Sexual Dysfunctions Flashcards
what are the subtypes of sexual dysfunctions
lifelong
acquired
generalized
situational
*can all help to point towards etiology
what 5 factors need to be considered during assessment of sexual dysfunctions
- partner factors (partners sexual problems, health status)
- relationship factors (poor communication, discrepancies in desire)
- individual vulnerability factors (poor body image, hx sexual or emotional abuse) or stressors (job loss etc) or psychiatric comorbidity
- cultural or religious factors
- medical factors relevant to prognosis, course or treatment
is there a diagnosis for a sexual dysfunction attributable to another medical cause
no–> no psychiatric diagnosis for this (i.e peripheral neuropathy)
how often much delayed ejaculation occur to meet criterion A of the DSM disorder
in almost all or all occasions (75-100% of the time) of PARTNERED sexual activity
what is criterion A for delayed ejaculation
either of the following symptoms must be experienced on almost all or all occasions (75-100% of the time) of partnered sexual activity and without the individual desiring the delay:
- marked delay in ejaculation
- marked infrequency or absence of ejaculation
what is the time criteria for delayed ejaculation
persistent for at least 6 months
how does delayed ejaculation change with age
more common in men over 50
men above 80 report twice as much difficulty ejaculating as men udner age 59
why is delayed ejaculation more common in men over 50
age related loss of fast conducting peripheral sensory nerves
+
age related decreased sex steroid secretion
what psych comorbidity may be related to delayed ejaculation
severe forms of MDD
how common is delayed ejaculation
the least common male sexual complaint
less than 1% of men, exact prevalence unclear
what is treatment for delayed ejaculation
dual sex therapy
extravaginal ejaculation and then gradual vaginal entry after stimulation to a point neat ejaculation
what % of men report always ejaculating during sexual activity
75%
what is criterion A for erectile disorder
at least ONE of the following symptoms must be experienced on almost all or all (approx. 75-100%) occasions of sexual activity
- marked difficulty in OBTAINING and erection during sexual activity
- marked difficulty in MAINTAINING and erection during sexual acrivity
- marked decrease in erectile RIGIDITY
what is the time criteria for erectile disorder
minimum 6 months of symptoms
what testing can help differentiate organic from psychogenic erectile problems
nocturnal penile tumescence testing
measured erectile turgidity during sleep
how do you assess vascular integrity when evaluating erectile disorder
doppler U/S
intravascular injection of vasoactive drugs
invasive procedures like dynamic infusion cavernosography
how do you assess nerve function when evaluating erectile disorder
PUDENDAL nerve conduction studies
what blood tests are often ordered when assessing erectile disorder
serum bioavailable or free testosterone
TSH
fasting glucose (diabetes)
serum lipids
what trait is common in men with psychogenic erectile disorder
alexithymia
list risk factors for erectile disorder
neurotic personality traits
submissive personality traits
alexithymia
depression, PTSD
age
smoking
lack of exercise
diabetes
decreased desire
list common comorbidities with erectile disorder
other sexual diagnoses (i.e premature ejaculation)
anxiety and depressive disorders
lower urinary symptoms related to prostatic hypertrophy
DLD
CV disease
hypogonadism
MS
diabetes
what % of men aged 40-80 complain of occasional problems with erections
13-21%
and 40-50% of men aged older than 60-70 have significant problems with erections
what % of men experienced erectile problems that hindered penetration during their first sexual experience
about 8%
what is criterion A for female orgasmic disorder
presence of either of the following symptoms, experienced on all or almost all (75-100%) occasions of sexual activity
- marked delay in, marked infrequency in, or absence of orgasm
- markedly reduced intensity of orgasmic sensation
(other criteria = 6months, distress, not better explained by another condition)
what is a specifier for female orgasmic disorder
“never experienced an orgasm under any situation”
does a woman able to experience orgasm with clitoral stimulation but not during penile-vaginal intercourse meet criteria for female orgasmic disorder
no
does the data support associations between specific patterns of personality traits or psychopathology and orgasmic dysfunction
no not generally
–> some women may have greater difficulty communicating about sexual issues
what % of women do not experience orgasm throughout their lifetime
10%
treatment for female orgasmic disorder
dual sex therapy
masturbate
what is criterion A for female sexual interest/arousal disorder
lack of, or significantly reduced, sexual interest/arousal, as manifested by at least THREE of the following:
- absent/reduced interest in sexual activity
- absent/reduced sexual/erotic thoughts or fantasies
- no/reduced initiation of sexual activity, and typically unresponsive to a partner’s attempts to initiate
- absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approx. 75-100%) of sexual encounters
- absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues
