Sexual dysfunction 9-10Q Flashcards
What is a sexual dysfunction?
disorders that make normal arousal and sexual response difficult or impossible
What is the difference between dysfunctions and paraphilias?
Paraphilias: arousal/response dependent on unusual things but physiological response intact
What are the 4 types of sexual dysfunctions?
- sexual desire disorders
- sexual arousal disorders
- orgasmic disorders
- sexual pain disorders
What is the prevalence of sexual dysfunction in females? males?
females 43%
males 31%
What is the prevalence of hypoactive sexual disorder in females? males?
females 30%
males 15%
Sexual arousal disorders (ED in men and sexual desire disorder in women) are how prevalent?
10-20%
What % of women does orgasmic disorder affect?
10-15%
What is the most common complaint of men?
premature ejaculation
What is the prevalence of premature ejaculation?
~30%
What is the prevalence of sexual pain disorders in women? men?
women 10-15%
men 5%
What are the basic causes of sexual dysfunction?
organic, psychogenic and cultural/interpersonal
What is a situation dysfunction?
a dysfunction that only occurs in given circumstances
What is a primary dysfunction?
present for all of life
what is a secondary dysfunction?
occurs now or sometimes
What are the 4 main strategies of sex counseling?
- changing attitudes
- providing info
- giving permission
- reducing anxiety
What did the early methods to treat sexual dysfunction focus on?
FREUD’s psychoanalytic model
What approach did KAPLAN and JOHNSON introduce?
behavioural approach
What was the combo method used by KAPLAN?
psychosexual therapy
What are the 2 sexual desire disorders that affect both genders?
low or inhibited sexual desire
compulsive sexual behaviour
What is low or inhibited sexual desire disorder?
lack of interest, doesn’t initiate, doesn’t respond but normal physiological function
What are the causes of low or inhibited sexual desire disorder?
- hormonal deficiencies or illness
- depression or anxiety
- relationship dissatisfaction
- history of assault or abuse
What are the tx methods for low or inhibited sexual desire disorder?
- relationship counseling and sex ed
- therapy for psychological illness or abuse
- behavioural exercises (sensate flow)
What is compulsive sexual behaviour?
constant sexual desire with pursuit of gratification, but an inability to have satisfying interpersonal relationships
What causes compulsive sexual behaviour?
- organic (disease or brain injury)
- strong need for love but inability to relate
what are the tx methods for compulsive sexual behaviour?
- lifestyle counseling or therapy
- meds
What is sexual aversion?
- extreme negative reaction to sexual activity
- repulsed by genitals (more often women)
Who can be affected by sexual aversion?
both genders
what are the causes of sexual aversion?
- shame, fear and anxiety
- hx of abuse or assault
What are the tx methods for sexual aversion?
- meds
- psychological counseling
Fill in the blanks: sometimes couples struggle with ______ of sexual activity and choice of ______, this is caused by _______ in timing, sex drive, lifestyle demands, emotional needs and activity preferences. Tx for this includes: ID and treat _______ causes and ________ counseling
sometimes couples struggle with frequency of sexual activity and choice of behaviours, this is caused by differences in timing, sex drive, lifestyle demands, emotional needs and activity preferences. Tx for this includes: ID and treat underlying causes and relationship counseling
What is dyspareuria? (general)
painful intercourse
Who does dyspareuria affect? (general)
both genders
Who is most commonly affected by dyspareuria? (general)
women
When does substance induced sexual dysfunction occur?
during or soon after intoxication or withdrawal
What are the 3 female sexual dysfunctions?
- interest/arousal disorder
- orgasmic disorder
- genito-pelvic pain/penetration disorders
What is interest/arousal disorder?
inadequate excitement and vaginal lubrication
What causes interest/arousal disorder?
- diabetes
- decreased estrogen levels
- neurological disorders
- anxiety or stress
- narcs, alcohol, meds
- negative experiences
What is the most common cause of interest/arousal disorder?
psychological related to specific situations
What are the tx methods for interest/arousal disorder?
