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PSYC3018 Abnormal Psychology > *Lecture 24 - Sexual Dysfunctions > Flashcards

*Lecture 24 - Sexual Dysfunctions Flashcards

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1
Q

How does the DSM-5 define a sexual dysfunction?

A
  • A clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure
  • A minimum duration of 6 months
  • Symptoms must cause significant distress
  • Experienced on almost all or all occasions of sexual activity (75%-100%)

Note: Important to consider cultural values & age!

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2
Q

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Prevalence of Sexual Dysfunction

A

VERY WIDESPREAD PUBLIC HEALTH PROBLEM
• At least one sexual dysfunction reported by 40–45%
of women and 20–30% of men (Lewis et al, 2010)
• Australia (Smith et al, 2012):
Ø 66% of women reported having one or more sexual difficulties, and
Ø 36% of women report at least one new sexual problem, during the previous 12 months

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3
Q

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SPECIFIERS/SUBTYPES:

A

Ø Nature of the onset
• Lifelongoracquired
Ø Context
• Generalized or situational
Ø Severity
• Mild, moderate, severe - based on level of distress
• Premature ejaculation is specified by time of ejaculation

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4
Q

How do sexual dysfunctions change in their classification between DSM-IV and DSM 5?

A

Moving away from DSM-IV classification based on simple linear sexual response (Kaplan’s 3 stages of sexual response cycle, 1979)

Replaced by GENDER SPECIFIC DYSFUNCTIONS

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5
Q

What are the gender specific dysfunctions ‘stage of sexual response’ categories?

A
  1. Desire
  2. Arousal
  3. Orgasm
  4. Pain
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6
Q

Which disorder was removed from the DSM-IV for the DSM-5?

A

Sexual Aversion Disorder

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7
Q

Which are the 2 female sexual interest/arousal disorders?

A
  • Hypoactive Sexual Desire Disorder

* Sexual Arousal Disorder

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8
Q

What are Sexual Desire Disorders?

A

Persistent disinterest in sexual activity

Distressed by this lack of interest

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9
Q

What are the differences in prevalence between gender and age in sexual desire disorders?

A

Prevalence: 7-33%
• Age differences
• Men in 40’s: 0.6% vs. 70’s: 26%

• Gender differences
• Men 8% vs. Women 55%
Most common female sexual dysfunction

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10
Q

Name four risk factors of Erectile Disorder (ED)?

A

Smoking
Obesity
Hypertension
Diabetes

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11
Q

What percentage of males will have erectile difficulties at some stage?

A

50%

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12
Q

Which disorder does this describe?
• 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%

A

Female Sexual Arousal disorder

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13
Q

What is female sexual arousal disorder?

A

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

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14
Q

What overlap does female sexual arousal disorder have with other female sexual disorders?
(give a range)

A

30-50%

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15
Q

Which disorder does this describe?
• 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 a chore, rather than a pleasure”
• Prevalence (Au): ~ 4% - the least common male sexual complaint

A

Delayed ejaculation

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16
Q

What kind of sexual disorder is delayed ejaculation?

A

(male) orgasmic disorder

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17
Q

Which is the least common male sexual disorder?

What is it’s prevalence in Australia?

A

Delayed ejaculation ~4%

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18
Q

Which disorder does this describe?
• Ejaculation with only minimal stimulation (<1 min after vaginal penetration) and before the man wishes it
• Prevalence (Australia): ~ 8%

A

Premature (early) ejaculation

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19
Q

Describe Premature (early) ejaculation?

A

Ejaculation with only minimal stimulation (<1 min after vaginal penetration) and before the man wishes it

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20
Q

Describe delayed ejaculation?

A
  • 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 a chore, rather than a pleasure”
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21
Q

What is the prevalence of premature ejaculation in Australia?

A

~8%

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22
Q

What kind of disorder is premature ejaculation?

A

(male) orgasmic disorder

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23
Q

Which disorder does this describe?
• Marked delay in, marked infrequency of, or absence of orgasm, OR markedly reduced intensity of orgasmic sensations
• Woman must be clinically distressed about her symptoms
• Lifelong vs. acquired; can be situational
• Orgasm is a learned (not automatic) response
• improves with experience
• Prevalence (Au): ~ 51%

A

Female Orgasmic Disorder

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24
Q

What kind of disorder is Female Orgasmic Disorder?

A

It is a female orgasmic disorder. The only one. That is why it is named Female Orgasmic Disorder.

25
Q

Describe Female Orgasmic Disorder?

A
  • Marked delay in, marked infrequency of, or absence of orgasm, OR markedly reduced intensity of orgasmic sensations
  • Woman must be clinically distressed about her symptoms
  • Lifelong vs. acquired; can be situational
  • Orgasm is a learned (not automatic) response
  • improves with experience
26
Q

What is the prevalence of Female Orgasmic Disorder in Australia?

A

~ 51%

27
Q

True or False?

In Female Orgasmic Disorder, orgasm is a learned (not automatic) response?

A

True

28
Q

Which disorder does this describe?
• Persistent or recurrent pain during attempted or complete vaginal entry and/or penile vaginal intercourse
• Prevalence: 14-27%

A

Dyspareunia

29
Q

Describe Dyspareunia.

