Sexuality/Sexual Dysfunction Flashcards
Characteristics of Linear model of sexual response: masters and johnson’s theory
- Four stage model of human sexual response cycle
- Based on physiologic arousal only
- All four stages do not always happen
Four stages of linear model of sexual response
a. Excitement
b. Plateau
c. Orgasm
d. Resolution
Criticism of linear model of sexual response
a. Assumes men and women have similar sexual response
b. Does not take into any psychosocial effects on sexual response
Characteristics of Circular model of sexual response: Basson
- Female response is more complex and circuitous
- Goal is not orgasm but personal satisfaction
- Affected by psychosocial issues: emotional intimacy, sexual stimuli, relationship satisfaction
- Many women have little spontaneous desire/interest
- Engage in sex to increase emotional intimacy
Characteristics of Variable control / Sexual tipping point model
- Most updated biopsychosocial model
- Mental and physical factors sit in both excitation and
inhibition - Mental and physical factors move and change from sex
negative to sex positive feedback and back again
DSM 5: definition female sexual dysfunction
- Female sexual dysfunction: heterogenous groups of disorders characterized by clinically significant disturbances in sexual response or the experience of sexual pleasure
ICSM/ ISSWHS
- HDD (hyposexual desire disorder) definition
-FSDD (female sexual desire disorder) definition
- HDD (hyposexual desire disorder): persistent or recurrent deficiency or absence of sexual or erotic thought or fantasies and desire for sexual activity symptoms present for at least 6 or more months
- FSDD (female sexual desire disorder): persistent or recurrent inability to attain or maintain arousal until completion of the sexual activity, despite adequate subjective assessment of genital response
Definition: sexuality
involves a wide range of practices and behaviors including fantasy, self-stimulation, noncoital pleasure, erotic stimuli other than touch, the ability to identify what is wanted and pleasurable
Definition: Hyposexual desire disorder
complete lack of, or significant reduction in, sexual interest or sexual arousal that is associated with three or more of the following six symptoms:
i. The absence or reduction of interest in sex
ii. An absence of or reduction in fantasies and erotic thoughts
iii. Absent or decreased desire to initiate sexual encounters with her partner and usually unreceptiveness when the partner attempts to initiate such encounters
iv. Absent or reduced sense of excitement/pleasure during sex
v. Absent or reduced response to sexual cute (verbal/visual)
vi. Absent or reduced sensations in the genitals or elsewhere during sex
***Must be distressing to the woman and must persist for minimum 6 months
How many categories does female sexual dysfunction include according to DSM 5?
3 categories
What is the presentation of dyspareunia?
One or more of the following:
i. Difficulty with vaginal penetration during sexual activity
ii. Vulvovaginal or pelvic pain during intercourse or attempted penetration
iii. Fear or anxiety about pain before, during or after vaginal penetration
iv. Pelvic floor muscles tensing or tightening when vaginal penetration is attempted
Risk factors for sexual dysfunction?
a. Neurological factors
b. Chronic pain
c. CV factors
d. Psychological factors
e. Socio-cultural factors
f. Interpersonal factors
g. Medications:
i. Dry things out
ii. Changes (decrease) blood flow: CV meds, BP meds
iii. Alters receptors in brain (serotonin) SSRI’s can be good or bad ~ serotonin
effects libido
iv. Exogenous hormones
h. Endocrine diseases (see table)
Medications that can cause vaginal dryness
- CV meds
- BP meds
-SSRI’s - Exogenous hormones
Endocrine disorders that affect female sexual function
- hyperpolactinemia, hypoandrogenism, diabetes, estrogen deficiency, hypercotisolism
PE items to note
- General
- Pelvic
General: affect, energy, signs of systemic disease
Pelvic: only performed if warranted – guarding?
Vulva: sparse pubic hair (endocrine); skin suggestive of disease (eczema)
Introitus: fissures, atrophy (breast feeding/post menopausal?), swelling, pain, tone
Internal: tone, tenderness, trigger points, fissures
