Questions and Answers
Female sexual interest/arousal disorder is classified under orgasm disorders in the DSM-5.
False
The ICD-10 includes lack or loss of sexual desire as a type of sexual dysfunction not caused by organic disorders.
True
Genitopelvic pain/penetration disorder is classified under sexual dysfunction in the DSM-5.
True
Delayed ejaculation is classified under sexual desire disorders in both DSM-5 and ICD-10.
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Excessive sexual drive is included in the category of non-organic dysparenia in the ICD-10.
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Prostate cancer is commonly associated with sexual dysfunction.
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Calcium channel blockers are known to enhance sexual function.
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Mastectomy is a surgical procedure that has no impact on sexual function.
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SSRIs are classified as drugs that may impair sexual function.
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Asthma is a cardiovascular condition that affects sexual dysfunction.
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The assessment of sexual dysfunction should ideally involve both the patient and their sexual partner.
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Hypotension is a medical condition commonly associated with sexual dysfunction.
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Renal failure is included in the 'other' category of conditions associated with sexual dysfunction.
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Psychological interventions have been proven ineffective for treating sexual dysfunction.
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Sex therapy was developed by Masters and Johnson in 1970.
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PDE-5 inhibitors are primarily used for treating female sexual dysfunction.
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A physical examination for sexual dysfunction often includes assessment of hair distribution.
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In sex therapy, partners are typically treated individually.
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Sensate Focus involves a series of structured touching techniques to reduce performance anxiety.
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Sexual drive is a secondary consideration in assessing sexual dysfunction.
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The first step in treating sexual dysfunction involves providing assurance and addressing underlying causes.
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Gynaecomastia is assessed during the genital examination for male sexual dysfunction.
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Substance misuse is not considered a potential cause of sexual dysfunction.
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The prevalence of sexual dysfunction among premenopausal women is estimated to be 50%.
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Around 40% of women reported a lack of sexual interest lasting for 6 months.
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Male erectile dysfunction was reported by 9% of men for a duration longer than 6 months.
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Psychological factors do not influence sexual dysfunction in individuals.
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Erectile dysfunction can serve as an early marker for cardiovascular disease.
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The majority of sexual problems reported in the UK sample lasted for more than 6 months.
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Intoxication from alcohol can impair sexual performance.
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The inability to reach orgasm was reported by 14% of women for more than 6 months.
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The reported response rate for the sexual dysfunction survey in the UK was 70%.
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Male premature orgasm was reported by 12% of men lasting for 1 month.
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PDE-5 inhibitors are effective in approximately 70% of erectile dysfunction cases.
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Hypoactive sexual desire disorder only affects men.
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Sexual skills training is categorized under psychological methods for treating sexual dysfunction.
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Female sexual arousal disorder is now treated separately from hypoactive sexual desire disorder in DSM-5.
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The inability to sustain an erection for satisfactory coitus is known as male erectile disorder.
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Testosterone is commonly used to treat women with hypoactive sexual desire disorder.
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Systematic desensitization is a method used in sex therapy.
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Loss of sexual desire in men is categorically classified as a primary male erectile disorder.
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Physical examinations and blood tests are unnecessary when assessing erectile dysfunction.
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Vacuum devices and dilators are considered drug treatments for sexual dysfunction.
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In the past, sexual dysfunction and preference disorders were primarily seen as physical medical issues.
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Homosexuality was classified as a psychiatric disorder until the 1980s.
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In contemporary psychiatry, sex therapy is primarily conducted within specialized clinics.
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Sexual dysfunction in women refers primarily to repeated impairment of sexual performance and interest.
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The DSM-5 states that disorders of sexual function must last at least three months for diagnosis.
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Paraphilias are considered uncommon and can have forensic implications.
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Gender dysphoria is defined as a perfect alignment between one's identity and anatomical sex.
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A brief sexual history is no longer considered important in psychiatric assessments.
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The 2013 study showed that the vast majority of men identified as heterosexual.
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There is a universally agreed definition of sexual dysfunction in psychiatry.
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PDE-5 inhibitors have completely replaced treatments such as intra-cavernosal injections for erectile dysfunction.
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Many women who do not reach orgasm during intercourse report significant distress about this issue.
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Male Orgasmic Disorder is solely caused by psychological inhibition.
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Premature ejaculation is more frequently observed in younger women than in younger men.
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Pain during intercourse, known as dyspareunia, can result from various factors, including inadequate lubrication.
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Vaginismus can occur even when a woman attempts to introduce her own finger into the vagina.
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The use of SSRIs is always necessary for the treatment of premature ejaculation.
