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

*Lecture 24 - Sexual Dysfunctions Flashcards

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
Describe Female Orgasmic Disorder?
* 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
What is the prevalence of Female Orgasmic Disorder in Australia?
~ 51%
27
True or False? | In Female Orgasmic Disorder, orgasm is a learned (not automatic) response?
True
28
Which disorder does this describe? • Persistent or recurrent pain during attempted or complete vaginal entry and/or penile vaginal intercourse • Prevalence: 14-27%
Dyspareunia
29
Describe Dyspareunia.
Persistent or recurrent pain during attempted or complete vaginal entry and/or penile vaginal intercourse
30
Which disorder does this describe? • Persistent or recurrent pain during attempted or complete vaginal entry and/or penile vaginal intercourse • Prevalence: 14-27%
Dyspareunia
31
What kind of disorder is dyspareunia?
A genito-pelvic pain/penetration disorder
32
What are the two genito-pelvic pain/penetration disorders?
1. Dyspareunia | 2. Vaginismus
33
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%
Vaginismus
34
Describe Vaginismus.
* 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
What kind of disorder is Vaginismus?
A genito-pelvic pain/penetration disorder
36
What is the prevalence of Vaginismus in Australia?
5-17%
37
What are some common cormorbid symptoms of genito-pelvic pain/penetration disorders?
* 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
What are limitations of obtaining accurate prevalence rates?
* 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
What are the four big aetiology factors of Sexual Dysfunction?
1. Biological/Physical 2. Psychosocial 3. Interpersonal 4. Environmental
40
Name 5 biological/physical factors that may effect sexual functioning?
* Aging * Illness * Disability * Medications * Substance use/abuse
41
Name 9 psychosocial factors that may effect sexual functioning?
* 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
Name 6 interpersonal factors that may effect sexual functioning?
* Attraction to partner * Partner performance & technique * Excessive goal orientation * Relationship quality & conflict * Routinization * Lack of partner
43
Name 3 environmental factors that may effect sexual functioning?
* Lack of privacy * Lack of time * Physical discomfort
44
What is Psychogenic Erectile Dysfunction (ED)?
* Often sudden onset * Preservation of morning erections and nocturnal erections * Achieve erection with masturbation * May be partner-specific * Younger patient (<40)
45
What is Organic Erectile Dysfunction (ED)?
* Gradual deterioration * Decrease in morning erections and nocturnal erections * No erections with masturbation * No loss of libido * Presence of co-morbid conditions
46
What are 4 different ways to treat sexual dysfunction?
1. MEDICAL treatments 2. BEHAVIOURAL therapy 3. COGNITIVE-BEHAVIOURAL therapy (CBT) 4. INTERNET-based interventions – e.g. Rekindle
47
Name and outline four different medical treatments for Erectile Dysfunction (ED)?
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
Name and outline 2 different medical treatments for female sexual dysfunctioning?
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
Name and outline 4 non-pharmacological treatments for 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 both vaginismus & dyspareunia
50
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54
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.
55
What are some barriers to treatment update and retention? | 5
* 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
What are some limitations to treatment research? | 3
• Inadequate research methodology • Limited treatment focus: commonly do not work from a bio-psycho-social perspective • Lack of studies
57
When/how is treatment most effective?
Treatment is most effective if multi-modal.
58
Which is the most common TYPE of female sexual dysfunction?
sexual desire disorders i.e. Hypoactive Sexual Desire Disorder & Sexual Arousal Disorder

PSYC3018 Abnormal Psychology (29 decks)

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