Sexual Dysfunctions Flashcards
Definition of Sexual Dysfunctions
disorders that make normal arousal and sexual response difficult or impossible
Dysfunctions should be differentiated from…
paraphilia in which arousal and response are dependent on unusual objects or behaviours, but physiological response is intact.
Types of Sexual Dysfunctions
- Sexual Desire Disorders
- Sexual Arousal Disorders
- Orgasmic Disorders
- Sexual Pain Disorders
Causes of Sexual Dysfunctions
- Organic
- Psychogenic
- Cultural/Interpersonal
Organic
physical trauma, illness, developmental differences, drug use, hormone changes.
+ Any possible organic cause should be investigated before other causes are explored.
Psychogenic
associated with low self esteem and confidence, conflict of personal values, history of abuse, anxiety and lack of sexual information.
Cultural/Interpersonal
problems arising from predominantly sexual repressive societal values and the feelings and desires of the individual or couple
Situational Dysfunctions
occur in given circumstances only, e.g.. with a specific partner or in a specific place.
+ They may be primary (present all of life) or secondary (occurring now or sometimes)
Early treatment methods focused on…
Freud’s psychoanalytic model
who introduced the behavioural approach?
Masters and Johnson
Kaplan used a combination model that she called?
psychosexual therapy
Most practitioners today use an…
eclectic approach that allows them to individualize their therapy and counselling to meet the needs of their clients.
Sex Counselling…
Changing Attitudes
Providing Information
Giving Permission
Reducing Anxiety
Sexual Desire Disorders
- Low or Inhibited Sexual Desire
- Compulsive Sexual Behaviour
Low or Inhibited Sexual Desire
- Lack of interest, does initiate, does not respond, but normal physiological function.
- Most common complaint, difficult to resolve.
Low or Inhibited Sexual Desire
– Causes
- hormonal deficiencies, illnessess
- depression & anxiety
- relationship dissatisfaction
- history of assault or abuse
Low or Inhibited Sexual Desire
– Treatment
- relationship counselling and sex education
- therapy for psychological illnesses and abuse
- behavioural exercises e.g. sensate focus
Compulsive Sexual Behaviour
constant sexual desire with pursuit of gratification, but an inability to have satisfying sexual interpersonal relationships.
Compulsive Sexual Behaviour
– Causes
- organic, e.g. disease or injury to the brain
- strong need for love but inability to relate
Compulsive Sexual Behaviour
– Treatment
- lifestyle counselling or therapy
- medications
Sexual Aversion
- extreme negative reaction to sexual activity
- repulsed by genital (more often women)
Sexual Aversion – Causes
- shame, fear & anxiety
- history of abuse or assault
Sexual Aversion – Treatment
- medications
- psychological counselling
Frequency of Sexual Activity & Choice of Behaviours
partners’ difference in timing, sex drive, and lifestyle demands, emotional needs and activity preferences.
Frequency of Sexual Activity & Choice of Behaviours
– Treatment
- identify and treat underlying causes
- relationship counselling
Dyspareunia
- painful intercourse (most often women)
- see notes on male/female issues
Substance/Medication — Induced Sexual Dysfunction
symptoms develop during or soon after intoxication or withdrawal or after exposure to substance/medication
Female Sexual Dysfunctions
– Interest & Arousal Disorders
inadequate excitement and vaginal lubrication
Female Sexual Dysfunctions
- Interest & Arousal Disorders
- Causes
-diabetes
- reduced estrogen levels
- neurological disorders e.g. SCI
- anxiety
- stress
- narcotics, alcohol, medications
- negative experiences such as
abuse
- most often psychological causes related to specific situations
Female Sexual Dysfunctions
- Interest & Arousal Disorders
- Treatment
- medical intervention for physical causes
- sexual counselling to reduce
- performance anxiety
relationship counselling
Female Sexual Dysfunctions
– Orgasmic Disorders
(anorgasmic or pre-orgasmic)
- difficulty or inability to achieve orgasm
Female Sexual Dysfunctions
- Orgasmic Disorders
- Causes
- guilt or anxiety
- insufficient clitoral stimulation
- often situational, e.g. Orgasmic in masturbation but not intercourse
Female Sexual Dysfunctions
- Orgasmic Disorders
- Treatment
- counselling and education to counteract negative attitude toward sex
- self exploration and massage
- couple education on female sexual response
- education and counselling on alternative sexual activities and use of devices such as vibrators
Female Sexual Dysfunctions
– Dyspareunia
pain intercourse or penetration of the vagina
Female Sexual Dysfunctions
- Dyspareunia
- Causes
- most often inadequate vaginal lubrication
- vaginal infection of STD’s
- P.I.D., endometriosis, other diseases
Female Sexual Dysfunctions
- Dyspareunia
- Treatment
- medical intervention for physical causes
- use of artificial lubricants
- counselling for psychological causes
e. g. Low Self Esteem, anxiety - education on sexual techniques
e. g. Increased Foreplay
Female Sexual Dysfunctions
– Vulvodynia
- is a condition characterized by vulvar pain, such as chronic burning, sensation, irruption, and soreness.
