Sexual Dysfunction

Question 1

• Phases of sexual arousal – based on Kaplan, 1974

Answer 1

o Desire (appetitive) phase
 Some physiological changes, but primarily subjective interest in sex (e.g. plans, mental images)
o Excitement Phase
 Subjectively increased arousal accompanied by a number of physiological changes (e.g. erection, lubrication, increased blood flow)
o Orgasm phase
 Subjectively peak pleasure accompanied by specific physiological features (e.g. muscle contractions, ejaculation)

Question 2

o Problems or dysfunction can occur in:
 Desire

Answer 2

o Hypoactive sexual desire
 Thought to be more based in dep.
 May be situational (partner/activity) or global
o Sexual aversion disorder
 Thought to be more based in anx.
 More commonly global
• Range from low interest to aversion
• Interacts with comorbidity – can involve fear, disgust, or sadness
• Sometimes non-voluntary presentation
o Partners bring for treatment

Question 3

o Problems or dysfunction can occur in:

 Arousal

Answer 3

o Female sexual arousal disorder
o Male erectile disorder
• Existence of physiological features of arousal (e.g. erection, lubrication) sufficient for pleasurable intercourse
• Must occur on majority of occasions
• Personal distress
• Distinctions between primary (lifelong) and secondary (recent)

Question 4

o Problems or dysfunction can occur in:

 Orgasmic

Answer 4

o Female/male orgasmic disorder
o Premature ejaculation
• Inadequate orgasm – either too soon or delayed/absent
o Too soon
 Mainly a problem with young inexperienced males, can be circular with anxiety
 Physiologically, time required for male to reach orgasm increases with age, thus less common in older. Also time to reach orgasm quicker, the longer it has been since sex.
• Majority of occasions
• Personal distress/interference
• Primary/secondary distinction

Question 5

o Problems or dysfunction can occur in: Pain disorder

Answer 5

o Dyspareunia
 Any pain during intercourse
o Vaginismus
 Involuntary contractions of vaginal muscles preventing penetration) rare – generally organic (e.g. due to infections, diseases or damage). In many cases pain in secondary to arousal problems.

Question 6

• Prevalence of sexual dysfunction

Answer 6

o Difficult to determine – stigma, secrecy
o Many surveys of normal sexual functioning – less of dysfunction
o Most questionnaire/anonymous survey focus on “problems”
o For many people (especially women), inability to “perform” is not necessarily distressing

Question 7

• Prevalence and demographics

Answer 7

o 30-50% of various populations report sexual “problems”
o Dysfunction in around 10-20%
o Slightly higher among women than men
 Different pattern – desire (women); arousal (men)
o Different patterns with age
 Arousal disorders – increases with age
 Orgasm problems more equal or higher in young

Question 8

• Comorbidity

Answer 8

o Sexual disorders common consequence of several disorders
o Mood disorders – especially low interest
o Anxiety
 Social anxiety
 Panic disorder
 PTSD (past abuse)
o Eating disorders
o Relationship difficulties
o Substance use disorders

Question 9

• Types of sexual problems reporting to an outpatient unit

Answer 9

o Male
 Erectile disorder 60%
 Premature 16%
 Low interest 8%
 Primarily functional problems among those presenting
o Females
 Low interest – 60%
 Vadinismus – 14%
 Dyspareunia 11%
 Orgasm disorder
 Primarily more emotional problems of those presenting

Question 10

• Frequency of sexual problems (self-defined problems)

Answer 10

o Lack of interest
 F – 31%
 M 14%
o Trouble lubricating/erection
 F – 20%
 M – 10%
o Climax too early
 F - -
 M – 30%
o Unable to orgasm
 F - 25%
 M – 7.5%
o Pain during intercourse
 F – 15.6%
 M - -
o Any sexual problem
 F – 43%
 M – 41%

Question 11

• Physical conditions often related to sexual dysfunction

Answer 11

o Diabetes
o Neurological diseases
o CVD
o Endocrine deficiencies
o Anything that causes circulatory problems as changes in blood flow are important for successful sex
o Painful conditions
o Medications
 SSRI’s
o Other drugs
 Alcohol

