Week 5 - Sexual Disorders in Men Diagnosis and Treatment Flashcards
Sexual dysfunctions in men
- Male hypoactive sexual desire disorder
- Erectile disorder
- Delayed ejaculation
- Premature ejaculation
Other specified sexual dysfunctions
- Sexual aversion
- Hyperactive sexual desire
Unspecified sexual dysfunction
Body dysmorphic disorder (genital related)
Male hypoactive sexual desire disorder
- Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity
- The assessments of this must take account of factors such as age and lifestyle
Prevalance MHSD
Periodically
* 0-6% (18 -24 years)
* 41% (66-74 years)
Longer than 6 months
* 1.8% (16-44 years)
A sexual response requires
- Adequate sexual stimulus
- Genital response, subjective experience of arousal
- Situational factors (context, opportunities, motivation)
- Physiological sensitivity (androgenic hormones, neurotransmitters etc.)
Production of testosterone
Testosterone is produced in the leydig cells of the testes and the adrenal glans
Production is regulated from the pituitary gland by:
* LH
* FSH
Why is testosterone important
- A minimum of testosterone is needed in order to function sexually
- Testosterone makes the system ready for sexual activity
- Lower levels are found in 1% of men aged between 20 and 40, but in 20% of over-65
What to do to make a diagnosis
Physical examination and lab tests
* “Lifestyle” (alcohol and drugs)
Individual history (anamnesis), focussing on
* Asking about psychiatric co-morbidity
* Negative sexual experiences
* Interest in sexual stimuli
Potential treatment
- Testosterone supplements
- Sex counselling
- Combination
Sex counselling
- Lifestyle changes: loss weight and exercise
- Break the pattern of avoidance behavior
* Look for positive sexual cues
* “Sensate focus” couple exercises: sex therapy technique (introduced by the Masters and Johnson team) refocusing the participants on their own sensory perceptions and sensuality, instead of goal-oriented behavior focused on the genitals and penetrative sex - Cognitive restructuring (rational emotive therapy)
- Couple therapy: for example, communication exercises, communicate about what you like sexually
Erectile disorder
- Marked difficulty in obtaining an erection during sexual activity
- Marked difficulty in maintaining an erection
- Marked decrease in rigidity
Prevalence ED
18-80 years around 6%
* 2% of men younger than 40 years
* 40-50% older than 60-70 years
* 27% among MSM group
Biological, medical and lifestyle risk factors
- Trauma
- Pelvic surgery
- Neurological diseases
- Hormonal diseases
- Alcohol, drugs use
- age
- Cardiovascular diseases
- Hyperlipidemia
- Diabetes mellitus
- Side effect of medication
- Smoking
Is an erectile disorder an arousal disorder
- Sexual arousal has a genital component (the erection) but also a subjective component (pleasure, pleasure, relaxation, self-esteem, intimacy) that may be at stake and require attentio
- Sexual arousal cannot be separated from sexual desire, as both can reinforce each other in a context of preconscious and explicit rewarding stimulation