Sexual disorders - DSM criteria Flashcards
What defines sexual dysfunction?
A clinically significant disturbance in a person’s ability to respond sexually or experience sexual pleasure.
Can multiple sexual dysfunctions coexist?
Yes, individuals can experience more than one sexual dysfunction at the same time, requiring separate diagnoses.
What are the main types of sexual dysfunctions?
- Delayed ejaculation
- Erectile disorder
- Female orgasmic disorder
- Female sexual interest/arousal disorder
- Genito-pelvic pain/penetration disorder
- Male hypoactive sexual desire disorder
- Premature ejaculation
- Substance/medication-induced sexual dysfunction
- Other specified or unspecified dysfunctions
What are the four subtypes used to classify sexual dysfunctions?
- Lifelong – Present since first sexual experiences.
- Acquired – Developed after a period of normal function.
- Generalized – Not limited to specific situations or partners.
- Situational – Occurs only with specific stimulation, situations, or partners.
How is the severity of sexual dysfunction classified?
- Mild – Slight distress and impairment.
- Moderate – Noticeable distress and interference in sexual function.
- Severe – Major distress and significant impairment.
Why is clinical judgment important in diagnosing sexual dysfunction?
To differentiate true dysfunction from cases of inadequate sexual stimulation or external factors affecting sexual function.
What partner factors may contribute to sexual dysfunction?
- Partner’s sexual dysfunction.
- Partner’s health status or medical conditions.
What relationship factors can contribute to sexual dysfunction?
- Poor communication.
- Desire discrepancy between partners.
What individual vulnerability factors can contribute to sexual dysfunction?
- Poor body image.
- History of sexual or emotional abuse.
- Psychiatric comorbidities (e.g., depression, anxiety).
What stressors may contribute to sexual dysfunction?
- Job loss.
- Bereavement (loss of a loved one).
- Major life stress events.
How do cultural and religious factors influence sexual dysfunction?
- Religious prohibitions against sexual activity or pleasure.
- Cultural attitudes that discourage open discussions of sexuality.
What medical factors should be considered in sexual dysfunction?
- Chronic illnesses (e.g., diabetes, cardiovascular disease).
- Medication side effects.
- Hormonal imbalances.
What factors must be considered in diagnosing sexual dysfunction?
- Lifelong vs. Acquired.
- Generalized vs. Situational.
- Severity level (Mild, Moderate, Severe).
- Six contributing factors (partner, relationship, individual vulnerabilities, stressors, cultural/religious, medical).
What are the two primary symptoms of Delayed Ejaculation (DE)?
- Marked delay in ejaculation.
- Marked infrequency or absence of ejaculation.
These must occur in 75-100% of partnered sexual activity without the individual desiring the delay.
How long must symptoms persist for a diagnosis of Delayed Ejaculation?
At least 6 months.
What conditions must be ruled out before diagnosing Delayed Ejaculation?
- Non-sexual mental disorders.
- Severe relationship distress.
- Significant stressors.
- Effects of substances/medications or medical conditions.
Why is the definition of “delay” in ejaculation difficult to establish?
There is no universal consensus on:
* What constitutes a reasonable time to reach orgasm.
* What is unacceptably long for most men and their partners.
What associated features may be reported by men with Delayed Ejaculation?
- Prolonged thrusting to the point of exhaustion or genital discomfort.
- Potential injury to themselves or their partner.
- Avoidance of sexual activity due to difficulty ejaculating.
- Partner’s concerns about their sexual attractiveness.
- Lower subjective arousal and increased sexual dissatisfaction.
How does Delayed Ejaculation affect relationship quality?
- Higher levels of relationship distress.
- Increased sexual dissatisfaction.
- Greater anxiety about sexual performance.
How common is Delayed Ejaculation?
It is the least common sexual complaint, and its prevalence is unclear due to the lack of a precise definition.
How does age affect the development of Delayed Ejaculation?
- Rates remain stable until around age 50.
- After 50, prevalence increases.
