Sexual Dysfunction and Disorders

Sexual Function Disorders

• Sexuality is a multidimensional concept, and the sexual cycle consists of several stages.
• Sexual dysfunction is difficulty experienced by an individual or a couple during any stage of a normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm.
• Sexual dysfunctions can have a profound impact on an individual's perceived quality of sexual life.

Sexual Dysfunction in Men

• Common problems in male sexual function:
  • Erection problems
  • Ejaculation problems
  • Curvature and/or pain during erection in the penis
  • Libido (sexual desire)

Erectile Dysfunction

• The problem of erectile dysfunction in men is the inability to initiate, provide, and maintain enough stiffness for sexual intercourse.
• Under the age of 40, the problem of persistent erectile dysfunction is rare, but this rate gradually increases with age.
• In 70-year-old men, 65% have erectile problems.
• Common causes of erectile dysfunction:
  • Diabetes
  • Hypertension
  • Heart disease and high cholesterol values
  • Psychological causes

Ejaculation Problems

• Premature ejaculation: a condition when ejaculation occurs immediately after erection, or even before sexual intercourse.
• Back (retrograde) ejaculation: semen is excreted mixed with urine in the next urinary discharge.
• Priapism: a condition in which the penis continues its erection involuntarily for more than 4-6 hours, which can cause ischemia.

Libido (Sexual Desire) Problem

• Libido is the desire or interest in sexual intercourse.
• Men with low libido have problems not only with erectile dysfunction but also with their sexual drive.
• Low testosterone levels are a common cause of low sexual drive.

Sexual Dysfunction in Women

• Decreased (Hypoactive Sexual Desire Disorder):
  • Nearly half of women (43%) reported sexual concerns, with the most common concern being low sexual desire.
  • Decreased or absent spontaneous desire, responsive desire, or loss of desire to initiate or participate in sexual activity.
• Female orgasmic disorder: it is often or always not experienced, delayed, or difficult to reach orgasm despite adequate sexual stimulation.

Vaginismus

• Involuntary muscle spasm that closes the opening to the vagina in the female reproductive tract.
• The spasm may be so intense that the vagina seems pathologically obstructed.
• Vaginismus is a sexual dysfunction resulting from physiological factors, such as sexual trauma, abuse, or anxiety experienced at the prospect of sexual intercourse.

Dyspareunia

• Painful or difficult sexual intercourse in the female.
• Disorders are generally physical rather than psychological.
• Dyspareunia may be caused by inflammation or infection of the vagina, vaginismus, remnants of the hymen, insufficient lubrication of the vagina, infection, endometriosis, tumors, or other pathologic conditions.

Sexual Rights

• The Declaration of Sexual Rights is a statement on sexual rights that was first proclaimed at the 13th World Congress of Sexology.
• Sexual rights are based on the freedom, dignity, and equality that all people have and include a commitment that these rights must be protected in order to be harmed.
• Sexual rights protect each individual's right to live, express, and enjoy sexual health by respecting the rights of other individuals.

Sexually Transmitted Diseases (STDs)

• STDs are conditions passed from one person to another through sexual contact.
• STDs can be caused by bacteria, viruses, or parasites.
• Symptoms of STDs:
  • Pain or discomfort during sex or urination
  • Sores, bumps, or rashes on or around the penis, vagina, anus, buttocks, thighs, or mouth
  • Unusual discharge or bleeding from the penis or vagina
  • Painful or swollen testicles
• Types of STDs:
  • Chlamydia
  • Gonorrhea

Chlamydia

• Caused by Chlamydia trachomatis bacteria.
• Symptoms:
  • Pain or discomfort during sex or urination
  • Green or yellow discharge from the penis or vagina
  • Pain in the lower abdomen
• If a pregnant woman has untreated chlamydia, she can pass it to her baby during birth, which can cause pneumonia, eye infections, and blindness.

