Sexual Dysfunction

Question 1

Diagnostic criteria

Answer 1

• Distress, persistent, minimum 6 months
• Evaluated by severity and duration: lifelong v. acquired, generalized v. situational

4 major categories:

1. Sexual desire
2. Sexual arousal
3. Orgasm
4. Sexual pain disorders

Question 2

Sexual desire disorders

Answer 2

Motivation to engage in sexual activity. AKA sex drive/appetite.

• Hypoactive sexual desire disorder (HSDD): persistent or recurrent deficient (or absent) sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty
• In women, HSDD is female sexual arousal disorder (FSAD). The normal “responsive desire” in females is less activated

Question 3

HSDD

Answer 3

• Low desire may be related to medical conditions or pharmacological treatments that affect hormone levels
• Medications may reduce sex drive - e.g. SSRIs, beta blockers, SERMs
• High stress
• Less overall satisfaction with relationships: conflict, less spontaneity/playfulness, less closeness/intimacy, more aversive feelings
• History of sexual abuse

Question 4

Comorbidities

Answer 4

Social phobia, OCD, panic disorder, mood disorders (particularly depression)

Question 5

Assessment and treatment of HSDD

Answer 5

Often first discovered by medical doctor and referred to psychologist.

• Testosterone/hormone treatment
• Psychological treatment: education about factors that affect sexual desire, couples exercises (scheduling times for physical and emotional intimacy), cognitive restructuring of dysfunctional beliefs, sexual fantasy training, sensate focus (couples learn to focus on pleasurable sensations, while decreasing attention to goal-directed sex, e.g. orgasm)

Question 6

Sexual arousal disorders

Answer 6

Disruptions to physical and mental readiness for sexual activity.

• ED
• Female sexual arousal disorder (FSAD)