- By their 80s, men are twice as likely to experience delayed ejaculation compared to those under 59.
What are the risk and prognostic factors for Delayed Ejaculation?
- Aging-related changes (e.g., reduced nerve conduction speed).
- Decline in sex hormone production.
- Genetic and physical factors (especially in men over 50).
What medical conditions must be ruled out before diagnosing Delayed Ejaculation?
- Retrograde ejaculation (where semen enters the bladder instead of exiting the penis).
- Anejaculation (complete absence of ejaculation).
- Ejaculatory duct obstruction.
- Other urological disorders.
What substances/medications can contribute to Delayed Ejaculation?
- Antidepressants (especially SSRIs).
- Antipsychotics.
- Alcohol (especially chronic use).
- Opioid drugs.
What is the difference between Delayed Ejaculation and Anhedonic Ejaculation?
- Delayed Ejaculation = Ejaculation is significantly delayed or absent.
- Anhedonic Ejaculation = Ejaculation occurs, but there is no pleasure or sensation.
Anhedonic ejaculation should not be coded as Delayed Ejaculation but may be classified as:
✔ Other specified sexual dysfunction.
✔ Unspecified sexual dysfunction.
What mental disorder is Delayed Ejaculation more common in?
Major Depressive Disorder (MDD) (especially in severe cases).
What are the three primary symptoms of Erectile Disorder (ED)?
- Marked difficulty obtaining an erection during sexual activity.
- Marked difficulty maintaining an erection until completion of sexual activity.
- Marked decrease in erectile rigidity.
Symptoms must occur in 75-100% of sexual activity.
How long must symptoms persist for a diagnosis of Erectile Disorder?
At least 6 months.
What conditions must be ruled out before diagnosing Erectile Disorder?
- Non-sexual mental disorders.
- Severe relationship distress.
- Significant stressors.
- Effects of substances/medications or medical conditions.
What is the difference between Erectile Dysfunction and Erectile Disorder?
- Erectile Dysfunction = A general term for difficulty obtaining/maintaining an erection.
- Erectile Disorder = A DSM-5 diagnosis requiring persistent symptoms for 6+ months and significant distress.
What psychological effects are commonly associated with Erectile Disorder?
- Low self-esteem and confidence.
- Depressed mood.
- Feelings of guilt, self-blame, or failure.
- Fear or avoidance of sexual encounters.
- Reduced sexual satisfaction in both the individual and their partner.
How does Erectile Disorder affect relationships?
- Can lead to relationship distress.
- Partner may experience reduced sexual desire or dissatisfaction.
- Individual may develop fear/avoidance of intimacy.
How does age affect Erectile Disorder?
- Under 40-50 years: ~2% report frequent erectile difficulties.
- 60-70 years and older: 40-50% prevalence.
- Age significantly increases the likelihood of experiencing erectile problems.
What factors are associated with first-time erectile failure?
- Having sex with a new partner.
- Drug or alcohol use.
- Not wanting to have sex (e.g., peer pressure).
Many first-time erectile failures resolve without professional intervention.
What are the key risk factors for Acquired Erectile Disorder?
Age
Smoking tobacco
Lack of physical exercise
Diabetes
Decreased sexual desire
What personality traits are associated with Erectile Disorder?
- Neurotic personality traits (in college-aged men).
- Submissive personality traits (in men 40+ years).
How can Erectile Disorder affect fertility?
- Can interfere with conception due to difficulty maintaining erections.
- Causes distress in both partners, affecting sexual activity frequency.
What medical conditions should be ruled out before diagnosing Erectile Disorder?
Dyslipidemia (high cholesterol).
Cardiovascular disease.
Hypogonadism (low testosterone levels).
Multiple sclerosis.
Diabetes mellitus.
Other vascular, neurological, or endocrine disorders.
How can you differentiate Erectile Disorder from normal erectile function?
- Consider whether expectations are unrealistic.
- Occasional erectile difficulties do not indicate dysfunction.
- Situational erectile difficulties may be psychological rather than biological.
