Week 6 Lecture 6 - Sexual Dysfunctions, Paraphilias, & Gender Dysphoria - Jo Fielding (DN) Flashcards
Lecture Summary
- Dysfunctions of sexual interest, desire, & arousal
- Aetiology: psychosocial, biological, drug related
- Problems of non-typical focus of sexual desire, arousal & gratification (Paraphilias)
- Aetiology of paraphilias: psychosocial, perhaps some biological causes in some disorders
- Distress accompanying gender identity - Gender dysphoria
What are the three main DSM-5 categories for Sexual Dysfunction?
Disorders of
- Interest, Desire & Arousal
- Orgasm
- Pain
13:20
What are the 3 disorders of Interest, Desire & Arousal?
Males
- Male hypoactive sexual desire disorder
- Erectile disorder
Females
- Female sexual interest/arousal disorder
What are the 3 Orgasmic Disorders?
Males
- Delayed ejaculation
- Premature (early) ejaculation
Females
- Female orgasmic disorder
What is the sexual disorder of Pain?
what gender does it occur in?
Genito-pelvic pain/penetration disorder
occurs in females
Key features of Female Orgasmic Disorder
- Persistent delay, infrequency or absence of orgasm after sexual excitement or
- reduced intensity 6 months or more
- 75% of occasions
Key features of Premature (early) ejaculation
one of the orgasmic disorders
- Persistent, recurrent ejaculation within 1 minute of penetration
- most common reason for referral to sexual clinic
- more common in men with anxiety disorders
- Mild - 30-60 sec
- Moderate - 15-30 sec
- Severe - within 15 sec 6 months +
29:15
How do we define premature?
ejaculating within
- 8 min (people generally complain)
- 3 min (no complaints!!!)
Key features of Delayed Ejaculation?
Persistent delay, infrequency or absence or orgasm
75% of occasions
31:45
What are the key features of Genitopelvic pain/penetration disorder?
Persistent pain with
- intercourse, penetration
- fear or anxiety about pain
- tensing of pelvic floor muscles
33:00
What are the DSM specifiers used to designate the onset of Sexual Dysfunction?
Lifelong
present from first sexual experience
Acquired
develop after period of relatively normal sexual function
Generalised
not limited to certain types of stimulation, situation, partner
Situational
only with certain types of stimulation, situation, partner
16:40
What 5 other factors should be considered during assessment for Sexual Dysfunction?
Factors considered during assessment:
1. Partner factors
- partners’ sexual problems, health status
2. Relationship factors
- poor communication, discrepancies in desire
3. Individual vulnerability factors
- body image, history of abuse, psychiatric comorbidity, stressors
4. Cultural/religious factors
- prohibitions, attitudes towards sexuality
5. Medical factors
- e.g. pelvic nerve damage 17:50
Which DSM-5 criteria exist for ALL of the sexual dysfunctions?
Common diagnostic criteria:
- Symptoms must have persisted for a minimum duration of 6 months
- Symptoms must cause clinically significant distress
- Symptoms not better explained by :
* 1. Non-sexual mental disorder
* 2. Severe relationship distress, partner violence
* 3. Other significant stressor
* 4. Effects of substance/medication
* 5. Other medical condition
- Symptoms not better explained by :
19:25
Female Sexual Interest /Arousal Disorder
A dysfunction of sexual interest, desire & arousal
Diminished, absent, or reduced frequency of at least 3 of the following :
- Interest in sexual activity
- Sexual/erotic thoughts or fantasies
- Initiation of sexual activity & responsiveness to partner’s attempts to initiate
* Beliefs & preferences highly relevant
- Initiation of sexual activity & responsiveness to partner’s attempts to initiate
- Sexual excitement/pleasure - ≥75% of sexual encounters
- Sexual interest/arousal elicited by any internal or external erotic cues
* Adequacy of sexual stimuli?
- Sexual interest/arousal elicited by any internal or external erotic cues
- Genital or nongenital sensations - ≥75% of sexual encounters
22:00
Male Hypoactive Sexual Desire Disorder
A dysfunction of sexual interest, desire & arousal
- Persistently deficient or absent sexual fantasies & desires, as judged by the clinician
- Considerations
- age, general/socio-cultural contexts
- e.g. pregnancies, considering terminating relationship
- Comorbidities
- depression
- other mental disorders
Erectile Disorder
A dysfunction of sexual interest, desire & arousal
- On at least 75% of sexual occasions
- Inability to attain or maintain an erection for completion of sexual activity, or
- Marked decrease in erectile rigidity interferes with penetration or pleasure
- Comorbidities = other sexual diagnoses
Female Orgasmic Disorder
An Orgasmic Disorder
- On at least 75% of sexual occasions;
- Marked delay, infrequency, or absence of orgasm, or
- Markedly reduced intensity of orgasmic sensation
- Inability to achieve orgasm despite adequate sexual desire & arousal
- Most common problem for which females seek professional help
- Threshold for reaching orgasm varies enormously
- ~25% significant difficulty reaching orgasm
- But only ~20% reliably experience orgasm during sex
Equally present in all age groups
- unmarried >married Distinct from sexual arousal
Premature (early) Ejaculation
An Orgasmic Disorder
- Persistent or recurrent pattern of ejaculation
- during partnered sexual activity
- within ~ 1 minute following penetration
- Most common reason for male’s referral to sexuality clinics
- ~60% as presenting complaint
- many also present with erectile dysfunction
- Prevalence: 20-30% at some time
- Promotes considerable anxiety
- Most common in young, sexually inexperienced males
29:15
Delayed Ejaculation
An Orgasmic Disorder
- Marked delay, infrequency, or absence of orgasm
- on at least 75% of sexual occasions
- Seldom seek treatment
- Rarely reported
- 75% report always ejaculating during sex
- Over 50 – loss of peripheral sensory nerves/ lower steroid secretion
Not in DSM-5, but Jo included it
- Retrograde ejaculation
- ejaculatory fluids travel backwards into the bladder rather than forwards
- Almost always caused by drugs or medical condition
31:45
Genitopelvic pain/penetration disorder
The Sexual Pain Disorder
Persistent or recurrent difficulties with at least one of the following:
- Vaginal intercourse/penetration
- Marked vulvovaginal or pelvic pain during vaginal penetration or intercourse attempts
- Marked fear or anxiety about pain or penetration
- Marked tensing of the pelvic floor muscles during attempted vaginal penetration
- Commonly associated with relationship distress
- High prevalence of other disorders related to pelvic floor
- E.g. cystitis, infection, IBS, endometriosis
34:00
What defines Genitopelvic pain/penetration disorder
persistent or recurrent pain during intercourse
pain at entry, during, or after penetration
Describe the process of diagnosis for Genitopelvic pain/penetration disorder
First step in diagnosis, exclude:
- exclude a medical problem (e.g. infection)
- lack of lubrication (common post-menopause)
- Can be diagnosed in men, but rare
- Most women with this disorder experience arousal & can achieve orgasm
Prevalence rates for occasional symptoms
10 – 30% (very common)
