week 4 Flashcards
sexual performance
“It is important to note that notions of deviance, standards of sexual performance, and concepts of appropriate gender role can vary from culture to culture.”
Sexual Dysfunction: General Description
“…clinically significant disturbance in a person’s ability to respond sexually or to experience sexual pleasure.”
Sexual Desire Disorders (SDD)
Delayed Ejaculation Erectile Disorder Female Orgasmic Disorder Female Sexual Interest / Arousal Disorder Genito-Pelvic Pain/Penetration Disorder Male Hypoactive Sexual Desire Disorder Premature (Early) Ejaculation
4 Common themes of SDD’s!
. 1.The cause of the problem is Psychological and not biological in nature!
2. You must think it is a problem and nobody but you decides it is a problem!
3. The problem has to persist across time and contexts to be a disorder!
4. The problem happens most of or all of the time
I.e., 75-100% of the time
5. The problem isn’t better explained by something else:
I.e., Nonsexual mental disorder, consequence of severe relationship distress, effects of a substance/medication, another medical condition.
4 common themes
delayed ejaculation erectile disorder female orgasmic disorder female sexual interest /arousal disorder male hypoactive sexual desire disorder premature ejaculation
Delayed Ejaculation
diagnostic criteria
(A)Either of the following on almost all or all occasions (approximately 75%-100%) of partnered sexual activity, and without the individual desiring delay:
- Marked delay in ejaculation.
- Marked infrequency or absence of ejaculation.
(B)Symptoms for a minimum of 6 months. (C)Clinically significant distress in the individual. (D)Not better explained by -Nonsexual mental disorder -Consequence of severe -relationship distress -Other significant stressors -Effects of a substance/medication -Another medical condition.
Erectile Disorder
criteria
(A)Any of the following on almost all or all occasions (approximately 75%-100%) of partnered sexual activity, and without the individual desiring delay:
-1.Marked difficulty in obtaining an erection during sexual activity
-2.Marked difficulty in maintaining an erection until completion of sexual activity
-3.Marked decrease in erectile rigidity
(B)Symptoms for a minimum of 6 months.
(C)Clinically significant distress in the individual.
(D)Not better explained by
-Nonsexual mental disorder
-Consequence of severe relationship distress
-Other significant stressors
-Effects of a substance/medication, or another medical condition.
Erectile Disorder
Differential Diagnosis
Nocturnal penile tumescence (esp. in REM sleep)
Nocturnal penile tumescence means = Erection during sleep or waking up. AKA “morning wood” or “morning glory”
(ie if getting a hard on during sleep or morning wood then its not organic it is psychogenic)
Female Orgasmic Disorder
(A)Either of the following on almost all or all occasions (approximately 75%-100%) of partnered sexual activity, and without the individual desiring delay:
- 1.Marked delay in, marked infrequency, or absence of orgasm.
- 2.Marked reduced intensity of orgasmic sensations.
(B)Symptoms for a minimum of 6 months.
(C)Clinically significant distress in the individual.
(D)Not better explained by
- Nonsexual mental disorder
- Consequence of severe relationship distress
- Other significant stressors
- Effects of a substance/medication
- Another medical condition.
Female Orgasmic Disorder
Prevalence
- Wide variation in prevalence rates of orgasm problems
- 10 – 42%
- Age, culture, duration of symptoms, severity cutoff
- Only a subset of these experience distress as a result
- Approximately 10% of women do not experience orgasm at all
Culture-Related Diagnostic Issues
- Sociocultural differences
- -Anorgasmia less prevalent in Northern Europe (17.7%)
- -Anorgasmia more prevalence in Southeast Asia (42.2%)
Age / generational differences
Female Sexual Interest / Arousal Disorder
interpersonal context
WARNING
“In assessing female sexual interest/arousal disorder, interpersonal context must be taken into account. A desire discrepancy in which a woman has lower desire for sexual activity than her partner, is not sufficient to diagnose female sexual interest/arousal disorder.”
Female Sexual Interest / Arousal Disorder
Diagnostic criteria
Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:
-Absent/reduced interest in sexual activity and/or sexual fantasies, and/or initiation of sexual activity, and/or most sexual activity (75%+) and/or arousal to stimulation, and sensations.
(A)Symptoms for a minimum of 6 months.
(B)Clinically significant distress in the individual.
(C)Not better explained by
- Nonsexual mental disorder
- Consequence of severe relationship distress
- Other significant stressors
- Effects of a substance/medication
- Another medical condition.
Genito-Pelvic Pain/Penetration Disorder
criteria
(A)Persistent or recurrent difficulties with one or more:
- 1.Vaginal penetration during intercourse.
- 2.Marked vaginovulval or pelvic pain during vaginal intercourse or penetration attempts.
- 3.Marked fear or anxiety about vaginovulval or pelvic pain in anticipation of, during, or as a result of vaginal penetration
- 4.Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
(B)Symptoms for a minimum of 6 months.
(C)Clinically significant distress in the individual.
(D)Not better explained by
- Nonsexual mental disorder, relationship distress, other significant stressors
- Effects of a substance/medication or another medical condition.
Previous Terms for Genito-Pelvic Pain/Penetration Disorder
Dyspareunia
- Recurrent or persistent genital pain associated with sexual intercourse in either a male or a female.
- The disturbance causes marked distress or interpersonal difficulty.
Vaginismus
- Recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal penetration is attempted.
- The disturbance must cause marked distress or interpersonal difficulty. The disturbance is not due to a general medical condition.
