Sexual Dysfunction

Question 1

Prevalence of sexual difficulties- men and women

Answer 1

Very common- 40-45% of women
20-30% of men
Aus- 66% of women- one or more

Question 2

Define sexual dysfunction

Answer 2

impairment in a person’s ability to respond sexually or experience sexual pleasure
impairment in one or more of the three stages of sexual functioning

Question 3

3 stages of sexual functioning

Answer 3

Desire
Arousal
Orgasm

Question 4

What is the minimum duration to be classified dysfunction?

How often does it have to occur?

Answer 4

6 months

almost all occasions to all- 75%-100%

Question 5

Specifiers/subtypes

Answer 5

Onset: lifelong or acquired
Context: generalized or situational
Severity (based on level of distress) mild, moderate, severe. Prematrue ejaculation is specified by time of ejaculation

Question 6

Is classification grouped linearly?

Answer 6

No now gender specific
Basson (2000) has suggested a circular model for women- not just sexual desire that initiates arousal- engage in activity as an expression of love, want or pleasure or closeness to partner, then may become aroused by sexual stimuli which triggers desire- influence of contextual factors are important and orgasm is not always essential

Question 7

What are the female sexual dysfunctions in DSM5

Answer 7

Female Sexual interest/ arousal disorder
Female Orgasmic Disorder
Genito-pelvic pain/penetration disorder: dyspareunia, vaginismus

Question 8

What are the male sexual dysfunctions in DSM5

Answer 8

Male hypoactive sexual desire disorder
Erectile disorder
Delayed ejaculation
Premature ejaculation

Question 9

What were the major DSM changes?

Answer 9

No more sexual aversion disorder

Question 10

Sexual desire disorders:

Prevalence

Answer 10

persistent disinterest in sex
distressed by lack of interest
age differences for men: .6% in 40s vs 26% in 70s
men 8% vs women 55%

Question 11

What is the most common female sexual dysfunction?

Answer 11

Sexual interest/desire disorder

Question 12

Erectile disorder- description

Prevalence

Answer 12

Difficulty obtaining or maintain erection or decrease in rigidity
Often spontaneously remits
Up to 50% of males have at some point- increases with age
1-10% younger than 40
20-40% 60-69
50-100% older than 70
higher among smokers, diabetics, hypertension, substance abusers

Question 13

Female Arousal disorder criteria

Prevalence

Answer 13

Difficulty attaining or maintaining sufficient lubrication

Prevalence uncertain- overlap with other disorders 30-50%

Question 14

Delayed ejac

Answer 14

maintains erection but delay or no ejaculation without the person desiring delay
Experienced on almost all occasions of partner sexual activity- can ejaculate during sleep or masturbation
least common male sexual complaint 4%

Question 15

Premature ejac

Answer 15

less than 1 min of vaginal penetration

8% prevalence in Aus

Question 16

Female orgasmic disorder

Answer 16

Marked delay in, marked infrequency of, or absence of orgasm, OR markedly reduced intensity of orgasmic sensations
Must be distressed
Lifelong vs acquired
Generalised vs situational 
prevalence around 51% in Aus

Question 17

Genito-Pelvic Pain/ Penetration Disorder

Answer 17

• Markeddifficultyhavingintercourse/penetration
• Markedvulvo-vaginalorpelvicpainduringintercourseor
penetration attempts
• Markedfearoranxietyaboutpainorvaginalpenetration
• Markedtensingofthepelvicfloorduringattemptedpenetration

Question 18

Dyspareunia

Answer 18

persistent pain during attempted or complete vaginal entry

14-27%

Question 19

Vaginismus

Answer 19

spasms- penetration impossible or painful- hitting brick wall
5-17%

Question 20

Limitations of Prevalence Rates

Answer 20

Diff samples- age groups, clinical vs. non-clinical
Diff measurement- self-report vs. clinical interview
Diff definitions

Question 21

Aetiology: biological, psycho-social, relational

Answer 21

Biological: aging, illness, injury, disability, substance use, meds
Psychosocial: self-acceptance, body image, esteem, cultural beliefs, attachment issues, past experiences, abuse or trauma history, inexperience, stress
Relational- attraction to partner, relationship, poor technical skill, excessive goal orientation, communication of needs and preferences, routinization, partners sexual problem, not enough time

Question 22

Psychogenic ED

Answer 22

• Often sudden onset
• Preservation of morning erections and nocturnal erections
• Achieve erection with masturbation
• May be partner-specific
• Younger patient (

Question 23

Organic ED

Answer 23

• Gradual deterioration
• Decrease in morning erections and nocturnal erections
• No erections with masturbation
• No loss of libido
• Presence of co-morbid conditions

Question 24

Behavioural Treatments- 3 components and effectiveness

Answer 24

Education
Communication skills training
Sensate Focus exercises- graded series of mutual body-touching exercises- first general body pleasuring then genitals
Only about 2/3 - more than performance anxiety

Question 25

CBT

Answer 25

challenge any unrealistic beliefs- monitor

Question 26

Medical Treatments for erectile dysfunction

Answer 26

Pills: Viagra, Levitra and Cialis- highly effective 70-90%
Penile Injections- smooth muscle relaxing drugs into erection chambers
Vacuum devices- 30mins 80-90% but high drop out rate (complications: coolness, numbness, pain with ejac)
Penile prosthesis (inflatable)- last resort, minimal complications

Question 27

Female pharmacological interventions

Answer 27

Hormonal therapy: vaginal or ssystemic oestrogen and androgen
Sildenafil (viagra): limited effectiveness but good to address medication side-effects

Question 28

Female non-pharmacological interventions

Answer 28

Kegel exercises (pelvic floor) and vaginal weights
Vaginal lubricants and moisturisers
Vaginal dilators to stretch vagina
Eros ctd: Female vacuum therapy-FDA-approved- requires prescription, gentle suction over clitoris to cause engorgement- improves vaginal blood floow and lubrication

Question 29

Communication skills training

Answer 29

Likes and dislikes
Comforts and insecurities
How to communicate verbally and behaviourally during sex
Discuss underlying relationship issues impacting sex