Sexual Dysfunctions Flashcards
Sexual problems & Sexual dsyfunction
For it to be considered dysfunction, the individual needs to be markedly distressed about the problem for both effects on themselves or distressed for effects on partner
Prevalance of sexual dysfunction
VERY WIDESPREAD PUBLIC HEALTH PROBLEM
• At least one sexual dysfunction reported by 40–45%
of women and 20–30% of men (Lewis et al, 2010)
• Australia (Smith et al, 2012):
- 66% of women reported having one or more
sexual difficulties, and
- 36% of women report at least one new sexual
problem, during the previous 12 months
Women do not have more problems, they just feel more distressed about them generally
- Most commonly reported problems are with libido
DEFINITION of Sexual Dysfunction (DSM-5)
A clinically significant disturbance in a person’s ability to
respond sexually or to experience sexual pleasure
• A minimum duration of 6 months
• Experienced on almost all or all occasions of sexual activity
(75%-100%)
• Important to consider cultural values & age!
Specifiers/Subtypes of Dysfunction
Nature of the onset
• Lifelong or acquired
Context
• Generalized or situational
Severity
• Mild, moderate, severe - based on level of distress
• Premature ejaculation is specified by time of ejaculation (severe - 15 seconds, moderate - 30-45 seconds, mild 45-60 seconds)
DSM-4 to DSM-5
• Moving away from DSM-IV classification based on simple linear sexual response (Kaplan’s 3 stages of sexual response cycle, 1979)
- DSM-5 Replaced by GENDER SPECIFIC DYSFUNCTIONS
MALE sexual dysfunctions
Male hypoactive sexual desire disorder (desire)
Erectile disorder (arousal)
Delayed ejaculation (orgasm)
Premature (early) ejaculation (orgasm)
FEMALE sexual dysfunction
Female sexual interest/arousal disorder (desire/arousal)
Female orgasmic disorder (orgasm)
Genito-pelvic pain/penetration disorder (pain)
Female SEXUAL DYSFUNCTIONS: DSM-IV vs. DSM-5
- Removal of sexual aversion disorder
- Hypoactive Sexual Desire Disorder and Sexual Arousal Disorder in group Female sexual interest/arousal disorder
- Female Orgasm Disorder & Sexual Pain Disorder (Dyspareunia & Vaginismus) in group Genito-pelvic pain/penetration disorder
Sexual DESIRE Disorders
Persistent disinterest in sexual activity • Distressed by this lack of interest • Prevalence: 7-33% • Age differences • Men in 40s: 0.6% vs. 70s: 26% • Gender differences • Men 8% vs. Women 55% • Most common female sexual dysfunction
Male SEXUAL AROUSAL DISORDERS
Erectile Disorder (ED)
• Difficulty in obtaining or maintaining erection or marked
decrease in erectile rigidity
• Often spontaneously remits
• Up to 50% of males will have erectile difficulties at some stage –> can be transient & recover on own
- Prevalence:
- 1–10% in men younger than 40 years
- 2–9% in men aged 40 to 49 years
- 20–40% in men aged 60–69 years
- 50–100% in men older than 70 years
- Prevalence higher among:
- Smokers, Diabetics, Hypertensives
- Substance abusers
Female SEXUAL AROUSAL disorder
- Difficulty attaining or maintaining adequate lubrication until completion of the sexual act
- Prevalence rates uncertain due to high overlap with
other female sexual disorders: 30-50% - Less research focused on females
Often they have desire but body doesn’t comply
Male ORGASMIC DISORDER - Delayed Ejaculation
• Maintains erection, but marked delay (or inability) to
achieve ejaculation, without the person desiring delay
• Experienced on almost all or all occasions of partners
sexual activity
• “thrusting a chore, rather than a pleasure”
• Prevalence (Australia): 4%
• the least common male sexual complaint
–> usually do not have problems if masturbating or during sleeping, mostly with partner
Male ORGASMIC DISORDER - Premature Ejaculation
Ejaculation with only minimal stimulation (
Female ORGASMIC DISORDER
- Harder naturally for women to achieve orgasm
Marked delay in, marked infrequency of, or
absence of orgasm, OR markedly reduced intensity
of orgasmic sensations
• Woman must be clinically distressed about her
symptoms
• Lifelong vs. acquired; can be situational
• Orgasm is a learned (not automatic) response
• improves with experience
• Prevalence (Australia): ~ 51%
GENITO-PELVIC PAIN/PENETRATION DISORDER
Common comorbid symptoms:
- Marked difficulty having intercourse/penetration
• Marked vulvo-vaginal or pelvic pain during intercourse or
penetration attempts
• Marked fear or anxiety about pain or vaginal penetration
• Marked tensing of the pelvic floor during attempted penetration
- Cycle of pain
- Not just during sex, often can’t use tampons or have gynaecological inspections
