimal stimulation (<1 min after vaginal penetration)
- Prevalence: 8%
What are the characteristics of female orgasmic disorder? What is the prevalence in Australia?
- Delay, infrequency, or absence of orgasm OR reduced intensity of orgasmic sensations
- Must be clinically distressed
- Can be situational
- Prevalence: approx 51%
What is the cycle of pain in genito-pelvic pain/penetration disorder?
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
What are the limitations of prevalence rates of sexual dysfunctions?
- 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
What are psychological factors associated with causing sexual dysfunctions?
Cultural and religious beliefs, self-acceptance, body image, self-esteem, perfectionism, depression/anxiety/grief, attachment issues, past experiences, abuse/trauma history, inexperience, life stressors
What are relational-interpersonal factors associated with causing sexual dysfunctions?
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
What are physiological factors associated with causing sexual dysfunctions?
Age, illness, injury, disability, medications, substance use
What are the features of organic erectile dysfunction vs. psychogenic erectile dysfunction?
- 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)
What are some environmental factors that can affect sexual dysfunction?
Lack of privacy, lack of time, physical discomfort
What are the 4 areas of aetiology of sexual dysfunctions?
- Biological/physical factors
- Interpersonal factors
- Psychological/psychosocial factors
- Environmental factors
What are some barriers to treating sexual dysfunctions?
- Patients unaware of available resources
- Lack of referral
- Lack of engagement
- Minimal attention to partners
- Treatments need more research
What are some limitations of sexual dysfunction treatment research?
- Inadequate research methodology
- Limited treatment focus
- Paucity of studies
What are some pharmacological treatments for female sexual dysfunction?
- Hormonal therapy (oestrogen, androgen)
- Sildenafil (viagra - but limited effectiveness)
What are some treatments for female genito-pelvic pain/penetration disorder?
Kegel exercises, vaginal weights, vaginal lubricants, vaginal moisturiser, vaginal dilators
What does the behavioural treatments “communicating skills training” for sexual dysfunction involve?
Communicating skills training - talking to partner about likes and dislikes, comforts and insecurities, how to communicate verbally/behaviourally in sex
What are senate focused exercises in treating sexual dysfunctions?
- 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
Which treatment is best for patients who are geographically isolated? Describe its main features.
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
What are some medical treatments for male sexual dysfunctions?
- Viagra, Levitra, Cialis
- Penile injections
- Vacuum devices
- Penile prosthesis
