Sexual Dysfunction

Question 0

What is the sexual response cycle?

Answer 0

Masters & Johnson

Desire (thoughts, fantasies, motivations) -> Arousal (own appraisal) -> Orgasm (peak arousal causing muscle contraction) -> Resolution

Question 1

What is the definition of sexual dysfunction?

Answer 1

Disturbance in sexual desire and the psychophysiological changes that characterise the sexual response cycle and cause marked distress and interpersonal difficulty.

Question 2

Give some examples of sexual dysfunctions in men and women.

Answer 2

Lack/loss of sexual desire or excessive sexual desire (addiction; possibly due to habituation?)

Erectile disorder (men)/sexual arousal disorder (women)

Rapid ejaculation/inhibited orgasm (men)

Orgasmic dysfunction/persistent sexual arousal disorder (women)

Sexual aversion/lack of sexual enjoyment

Dyspareunia = difficulty/pain during/after sex

Vaginismus = persistent/recurrent difficulties in allowing vaginal entry of any objects despite the woman’s expressed wish to do so

Question 3

What are some important classifications of sexual dysfunctions?

Answer 3

Problems occur irrespective of sexual orientation

More than one problem can co-exist in the same individual

Problems often present in both partners

Problems may be lifelong or acquired

Problems may be due to physical/psychological difficulties

Question 4

What are some important points to note on the ways sexual dysfunction presents?

Answer 4

Reluctance to raise sexual problems

Repeated negative investigations for pain/discharge

Never happy with offered methods of contraception

Question 5

What are some important points to note when discussing sex with patients?

Answer 5

Empathise & reassure 
Note embarrassment/stigma surrounding sexual issues 
Remember privacy & confidentiality 
Use open/specific questions 
Avoid labels/value judgements (do not make assumptions) 
Note terminology used 
Note religious/cultural issues 
Interview partners as well 

+ ask about sexuality, relationships (current & past), significant life events, medical & mental health history, culture, family & psychosexual history

Question 6

What are some of the precipitating and predisposing factors involved in sexual dysfunction?

Answer 6

PRECIPITATING:

• physical
• psychological
• life events
• partner(s)’ problems

PREDISPOSING:

• false beliefs/concepts
• unrealistic expectations
• poor communication skills
• physical vulnerability
• early sexual trauma

Question 7

What are some of the perpetuating factors involved in sexual dysfunction?

Answer 7

Self:

• loss of confidence
• spectating
• guilt/shame
• anger/frustration

Partner(s):

• breakdown in communication
• pressure to perform
• criticism/hostility
• guilt/self-blame

Question 8

Outline the physical and psychosexual treatments for sexual dysfunction.

Answer 8

PHYSICAL (male):

• oral drugs e.g. viagra (erectile dysfunction), cialis, testosterone, SSRIs
• local drugs e.g. EMLA cream (reduced sensitivity)
• self-injection therapy (erectile dysfunction)
• mechanical therapy e.g. pumps, rings (erectile dysfunction)
• surgery e.g. penile implants (risks usually outweigh benefits)

PHYSICAL (female):

• testosterone (post-menopausal women)
• oestrogen
• lubricants (Sylk, not KY - irritates and dries)
• clitoral therapy device (EROS) (similar to penile pump)
• zestra gel (increased pleasure, similar to commercial products)

PSYCHOSEXUAL (based on assumption that majority of sexual dysfunctions are caused by attitudes/ignorance/anxiety)

• educative counselling (individual & couple)
• modification of attitudes/beliefs
• facilitation of communication/assertiveness
• specific directions for sexual behaviour e.g. sensate focus, dilator therapy, stop-start