Sexual dysfunctions Flashcards
How prevalent is sexual dysfunction?
40-45% of women, 20-30% of men
In Australia, 66% of women report having 1+ problems
36% of women report 1+ new problem during the previous 12 months
What is sexual dysfunction and what are the specifiers?
A clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure that lasts for at least 6 mo and is experienced on almost all or all occasions of sexual activity.
It can be lifelong/acquired, generalised/situational (certain types of stimulation, situations, partners), mild/moderate/severe based on distress. Premature ejaculation is specified by time of ejaculation following vaginal penetration (15, 30, 60 sec severe -> mild).
How is sexual dysfunction classified for males?
Desire - male hypoactive sexual desire disorder
Arousal - erectile disorder
Orgasm - delayed/premature ejaculation
How is sexual dysfunction classified for females?
Desire + Arousal - female sexual interest/arousal disorder
Orgasm - female orgasmic disorder
Pain - genito-pelvic pain/penetration disorder
What are the differences between the DSM-IV and DSM-5 classifications of female sexual dysfunctions?
Hypoactive sexual desire disorder and arousal disorder have been combined into female sexual interest/arousal disorder.
Sexual aversion disorder is not in the DSM-5 anymore.
Female orgasm disorder remains in the DSM-5.
Sexual pain disorder has been re-named Genito-pelvic pain/penetration disorder.
What are some of the issues with studies on sexual dysfunction?
Sampling participants from different sub-populations, different age groups, the definition of dysfunction is inconsistent, measures used to assess dysfunction in non-clinical samples are not as reliable.
What is low sexual desire and how common is it?
Persistent and recurrent disinterest in sexual activity and are distressed by lack of interest. Estimated about 7-33% of people have hypoactive sexual desire disorder. It increases with age. Approx 8% of men, 55% women. It is the most common female sexual dysfunction.
What are the sexual arousal disorders for men and women?
Males can experience erectile disorder which is the difficulty in attaining or maintaining an erection for sexual intercourse. It is more common in men aged over 60 and up to 50% of men will experience it at some point. There is a higher prevalence among people who smoke, have heart disease, diabetes, hypertension.
Women can experience sexual arousal disorder which is difficulty in attaining or maintaining adequate lubrication until the completion of the sexual act. 30-50% of women might have dysfunction in the desire, arousal or orgasm phases.
What are the orgasmic disorders for men and women?
Delayed ejaculation is when men maintain an erection but have a delay or inability to ejaculate. Experienced by 4% of Aus men. Premature ejaculation is ejaculation within 1 minute of vaginal penetration. Occurs in 8% of Aus men.
Female orgasmic disorder is the delay or absence of orgasm or reduced intensity of orgasmic sensations. It can be lifelong/acquired, generalised/situational. It occurs in approx 51% of Aus women.
What is genito-pelvic pain/penetration disorder?
Difficulties in: vaginal penetration, vaginal or pelvic pain during penetration attempts or intercourse (Dyspareunia), fear about pain or penetration, tensing of pelvic floor during attempted penetration (Vaginismus).
What is the difference between the linear and circular model of sexual dysfunction?
Linear model: people go through a sequence of stages (desire, arousal, orgasm). The disorders are based on these stages.
Circular model: There is a circular relationship between desire and arousal, and desire to have sex may not come first. If the woman is aroused by sexual stimuli, this may trigger a desire for sex, which then increases further arousal.
Orgasm is not needed in the circular model. Women who have sexual dysfunction tend to have problems in several stages as they influence one another.
What are some of the causes of sexual dysfunction?
Relationship factors: not enough time, not attracted to partner, not satisfied with the relationship, different in level of desire, focus on orgasm, poor needs communication, not setting aside time
Psychosocial factors: cultural and religious beliefs (negative sexual messages), body image problems, performance anxiety, depression, abuse, inexperience
Biological factors: ageing, illness, disability, physical inactivity, high blood pressure drug use, medication
What is the difference between psychogenic and organic erectile dysfunction?
Psychogenic = occurs in males
Describe some of the treatments for male sexual dysfunction.
Medical treatments include medication (e.g. Viagra, Cialis) which increases blood flow and allows men to obtain an erection; Penile injections of muscle relaxing drugs; vacuum devices for 30 min erection and can be painful; inflatable penile prosthesis is invasive but has a high satisfaction rate. These do not address the underlying problems that lead men to experience sexual dysfunction. Sexual intimacy can be promoted by creating emotional connection, physical contact, sexual activities that do not involve penetration.
Describe some of the treatments for female sexual dysfunction.
Medical treatments: hormonal therapy, Viagra with mixed results. Doesn’t change relationship issues, body satisfaction.
Kegel exercises, vaginal weights to strengthen pelvic floor; lubricants to reduce pain, make penetration easier; vaginal moisturisers to restore natural lubrication; vaginal dilators to stretch vagina; female vacuum therapy improves blood flow and lubrication.
What are behavioural treatments for sexual dysfunction?
Sensate focus exercises: focus on pleasurable sensations that accompany body and genital stimulation, communicate preferred experiences.
What are internet-based treatments for sexual dysfunction?
Rekindle: sexual life after cancer - personalised, interactive online psycho-educational resource for cancer patients and partners. The modules aim to improve intimacy and sex life.
What are the barriers to treatment uptake and retention?
Patients are not aware of resources, they feel embarrassed to go to the GP, they are not engaged or partner isn’t, partners not included in the treatment.
What are limitations of treatment research?
Lack of a control group to compare the effectiveness of the treatment; no long-term follow up; treatments do not incorporate emotion, interpersonal aspects and are focused on the physical.