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Abnormalities of sexual preference, also known as paraphilias, have always been viewed positively throughout history.
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The treatment of dyspareunia often requires an initial prohibition on attempts at intercourse.
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The accepted view of what is considered 'normal' sexual preference is consistent across all societies and eras.
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The prevalence of paedophilic disorder is estimated to range from 1% to 7% in the male population.
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Voyeruistic behaviour can sometimes be accompanied by masturbation.
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Exhibitionistic behaviour is reported to occur at rates as high as 5% to 10% in the general population.
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Frotteuristic activity most commonly occurs among individuals over the age of 30.
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Sexual sadism is classified as one of the most common forms of sexual activity.
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Fetishistic disorder is classified under abnormalities of the act of sexual preference.
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The aetiology of paraphilias is well understood with strong supporting evidence.
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Alfred Binet proposed that fetishism arises from the chance co-occurrence of sexual excitement with the object that later becomes the fetish object.
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Sexual masochism disorder is categorized under abnormalities of the object of sexual interest.
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Paraphilias that start in middle age may be secondary to dementia or other organic disorders.
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Psychophysiological assessments are routinely used in the assessment of abnormalities of sexual preference.
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Obtaining consent from a regular sexual partner is not important during the assessment of sexual preferences.
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The relationship of the interview to possible legal proceedings should be explained to the patient.
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Castration anxiety that is unresolved in childhood may lead to the development of fetishism.
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Patients often approach doctors about sexual behavior due to overwhelming desire for change.
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The estimated prevalence of fetishistic disorder in men ranges from 1-18%.
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Transvestic disorder is equally prevalent in men and women.
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Paedophilia is characterized by sexual activity with post-pubertal children.
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All types of treatment for paraphilias are equally supported by high-quality evidence.
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The preferred means of sexual excitement in fetishistic disorder typically involves direct sexual associations.
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Individuals with transvestic disorder frequently report being sexually aroused by cross-dressing.
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Psychotherapy as a treatment strategy for paraphilias includes counseling, education, and social skills training.
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Clinical implications of paedophilia are generally considered benign.
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Fetishistic disorder is considered abnormal when it does not precede usual patterns of sexual intercourse.
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The onset of transvestic disorder typically occurs at puberty.
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Study Notes
Classification Overview
- DSM-5 categorizes sexual dysfunctions into: sexual desire/arousal disorders, orgasm disorders, genitopelvic pain/penetration disorder, and substance/medication-induced sexual dysfunction.
- ICD-10 emphasizes non-organic sexual dysfunction due to lack of sexual desire, sexual aversion, and failure of genital response.
Medical Conditions and Surgical Procedures
- Common medical conditions contributing to sexual dysfunction:
- Endocrine: Diabetes, hyperthyroidism, Addison's disease.
- Gynaecological: Vaginitis, endometriosis, pelvic infections.
- Cardiovascular: Hypertension, myocardial infarction.
- Other: Prostate cancer, arthritis, renal failure.
- Surgical procedures: Mastectomy, prostate surgery, colostomy.
Drug-Induced Sexual Dysfunction
-
Therapeutic agents that may impair sexual function include:
- Diuretics and antihypertensives: β-blockers, calcium channel blockers.
- Antidepressants: SSRIs, tricyclics.
- Anxiolytics: Benzodiazepines.
- Antipsychotics: Particularly those raising prolactin levels.
- Misused substances affecting sexual function: Alcohol, heroin, cocaine.
Assessment Procedures
-
History-taking should address:
- Sexual drive and baseline function.
- Relationship dynamics and psychiatric history.
- Medical illnesses and any substance misuse.
- Physical examination should focus on general health and specific genital assessments, along with appropriate laboratory tests for hormonal levels.
Prevalence Data
- Study of 11,000 UK adults aged 16-44 revealed higher incidence of sexual dysfunction in women.
- Common reported issues include:
- Inhibited female orgasm (19%).
- Lack of sexual desire (17% women, 7% men).
- Male erectile dysfunction (9%).
Causes of Sexual Dysfunction
- Biological: Conditions like diabetes, hormonal shifts post-menopause, and side effects from medications may all lead to dysfunction.
- Psychological: Factors such as negative body image and performance anxiety play significant roles.
- Sociocultural: Psychosocial factors influence sexual function and perceptions.
Treatment Approaches
- Initiate treatment with advice and reassurance, addressing both psychological and physical aspects of dysfunction.
- Psychological methods: Include sexual skills training, cognitive behavioral therapy (CBT), and sensate focus exercises.
- Drug treatments: PDE-5 inhibitors (e.g., sildenafil) are the primary pharmacological intervention for erectile dysfunction.