Question 12

• Psychological factors related to sexual dysfunction

Answer 12

o Relationship problems
o Lack of communication
o Psychopathology (e.g. anxiety, depression)
o Traumas (e.g. sexual abuse)
o Societal/cultural/religious views
o Lack of education
o Extreme beliefs/standards
o Stressors/life events/tiredness

Question 13

• Strongest predictors of sexual difficulties in women

Answer 13

o Low desire
 Predictor – emotional problems 2.7x
o Arousal disorder
 Predictor – urinary tract problem
 Emotional problems
 Sexual force
o Sexual pain
 Urinary tract problems
 Health problems

Question 14

• Predictors amongst men

Answer 14

o Low desire
 Emotional problems
 Poor health
 Daily alcohol
o Premature ejaculation
 Poor health
 Emotional problems
o Erectile dysfunction
 Emotional problems
 Urnary tract problem
 Sex abuse pre-puberty

Question 15

• Paraphilias

Answer 15

o Sexual responsiveness to “unusual” stimuli
o Largely social/cultural definition
o Distinguishing normal from abnormal extremely difficult – but has legal and social ramifications
o Key issues
 Primary focus of arousal
 Considerable effort and time involved in using object
 Life interference or distress

Question 16

• Types of paraphilias

Answer 16

o Fetishism
 Objects, body parts
o Transvestic fetishism
 Dressing as opposite sex
o Exhibitionism
 Exposing genitals
o Voyeurism
 Observing others
o Sadism/masochism
 Giving or receiving pain/suffering
o Paedophilia
 Pre-or early-pubescent children

Question 17

• Misconceptions of paedophilia

Answer 17

o Usually not violent/forceful
o Usually touching or exposure only
o Most are known to child
o Mean age mid 30’s
o Married

Question 18

• Paedophilia types

Answer 18

o Preferential
 Prefer children
 Poor social relationships with adults
o Situational
 Prefer adults but children more available
 More impulsive
 Older children

Question 19

• Socio-demographic features of paraphilias

Answer 19

o Prevalence – unknown
o Mostly male
o Onset – adolescence to 20’s
o Comorbidity
 Other paraphilias
 Anxiety
 Depression
 Substance abuse
 Personality disorders (antisocial)

Question 20

• Learning factors in paraphilia

Answer 20

o Old “traditional” view – paraphilias are “learned”
o Conditioning view – unusual object paired with arousal – takes on arousing properties (MacGuire, 1965)
o Led to long history of aversive conditioning treatments
o One important feature of paraphilias is that they last.

Question 21

• Problems with the conditioning theory of paraphilias

Answer 21

o One pairing (or none)
o Comorbidity between paraphilias
o Many males have accidental pairings
o Sex differences
 Women orgasm, why mainly males with paraphilias

Question 22

• Potentially important features in Paedophilia (paraphilia)

Answer 22

o There are no features that are common to all paedophiles (paraphilias) – in fact most characterise minority
 Antisocial personality vs. shy/unassertive
 History of sexual abuse
 Permitting/positive beliefs
 Poor skills and relationships
 Lack of intimacy

Question 23

• Theories of paedophilia – Araji & Finkelhor (1985)

Answer 23

o Paedophiles find children more emotionally attractive (e.g. less threatening)
o Paedophiles are more aroused by children than adults (may be due to modelling, learning, biology)
o Pedophiles fear, or have difficulty with, adult relationships (e.g. have poor social skills, social anxiety etc)
o Pedophiles lack inhibition over normal desires (e.g. impulsive, alcohol abuse, etc)

Question 24

• Penile responses to films of adults vs children

Answer 24

o Pedophiles are more aroused by children than controls and less aroused by adults that controls but are still considerably more aroused by adults rather than children.

Question 25

• Family characteristics of sex offenders

Answer 25

o Not close to father
o Not close to mother
o Neglected by father
o Neglected by mother
o Physical abuse by parents