Sexual Dysfunction Flashcards
Delayed or absent ejaculation/orgasm on almost all occasions of partnered sexual activity for at least 6 months
Delayed Ejaculation
Causes of Delayed Ejaculation
Drug-induced
General medical condition
Severe depression
Anger at women/men or sexual partner
More likely psychological if difficulty is partner specific
Treatment of delayed ejaculation
Tailored
Patient/couple psychoeducation
Failure to obtain erections in a situation where they were anticipated, causing embarrassment, self-doubt, and loss of self-confidence
Erectile Disorder
Causes of erectile disorder
Increased age, depression, smoking, diabetes, hypertension, neuro disorder, social anxiety, PTSD
Treatment of erectile disorder
-0 Phosphodiesterase type 5 inhibitors (e.g. sildenafil, avanafil, tadalafil, vardenafil)
- Contraindicated in hypotension, nitrate use, MI in last 6 months
- Complaint of normal libido and sexual excitement without the capacity to reach orgasm.
- Marked delay in, marked infrequency of, or absence of orgasm or marked reduced intensity of orgasmic sensations present on all or almost all sexual activity.
- May be psychogenic, drug-induced, or due to a general medical condition.
Female Orgasmic Disorder
Treatment of female orgasmic disorder
Often related to depression, and cognitive-behavioral therapy involving changing of negative sexual thoughts and attitudes can be an effective treatment.
Lack of or significantly reduced sexual interest/arousal for at least 6 months
Female Sexual Interest/Arousal Disorder
Causes of Female Sexual Interest/Arousal Disorder
Medical conditions (spinal cord lesion, MS, diabetes, thyroid dysfunction), substance abuse, medications, psych disorders, interpersonal conflict, partner factors, individual vulnerability, stressors, cultural/religious issues, negative attitudes toward sexuality, problems with sexual intimacy
Treatment of Female Sexual Interest/Arousal Disorder
- Both sex therapy and cognitive interventions have been used for desire and arousal problems.
- Bupropion has been reported to increase various indices of sexual responsiveness in women with low sexual desire.
- Difficulty having intercourse, genito-pelvic pain, fear of pain on vaginal penetration, tension of the pelvic floor muscles
- Partner/relationship factors, cultural/religious factors, and medical factors may play role
Genito-Pelvic Pain/Penetration Disorder
Causes of Genito-Pelvic Pain/Penetration Disorder
May be to due to medical conditions, sexual dysfunction, inadequate sexual stimulation, psychological factors
Treatment of Genito-Pelvic Pain/Penetration Disorder
- Treatment should be multidisciplinary (including psychiatric, gynecological, and urological examinations) and individualized.
- Psychotherapy treatments involves acknowledging the pain and cognitive behavioral pain management.
Absence of desire for sexual activity and persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies for at least 6 months
Male Hypoactive Sexual Desire Disorder
Causes of Male Hypoactive Sexual Desire Disorder
- May be due to hypogonadism, transient stress or interpersonal conflict, mood disorder, schizophrenia, substance abuse, medications, normal age-related decline in sexual desire
- Most lifelong cases will be due to earlier experiences, thus will be psychogenic in etiology
Treatment of Male Hypoactive Sexual Desire Disorder
Usually involves CBT combined with behavioral sex therapy. Major goal is to educate patient how to communicate sexual preferences to the partner.
Persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it. Present for at least 6 months, occurring all or almost all of the time and causing distress.
Premature ejaculation
Causes of Premature ejaculation
Possible causes include an unconscious anger toward women, performance anxiety, abnormalities in spinal and central nervous system mechanisms. Possibly more common in men with panic disorder and social anxiety.
Treatment of Premature ejaculation
Serotonergic drugs (e.g. Paroxetine, Clomipramine)
Behavioral techniques (e.g. “start-stop,” “squeeze” techniques)
- Significant disturbance in sexual function which developed during or soon after substance intoxication or withdrawal or after exposure to a medication AND the involved substance/medication is capable of producing these symptoms.
- Prevalence varies based on implicated substance (numerous medications, namely SSRIs, TCAs, MAOIs, antipsychotics, but also anti-hypertensives, hormones and others; and substances of abuse such as Atenolol (Tenormin), heroin, methadone, and others).
Substance/Medication-Induced Sexual Dysfunction
Treatment of Substance/Medication-Induced Sexual Dysfunction
There are numerous strategies for antidepressant-associated and other medication associated sexual dysfunctions (waiting for a spontaneous remission, starting with or switching to an antidepressant with a lower incidence of associated sexual dysfunction, reduction to a minimal effective dose, or use of numerous “antidotes”).
