Sexual Dysfunction

Question 1

Delayed or absent ejaculation/orgasm on almost all occasions of partnered sexual activity for at least 6 months

Answer 1

Delayed Ejaculation

Question 2

Causes of Delayed Ejaculation

Answer 2

Drug-induced
General medical condition
Severe depression
Anger at women/men or sexual partner
More likely psychological if difficulty is partner specific

Question 3

Treatment of delayed ejaculation

Answer 3

Tailored
Patient/couple psychoeducation

Question 4

Failure to obtain erections in a situation where they were anticipated, causing embarrassment, self-doubt, and loss of self-confidence

Answer 4

Erectile Disorder

Question 5

Causes of erectile disorder

Answer 5

Increased age, depression, smoking, diabetes, hypertension, neuro disorder, social anxiety, PTSD

Question 6

Treatment of erectile disorder

Answer 6

-0 Phosphodiesterase type 5 inhibitors (e.g. sildenafil, avanafil, tadalafil, vardenafil)
- Contraindicated in hypotension, nitrate use, MI in last 6 months

Question 7

• 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.

Answer 7

Female Orgasmic Disorder

Question 8

Treatment of female orgasmic disorder

Answer 8

Often related to depression, and cognitive-behavioral therapy involving changing of negative sexual thoughts and attitudes can be an effective treatment.

Question 9

Lack of or significantly reduced sexual interest/arousal for at least 6 months

Answer 9

Female Sexual Interest/Arousal Disorder

Question 10

Causes of Female Sexual Interest/Arousal Disorder

Answer 10

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

Question 11

Treatment of Female Sexual Interest/Arousal Disorder

Answer 11

• 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.

Question 12

• 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

Answer 12

Genito-Pelvic Pain/Penetration Disorder

Question 13

Causes of Genito-Pelvic Pain/Penetration Disorder

Answer 13

May be to due to medical conditions, sexual dysfunction, inadequate sexual stimulation, psychological factors

Question 14

Treatment of Genito-Pelvic Pain/Penetration Disorder

Answer 14

• Treatment should be multidisciplinary (including psychiatric, gynecological, and urological examinations) and individualized.
• Psychotherapy treatments involves acknowledging the pain and cognitive behavioral pain management.

Question 15

Absence of desire for sexual activity and persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies for at least 6 months

Answer 15

Male Hypoactive Sexual Desire Disorder

Question 16

Causes of Male Hypoactive Sexual Desire Disorder

Answer 16

• 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

Question 17

Treatment of Male Hypoactive Sexual Desire Disorder

Answer 17

Usually involves CBT combined with behavioral sex therapy. Major goal is to educate patient how to communicate sexual preferences to the partner.

Question 18

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.

Answer 18

Premature ejaculation

Question 19

Causes of Premature ejaculation

Answer 19

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.

Question 20

Treatment of Premature ejaculation

Answer 20

Serotonergic drugs (e.g. Paroxetine, Clomipramine)
Behavioral techniques (e.g. “start-stop,” “squeeze” techniques)

Question 21

• 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).

Answer 21

Substance/Medication-Induced Sexual Dysfunction

Question 22

Treatment of Substance/Medication-Induced Sexual Dysfunction

Answer 22

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”).