- absent/reduced genital or nongenital sensations during sexual activity in almost all or all sexual encounters
list some risk factors for female sexual interest/arousal disorder
negative cognitions and attitudes about sexuality
past history of mental disorders
differences in propensity for sexual excitation and inhibition may also predict likelihood of sexual problems
relationship difficulties, partner sexual functioning, developmental history (i.e early relationships with caregivers)
some medical conditions (i.e thyroid, diabetes)
distressing low desire can also be associated with what other conditions
depression
thyroid problems
anxiety
urinary incontinence
arthritis
IBD
use of alcohol
abuse in childhood
global mental functioning
criterion A for genito-pelvic pain/penetration disorder
persistent or recurrent difficulties with ONE or more of the following:
- vaginal penetration during intercourse
- marked vulvovaginal or pelvic pain during intercourse or penetration attempts
- marked fear or anxiety about vulvovaginal or pelvic pain in anticipation or, during, or as a result of vaginal penetration
- marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
list risk factors for genito-pelvic pain/penetration disorder
sexual and/or physical abuse
vaginal infections
pain during tampon insertion or the inability to insert tampons before any sexual contact has been an attempted = important RF
what % of women in north america report recurrent pain during intercourse
about 15%
treatment for genito-pelvic pain/penetration disorder
dilators
hypnotherapy
behavioural therapy
mindfulness
criterion A for male hypoactive sexual desire disorder
persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies AND desire for sexual activity
–> MUST HAVE BOTH
judgment of deficiency is made by the clinician–> taking into account factors that affect sexual functioning such as age, general and sociocultural contexts of the individuals life
what must be taken into account when assessing male hypoactive sexual desire disorder
interpersonal context–> a “desire discrepancy” ie in which man has lower desire for sexual activity than partner is not sufficient for diagnosis of male hypoactive sexual desire disorder
use of what substance may increase occurrence of low sexual desire
alcohol use
what endocrine disorders may contribute to low sexual desire
hyperprolactinemia
what % of younger vs older men have problems with sexual desire
about 6% of those age 18-24 and about 41% of those aged 66-74
(but only a small % of these are affected persistently)
criterion A for premature ejaculation
a persistent and recurrent pattern of ejaculation occurring during partnered sexual activity within aprpoximately ONE MINUTE following vaginal penetration and before the individual wishes it
how might someone subjectively experience premature ejaculation (emotionally etc)
sense of LACK OF CONTROL over ejaculation and APPREHENSION about anticipated inability to delay ejaculation on future sexual encounters
what areas have been identified on neuroimaging as implicated in premature ejaculation
PET–> primary activation in MESOCEPHALIC TRANSITION ZONE including VENTRAL TEGMENTAL AREA
list risk factors for premature ejaculation
anxiety disorders–> especially social anxiety disorder
may be associated with DOPAMINE TRANSPORTER GENE polymorphism or SEROTONIN TRANSPORTER GENE polymorphism
thyroid disease
prostatitis
drug withdrawal (i.e opioids)
what is the estimated prevalence of premature ejaculation
1-3% (for DSM criteria, though many men have concerns about how soon they ejaculate)
list treatments for premature ejaculation
squeeze technique
sex therapy
behavioural therapy
mindfulness
SSRIs
topical anesthetic cream
list substances that can result in sexual dysfunctions in association with intoxication
opioids
sedatives, hypnotics, anxiolytics
stimulants
list medications that can cause sexual dysfunctions in relation to withdrawal from those substances
alchohol
opioids
sedatives, hypnotics, anxiolytics
list medications that can affect sexual function/dysfunction
hormonal contraceptives
antidepressants
antipsychotics
what is the most commonly reported side effect of antidepressant drugs
difficulty with orgasm or ejaculation
list some of the sexual problems that can be encountered with antipsychotics
problems with sexual desire, lubrication, ejaculation or orgasm
what impact might gabapentin have on sexual function
problems with orgasm
what impact might lithium and anticonvulsants have on sexual function
may suppress desire
(except lamotrigine)_
which has more of a negative impact on sexual function, methadone or buprenorphine
methadone–> rarely seen with buprenorphine
what % of people on antipsychotics will experience sexual side effects
about 50%
what % of people on MAOIs, TCAs, SSRIs, SNRIs will report sexual side effects
wide range–> 25-80%
which drug of abuse has a higher incidence of sexual side effects with chronic use
heroin (when compared to amphetiamines, MDMA)
how quickly might antidepressant induced sexual dysfunction start
as soon as 8 days after med onset
what % of people with mild-to moderate orgasm delay will experience spontaneous remission within 6 months
about 30%
does SSRI induced sexual dysfunction resolve after med stopped?
sometimes can continue after agent is discontinued