What substances/medications can cause Erectile Disorder?
Antidepressants (SSRIs).
Antipsychotics.
Alcohol (chronic use).
Certain blood pressure medications.
What are common comorbid disorders with Erectile Disorder?
- Premature ejaculation.
- Male hypoactive sexual desire disorder.
- Anxiety and depressive disorders.
What is the primary symptom of Male Hypoactive Sexual Desire Disorder?
Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity.
How long must symptoms persist for a diagnosis of Male Hypoactive Sexual Desire Disorder?
At least 6 months.
What conditions must be ruled out before diagnosing Male Hypoactive Sexual Desire Disorder?
- Non-sexual mental disorders (e.g., depression).
- Severe relationship distress.
- Significant life stressors.
- Effects of substances/medications or medical conditions.
How does Male Hypoactive Sexual Desire Disorder affect relationships?
- Men with this disorder rarely initiate sexual activity.
- They may be minimally receptive to a partner’s attempts to initiate.
- Relationship-specific sexual initiation preferences should be considered in diagnosis.
How does age affect the prevalence of Male Hypoactive Sexual Desire Disorder?
- Younger men (18-24 years) have fewer problems with sexual desire.
- Older men (66-74 years) experience increased prevalence of low sexual desire.
- Sexual cues become less potent with age
What psychological factors are risk factors for Male Hypoactive Sexual Desire Disorder?
- Mood disorders (depression, anxiety)
- Low self-esteem
- Emotional attachment issues
- Perception of partner’s sexual desire
What social and cultural factors may contribute to low sexual desire in men?
- Alcohol use
- Self-directed homophobia
- Interpersonal relationship problems
- Cultural attitudes about sex
- Lack of adequate sex education
- History of trauma
What biological factors may contribute to Male Hypoactive Sexual Desire Disorder?
- Endocrine disorders (hormonal imbalances)
- Age-related testosterone decline
How does Male Hypoactive Sexual Desire Disorder differ from other diagnoses?
- MDD (Major Depressive Disorder): If low desire is due to depression, a separate diagnosis of Male Hypoactive Sexual Desire Disorder is not made.
- Substance/Medication Use: If low desire began after starting a medication, it is classified as Substance/Medication-Induced Sexual Dysfunction.
- Medical Condition: If caused by another medical issue, Male Hypoactive Sexual Desire Disorder is not diagnosed.
- Interpersonal Factors: If low desire is due to relationship distress, other stressors must be considered.
- Other Sexual Dysfunctions: The disorder can coexist with erectile or ejaculatory problems.
What comorbid conditions are commonly seen with Male Hypoactive Sexual Desire Disorder?
- Depression
- Mental health disorders
- Endocrine disorders (e.g., low testosterone)
What is the primary characteristic of Premature (Early) Ejaculation?
Ejaculation occurring within approximately 1 minute of vaginal penetration and before the individual wishes it.
How frequently must premature ejaculation occur to meet diagnostic criteria?
On almost all or all (approximately 75%-100%) occasions of sexual activity for at least 6 months.
What emotional effects are commonly associated with Premature Ejaculation?
- Sense of lack of control over ejaculation
- Apprehension about future sexual encounters
- Decreased self-esteem and self-confidence
- Distress and reduced sexual satisfaction in both partners
What percentage of men meet the diagnostic criteria for Premature Ejaculation?
Only 1%-3% of men when defined as ejaculation occurring within 1 minute of vaginal penetration.
What is the difference between lifelong and acquired Premature Ejaculation?
- Lifelong: Begins from the first sexual experience and remains stable throughout life.
- Acquired: Develops later in life and may have specific medical or psychological causes.
What psychological and medical factors may contribute to Premature Ejaculation?
- Anxiety disorders, especially social anxiety disorder
- Genetic predisposition
- Thyroid disorders
- Prostatitis
- Drug withdrawal
What interpersonal consequences can Premature Ejaculation have?
- Relationship distress
- Partner dissatisfaction
- Avoidance of sexual encounters
How is Premature Ejaculation differentiated from other diagnoses?
