Lecture 23: Sexual dysfunction Flashcards
what is sexuality
- important and legitimate aspect of well being
- no normal or average
- we’re all sexual beings with or without partner
- intimacy
- loving relationship
- sexual activity
- physical appearance, body image
what is sexual health
physical, emotional, well-being relating to sexuality
- not merely absence of disease, dysfunction
what is sexual dysfunction
when you can’t participate in sexual relationship he or she would wish
prevalence of sexual dysfunction: at least 1 sexual dysfunction–>women
40-50%
prevalence of sexual dysfunction: at least 1 sexual dysfunction–>men
20-30%
prevalence rates (limitations)
- diff samples– age groups, clinical vs. non-clinical
- diff measurements– self-report vs. clinical interview
- instead of asking: are you sexually active? yes or no
ask: how satisfied are you with your sexual life?
kaplan’s triphasic (3-stage) models of sexual response
- desire
- excitement
- orgasm
basson’s non-linear model of F sexual response
circular, rather than linear model
emotional intimacy–> sexual stimuli–> sexual arousal–> arousal and sexual desire–> emotional + physical satisfaction–> goes back to emotional intimacy
= considers how emotional intimacy, sexual stimuli, relationship satisfaction–> affect F sexual response
how to detect sexual dysfunction (DMS-5)
- clinically sig disturbance in person’s ability to respond sexually or to experience pleasure
- min duration of 6 months
- symptoms must cause sig distress
- experienced almost all or all occasions of sexual activity
- important to consider cultural values + age
what are sexual dysfunction: subtypes
- nature of onset
- context
- severity
- nature of onset
lifelong or acquired
- context
generalised or situational
- severity
mild, moderate, severe– based on level of distress
DSM-5 classification of sexual dysfunction
- moving away from kaplan’s model
- replaced with gender specific dysfunctions
stage of sex response: desire (male)
male hypoactive sexual desire disorder
stage of sex response: arousal (male)
erectile disorder
stage of sex response: orgasm (male)
- delayed ejaculation
- premature ejaculation
stage of sex response: desire (female)
female sexual interest / arousal disorder
stage of sex response: arousal (female)
female sexual interest / arousal disorder
stage of sex response: orgasm (female)
F orgasmic disorder
stage of sex response: pain (female)
genito- pelvic / pain penetration disorder
what are sexual desire disorders
- don’t think about it, not excited about doing it= frustrated about this= why am I not feeling this?
- gender differences: M= 8% F= 55%
- age differences
what is the most common F sexual dysfunction
sexual desire disorders
male hypoactive sexual desire disorder
- not interested in sex, little sexual activity + fantasising
- physical response–> normal
F sexual interest / arousal disorder
- not interested in sex
- arousal: hard to attain or maintain wet till end of sex– painful
M sexual arousal disorders
- erectile disorder (ED)
- hard to get or maintain erection, or decrease in erectile rigidity
- v age related
causes of sexual dysfunction
- biological / physical factors
- psychosocial stuff
- personal stuff
- env. stuff
- biological / physical factors
- aging
- illness
- substance abuse
- medications (ex. antidepressants)
- psychosocial stuff
- cultural, religious beliefs
- body image
- self acceptance
- depression, anxiety
- life stressors
- past experience (trauma, abuse)
- personal stuff
- attraction to partner
- excessive goal orientation
- relationship problems
- can you compensate for each other?- libido differences
- env. stuff
- lack of privacy
- don’t have time
- physical discomfort
medical trt for erectile dysfunction
- pharmacotherapy / oral medication
- penile injections
- vacuum device
- penile prosthesis
- pharmacotherapy / oral medication
- time to take effect + duration of effect= diff
- rly effective
- dose modification might be necessary
= increased satisfaction
- penile injections
- injection of smooth muscle relaxing drugs into erection chambers
- erection= 30-45 mins
- vacuum device
erection= 30 mins
- effective, but high drop out
- numbness, pain
- penile prosthesis
last resort trt
important to…?
promote sexual intimacy
- doesn’t have to be just sex
- oral sex, sex toys, holding hands, kissing, cuddling
- emotional connection
psychogenic erectile dysfunction
- often sudden onset
- situational
- continued morning erections
- erection with masturbation
- spouse relationship: might be partner specific
- younger patient (<40)
- abnormal sex development
organic erectile dysfunction
- gradual onset / deterioration
- decrease in morning erections
- no erection w/ masturbations
- chronic medical illness
- pelvis trauma / surgery
- recreational drugs
- reduced size of penis
M orgasmic disorders
- delayed ejaculation
- premature (early) ejaculation
- delayed ejaculation
- maintains erection, but delayed to ejaculate w/o person wanting delay
- experience it almost all the time
- prevalence: about 4&– not so common
- premature (early) ejaculation
- ejaculate with only little stimulation (less than 1 min of penetration)– before guy wishes it
- prevalence; about 8%
F orgasmic disorder
- marked delay, infrequency, no orgasm, OR not much intensity of orgasmic sensations
- but if orgasm achieved with clitorial stimulation but not penetration–> doesn’t meet criteria
- needs to be distressed about this
- can be situational
- orgasm learnt response (not automatic)– improves with experience
- prevalence; 5%
DSM-5 genito pelvic pain / penetration disorder
persistent or recurrent difficulties in any 1 of following:
- vaginal penetration during sex
- pelvic pain
- fear or anxiety about pain (actual + thinking about it) or after penetration
- tensing, tightening of pelvic floor muscles
- important to take detailed history
medical trt for D sexual dysfunction
pharmacological
- hormonal therapy: vaginal or systemic oestrogen + androgen
- oral medication for low sexual desire in premenopausal women– but serious side effects: low blood pressure, dizziness– not good to mix with alcohol
non-pharmocological interventions for F sexual dysfunction
- vag lubricants
- vag moisturisers
- vag dilators
what are barriers to trt uptake
- embarrassment
- patients unaware of available resources
- lack of engagement
- always ask if its desired– what if theres abuse in relationship
trt most effective if…
- multi-modal, involving partner
- be more comfortable talking about sex
- intimacy= always possible