- Although it can lead to painful intercourse not seen as a true sexual dysfunction
Female Sexual Dysfunctions
– Vaginismus
involuntary contractions of the pelvic muscles surrounding the outer third of the vaginal barrel
Female Sexual Dysfunctions
- Vaginismus
- Causes
fear of vaginal penetration often related to history of assault or abuse
Female Sexual Dysfunctions
- Vaginismus
- Treatment
- use of graduated plastic vaginal dilators
- couples sexual activities with women in control
- intercourse with women on top
- counselling regarding prior abuse
Male Sexual Dysfunctions
Sexual dysfunction can be related to: desire, arousal, penetration, erection maintenance, orgasm & ejaculation
Male Sexual Dysfunctions
– Erectile Dysfunction (impotence) (ED)
inability to achieve or maintain an erection of sufficient firmness to have intercourse
Male Sexual Dysfunctions
- Erectile Dysfunction
- Causes
- diabetes (1/2 of all)
- stress and fatigue
- low testosterone
- vascular problems
- general illness
- anxiety about performance
- use of abuse of narcotics, alcohol, and medications
Male Sexual Dysfunctions
- Erectile Dysfunction
- Treatment
- 50% psychological — therapy aimed at decreasing anxiety so sexual response can occur normally. Treatment could include sensate focus etc.
- medical intervention for physical causes
- Vacuum Pump
- Penile Injections
- Penile Prostheses — Malleable
- Penile Prosthesis — Inflatable
Male Sexual Dysfunctions
- Erectile Dysfunction
- Treatment
- Penile Injections
- gold standard of therapies for ED
- mixture(s) of: papaverine, PGE1, phentolamine, foreskolin
Male Sexual Dysfunctions
- Erectile Dysfunction
- Treatment
- Penile Prosthesis (Inflatable)
3 piece: most natural appearing erection & excelling flaccidity for optimal concealment
2 piece: easier implantation & larger scrotal pump
Complications: infection, erosion, deformities, mechanical malfunction
Male Sexual Dysfunctions
– Premature Ejaculation (Rapid Ejaculation) (RE)
is an inability to delay ejaculation as long as he wishes
Male Sexual Dysfunctions
- Premature Ejaculation (Rapid Ejaculation) (RE)
- Causes
Most have psychological causes:
- Masturbating in secret, learned for immediate gratification
- 1st sexual experience in less than ideal situations etc…
- anxiety
Male Sexual Dysfunctions
- Premature Ejaculation (Rapid Ejaculation) (RE)
- Treatment
- Goal of therapy is to train the man to focus his sensations. This focusing teaches him to anticipate orgasm and to gain control over the timing of his ejaculation.
- Two Primary methods:
1. stop & go technique
2. squeeze techniques
Male Sexual Dysfunctions
– Ejaculatory Incompetence
inability to ejaculate after penetration despite firm erection and sufficient arousal
Male Sexual Dysfunctions
- Ejaculatory Incompetence
- Causes
Primarily psychological, anxiety related with penetration and ejaculation
Male Sexual Dysfunctions
- Ejaculatory Incompetence
- Treatment
Focus on the psychological causes for the inhibition along with the use of sensate focus exercise, also can use behaviour approach
Male Sexual Dysfunctions
– Dyspareunia - Genito-Pelvic Pain / Penetration Disorders
recurrent or persistent genital pain occurring either before, during or after intercourse (not very common)
Male Sexual Dysfunctions
- Dyspareunia - Genito-Pelvic Pain / Penetration Disorders
- Causes
- Usually associated with an organic condition, such as herpes, prostatitis, or Peyronie’s Disease (curvature of penis caused by sclerotic plaques on the penis)
- Peyronie’s Disease: acquired disorder of the tunica albuginea
Fibrous plaque, pain & penile curvature
– Treatment: Orally can take Vitamin E & Cochicine, Ultrasound, Surgery
Male Sexual Dysfunctions
- Dyspareunia - Genito-Pelvic Pain / Penetration Disorders
- Treatment
Medical intervention to address underlying organic causes
