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3018 > Lecture 23 Sexual Dysfunctions > Flashcards

Lecture 23 Sexual Dysfunctions Flashcards

1
Q

define sexual health

A

a state of physical, emotional, mental and social well-being relating to sexuality.

not merely the absence of disease, dysfunction or infirmity.

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2
Q

define sexual dysfunction

A

‘the various ways in which an individual is unable to participate in a sexual relationship… he/she would wish’.

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3
Q

prevalence of sexual problems

A

at least one sexual dysfunction:
40-45% women
20-30% men

aus women in hetero relationship:
at least 1 sexual difficulties: 66%
at least one new sexual difficulty during previous 12 months: 36%

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4
Q

limitations of measuring sexual dysfunction prevalence rates

A

different samples:

  • age group 18+,40+, 70+
  • clinical vs non-clinical
different measurements:
-self-report vs clinical interview
-asking the right question
eg. sex != coital intercourse
sexual satisfaction != preserved/restored functionality
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5
Q

Kaplan’s triphasic models of sexual response

A

desire
excitement
orgasm

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6
Q

Basson’s non-linear model of female sexual response

A

re-conceptualisation of female sexual dysfunction
-circular rather than linear

acknowledges how emotional intimacy, sexual stimuli and relationship satisfaction affect female sexual response

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7
Q

DSM-5 definition of sexual dysfunction

A

clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure

minimum duration of 6 months

symptoms must cause significant distress

experienced on almost all or all occasions of sexual activity (75% - 100%)

important to consider cultural values & age

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8
Q

DSM-5 sexual dysfunction specifiers

A
  1. Nature of the onset: lifelong or acquired
  2. Context: generalized or situational
  3. Severity: mild, moderate, severe - based on level of distress (Premature ejaculation is specified by time it takes to ejaculate)
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9
Q

DSM-5 gender specific dysfunctions

A

male

1) desire:
- male hypoactive sexual desire disorder
2) arousal:
- erectile disorder
3) orgasm:
- delayed ejaculation
- premature ejaculation

female

1) desire and arousal:
- female sexual interest/arousal disorder
2) orgasm:
- female orgasmic diorder
3) pain:
- genito-pelvic pain/penetration disorder

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10
Q

sexual desire disorders

A

persistent disinterest in sexual activity

the person is distressed by their lack of interest

prevalence 7-33%

aus men 8% vs women 55%

most common female sexual dysfunction

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11
Q

male vs female sexual desire disorders

A

male hypoactive sexual desire disorder:

  • lack of interest in sex, little sexual activity and fantasising
  • physical response may be normal

female sexual interest/arousal disorder:

  • interest/Desire: A lack of, or significantly reduced, sexual interest in sexual activity and fantasising
  • arousal: difficulty attaining or maintaining adequate lubrication until completion of the sexual act
  • prevalence rates: uncertain due to high overlap with other female sexual disorders (~30-50%)
  • less research focused on females (much more research on males – erectile disorder especially)
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12
Q

erectile disorder

A
  • marked difficulty in obtaining or maintaining an erection until completion of sexual activity, or marked decrease in erectile rigidity
  • often spontaneously remits
  • up to 50% adult men have erectile difficulty during intercourse at least some of the times
  • steep age-related increase of ED
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13
Q

psychogenic vs organic ED

A

often sudden onset vs gradual onset/deterioration

situational vs always

preservation of morning erections vs decrease in morning erections

erection with masturbation vs no erections with masturbation

psychogenic ED:

  • maybe partner-specific
  • younger patient (<40)
  • other psychological problems
  • abnormal sex development

organic ED:

  • +/- loss of libido
  • chronic medical illness
  • pelvis trauma/surgery
  • endocrine/neurological disease
  • recreational drugs
  • +/- reduced size of penis
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14
Q

male orgasmic disorders

A

delayed ejaculation

  • Maintains erection, but marked delay (or inability) to achieve ejaculation, without the person desiring delay
  • Experienced on almost all or all occasions of partnered sexual activity
  • “thrusting is a chore, rather than a pleasure”
  • Prevalence (Au): 4% - the least common male sexual complaint

premature ejaculation

  • Ejaculation with only minimal stimulation (less than 1min after vaginal penetration) and before the man wishes it
  • Prevalence (Au): 8%
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15
Q

female orgasmic disorder

A

-Marked delay in, marked infrequency of, and/or absence of orgasm, OR markedly reduced intensity of orgasmic sensations