Gonorrhea

• Caused by N. gonorrhoeae bacteria.
• The incubation period is 2-14 days.
• It can affect the genital tract, oro-pharynx, and anal canal.
• Symptoms:
  • Pain or discomfort during sex or urination
  • Green or yellow discharge from the penis or vagina
  • Pain in the lower abdomenHere are the study notes based on the text:
• STDs (Sexually Transmitted Diseases)*

Gonorrhea

• Caused by Neisseria gonorrhoeae
• Symptoms appear 1-14 days after infection
• Symptoms include:
  • White, yellow, beige, or green-colored discharge from penis or vagina
  • Pain or discomfort during sex or urination
  • More frequent urination than usual
  • Itching around the genitals
  • Sore throat
• Can cause serious health problems in newborns if passed from mother to child during childbirth
• Can be treated with antibiotics

Syphilis

• Caused by Treponema pallidum
• Often goes unnoticed in its early stages
• Symptoms include:
  • Small, round sore (chancre) on genitals, anus, or mouth
  • Rash
  • Fatigue
  • Fever
  • Headaches
  • Joint pain
  • Weight loss
  • Hair loss
• Can be treated with antibiotics, especially if caught early
• If left untreated, can lead to serious health problems, including blindness and death

HPV (Human Papillomavirus)

• Virus that can be passed from one person to another through intimate skin-to-skin or sexual contact
• Can cause cervical cancer, vulvar cancer, penile cancer, anal cancer, and oral cancer
• Symptoms include:
  • Warts on the genitals, mouth, or throat
• No treatment for HPV, but HPV vaccine can prevent infections and cancers
• Recommended for people ages 9-45

HIV (Human Immunodeficiency Virus)

• Can damage the immune system and raise the risk of contracting other viruses or bacteria and certain cancers
• Symptoms include:
  • Fever
  • Chills
  • Aches and pains
  • Swollen lymph nodes
  • Sore throat
  • Nausea
  • Rashes
• No cure, but treatment options are available to manage the virus

Herpes Simplex Virus (HSV)

• Two main strains: HSV-1 and HSV-2
• Can cause genital herpes
• Symptoms include:
  • Blistery sores on the genitals or mouth
• No cure, but medications can help control outbreaks and alleviate symptoms

Hepatitis B and C

• Viral infections that cause liver inflammation
• Hepatitis B can be prevented with a vaccine
• Hepatitis C spreads through contaminated blood
• Symptoms include:
  • Fatigue
  • Loss of appetite
  • Yellow skin and eyes (jaundice)
  • Dark-colored urine
  • Itchy skin
  • Fluid buildup in the abdomen (ascites)
  • Swelling in the legs
  • Weight loss
  • Confusion, drowsiness, and slurred speech (hepatic encephalopathy)
  • Spider-like blood vessels on the skin (spider angiomas)

Trichomoniasis

• Caused by a protozoan organism
• Symptoms include:
  • Discharge from the vagina or penis
  • Burning or itching around the vagina or penis
  • Pain or discomfort during urination or sex
  • Frequent urination
• Can be treated with antibiotics
• Contraceptive Methods*

Withdrawal

• Least effective contraceptive method
• Works by keeping sperm out of the woman's body
• Effectiveness depends on the ability of the couple to use withdrawal with every act of intercourse

Barrier Methods

Male Condoms

• Protect against sexually transmitted infections (STIs)
• More than 80% effective against pregnancy when used correctly

Female Condoms

• Can be used instead of male condoms
• About 79% effective against pregnancy

Diaphragm

• Barrier method of contraception placed inside the vagina
• Must be used with spermicide
• Close to 90% effective when used with spermicide### Barrier Methods
• Diaphragm: must be inserted a few hours before intercourse, left in place for 6 hours after sex, and removed after 24 hours; does not protect against STIs
• Cervical Cap: a soft silicone cup that covers the cervix to stop sperm from reaching an egg; effectiveness ranges from 70 to 85 percent; does not protect against STIs
• Sponge: made of polyurethane foam and containing spermicide, placed deep inside the vagina to block entry to the uterus; 76 to 88 percent effective when used alone, further reduces risk of pregnancy and STIs when used with a condom
• Spermicide: a chemical that inactivates sperm, used with forms of barrier contraception, but not with the sponge; approximately 71 percent effective