A

Persistent or recurrent pain during attempted or complete vaginal entry and/or penile vaginal intercourse

30
Q

Which disorder does this describe?
• Persistent or recurrent pain during attempted or complete vaginal entry and/or penile vaginal intercourse
• Prevalence: 14-27%

A

Dyspareunia

31
Q

What kind of disorder is dyspareunia?

A

A genito-pelvic pain/penetration disorder

32
Q

What are the two genito-pelvic pain/penetration disorders?

A
  1. Dyspareunia

2. Vaginismus

33
Q

Which disorder does this describe?
• Involuntary spasms of the muscles surrounding the entrance to the vagina, making penetration impossible and/or painful
• “ it feels like ‘hitting a brick wall’…”
• Prevalence: 5-17%

A

Vaginismus

34
Q

Describe Vaginismus.

A
  • Involuntary spasms of the muscles surrounding the entrance to the vagina, making penetration impossible and/or painful
  • “ it feels like ‘hitting a brick wall’…”
35
Q

What kind of disorder is Vaginismus?

A

A genito-pelvic pain/penetration disorder

36
Q

What is the prevalence of Vaginismus in Australia?

A

5-17%

37
Q

What are some common cormorbid symptoms of genito-pelvic pain/penetration disorders?

A
  • Marked difficulty having intercourse/penetration
  • Marked vulvo-vaginal or pelvic pain during intercourse or penetration attempts
  • Marked fear or anxiety about pain or vaginal penetration
  • Marked tensing of the pelvic floor during attempted penetration
38
Q

What are limitations of obtaining accurate prevalence rates?

A
  • Different samples
    • Age groups: 18+, 40+, 70+
    • Clinical vs. non-clinical
  • Different measurements
    • Self-report vs. clinical interview
  • Different definitions
    • Lack of specificity in definitions
39
Q

What are the four big aetiology factors of Sexual Dysfunction?

A
  1. Biological/Physical
  2. Psychosocial
  3. Interpersonal
  4. Environmental
40
Q

Name 5 biological/physical factors that may effect sexual functioning?

A
  • Aging
  • Illness
  • Disability
  • Medications
  • Substance use/abuse
41
Q

Name 9 psychosocial factors that may effect sexual functioning?

A
  • Cultural and religious beliefs
  • Self-acceptance (identity, orientation)
  • Body image
  • Depression, anxiety
  • Life stressors
  • Past experiences (abuse, trauma)
  • Inexperience
  • Perfectionism/performance anxiety
  • Attachment issues
42
Q

Name 6 interpersonal factors that may effect sexual functioning?

A
  • Attraction to partner
  • Partner performance & technique
  • Excessive goal orientation
  • Relationship quality & conflict
  • Routinization
  • Lack of partner
43
Q

Name 3 environmental factors that may effect sexual functioning?

A
  • Lack of privacy
  • Lack of time
  • Physical discomfort
44
Q

What is Psychogenic Erectile Dysfunction (ED)?

A
  • Often sudden onset
  • Preservation of morning erections and nocturnal erections
  • Achieve erection with masturbation
  • May be partner-specific
  • Younger patient (<40)
45
Q

What is Organic Erectile Dysfunction (ED)?

A
  • Gradual deterioration
  • Decrease in morning erections and nocturnal erections
  • No erections with masturbation
  • No loss of libido
  • Presence of co-morbid conditions
46
Q

What are 4 different ways to treat sexual dysfunction?

A
  1. MEDICAL treatments
  2. BEHAVIOURAL therapy
  3. COGNITIVE-BEHAVIOURAL therapy (CBT)
  4. INTERNET-based interventions – e.g. Rekindle
47
Q

Name and outline four different medical treatments for Erectile Dysfunction (ED)?

A

Sildenafil (Viagra), Levitra and Cialis
• Highly effective (70-90%)
• Dose modifications may be necessary over time
• Lead to increased satisfaction in both men & women

Penile Injections
• Injections of smooth muscle relaxing drugs into erection chambers

Vacuum devices
• Erection limited to 30 minutes
• Results: 80%-90% but high drop out rate
• Complications: coolness, numbness, pain with ejaculation

Penile prosthesis (inflatable)
• ‘Last-resort’ treatment
• Out-patient surgery
• Minimal complications (<5%), high satisfaction rate

48
Q

Name and outline 2 different medical treatments for female sexual dysfunctioning?

A

Hormonal therapy: vaginal or systemic oestrogen & androgen

Sildenafil (Viagra): limited effectiveness, promising to address medication side-effects

Limitations: Heavy focus on objective measures rather than subjective experience and
relationship issues

49
Q

Name and outline 4 non-pharmacological treatments for genito-pelvic pain/penetration disorder?

A

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 both vaginismus & dyspareunia

50
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51
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52
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53
Q

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54
Q

Female sexual arousal disorder

A

• 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.

55
Q

What are some barriers to treatment update and retention?

5

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)
56
Q

What are some limitations to treatment research?

3

A

• Inadequate research methodology
• Limited treatment focus: commonly do not work
from a bio-psycho-social perspective
• Lack of studies

57
Q

When/how is treatment most effective?

A

Treatment is most effective if multi-modal.

58
Q

Which is the most common TYPE of female sexual dysfunction?

A

sexual desire disorders

i.e.
Hypoactive Sexual Desire Disorder & Sexual Arousal Disorder

PSYC3018 Abnormal Psychology (29 decks)

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