- Substance/medication-induced sexual dysfunction: If ejaculation problems are due to substance use, intoxication, or withdrawal.
- Ejaculatory concerns that do not meet diagnostic criteria: Includes men with normal ejaculation latencies who simply desire longer durations.
What conditions are commonly comorbid with Premature Ejaculation?
- Erectile problems
- Anxiety disorders (especially in lifelong cases)
- Medical conditions like prostatitis, thyroid disease, or drug withdrawal in acquired cases
What are the key symptoms of Female Orgasmic Disorder?
- Marked delay, infrequency, or absence of orgasm.
- Markedly reduced intensity of orgasmic sensations.
How frequently must the symptoms occur to meet the diagnostic criteria?
On almost all or all (approximately 75%-100%) occasions of sexual activity for at least 6 months.
Can a woman who orgasms with clitoral stimulation but not during intercourse be diagnosed with Female Orgasmic Disorder?
No. Many women require clitoral stimulation to reach orgasm, and the disorder is only diagnosed if orgasmic difficulties cause clinically significant distress.
What is the estimated prevalence of Female Orgasmic Disorder?
Prevalence estimates range from 10% to 42%, but only about 10% of women never experience an orgasm in their lifetime.
What factors can interfere with a woman’s ability to experience orgasm?
- Psychological factors (anxiety, pregnancy concerns).
- Relationship problems (conflict, dissatisfaction).
- Medical conditions (multiple sclerosis, spinal cord injury, pelvic nerve damage).
- Medications (SSRIs can delay or inhibit orgasm).
- Sociocultural factors (beliefs, sexual education).
Do women who experience orgasm less frequently necessarily have lower sexual satisfaction?
No. Overall sexual satisfaction is not strongly correlated with orgasm frequency. Many women report high sexual satisfaction despite rarely or never experiencing orgasm.
How does age impact orgasm consistency in women?
Women tend to have a more variable age of first orgasm than men. Many learn to experience orgasm as they gain more sexual experience and knowledge of their bodies.
What medical conditions and medications may affect orgasm in women?
- Conditions: Multiple sclerosis, pelvic nerve damage, spinal cord injury.
- Medications: SSRIs are known to delay or inhibit orgasm.
What cultural and interpersonal factors influence Female Orgasmic Disorder?
- Cultural attitudes towards female sexuality and orgasm.
- Relationship satisfaction and communication about sexual needs.
- Degree of sexual education and exploration.
How is Female Orgasmic Disorder differentiated from other conditions?
- Non-sexual mental disorders: MDD may explain orgasm difficulties.
- Substance/medication-induced sexual dysfunction: Drugs like SSRIs may be responsible.
- Interpersonal factors: Severe relationship distress may be the primary issue.
- Medical conditions: If the issue is due to a medical condition, a separate diagnosis is made.
- Other sexual dysfunctions: Can co-occur but are diagnosed separately.
What is a common comorbidity of Female Orgasmic Disorder?
Women with orgasm difficulties may also experience sexual interest/arousal difficulties.
What are the key symptoms of Female Sexual Interest/Arousal Disorder?
A lack of, or significantly reduced, sexual interest/arousal, with at least three of the following:
* Reduced interest in sexual activity.
* Reduced sexual thoughts/fantasies.
* No/reduced initiation of sexual activity & unreceptive to partner’s attempts.
* Reduced sexual pleasure during sexual activity (in 75%-100% of encounters).
* Reduced interest/arousal to internal/external sexual cues.
* Reduced genital or non-genital sensations during sexual activity.
How long must symptoms persist for a diagnosis?
At least 6 months and must cause clinically significant distress in the individual.
What factors can cause Female Sexual Interest/Arousal Disorder?
- Psychological factors (e.g., negative attitudes about sex, past mental health disorders).
- Relationship difficulties (e.g., conflict, partner dysfunction).
- Medical conditions (e.g., thyroid issues, urinary incontinence).
- Substance use (e.g., alcohol, medications).