- Other physical treatments: May involve vacuum devices or dilators for specific cases.
Specific Sexual Dysfunctions
- Lack or Loss of Sexual Desire: Predominantly reported by women; treated with psychological interventions and possibly testosterone for men.
- Female Sexual Arousal Disorder: Often linked to inadequate arousal and hormonal levels.
- Male Erectile Disorder: Can be primary or secondary; assessment includes evaluating psychological and medical factors.
- Female Orgasmic Disorder: Treatment usually involves sexual skills training; some women may not classify it as a disorder.
- Premature Ejaculation: More common in younger men; managed with behavioral techniques and SSRIs if persistent.
- Genitopelvic Pain/Penetration Disorder: Includes dyspareunia and vaginismus; treatment focuses on addressing physical and psychological causes.
Historical Context
- Sexual matters historically viewed through a psychiatric lens; homosexuality classified as a disorder until the 1970s.
- Transition to multidisciplinary approaches in modern clinics with an emphasis on managing comorbidities rather than solely psychiatric frameworks.
Epidemiology of Sexual Orientation
- A 2013 US study found:
- 92% of women and 95% of men identified as heterosexual.
- About 5% identified as bisexual, with very low percentages identifying as homosexual or undecided.
Conclusion
- Sexual dysfunctions are complex and multifaceted, often requiring a comprehensive assessment and a tailored treatment approach combining medical, psychological, and therapeutic interventions.### Dyspareunia and Vaginismus Treatment
- Sexual history assessment focuses on triggers, partner's technique, and traumatic experiences.
- Limited trials for dyspareunia and vaginismus treatment necessitate reliance on clinical experience.
- Initial treatment often involves refraining from intercourse to alleviate fears.
- Psychological approaches assist with desensitization through gradual insertion of fingers and dilators.
Abnormalities of Sexual Preference (Paraphilias)
- Abnormal sexual preferences disrupt societal norms, varying across cultures and historical contexts.
- Abnormalities are categorized into object-based and act-based preferences:
- Object-Based: Includes paedophilic and fetishistic disorders.
- Act-Based: Encompasses exhibitionistic, voyeuristic, and sexual masochism disorders.
Aetiology of Paraphilias
- The origins of paraphilias remain largely unclear; multiple theories exist with insufficient evidence:
- Behavioral Models: Suggest preferences develop through reinforcement during growth; Alfred Binet posited fetishism arises from sex-object association.
- Psychoanalytical Models: Attribute fetishism to unresolved childhood castration anxiety, with the fetish object symbolizing a phallus.
- Biological Models: Link paraphilias to abnormal brain structures or genetics.
- Disease Models: Identify possible paraphilias arising secondary to conditions like dementia or due to medication effects.
Assessment of Abnormal Preferences
- Assessment often coincides with legal issues, necessitating clear communication about confidentiality and consent.
- Interviews may include partners or informants to gain a fuller picture of the individual’s behavior.
- Evaluation involves:
- Excluding other psychiatric disorders, especially in later life presentations.
- Documenting the nature and impact of sexual behaviors.
- Assessing patient motivation, which varies from compliance to pressures from others or situational depression.
- Psychophysiological methods like penile plethysmography are not standard but may be used by specialists.
Management of Paraphilic Disorders
- Provisional diagnosis and immediate risk assessment are critical for effective management.
- Treatment approaches include:
- Psychotherapy: Individual, couple, or group therapies using behavioral or psychodynamic methods.
- Pharmacotherapy: Utilizing SSRIs, steroid analogues, and hormone-releasing analogues.
- Rehabilitation: Encompassing counseling, education, and social skills development.
- An algorithm guides appropriate biological treatments based on severity and risk.
Types of Abnormality of Preference for the Sexual Object
- Preferences may involve inanimate objects, children (paedophilic disorder), or animals (zoophilia).
- Fetishistic disorder draws most attention, characterized by sexual arousal linked to inanimate objects not inherently sexual.
- Prevalence estimated at 1-18% in men; rare in women with unclear treatment outcomes.
- Transvestic disorder involves cross-dressing for sexual arousal, with around 1% prevalence in men, typically initiated at puberty; it's rare in women.
Paedophilia
- Represents significant socio-legal concerns, involving sexual activities with pre-pubertal children.
- Considered a severe paraphilia with a predominant male prevalence.
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Description
This quiz explores the key aspects of assessing sexual dysfunction, including communication between partners, physical examinations, and relevant medical evaluations. It also covers the main treatments available for sexual dysfunction, helping individuals understand the necessary steps for addressing this issue. Test your knowledge on this important health topic.
