Sexology College 5: Male Sexual Problems Flashcards
(27 cards)
sexual disorders in men (DSM-V)
1) male hypoactive sexual desire disorder
2) erectile disorder
3) delayed ejaculation
4) premature ejaculation
criteria for diagnosing sexual disorders DSM-V
- significant distress
- occurs in 75%-100% of situations
- minimal duration of 6 months
not attributable to another disorder, severe relationship distress, or medication/substances
subtypes of sexual disorders (DSM-V)
- lifelong vs. acquired
- generalized vs. situational
- severity: mild, moderate, severe
de Graaf (2023): Sexual Frequency (with or without partner) last 6 months
frequency: 1-3 per month with partner
masturbation:
- females 17% weekly, 30% never
- males 51% weekly, 15% never
most common sexual problems in netherlands
self-reports
1) at least 1 sexual problem
2) no desire
3) erectile dysfunction
DSM-V
1) sexual fear
2) at least 1 sexual problem
3) erectile dysfunction
1) male hypoactive sexual desire disorder
persistently/recurrently deficient or absent sexual fantasies or desire for sexual activity
prevalence:
- periodically: 0-6% 18-24, 41% 66+
- > 6 months: 1.8%
what is sexual desire? a sexual response requires:
1: adequate sexual stimulus
2 genital response, subjective experience of arousal
3: situational factors (context, motivation, opportunities)
4: physiology sensitivity (androgenic hormones, neurotransmitters)
Both & Everaerd (2003)
see image
sexual stimulus + sensitivity system, together with regulation/inhibition, lead to action tendency, which leads to sexual behavior
conclusion of testosterone
- minimum of testosterone is needed to function sexually
- testosterone makes system ready for sexual activity
- lower levels are found in 1% 20-40, 20% 65<
role of testosterone in physical state
production of testosterone: in Leydig cells of the testes and adrenal glands
- production is regulated from pituitary gland by
1) LH (luteinizing hormone)
2) FSH (follicle stimulating hormone)
diagnosis of hypoactive disorder
physical examination and lab tests
- life style (alcohol, drugs)
- anamnesis = history
sex-counseling for hypoactive disorder
lifestyle changes: weightloss, exercise
break pattern of avoidance behavior
- sensate focus exercises
- cognitive restructuring (Rational Emotive Therapy)
- couple therapy
2) erectile disorder
criteria:
- difficulty in obtaining and/or maintaining an erection
- decrease in rigidity (stijfheid)
prevalence:
- 18-80 years: 6% (45% of which 65+)
- 27% among men who have sex with men
biological, medical and lifestyle “risk” factors for erectile disorder
trauma
pelvic surgery
neurological, hormonal or cardiovascular diseases
alcohol/drugs/smoking
age
side effects of medication
hyperlipidemia
diabetes mellitus
social/cultural and relational factors in erectile disorder
erotophobia = learned negative attitudes towards sexuality
traditional beliefs
poor relationships, bad communication
psychological factors in erectile disorder
stress
psychopathology (like PTSS)
negative cognitive schemas due to negative sexual experiences
fear of failure (performance anxiety)
is there an organic of psychogenic cause for erectile disorder?
ask for:
- “spontaneous erections”
- erectile failure during masturbation?
- morning erections
and
- NPT (nocturnal penile tumescence) measurement
Barlow et al: fear of failure, performance pressure and sexual arousal
men with erectile disorders:
- negative affect to sexuality
- underreport level of sexual arousal
- reduced perception of control in relation to sexual arousal
- anxiety inhibits sexual arousal
- distracted by performance-related stimuli (attention bias)
this selective attention increases when performance pressure increases, causing attention on other things than the sexual stimuli (confirmation bias)
see image
image: Barlow et al
approach -> positive affect and expectations, perception of control -> increased attention on erotic stimuli -> functional erection
avoidance (confirmation bias) -> negative affect and expectations, perceived lack of control -> increased attention on consequences of erectile failure (attention bias) -> dysfunctional erection
treatment of erectile disorder
- medication: viagra
- “injection” therapy: vitaros urethral system for erection (opens vessels, relaxes muscles)
- penile prosthesis
- sex counseling
3) delayed ejaculation/anorgasmia
criteria:
- delay in ejaculation
- infrequency/absence of ejaculation
- 75-100% of situations
causes:
- physical (neurological diseases)
- psychogenic
ethological factors in delayed ejaculation
- less knowledge
- absence of adequate sexual stimuli
- need of strong genital stimulation
- performance anxiety/selective attention/anticipation of failure
- avoidance of sex because of low reward
- lack of self-focused attention
- “unconscious” motives or fears
treatment of delayed ejaculation
therapy; aim = increase and focus on sexual arousal
- clear goals, training, involving partner, step-by-step plan
pharmalogical treatment: SSRI’s, anesthetic creams
sex therapys: goals/expectations, pelvic floor muscle relaxation exercise
substance/psychiatric medication-induced sexual dysfunction
antidepressants: 25-80%
antispsychotics: >50%
drugs: increase disinhibition, but induce sexual dysfunction (heroin: 60-70%)