- Environmental factors (e.g., childhood stress, poor sexual education).
How does age affect sexual interest/arousal in women?
- Sexual desire may decrease with age.
- Older women often report less distress about low sexual interest than younger women.
- Women in long-term relationships may engage in sex despite low initial desire.
What are common associated features of this disorder? - Female orgasmic Disorder
- Difficulty experiencing orgasm.
- Pain during sexual activity.
- Relationship dissatisfaction.
- Unrealistic expectations about sexual desire.
- Poor sexual techniques & lack of sexual knowledge.
What mental health and medical conditions are commonly comorbid with Female Sexual Interest/Arousal Disorder?
- Depression & Anxiety.
- Thyroid problems.
- Urinary incontinence.
- Sexual/physical abuse history.
- Substance use (e.g., alcohol, medications).
How is Female Sexual Interest/Arousal Disorder differentiated from other conditions?
- Mental disorders (e.g., MDD): If lack of desire is due to depression, a separate diagnosis is made.
- Substance/medication-induced dysfunction: If symptoms began due to medication or drug use.
- Medical conditions: If a medical illness fully explains the symptoms.
- Relationship distress: If relationship issues (e.g., abuse) are the primary cause.
- Inadequate sexual stimuli: If symptoms are due to lack of proper sexual stimulation.
What is the relationship between Female Sexual Interest/Arousal Disorder and overall relationship satisfaction?
Sexual dysfunction strongly correlates with decreased relationship satisfaction. Women with low arousal often experience higher rates of relationship distress and dissatisfaction with their sex life.
What are the key symptoms of Genito-Pelvic Pain/Penetration Disorder?
Persistent or recurrent difficulties with one or more of the following:
* Difficulty with vaginal penetration during intercourse.
* Marked vulvovaginal or pelvic pain during intercourse or penetration attempts.
* Marked fear or anxiety about pain before, during, or after vaginal penetration.
* Tensing or tightening of pelvic floor muscles during penetration attempts.
How long must symptoms persist for a diagnosis?
At least 6 months and must cause clinically significant distress in the individual.
What are common associated features of this disorder?
- Strongly associated with reduced sexual desire and interest.
- Women often avoid sexual situations, similar to phobic disorders.
- Can cause relationship problems and reduce a woman’s sense of femininity.
How common is Genito-Pelvic Pain/Penetration Disorder?
Exact prevalence is unknown, but approximately 15% of U.S. women report recurrent pain during intercourse.
When do symptoms of Genito-Pelvic Pain/Penetration Disorder typically develop?
- Can begin at any stage but often peaks in early adulthood and during peri- and postmenopause.
- Women may not seek treatment until sexual problems arise.
- Can also occur after childbirth (postpartum period).
What are risk and prognostic factors for developing Genito-Pelvic Pain/Penetration Disorder?
- Mood & anxiety disorders increase the risk 4x.
- Psychosocial & interpersonal factors (e.g., history of abuse, fear of intimacy).
- Previous vaginal infections or difficulty using tampons before sexual contact.
- Relationship distress, partner’s sexual dysfunction, or fear of abuse.
What are the functional consequences of this disorder?
- Avoidance of sexual activity and relationship difficulties.
- Can interfere with romantic relationships and ability to conceive via intercourse.
- May impact self-esteem and body image.
What are the differential diagnoses for this disorder? - Genito-Pelvic Pain Disorder
- Medical conditions: Some cases are caused by infections, endometriosis, or pelvic floor disorders.
- Somatic symptom disorders: May overlap, making differentiation difficult.
- Inadequate sexual stimuli: Lack of arousal or foreplay may mimic symptoms.
- Partner issues: Erectile dysfunction or premature ejaculation in a partner may lead to pain or penetration difficulties.
What conditions often co-occur with Genito-Pelvic Pain/Penetration Disorder?
- Other sexual dysfunctions (e.g., female sexual interest/arousal disorder).
- Chronic pelvic pain disorders.
- Relationship distress.
- Anxiety & trauma-related disorders.
