*Lecture 24 - Sexual Dysfunctions Flashcards
How does the DSM-5 define a sexual dysfunction?
- 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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Prevalence of Sexual Dysfunction
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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SPECIFIERS/SUBTYPES:
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
How do sexual dysfunctions change in their classification between DSM-IV and DSM 5?
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
What are the gender specific dysfunctions ‘stage of sexual response’ categories?
- Desire
- Arousal
- Orgasm
- Pain
Which disorder was removed from the DSM-IV for the DSM-5?
Sexual Aversion Disorder
Which are the 2 female sexual interest/arousal disorders?
- Hypoactive Sexual Desire Disorder
* Sexual Arousal Disorder
What are Sexual Desire Disorders?
Persistent disinterest in sexual activity
Distressed by this lack of interest
What are the differences in prevalence between gender and age in sexual desire disorders?
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
Name four risk factors of Erectile Disorder (ED)?
Smoking
Obesity
Hypertension
Diabetes
What percentage of males will have erectile difficulties at some stage?
50%
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%
Female Sexual Arousal disorder
What is female sexual arousal disorder?
Difficulty attaining or maintaining adequate lubrication until completion of the sexual act
What overlap does female sexual arousal disorder have with other female sexual disorders?
(give a range)
30-50%
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
Delayed ejaculation
What kind of sexual disorder is delayed ejaculation?
(male) orgasmic disorder
Which is the least common male sexual disorder?
What is it’s prevalence in Australia?
Delayed ejaculation ~4%
Which disorder does this describe?
• Ejaculation with only minimal stimulation (<1 min after vaginal penetration) and before the man wishes it
• Prevalence (Australia): ~ 8%
Premature (early) ejaculation
Describe Premature (early) ejaculation?
Ejaculation with only minimal stimulation (<1 min after vaginal penetration) and before the man wishes it
Describe 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 a chore, rather than a pleasure”
What is the prevalence of premature ejaculation in Australia?
~8%
What kind of disorder is premature ejaculation?
(male) orgasmic disorder
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%
Female Orgasmic Disorder
What kind of disorder is Female Orgasmic Disorder?
It is a female orgasmic disorder. The only one. That is why it is named Female Orgasmic Disorder.
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
What is the prevalence of Female Orgasmic Disorder in Australia?
~ 51%
True or False?
In Female Orgasmic Disorder, orgasm is a learned (not automatic) response?
True
Which disorder does this describe?
• Persistent or recurrent pain during attempted or complete vaginal entry and/or penile vaginal intercourse
• Prevalence: 14-27%
Dyspareunia
Describe Dyspareunia.
Persistent or recurrent pain during attempted or complete vaginal entry and/or penile vaginal intercourse
Which disorder does this describe?
• Persistent or recurrent pain during attempted or complete vaginal entry and/or penile vaginal intercourse
• Prevalence: 14-27%
Dyspareunia
What kind of disorder is dyspareunia?
A genito-pelvic pain/penetration disorder
What are the two genito-pelvic pain/penetration disorders?
- Dyspareunia
2. Vaginismus
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
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’…”
What kind of disorder is Vaginismus?
A genito-pelvic pain/penetration disorder
What is the prevalence of Vaginismus in Australia?
5-17%
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
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
What are the four big aetiology factors of Sexual Dysfunction?
- Biological/Physical
- Psychosocial
- Interpersonal
- Environmental
Name 5 biological/physical factors that may effect sexual functioning?
- Aging
- Illness
- Disability
- Medications
- Substance use/abuse
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
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
Name 3 environmental factors that may effect sexual functioning?
- Lack of privacy
- Lack of time
- Physical discomfort
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)
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
What are 4 different ways to treat sexual dysfunction?
- MEDICAL treatments
- BEHAVIOURAL therapy
- COGNITIVE-BEHAVIOURAL therapy (CBT)
- INTERNET-based interventions – e.g. Rekindle
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
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
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
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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.
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)
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
When/how is treatment most effective?
Treatment is most effective if multi-modal.
Which is the most common TYPE of female sexual dysfunction?
sexual desire disorders
i.e.
Hypoactive Sexual Desire Disorder & Sexual Arousal Disorder
