Sexual Dysfunctions Flashcards
What makes sexual dysfunctions different from sexual disorders?
Sexual disorders -> errors in erotic targets
Sexual dysfunctions -> problems in sexual function
Sexual dysfunction as defined by the DSM 5
Disturbance in a person’s ability to respond sexually or to experience sexual pleasure
For a sexual dysfunction to be diagnosed how long must it be present?
A minimum of 6 months
What are the 3 different dimensions of sexual function?
- Onset (primary/ lifelong OR secondary/acquired)
- Context (generalized OR situational)
- Severity (mild, moderate, severe)
What is the correlation between sexual desire and sexual behaviour? What does this mean?
The correlation is poor.
This means that we cannot infer sexual desire from one’s sexual behaviour and vice versa (i.e., a person may have low sexual desire but still engage in frequent sexual behaviour for a variety of reasons OR a person may have a really high sexual desire but not engage in frequent sexual behaviour for a variety of reasons)
What is the male sexual DESIRE dysfunction?
Hypoactive sexual desire disorder (HSDD)
*low desire
DSM 5 definition:
Persistent deficiency or absence of sexual thoughts, fantasies, and desire
Desire discrepancy
One member of the couple wants to engage in less sexual activity than the other
BUT….
… this does not mean that that partner has low desire, it is just DIFFERENT than their partner
When assessing someone for hypoactive sexual desire disorder (HSDD) it is important to distinguish it from ___________
desire discrepancy
What is the female sexual DESIRE/AROUSAL dysfunction?
Sexual interest/arousal disorder (SIAD)
DSM 5 definition:
Deficiency or absence of sexual interest/arousal
What are some risk factors for HSDD in males and SIAD in females?
- > Negative sexual cognitions/attitudes
- > Past/current history of psychiatric conditions
- > Medications (especially for mood disorders)
- > Partner and relationship factors
What is the male sexual AROUSAL dysfunction?
Erectile dysfunction (ED)
**VERY COMMON as a transitory issue so it must be present for at least 6 months to be diagnosed as a dysfunction
What are some risk factors for ED?
- > age (especially 50+)
- > Past/current history of psychiatric conditions
- > Medications (particularly those that affect cardiovascular system)
- > Medical conditions
- > Partner and relationship factors
- > Lifestyle (exercise, smoking, etc.)
What are the male ORGASM dysfunctions?
Delayed ejaculation (DE)
and
Premature (early) ejaculation (PE)
What is the male counterpart of female orgasmic disorder?
Delayed ejaculation
Delayed ejaculation (DE)
Presence of the following during PARTNERED sexual activity:
- delay in ejaculation
- infrequency or absence of ejaculation
to determine how long is TOO long must be determined and agreed upon by partners
What are some risk factors of delayed ejaculation (DE)?
- > Age
- > Psychological
- > Medications
- > Partner/relationship factors
- > “autosexual” orientation
- > Quirky masturbation habits
Premature (early) ejaculation (PE)
Ejaculation occurring during partnered sexual activity within approx. 1 minute following penetration
Average healthy time is 3 to 8 minutes
What are some risk factors of premature (early) ejaculation (PE)?
- > Anxiety disorders (especially social anxiety)
- > Genetics (like penile hypersensitivity)
- > Learning and environmental factors
Female orgasmic disorder
Delay in, infrequency of, or absence of orgasm
Reduced intensity of orgasmic sensations
What are some risk factors of female orgasmic disorder?
- > Psychological (anxiety, fatigue, mental health)
- > Medications (especially for mood disorders)
- > Medical conditions
- > Partner and relationship factors
- > Sociocultural factors
Genitopelvic pain/penetration disorder (GPPPD) DSM 5 definition
Persistent or recurrent difficulties with at least one of the following:
- Vaginal penetration during intercourse
- Vulvovaginal or pelvic pain during intercourse
- Fear/anxiety about pain (before, during, or after penetration)
- Tensing/tightening of pelvic floor
What two conditions in the DSM 4 were comprised to make the GPPPD category in the DSM 5?
Dyspareunia AND Vaginismus
GPPPD has now been distilled into two conditions:
- Vulvodynia
2. Vaginismus
Vulvodynia
Vulvar pain of at least 3 months with no clear cause
Risk factors for vulvodynia
- > History of repeated yeast infections
- > Hormones
- > Childhood victimization
- > Psychological factors
- > Vulvar hypersensitivity
Vaginismus
Specific phobia related to vaginal penetration
Characterized by increased muscle tension and behavioural avoidance
Risk factors for vaginismus
- > Negative sexual attitudes
- > Lack of sexual education
- > Relationship factors
- > history of sexual or physical abuse
- > Pelvic floor issues
Persistent genital arousal disorder (PGAD)
Symptoms of physiological sexual arousal persist for an extended period of time and do not subside on their own
Arousal consists of at least two things:
- Subjective feelings
2. Genital feelings
In what cases may a person experience subjective feelings of arousal but not genital feelings?
SIAD (in women) and ED (in men)
In what cases may a person experience genital feelings of arousal but not subjective feelings?
PGAD
The causes of sexual dysfunctions are typically divided into 4 categories…
- Intrapsychic
- Interpersonal/relational
- Cultural/psychosocial
- Organic
What are some intrapsychic factors that play a role in the development of sexual dysfunctions/problems?
- > Interactions with and observations of family members
- > Lack of discussion or mislabeling around sexuality
- > Childhood sexual abuse
- > Performance anxiety
- > Traditional sexual script may not be appropriate for the individual
- > Fear of pregnancy and STIs
- > Low self-esteem
- > Fear of being inadequate
Why is it that people with disabilities may suffer from sexual problems?
Despite expressing the same desires related to sexuality and intimacy as their peers, they participate in fewer social activities and fewer intimate relationships
Additionally, they receive less sexual health education than others given that others view them as more asexual
What are some interpersonal/relational factors that play a role in the development of sexual dysfunctions/problems?
- > Inadequate or lack of communication
- > Problems with conflict resolution
- > Being unable to express anger
- > Cheating (non-consensual non-monogamy)
- > Jealousy
- > Distrust
- > Fear of being hurt or disappointed again
What are some cultural/psychosocial factors that play a role in the development of sexual dysfunctions/problems?
- > Religious teachings
- > Family-based teachings
- > School-based education
- > Sources of misinformation (myths, videos)
What are some organic factors that play a role in the development of sexual dysfunctions/problems?
- > Disease
- > Disability
- > Drugs (most common organic factor of sex problems, hormonal contraceptives)
- > Hormones
- > Neurological disorders, CNS injuries (diabetes)
What sexual dysfunction is the best known among men but NOT the most common
Erectile dysfunction
What sexual dysfunction is the most common among men
Premature (early) ejaculation
What does the drug Addyi treat?
HSDD in women (low desire)
Is there a drug treatment for low desire in men?
Nope
Why is Addyi controversial?
A recent review suggests that it is no more effective than placebo (among other controversies)
If a woman comes to a clinician saying that she is having trouble lubricating should the clinician just suggest her to use lubricant?
No, must also take a look at other factors… maybe she is not subjectively aroused
Best way to treat erectile dysfunction?
Sex therapy
OR
Combination of sex therapy and PDE-5 inhibitors
Best way to treat premature (early) ejaculation?
Psychoeducational counselling
shift focus away from trying to last longer to trying to give partner more pleasure through oral/ manual stimulation
Best way to treat delayed ejaculation?
Communication with partner regarding ways to increase partner’s arousal
Withdrawal of medication that is causing it
Best way to treat orgasmic disorder in women?
Psychoeducational counselling
