Week 4 - Sexual Dysfunctions in Women Flashcards
3 Sexual disorders in women according to DSM 5
- Sexual interest/arousal disorder
- Orgasmic disorder
- Sexual pain/penetration disorders
Criteria for sexual disorder
- Must cause significant distress
- Must occur on 75-100% of occasions
- Minimum duration of 6 months
- Not attributable to
* Another disorder (Axis I disorder) and/or
* Severe relationship distress and/or
* The effect of somatic disease, medication/substance (e.g. alcohol/drugs)
Sexual complaints in women
- Reduced desire problems
- Dyspareunia
- Arousal problems
- Vaginismus
- Orgasmic problems
Symptoms Female sexual interest/arousal disorder
A lack or marked decrease in sexual interest or arousal
Symptoms:
1. Lack of intrest,
2. Lack of sexual thoughts/fantasies
3. Lack of sexual excitement/pleasure
4. Lack of arousal to erotic cues
5. Lack of genital sensations during sexual activity
Gender differences
Compared to women:
1. Men masturbate more often
2. Fantasize about sex more often
3. Experience sexual desire more often
4. Rapport less often problems of lack of sexual desire
Prevalence of sexual interest and arousal problems in women
- Lack of sexual desire: 20-30%
- Sexual arousal problems: 11-31%
- When sexual distress is included as criterion: decrease of 50%
- High co-morbidity of desire and arousal problems
Symptoms orgasmic disorder
- Marked delay in, infrequency of, or absence of orgasm
- Marked reduced intensity of orgasmic sensations
Prevalance of female orgasmic problems
- 3.5 - 35% problems reaching orgasm
- Only 25-30% often or always reaches orgasm during intercourse
Incentive motivation model
Stimulus
Step 1:
1. Memory influences SM
2. Sexual motivation, influences step 2
3. Physical state influences SM
Step 2:
1. Behaviour
2. Genital response
3. Feelings
Context:
* Regulation/inhibition influences SM
How does sex work
Sex is an emotion
Stimulus –> (automatic) physiological respons –> awareness (feeling / behavior (fight, flight, freeze, approach)
Physical state: arousability
- Hormone levels (estrogen and androgen)
* Cancer ovaries, surgical menopause, low estrogen/testosterone - Somatic diseases
* Neurological disorders: multiple sclerosis, spinal cord injury Endocrine disorders: hypothyroidism, hyperprolactine - Medication
* Anti-depressives (SSRI’s), Anti-psychotics (Dopamine antagonists), Anti-androgens (Diane pil)
Psychophysiological studies: aversive learning
- Association sex and negative stimulus (pain, disgust) results in lower sexual arousal
- Sexual response restores when negative stimulus stops
- But negative feeling and tendency to avoid are more persisten
Psychological factors
- Lack of rewarding experience
- Negative sexual experiences
- Restrictive upbringing
- Negative opinions and attitudes regarding sex
- Negative mood -stress
- Fear of failure
- Negative body image
- Relationship dissatisfaction
Psychosocial factors orgasmic problems
- Psychosocial factors orgasmic problems
- Strict religiousness
- Feelings of guilt regarding sex
- Fear of losing control (or of looking or behaving ‘strange’)
- Inability to focus on individual physical sensations (solo-phase, being ‘selfish’)
- Negative interaction with partner, not feeling safe …
- Inadequate communication with partner
Conclusions
- Substantial part(15%) women has at least 1 sexual problem
- Desire, arousal, orgasmic and pain problems often go together (sexual response is not developing)
- Desire, arousal, orgasm are the result of an interaction of a sensitive sexual system with competent stimuli
- In healthy women with sexual disorders no evidence for diminished genital arousability
- Sex is less pleasurable and rewarding for women (lack of adequate stimulation)
- Sex is in women more often associated with negative experience (sexual violence and pain)
