Sexual Dysfunctions + Treatments! Flashcards
What are some psychological, physical, cultural, and social factors that influence the diagnostic processes of sexual dysfunctions
- Relationship factors (i.e. partner violence)
medical/psychiatric and medical comorbidities - Is the person functioning in their daily life?
- Cultural or religious factors: a therapist may not be able to suggest masturbation if this contradicts their values and beliefs
- Cultural expectations: our idea about sex as penis and vagina, and our standards for erections may be unrealistic
- Lifestyle factors, overall health
Why do we need complex diagnostic processes
- To account for the complexity of sexual function and pleasure
- Accept that etiologies are usually unknown
- Rule out issues that would preclude a diagnosis of sexual dysfunction (i.e. mood disorder can impact sexual dysfunction)
What is the definition of a sexual dysfunction
-A clinically significant disturbance in a person’s ability to respond sexually or experience sexual pleasure
-Clinically significant = distress - this is why they are coming to see a physician
-Need to assess levels of distress: mild (1-3), moderate (4-6), severe (7-10)
-Don’t need to diagnose if there is no distress or does not appear to be an issue for the individual; Distress and dysfunction don’t always go together: people can be sexually distressed even without a diagnosable sexual dysfunction
How does desire change relative to the partner you are with?
You may have high desire, but when you are with someone who has higher desire, you may experience lower desire because you experience less desire relative to your partner
Low Sexual Desire
- Low initiation and receptivity: people may not go out of their way to show sexual cues, or are not receptive to the cues of their partner
- Low sexual desire is common, but diagnoses are not
- It is hard to treat low desire because people may be receptive but not initiating, or visa versa
Hypoactive Sexual Desire Disorder (HSDD)
- “desire” dysfunction
- Persistent or recurrently deficient (or absent) sexual erotic thoughts or fantasies and desire for sexual activity (6 months+)
- Only in men
Sexual Interest/Arousal Disorder
- Only in women
- “desire” and “arousal” dysfunction
Need at least 3 of the following of absent/reduced: - Interest in sexual activity
- Sexual thoughts or fantasies
- Initiation of sexual activity, receptivity
- Sexual excitement/pleasure in 75-100% of sexual encounters
- Sexual interest/arousal in response to sexual cues (internal, external)
- genital/nongenital sensations in 75-100% of sexual encounters
Treatment: PLISSIT, Addyi pill
Common risk factors for sexual dysfunctions
- Negative sexual cognitions or attitudes
past/current history of psychiatric conditions - Medications (especially for mood disorders)
- Medical conditions
- Partner and relationship factors
Erectile Disorder and Treatment
- “arousal” dysfunction
- Difficulty in obtaining an erection
- Difficulty in maintaining an erection
- Decrease in erectile rigidity
Risk Factor:
-Age (especially 50+ years)
- Lifestyle (exercise, smoking)
- other common symptoms
Others: can lead people to get checked out for heart conditions
Treatments:
Pharmacological Treatments: Viagra (lasts 46 hours), Cialis (lasts an entire weekend), Levitra
Injectable Medications: Intracavernosal injections
Medicatied Urethral System
Vacuum erection pumps:
Viagra
originally developed for high blood pressure and heart disease; Clinical trials found that it didn’t work for high blood pressure and heart disease, but patients reported having longer and stronger erections, so they shifted to market for this instead
Blocks Enzyme PDE-5 which increases bloodflow to the penis; Sexual stimulation is needed - erections don’t just happen on their own
Take 30 minutes before sex
Viagra Side Effects
Erection lasts for 4 hours or longer
Red flush to the face or chest
Headaches due to disregulated bloodflow
Ultravision (blue tinge)
Dizziness
Nasal congestion
Should not take viagra if on meds for a heart condition that have nitrate in them
Intracavernosal injections
Injection of vasodilators into the cavernosa in the penis opens up arteries to increase bloodflow in the penis
No sexual stimulation is needed - this induces a purely physiological response
Erections last about an hour
Side Effects:
Numbness of the glans of the penis
Medicated Urethral System
A pellet goes into the urethra with an applicator
Penis is massaged to spread the medication around
Effects are localized, just not very effective
1 pellet at a time
Not as effective as injections:
Only at tip of penis, not the shaft
Can cause floopy erections because the base is floopy but the top is erect
Can cause a dull aching pain in the penis
Condom should be used with MUSE - especially if the other partner is pregnant so that the medication is not penetrated into the vulva
sexual aversion disorder
It was in the DSM-5 but has since been removed
It is not a general reluctance to have sex, but an intensely negative or fearful response to a specific aspect of sexual interaction
For example, an individual might look forward to having sex until they come into contact with a moustache and then they freeze or shut down. This reaction is often found amongst survivors of sexual trauma
Early Ejaculation
Intra-vaginal ejaculatory latency time (IELT), which is within 1 minute of penetration
Recurring pattern of ejaculation occuring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it.
