Sexual Disorders Flashcards
What is the epidemiology of sexual disorders?
At least one sexual dysfunction reported by 40–45%
of women and 20–30% of men
Sexual Desire disorders
- Prevalence: 7-33%
- Age differences Men in 40s: 0.6% vs. 70s: 26%
- Gender differences Men 8% vs. Women 55% ( Most common female sexual dysfunction)
What is the DSM definition of a sexual disorder?
- A clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure
- A minimum duration of 6 months
- Experienced on almost all or all occasions of sexual activity (75%-100%)
specifiers
- lifelong or aquired
- generalised or situational
- severity based on level of distress (or time in case of ejaculation)
How are sexual dysfunctions categorised in the DSM 5?
Moving away from Kaplan’s 3 stages towards gender based categories.
Dysfunction is based on gender and stage of sexual activity (desire, arousal, orgasm and pain)
What are the characteristics of Erectile disorder (ED)?
This is a male sexual arousal disorder characterised by difficulty in obtaining or maintaining erection or marked
decrease in erectile rigidity
Up to 50% of males will have erectile difficulties at some stage
- likelihood increases steadily with age
- likelihood increases with smoking, substance abuse, diabetes etc
often spontaneous remitts
What are the characteristics of Female Sexual arousal disorder?
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
What are the characteristics of male orgasmic disorders?
Delayed ejaculation disorder:
- Maintains erection, but marked delay (or inability) to
achieve ejaculation, without the person desiring delay
- Experienced on almost all or all occasions of partners
sexual activity
- Prevalence in Aus: 4% (least common male complaint)
Premature ejaculation disorder:
- Ejaculation with only minimal stimulation (
What are the characteristics of female orgasmic disorder?
Marked delay in, marked infrequency of, or absence of orgasm, OR markedly reduced intensity of orgasmic sensations
- Must cause clinically distress
Lifelong vs. acquired; can be situational
- Orgasm is a learned (not automatic) response improves with experience
Prevalence (Australia): ~ 51%
What are the characteristics of Genito-pelvic pain/penetration disorders?
Dyspareunia
- Persistent or recurrent pain during attempted or
complete vaginal entry and/or penile vaginal
intercourse
- Prevalence: 14-27%
Vaginismus
- Involuntary spasms of the muscles surrounding the
entrance to the vagina, making penetration impossible
and/or painful
- Prevalence: 5-17%
Cycle of pain
- pain experienced increases anxiety, which increases pain
What are the limitations of research on and treatment of sexual disorders?
Research
- Different samples; (Age groups: 18+, 40+, 70+, Clinical vs. non-clinical)
- Different measurements (Self-report vs. clinical interview)
- Different definitions (Lack of specificity)
- Asking the right questions (men and women have different concepts about sex often)
Treatment
- 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 is the aetiology of sexual disfuntions?
Physiological factors: aging, illness, substance use, medications etc
psychosocial factors: body image, cultural sanction, self esteem, trauma, lack of experience, mood disorders etc
relationship/interpersonal factors: attraction, communication, excessive goal-orientation, etc
What are the differences between organic and psychosocial ED disorders?
psychogenic: Often sudden onset, preservation of morning, nocturnal, masturbation erections, may be partner-specific, younger patient (
What are the medical treatments for sexual disorders?
Male medical treatments
- drugs; (viagra, levitra & cialis) highly effective (70-90%)
- penile injections (muscle relaxants)
- vaccuum devices: Erection limited to 30 minutes, high efficacy (80-90%) but complications (coolness, numbness, pain with ejaculation) lead to dropout
Female medical treatments
- Hormonal therapy: vaginal or systemic oestrogen &
androgen
- Drugs (Viagra): limited effectiveness, promising to address medication side-effects
- Kegel exercises and vaginal weights
- Vaginal lubricants and moisturisers
- female vacuum tubes to increase bloodflow
- vaginal dilators (stretch vagina)
Heavy focus on objective measures rather than subjective experience and relationship issues
What are the behavioural treatments for sexual disorders?
Communication Skills training
- How to communicate verbally and behaviourally during sex
- Discuss underlying relationship issues impacting sex
- Discuss comforts and insecurities, likes/dislikes
Sensate focus exercises
- Non-goal-oriented physical intimacy (takes pressure off)
- Discovering whether aspects of intimacy bring up any feelings of discomfort
- focus on details of sensation of touching and receiving
internet based treatments
- sex after cancer website - tailored exercises
How does CBT for sexual disorders work?
Focus on cognitive barriers to sexual enjoyment
- goal oriented thoughts
- perfectionism
- self image
