Sexual Dysfunction Flashcards
Prevalence of sexual difficulties- men and women
Very common- 40-45% of women
20-30% of men
Aus- 66% of women- one or more
Define sexual dysfunction
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
3 stages of sexual functioning
Desire
Arousal
Orgasm
What is the minimum duration to be classified dysfunction?
How often does it have to occur?
6 months
almost all occasions to all- 75%-100%
Specifiers/subtypes
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
Is classification grouped linearly?
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
What are the female sexual dysfunctions in DSM5
Female Sexual interest/ arousal disorder
Female Orgasmic Disorder
Genito-pelvic pain/penetration disorder: dyspareunia, vaginismus
What are the male sexual dysfunctions in DSM5
Male hypoactive sexual desire disorder
Erectile disorder
Delayed ejaculation
Premature ejaculation
What were the major DSM changes?
No more sexual aversion disorder
Sexual desire disorders:
Prevalence
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%
What is the most common female sexual dysfunction?
Sexual interest/desire disorder
Erectile disorder- description
Prevalence
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
Female Arousal disorder criteria
Prevalence
Difficulty attaining or maintaining sufficient lubrication
Prevalence uncertain- overlap with other disorders 30-50%
Delayed ejac
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%
Premature ejac
less than 1 min of vaginal penetration
8% prevalence in Aus
Female orgasmic disorder
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
Genito-Pelvic Pain/ Penetration Disorder
• Markeddifficultyhavingintercourse/penetration
• Markedvulvo-vaginalorpelvicpainduringintercourseor
penetration attempts
• Markedfearoranxietyaboutpainorvaginalpenetration
• Markedtensingofthepelvicfloorduringattemptedpenetration
Dyspareunia
persistent pain during attempted or complete vaginal entry
14-27%
Vaginismus
spasms- penetration impossible or painful- hitting brick wall
5-17%
Limitations of Prevalence Rates
Diff samples- age groups, clinical vs. non-clinical
Diff measurement- self-report vs. clinical interview
Diff definitions
Aetiology: biological, psycho-social, relational
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
Psychogenic ED
- Often sudden onset
- Preservation of morning erections and nocturnal erections
- Achieve erection with masturbation
- May be partner-specific
- Younger patient (
Organic ED
- Gradual deterioration
- Decrease in morning erections and nocturnal erections
- No erections with masturbation
- No loss of libido
- Presence of co-morbid conditions
Behavioural Treatments- 3 components and effectiveness
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
CBT
challenge any unrealistic beliefs- monitor
Medical Treatments for erectile dysfunction
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
Female pharmacological interventions
Hormonal therapy: vaginal or ssystemic oestrogen and androgen
Sildenafil (viagra): limited effectiveness but good to address medication side-effects
Female non-pharmacological interventions
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
Communication skills training
Likes and dislikes
Comforts and insecurities
How to communicate verbally and behaviourally during sex
Discuss underlying relationship issues impacting sex
