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 Prevalence: 4% Least common male sexual complaint ```

GENITO-PELVIC PAIN/ PENETRATION Disorder

Marked difficulty having intercourse/penetration Mrked vulvo-vaginal or pelvic pain during intercourse or penetration attempts Marked fear or anxiety about pain or vaginal penetration Marked tensing of pelvic floor during attempted penetration

What are the limitations of prevalence rates?

Different samples ``` Age groups: 18+, 40+, 70+ Clinical vs. non-clinical Different measurements Self-report vs. Clinical interview Different definitions Lack of specificity in definitions ```

Psychogenic Erectile Dysfunction

Often sudden onset Preservation of morning erections and nocturnal erections Achieve erection with masturbation May be partner-specific Younger patient (<40)

Organic Erectile Dysfunction

Gradual deterioration Decrease in morning erections and nocturnal/night erections No erections with masturbation No loss of libido Presence of co-morbid conditions

Sexual Dysfunctions (SD) Flashcards by Hannah Vuong

What are the specifiers/subtypes of SD

- Nature of onset:

<ul>
<li>Lifelong vs. Acquired</li>
</ul>

- Context:

<ul>
<li>Generalised vs. Situational</li>
</ul>

- Severity:

<ul>
<li>Mild, moderate, severe - based the level of distress</li>
<li>Premature ejaculation is specified by time of ejaculation</li>
</ul>

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Sexual DESIRE Disorders

- Persistent disinterest in sexual activity

- Distressed by this lack of interest

- Prevalence: 7-33%

<ul>
<li>Age differences: men in 40s (0.6%) vs. 70s (26%)</li>
<li>Gender: men (8%) vs. women (55%)</li>
</ul>

- Most commonfemalesexual dysfunction

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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

• Prevalence increases with age

• Prevalence higher among:

<ul>
<li>Smokers, Diabetics, Hypertensives</li>
<li>Substance abusers</li>
</ul>

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Female SEXUAL AROUSAL Disorder

<ul>
<li>Difficulty attaining or maintainign adequate lubrication until completion of the sexual act</li>
<li>Prevalence rates uncertain due to high overlap with the other female SD: 30-50%</li>
<li>Less research focused on females</li>
</ul>

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Male ORGASMIC Disorderss

Delayed vs. Premature ejaculation

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Delayed Ejaculation

<ul>
<li>
Maintains erection, but marked delay (or inability) to

~~~
achieve ejaculation, without the person desiring delay
</li>
<li>
Experienced on almost all or all occasions of partners sexual activity
</li>
<li>
Prevalence: 4%
</li>
<li>
Least common male sexual complaint
</li>
</ul>

~~~

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Premature ejaculation

<ul>
<li>Ejaculation with only minimal stimulation (<1 min after vaginal penetration) and before the man wishes it</li>
<li>Prevalence: *%</li>
</ul>

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Female ORGASMIC Disorder

<ul>
<li>Marked delay in, marked infrequency of, or absence of orgams</li>
<li>OR markedly reduced intensity of orgasmic sensations</li>
<li>Marked distressed</li>
<li>Lifelong vs. Acquired</li>
<li>Can be situational</li>
<li>Orgasm is a learned (not automatic) response
<ul>
<li>improves with experience</li>
</ul>
</li>
<li>Prevalence: ~51%</li>
</ul>

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GENITO-PELVIC PAIN/

PENETRATION Disorder

<ul>
<li>Marked difficulty having intercourse/penetration</li>
<li>Mrked vulvo-vaginal or pelvic pain during intercourse or penetration attempts</li>
<li>Marked fear or anxiety about pain or vaginal penetration</li>
<li>Marked tensing of pelvic floor during attempted penetration</li>
</ul>

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Cycle of Pain in Penetration Disorder

The body anticipates pain, fear/anxiety

>> The body automatically tightens vaginal muscles

>> Tightness makes sex painful, penetration may be impossible

>> pain reinforces/intensifies

>> Body reacts by 'bracing'

>> Avoidance of intimacy

>> Cycle repeats

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Dyspareunia in Penetration Disorder

<ul>
<li>Persistent or recurrent pain during attempted or completevaginal entry and/or penile vaginal intercourse</li>
<li>Prevalence: 14-27%</li>
</ul>

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Vaginismus in Penetration Disorder

<ul>
<li>Involuntary spasms of the muscles surrounding the entrance to the vagina, making penetration impossible and/or painful</li>
<li>Prevalence: 5-17%</li>
</ul>

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What are the limitations of prevalence rates?

<ul>
<li>Different samples

~~~
<ul>
<li>Age groups: 18+, 40+, 70+</li>
<li>Clinical vs. non-clinical</li>
</ul>
</li>
<li>Different measurements
<ul>
<li>Self-report vs. Clinical interview</li>
</ul>
</li>
<li>Different definitions
<ul>
<li>Lack of specificity in definitions</li>
</ul>
</li>
</ul>

~~~

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Psychogenic Erectile Dysfunction

<ul>
<li>Often sudden onset</li>
<li>Preservation of morning erections and nocturnal erections</li>
<li>Achieve erection with masturbation</li>
<li>May be partner-specific</li>
<li>Younger patient (<40)</li>
</ul>

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Organic Erectile Dysfunction