- med intervention for physical causes
- sex counseling to decrease performance anxiety
- relationship counseling
What are the 2 types of orgasmic disorders?
anorgasmic
preorgasmic
What is orgasmic disorder?
difficulty or inability to achieve orgasm
what are the causes of orgasmic disorder?
- guilt or anxiety
- insufficient clit stimulation
- often situational
What are the tx methods for orgasmic disorder?
- counseling and education to counteract negative attitudes towards sex
- self exploration and massage
- couple education on female sexual response
- education and couseling on alternative sexual activities and use of devices
What is dyspareuria? (F)
painful intercourse/vaginal penetrations
What are the causes of dyspareuria? (F)
- most often: inadequate vaginal lubrication
- vaginal infection
- PID, endometriosis, other diseases
What are the tx methods for dyspareuria? (F)
- medical intervention for physical causes
- lube
- try different positions
- counseling for psychological causes (low self esteem, anxiety)
- education on sexual techniques
- foreplay
What is vulvodynia?
Not a sexual dysfunction!!
vulvar pain- such as chronic burning, irritation and soreness
What are the 2 genito-peliv/penetration disoders?
- dyspareuria
2. vaginismus
What is vaginismus?
involuntary contractions of the pevlic muscles surrounding outer 3rd vaginal barrel
What are the causes of vaginismus?
- fear of vaginal penetration often related to assault or abuse
What are the tx methods for vaginismus?
- use of graduated plastic vaginal spreaders
- couples have sex with women in control
- intercourse with women on top
- counseling
What are the 5 things that male SD can be related to?
- desire
- arousal
- penetration
- erection maintenance
- orgasm and ejaculation
What is erectile dysfunction?
inability to achieve or maintain an erection of sufficient firmness for intercourse
What are the possible causes of erectile dysfunction?
- diabetes (50%)
- stress and/or fatigue
- decreased testosterone
- vascular problems
- general illness
- narcs, alcohol or meds
- anxiety about performance
Can you ejaculate without being hard?
yes
What are the tx methods for erectile dysfunction?
- 50% psychological: tx aimed at decreased anxiety
- vacuum pump
- penile injection
- penile prosthesis
- meds
What is a penile injection?
gold standard for erectile dysfunction
What is in a penile injection?
mixtures of papaverine, PGE1, phentolamine, foreskolin
What are the 2 types of penile prosthesis?
malleable and inflatable
How long have inflatable prosthesises been used?.
since 1973
explain the 2 types of inflatable prosthesises
3 piece: most natural appearing, excellent flaccidity as well
2 piece: easier to implant, larger scrotal pump
What are the complications of penile prosthesis?
- infection
- erosion
- deformities
- mechanical malfunction
- pt dissatisfaction
What is premature ejaculation (rapid ejaculation)?
inability to delay ejaculation as he wishes
What are the causes of premature ejaculation (rapid ejaculation)?
- most have psychological causes
- masturbating in secret, learned immediate gratification
- 1rst sexual experience in less than ideal situations
- anxiety
What is the tx for premature ejaculation (rapid ejaculation)?
focused on training the man to focus sensations, anticipate and control orgasm
2 methods:
1. stop and go
2. squeeze technique
also some antidepressants may be prescribed
What is ejaculatory incompetence?
inability to ejaculate after penetration despite firm erection and sufficient arousal
What are the causes of ejaculatory incompetence?
primarily psychological, anxiety
What is the tx for ejaculatory incompetence?
focus on psych causes for the inhibition along with use of sensate focus exercises
What is dyspareuria? (M)
recurrent or persistent pain occurring either before, during or after intercourse
What causes dyspareuria? (M)
herpes, prostatitis or peyronie’s disorder
What is the tx for dyspareuria? (M)
tx the cause
What is peyronie’s disorder?
curvature of penis caused by sclerotic plaques on penis
- acquired from disorder of tunia albuginea
How do you tx peyronie’s disorder?
- oral vit E and cochicine
- ultrasound
- surgery