Male Hypoactive Sexual Desire Disorder
(A)Persistently or recurrently deficient (or absent) sexual / erotic thoughts or fantasies and desire for sexual activity.
-The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual’s life.
(B)Symptoms for a minimum of 6 months.
(c)Clinically significant distress in the individual.
(D)Not better explained by
- Nonsexual mental disorder, relationship distress, other significant stressors
- Effects of a substance/medication, another medical condition.
Sexual DysfunctionPremature (Early) Ejaculation
(A)A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it.
-Although the diagnosis of premature (early) ejaculation may be applied to individuals engaged in nonvaginal sexual activities, specific duration criteria have not been established for these activities.
(B)Symptoms for a minimum of 6 months.
(C)Clinically significant distress in the individual.
(D)Not better explained by
- Nonsexual mental disorder, relationship distress, or other stressors
- Effects of a substance/medication
- Another medical condition.
Premature (Early) Ejaculation
prevaslence
20 – 30% of men 18-70 yrs report concern about speed of ejaculation
With the narrower (1 minute) timeframe, prevalence is estimated at 1 – 3%
Paraphilia vs Paraphilic Disorder
Paraphilia
“The term paraphilia denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners.”
Paraphilic Disorder
“A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others.
A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not necessarily justify or require clinical intervention.”
Paraphilic Disorders
Voyeuristic Disorder Exhibitionistic Disorder Frotteuristic Disorder Sexual Masochism Disorder Sexual Sadism Disorder Pedophilic Disorder Fetishistic Disorder Transvestic Disorder
General Diagnostic Criteria for Paraphilic Disorders
(A)Specific details of the paraphilic disorder
(B)The individual has acted on these sexual urges with a non-consenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. (This is very important)
(C)The individual experiencing the arousal and/or acting on the urges is at least 18 years of age.
paraphilic disorders criteria (II)
The individual has acted on these sexual urges
with a non-consenting person,
the sexual urges or fantasies cause clinically significant distress or impairment
The individual experiencing the arousal and/or acting on the urges is at least 18 years of age.
Criterion A & B of Pedophilic Disorder
A. Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).
If B not present then it is Pedophilic Sexual Orientation not a disorder
Voyeuristic Disorder
Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors.
Exhibitionistic Disorder
Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.
Frotteuristic Disorder
Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a non-consenting person, as manifested by fantasies, urges, or behaviors.
Sexual Masochism Disorder
Over a period of at least 6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviors.
Sexual Sadism Disorder
Over a period of at least 6 months, recurrent and intense sexual arousal from the physical or psychological suffering of another person, as manifested by fantasies, urges, or behaviors.
Fetishistic Disorder
Over a period of at least 6 months, recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors. It must cause distress to self or others.
Transvestic Disorder
Over a period of at least 6 months, recurrent and intense sexual arousal from crossdressing,
as manifested by fantasies, urges, or behaviors. It must cause distress to self or others.
Fetishism
Controversy
- Some authors have argued that Fetishism should not be considered a clinical disorder
- -Individual arousal in response to stimulus is a “private matter”
- -As defined in DSM, Fetishism does not involve anyone other than the individual
But
If the condition causes clinically significant distress or impairment…?
What did Freud suggest?
Freud’s conclusion was that Fetishes become a problem when they result in deviation from the primary purposes of fetishes….
Freud’s ideas were a major influence to the sexual revolution some decades later….
Important Factors to consider in sexual problems
- Partner factors
- Partner’s sexual problems; partner’s health status - Relationship factors
- Poor communication; discrepancies in desire for sexual activity - Individual vulnerability factors
- Poor body image; history of sexual or emotional abuse, - Psychiatric comorbidity
- Depression, anxiety, or stressors (e.g., job loss, bereavement); - Cultural or religious factors
- Inhibitions related to prohibitions against sexual activity or pleasure; attitudes toward sexuality - Medical factors relevant to prognosis, course, or treatment.
Other Specified Paraphilic Disorder
This category is included for coding Paraphilias that do not meet the criteria for any of the specific categories.
Including (but are not limited to)
telephone scatologia (obscene phone calls)
necrophilia (corpses)
partialism (exclusive focus on part of body)
zoophilia (animals)
coprophilia (feces)
klismaphilia (enemas)
urophilia (urine).
SSRIs and Sexual Dysfunction
SSRI-related dysfunction
- Problems with
- -Disturbance in sexual response cycle
- -Pain associated with intercourse
- Onset within 1 month
Management of Dysfunction
1.Use antidepressants with less sexual dysfunction
-Mirtazepine, bupropion
2.Wait for spontaneous remission
-Low rate, and long wait
3.Reduce antidepressant dose
4.Introduce drug holidays or
-partial holidays
-May worsen anxiety/depression
-May encourage non-adherence
5.Schedule sexual activity prior to main dose
6.Add “antidotes”
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Erectile Disorder
Subtypes
–Lifelong vs Acquired
–Generalized vs Situational
Prevalence
-Strong age-related -prevalence and incidence, esp. >50 yrs
–13 – 21% of men 40-80 report occasional erectile problems
–2% of men < 40 report frequent problems with erections
–40 – 50% of me > 60 report significant erectile problems
Other Dysfunctions
Sexual Dysfunction due to a General Medical Condition Substance-Induced Sexual Dysfunction -Alcohol -Other recreational/illicit drugs -Antihypertensives -H2 histamine antagonists --SSRI antidepressants --Antipsychotics --Anabolic steroids -Anticonvulsants
Unspecified Sexual Dysfunction