<ul>
<li>Gradual deterioration</li>
<li>Decrease in morning erections and nocturnal/night erections</li>
<li>No erections with masturbation</li>
<li>No loss of libido</li>
<li>Presence of co-morbid conditions</li>
</ul>

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Treatment of Sexual Dysfunction

<ul>
	<li>Medical treatments</li>
	<li>Behavioural therapy</li>
	<li>CBT</li>
	<li>Internet-based treatments</li>
</ul>

Medical treatments for MALE sexual dysfunction

(Erectile Dysfunction)

<ul>
	<li>Sildenafil (Viagra), Levita and Cialis
	<ul>
		<li>Highly effective (70-90%)</li>
		<li>Dose modification may be necessary over time</li>
		<li>Lead toincreased satisfaction in both men &amp; women</li>
	</ul>
	</li>
	<li>Penile Injections
	<ul>
		<li>Injections of smooth muscle relaxing drugs into erection chambers</li>
	</ul>
	</li>
	<li>Vacuum devices
	<ul>
		<li>Erection limited to 30mins</li>
		<li>Results: 80-90% but high drop out rate</li>
		<li>Complications: coolness, numbness, pain with ejaculation</li>
	</ul>
	</li>
	<li>Penile prothesis (inflatable)
	<ul>
		<li>'Last-resort' treatment</li>
		<li>Out-patient surgery</li>
		<li>Minimal complications (<5%), high satisfaction rate</li>
	</ul>
	</li>
</ul>

Medical treatments for FEMALE sexual dysfunctions

Pharmacological interventions:
Hormonal therapy: vaginal or systemic oestrogen and androgen
Sildenafil (Viagra): limited effectiveness, promo sign to address medication side effects

Limitations:
Heavy focus on objective measures
Not enough focus on subjective experience and relationship issues

Non-pharmacological treatments for FEMALE sexual dysfunction

Kegel exercises and vaginal weights
Strengthen the muscle of the pelvic floor

Vaginal lubricants:
Minimise dryness and/or pain during sexual activity

Vaginal moisturisers:
Non-hormonal products
Improve overall vaginal health by restoring lubrication and the natural pH level to the vagina and vulva

Vaginal dilator:
Plastic/rubber tube used to stretch the vagina
To treat vaginismus and dyspareumia

Eros ctd: Female vacuum therapy
FDA-approved to treat female sexual arousal disorder
Requires prescription
Creates gentle suction over the clitoris to cause engagement
Improves vaginal blood flow and lubrication
Improve respond in sensation, lubrication, orgasm, and satisfaction

What are the barriers to treatment uptake and retention in SD?

Patients unaware of availability sources
Lack of referral
Embarrassment (patients and/or GP providers)
Lack of engagement (either or both partners)
Minimal attention to partners (not included or assessed)

What are some of the limitations in treatment research for SD?

Inadequate research methodology
Limited treatment focus: commonly do not work form a bio-psycho-social perspective
Paucity of studies

Pharmacological interventionsfor FEMALE sexual dysfunction

•Hormonal therapy: vaginal or systemic oestrogen &

androgen

• Sildenafil (Viagra): limited effectiveness, promising to

address medication side-effects

•Limitations: Heavy focus on objective measures

rather than subjective experience and

relationship issues

NON-PHARMACOLOGICAL INTERVENTIONS

for FEMALE sexual dysfunction

- Kegel exercises and vaginal weights

<ul>
<li>aimed at strengthening the muscle of the</li>
</ul>

- Vaginal lubricants

<ul>
<li>usually a liquid/gel that is applied around the clitoris,labia and inside the vaginal entrance to minimise drynessand/or pain during sexual activity</li>
</ul>

- Vaginal moisturisers

<ul>
<li>non-hormonal products</li>
<li>improve overall vaginal health by restoring lubricationand the natural pH level to the vagina and vulva</li>
</ul>

- Vaginal dilators

<ul>
	<li>
	<p>Plastic/rubber tube used to stretch the vagina</p>
	</li>
	<li>
	<p>To treat vaginismus &amp; dyspareunia</p>
	</li>
</ul>

-Eros ctd: Female vacuum therapy

<ul>
<li>
FDA-approved to treat female sexual arousal

~~~
disorder
</li>
<li>
Requires prescription
</li>
<li>
Creates gentle suction over the clitoris to causeengorgement
</li>
<li>
Improves vaginal blood flow and lubrication
</li>
</ul>

~~~

SENSATE FOCUS exercises

• Non-goal-oriented physical intimacy

<ul>
<li>Takes the pressure off of“performance” and achieving orgasm</li>
</ul>

• Focus on sensation of touching yourpartner

• Exploring sensual touching beyond thegenitals

• Discovering whether aspects of intimacybring up any feelings of discomfort

INTERNET-based TREATMENTS for sexual dysfunction

• Personalised, interactive ONLINE PSYCHO-EDUCATIONAL RESOURCE

• For cancer patients and partners

• 6 self-led online modules

• Tailored according to:

```

Type of user (patient &/or partner)
Gender of user
Sexual orientation

```

• RCT stage

What are some of the barriers to treatment uptake and retention in SD?

• Patients are unaware of available resources

• Lack of referral

• Embarrassment (patients and/or GP providers)

• Lack of engagement (either or both partners)

• Minimal attention to partners (not included or assessed)

What are some limitations to treatment research for SD?

• Inadequate research methodology

• Limited treatment focus: commonly do not work from a bio-psycho-social perspective

• Paucity of studies