SEXUAL HEALTH Psychiatric, Psychosomatic Flashcards
Ejaculation Disorders
Ejaculation involves coordinated muscular and neurological events that involve deposition of semen in the urine channel (emission) and ejection of the fluid from the urethral meatus (ejaculation proper). Emission is accomplished by contraction of the vas deferens, seminal vesicles, and ejaculatory ducts. This process is under adrenaline control. Ejaculation proper results from the rhythmic contractions of the muscles around the urethra, which causes the forcible ejection of the ejaculate. Within the spinal cord lies the ejaculation center which is the area involved in the coordination of signals from the brain and penis that eventually lead to ejaculation.
In normal men there exists a linear sexual response cycle;
desire, arousal, plateau, orgasm, and resolution.
Orgasm can be subdivided into climax and ejaculation. During the resolution phase it is normal for men to experience a refractory period; during the refractory period it is not possible to stimulate the penis back into the erect state. The refractory period is typically very brief in young men but becomes progressively longer with age.
There are 4 main ejaculatory disorders that are seen in clinical practice (i) retrograde ejaculation (ii) premature ejaculation (iii) retarded ejaculation (orgasm) and, (iv) failure of ejaculation (anejaculation).
SYMPTOMS: A comprehensive medical and sexual history is the most important aspect in the diagnosis of men with ejaculatory dysfunction. A focused genital exam is also indicated in most circumstances. Testosterone is often the most commonly performed blood test in the evaluation of ejaculatory dysfunction.
Premature ejaculation, also known as rapid ejaculation, lacks a definition that is agreed upon by all practitioners but essentially is the condition whereby a patient ejaculates with minimal sexual stimulation and before he wishes it to occur.
PE is currently defined by the International Society of Sexual Medicine as a lifelong history of ejaculation occurring within less than 1 minute of penetration (lifelong PE) or a clinically significant and bothersome reduction in latency time, often to about 3 minutes or less (acquired PE). Patients will also have reduced or absent ejaculatory control. Premature ejaculation often causes negative personal consequences, such as distress, bother, frustration and/or the avoidance of sexual intimacy.
Patients with retrograde ejaculation will have a normal sensation of orgasm and climax but will have little to no anterograde (forward) propulsion of semen. This is often referred to as a dry orgasm. This process is diagnosed by the finding of seminal fluid and/or sperm within a urine specimen obtained immediately after orgasm.
Delayed ejaculation or anorgasmia involves the inability of the patient to achieve orgasm (ejaculation) in a timely manner and in severe cases men fail to achieve orgasm on any occasion. As men age, there is an increase in the time it takes to achieve ejaculation, however, in some men this increase may lead to the inability to ejaculate within a 30 minute time period from the initiation of sexual stimulation.
CAUSE: Delayed ejaculation can result from medications, certain chronic health conditions and surgeries. Or it might be caused by substance misuse or a mental health concern, such as depression, anxiety or stress. In many cases, it is due to a combination of physical and psychological concerns
Erectile Dysfunction
Also known as impotence, is defined by difficulty getting and keeping an erection. It can be an embarrassing thing to talk about. It’s been reported that more than half of men between the ages of 40 and 70 experience some form of ED. So take comfort in knowing that you are not alone
SYMPTOMS: Trouble getting an erection.
Trouble keeping an erection.
Reduced sexual desire.
CAUSE: Physical issues like heart disease, high cholesterol, high blood pressure, diabetes, obesity, and smoking can all cause erectile dysfunction. On the other hand, depression, anxieties, stress, relationship problems, and other mental health concerns can also interfere with sexual feelings.
Orgasm Disorders
Anorgasmia is delayed, infrequent or absent orgasms — or significantly less-intense orgasms — after sexual arousal and adequate sexual stimulation. Women who have problems with orgasms and who feel significant distress about those problems may be diagnosed with anorgasmia
SYMPTOMS: Delayed orgasm.
Absence of orgasm.
Fewer orgasms.
Less-intense orgasms.
CAUSE: Common causes of orgasm problems in women include: not being stimulated sufficiently. worrying about sexual performance. mood disorders, such as depression, anti-depressant medication.
Vaginismus
The body’s automatic reaction to the fear of some or all types of vaginal penetration. Whenever penetration is attempted, your vaginal muscles tighten up on their own. You have no control over it. Occasionally, you can get vaginismus even if you have previously enjoyed painless penetrative sex.
SYMPTOMS: Discomfort or pain during vaginal penetration.
Inability to have sex or have a pelvic exam due to vaginal muscle spasms or pain.
Painful intercourse.
CAUSE: Anxiety disorders. Childbirth injuries, such as vaginal tears. Prior surgery.