Hormonal Contraceptives

• Implants: small plastic rods that release a progestin, preventing ovulation and thickening cervical mucus; 99% effective
• Combined Oral Contraceptives (COCs): pills that contain low doses of estrogen and progestin, preventing ovulation; 99% effective when no pill-taking mistakes are made
• Side effects and benefits of OCPs: changes in bleeding patterns, headaches, dizziness, nausea, breast tenderness, mood changes, weight changes, acne, and ovarian cysts; helps protect against cancer of the lining of the uterus, ovarian cancer, symptomatic pelvic inflammatory disease, and iron-deficiency anemia

Contraindications for OCPs

• Not breastfeeding and less than 3 weeks since giving birth
• Not breastfeeding and between 3 and 6 weeks postpartum with additional risk of VTE
• Primarily breastfeeding between 6 weeks and 6 months since giving birth
• Age 35 or older and smokes fewer than 15 cigarettes a day
• High blood pressure
• History of high blood pressure
• History of jaundice while using OCPs in the past
• Gallbladder disease
• Age 35 or older and has migraine headaches without aura
• Diabetes for more than 20 years or damage to arteries, vision, kidneys, or nervous system caused by diabetes
• Multiple risk factors for arterial cardiovascular disease

Progestin-only Pills

• Do not contain estrogen, can be used throughout breastfeeding and by women who cannot use methods with estrogen
• Work primarily by thickening cervical mucus and disrupting the menstrual cycle
• Safe in women who smoke cigarettes, of any age, and with certain medical conditions
• Reduce the risk of ectopic pregnancy

Emergency Contraceptive Pills

• Help prevent pregnancy after unprotected sex
• Work by preventing the release of an egg from the ovary or delaying its release
• Do not disrupt an existing pregnancy or protect against STIs
• All women can use ECPs safely and effectively

Progestin-only Injectables

• Contain a progestin, do not contain estrogen
• Can be used throughout breastfeeding and by women who cannot use methods with estrogen
• Work primarily by preventing ovulation
• Bleeding changes are common, but not harmful
• Return of fertility is often delayed

Monthly Injectables

• Contain 2 hormones, a progestin and an estrogen
• Work primarily by preventing ovulation
• Bleeding changes are common, but not harmful
• Return of fertility is delayed

Combined Vaginal Rings

• A flexible ring that a woman places in her vagina
• Continuously releases 2 hormones, a progestin and an estrogen
• Works primarily by preventing ovulation
• Bleeding changes are common, but not harmful

Copper-Bearing Intrauterine Device

• Long-term pregnancy protection
• Immediately reversible
• Bleeding changes are common, but not harmful
• TCu-380A is effective for 12 years

Misunderstandings about IUDs

• Can be used by women of any age
• Can be used by women who have had children and those who have not
• Rarely lead to PID
• Do not increase the risk of contracting STIs, including HIV
• Do not increase the risk of miscarriage when a woman becomes pregnant after the IUD is removed

Levonorgestrel Intrauterine Device

• Long-term pregnancy protection
• Very effective for 5 years
• Immediately reversible
• Makes bleeding lighter and can prevent monthly bleeding for many months

Vasectomy

• Permanent contraception for men
• Works by closing off each vas deferens, keeping sperm out of semen
• 3-month delay in taking effect
• Men must use condoms or another contraceptive method for 3 months after the vasectomy

Sexual Dysfunction

• DSM-5 categorizes sexual dysfunction into three categories: sexual desire, arousal, and interest disorders; orgasmic disorders; and genital-pelvic pain disorders
• Some examples of sexual dysfunction include:
  • Sexual interest/arousal disorder in women
  • Male hyposexual disorder and Erectile disorder in men
  • Female orgasmic disorder in women
  • Premature ejaculation and delayed ejaculation in men