If this occurs 75% of the time and for 6 months or longer, and if it causes distress for the individual experiencing the symptoms, then they can be diagnosed with premature (early) ejaculation
factors: Excitement
Frequency (abstaining from ejaculation for a period of time can cause faster ejaculation)
Average time from vaginal penetration to ejaculation in healthy populations is 4-10 minutes
Treatment:
Ejaculate more frequently
Event after ejaculation, you can still continue sexual activities: doesn’t need to stop after ejaculation
Change in positions
Communicate with partner: I’m close, should I delay or keep going?
Squeeze technique: used for early ejaculation; stimulate penis to have an erection and then squeeze the penis
but when the partner senses the ejaculate coming, stop squeezing
This makes the time to ejaculate get longer and longer
Delayed ejaculation
Male anorgasmia
- Presence of both a delay in ejaculation and infrequency/absence of ejaculation
- Person must not desire the delay (not a disorder if the delay is not a concern for them)
- with women just “Anorgasmia”: persistent inability to achieve orgasm
- Primary: lifelong; often related to a woman’s lack of knowledge of her own body
-Secondary: recent onset generally more complex in origin and treatment
primary anorgasmia treatment
Psychoeducational counselling and bibliotherapy (offering information on female anatomy, focusing on the importance of clitoral stimulation
dyspareunia
Pain during intercourse/pain related to sex
Most literature focuses on women, and it is often overlooked in men
causes of genital/pelvic pain
Ovulation
Dermatological conditions
Blisters, genital warts, other STIs
Yeast infection
Genito-pelvic pain/penetration (GPPPD)
The muscular component of GPPPD is when the opening of the vagina has an involuntary spasm that tightens and tenses due to the fear of pain on penetration
Vaginal penetration during intercourse
Vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts
fear/anxiety about pain in anticipation of, during, or as a result of vaginal penetration
tensing/tightening of the pelvic floor muscles during attempted vaginal penetration
Treatment: pelvic floor physiotherapy
orgasm disorders for men and women
Delayed ejaculation and premature ejaculation for men
Orgasmic disorder for women
criteria characterize orgasmic disorder
Presence of either of the following symptoms, experiences on all/almost all occasions of sexual activity
Delay in, infrequency of, or absence of orgasm
Reduced intensity of orgasmic sensations
pain disorders for men
(not under the DSM-5)
Penile, testicular, and pelvic pain
Ejaculatory pain without evidence of UTI or other causes
3 months or more
Pelvic floor dysfunction can be a cause
vulvodynia
Umbrella term for chronic vulvar pain
3 months of vulvar pain with no identifiable cause
Provoked (when touched) vestibulodynia: Pain during activity involving vaginal penetration (sexual or non-sexual, such as tampon insertion)
Occurs in the vulvar vestibule
Provoked, not constant
Generalized unprovoked vulvodynia: pain over the vulva that is always there
Clitorodynia
Primary: it has been around for as long as you can remember
Secondary: developed later on