-If orgasm achieved with clitorial stimulation but not penetration
=> does not meet criteria

  • Woman must be clinically distressed about these symptoms
  • Lifelong vs. acquired; can be situational
  • Orgasm is a learned (not an automatic) response => improves with experience
  • prevalence (Au): 51%
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16
Q

genito-pelvic pain/penetration disorder

A

Persistent or recurrent difficulties in any one of the following:

  • Vaginal penetration during intercourse;
  • Marked vulvovaginal or pelvic plain during vaginal intercourse or penetration attempts;
  • Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation, or during, or as a result of vaginal penetration;
  • Marked tensing or tightening of the pelvic floor muscles resulting during attempted vaginal penetration.
  • Important to take a detailed history
17
Q

cycle of pain

A

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
  • > anticipates pain…
18
Q

aetiology of sexual dysfunction

A

biological/physical:
-aging, disability, illness, medications, substance use

psychosocial:

  • cultural/religion
  • self-acceptance (identity, orientations)
  • body image
  • anxiety, depression
  • life stressors
  • past experience (abuse, trauma)
  • inexperience
  • perfectionism, performance anxiety

environmental:
-lack of privacy, lack of time, physical discomfort

interpersonal:

  • attraction to partner
  • partner performance
  • excessive goal orientation
  • relationship quality, conflict
  • routinisation, change in roles
  • lack of partner
19
Q

medical treatment for ED

A

pharmacotherapy:

  • viagra, cialis, levitra
  • highly effective (70-90%)
  • dose modifications may be necessary over time
  • increased satisfaction in both men and women

penile injections:

  • injections of smooth muscle relaxing drugs into erection chambers
  • erection: 30-45 mins

vacuum devices:

  • erection limited to 30 min
  • 80-90% but high drop out rate
  • complications: coolness, numbness, pain with ejaculation

penile prosthesis:

  • last resort treatment
  • minimal complications (<5%), high satisfaction rate

Important to promote sexual intimacy despite functional challenges

20
Q

pharmacological treatment for female sexual dysfunction

A

Pharmacological interventions / medication:
• Hormonal therapy: vaginal or systemic oestrogen & androgen
• Addyi: oral medication for low sexual desire in premenopausal women
• approved in 2015
• effective for a small group of women
• potentially serious side effects: low blood pressure, dizziness and fainting, particularly if mixed with alcohol
Medical treatments need to be offered in the context of a holistic care accounting for subjective and relationship experiences

21
Q

non-pharmacological treatments for female sexual dysfunction

A

genito-pelvic pain/penetration disorder:

Kegel exercises and vaginal weights
- aimed at strengthening the muscle of the pelvic floor

Vaginal lubricants
- usually a liquid/gel that is applied around the clitoris, labia and inside the vaginal entrance to minimise dryness and/or pain during sexual activity

Vaginal moisturisers

  • non-hormonal products
  • improve overall vaginal health by restoring lubrication and the natural pH level to the vagina and vulva

Vaginal dilators

  • Plastic/rubber tube used to stretch the vagina
  • To treat vaginismus & dyspareunia

female sexual arousal disorder:

Eros ctd: Female vacuum therapy
• FDA-approved; requires prescription
• Creates gentle suction over the clitoris to cause engorgement
• Improves vaginal blood flow and lubrication
• Billups et al. (2011, n=32): improved response in sensation, lubrication, orgasm, and satisfaction.

22
Q

sensate focus exercises

A

A graded series of mutual body-touching excercises:

  • Exercise I: general body pleasuring => focus on sensation of touching partner
  • Exercise II: introducing genital body pleasuring in the absence of intercourse

Non-goal-oriented physical intimacy (incl. orgasm) => to minimize ‘performance’ pressure/anxiety and reduce ‘spectatoring’

Enhancing communication between partners about sensual and sexual experiences

Effective in treating female desire, arousal & orgasmic dysfunctions and erectile disorders

23
Q

barriers to treatment uptake and retention

A

Patients are unaware of available resources

Lack of referral

Embarrassment (patients and/or GP providers)

Lack of engagement (either or both partners)

Minimal attention to partners (not included or assessed)

24
Q

limitations to treatment research

A

Inadequate research methodology

Limited treatment focus: commonly do not work from a bio-psycho-social perspective

Small number of studies

3018 (23 decks)

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