Podcast
Questions and Answers
In the context of the human sexual response cycle, which of the following statements best characterizes the intricate interplay between physiological and psychological factors during the excitement phase?
In the context of the human sexual response cycle, which of the following statements best characterizes the intricate interplay between physiological and psychological factors during the excitement phase?
- The subjective sense of pleasure is independent of the accompanying physiological changes, allowing for dissociative experiences during sexual activity.
- The excitement phase is solely driven by subjective feelings of pleasure, with minimal physiological changes.
- The excitement phase involves a complex integration of subjective pleasure and physiological changes, reflecting a bidirectional influence between psychological perception and somatic response. (correct)
- The intensity of physiological changes during the excitement phase is directly proportional to the individual's conscious effort to enhance sexual arousal.
Considering the variations in sexual response patterns among individuals, which of the following best characterizes the concept of 'normal' sexual response?
Considering the variations in sexual response patterns among individuals, which of the following best characterizes the concept of 'normal' sexual response?
- The absence of any subjective distress or interpersonal conflict related to sexual activity. (correct)
- A sexual response that aligns with the average response observed in population studies, regardless of individual experiences.
- A sexual response that consistently follows the linear progression of desire, excitement, orgasm, and resolution.
- A sexual response that deviates from the established norms but contributes to the overall satisfaction of the experience.
When evaluating disparate research findings on the epidemiology of sexual dysfunction, what methodological consideration is most crucial in interpreting the reported prevalence rates?
When evaluating disparate research findings on the epidemiology of sexual dysfunction, what methodological consideration is most crucial in interpreting the reported prevalence rates?
- The geographical location of the study, as sexual dysfunctions vary widely across different countries.
- The publication date of the study, as more recent studies utilize more advanced statistical analysis.
- The diagnostic criteria used, as variations in criteria (e.g., DSM-5 vs. ICD-10) affect prevalence rates. (correct)
- The sample size of the study, as larger samples provide more reliable estimates of prevalence.
Taking into account the intersectionality of gender and sexual dysfunction, which of the following statements accurately reflects the differential research focus and epidemiological findings?
Taking into account the intersectionality of gender and sexual dysfunction, which of the following statements accurately reflects the differential research focus and epidemiological findings?
Drawing upon the PRESIDE study, what represents the most critical methodological challenge in extrapolating its findings on female sexual dysfunction to the broader U.S. population?
Drawing upon the PRESIDE study, what represents the most critical methodological challenge in extrapolating its findings on female sexual dysfunction to the broader U.S. population?
Given the multifactorial etiology of erectile dysfunction (ED), what represents the most nuanced approach to comprehensively assessing its underlying causes in a 55-year-old male patient?
Given the multifactorial etiology of erectile dysfunction (ED), what represents the most nuanced approach to comprehensively assessing its underlying causes in a 55-year-old male patient?
Considering the DSM-5 diagnostic criteria for sexual dysfunctions, what is the most critical component in differentiating a diagnosis of 'lifelong' versus 'acquired' dysfunction?
Considering the DSM-5 diagnostic criteria for sexual dysfunctions, what is the most critical component in differentiating a diagnosis of 'lifelong' versus 'acquired' dysfunction?
How might one differentiate between 'Generalized' versus 'Situational' specifiers in sexual dysfunction?
How might one differentiate between 'Generalized' versus 'Situational' specifiers in sexual dysfunction?
In distinguishing between the diagnostic criteria for delayed ejaculation and male orgasmic disorder, what nuanced factor plays a pivotal role?
In distinguishing between the diagnostic criteria for delayed ejaculation and male orgasmic disorder, what nuanced factor plays a pivotal role?
Considering the diagnostic criteria for female orgasmic disorder, what is the most critical element in differentiating it from normative variations in female sexual response?
Considering the diagnostic criteria for female orgasmic disorder, what is the most critical element in differentiating it from normative variations in female sexual response?
What is the most crucial consideration when differentiating between female sexual interest/arousal disorder (FSIAD) and normative variations in female sexual desire and arousal?
What is the most crucial consideration when differentiating between female sexual interest/arousal disorder (FSIAD) and normative variations in female sexual desire and arousal?
Regarding the multifaceted etiology of genito-pelvic pain/penetration disorder (GPPPD), what factor most significantly obscures accurate diagnosis and effective treatment planning?
Regarding the multifaceted etiology of genito-pelvic pain/penetration disorder (GPPPD), what factor most significantly obscures accurate diagnosis and effective treatment planning?
What is the most relevant factor when clinically differentiating male hypoactive sexual desire disorder from normative variations in male sexual interest?
What is the most relevant factor when clinically differentiating male hypoactive sexual desire disorder from normative variations in male sexual interest?
Accounting for significant variability in sexual behaviors, what is the most important aspect when diagnosing premature ejaculation?
Accounting for significant variability in sexual behaviors, what is the most important aspect when diagnosing premature ejaculation?
What crucial criterion must be met to attribute a sexual dysfunction to a substance/medication, rather than considering it a primary sexual dysfunction?
What crucial criterion must be met to attribute a sexual dysfunction to a substance/medication, rather than considering it a primary sexual dysfunction?
Considering the complex interplay of biological, psychological, and sociocultural factors, which of the following best encapsulates the etiological model for most sexual dysfunctions?
Considering the complex interplay of biological, psychological, and sociocultural factors, which of the following best encapsulates the etiological model for most sexual dysfunctions?
Considering the biological factors associated with diminished sexual desire, which condition is most likely to cause a decrease in sexual desire?
Considering the biological factors associated with diminished sexual desire, which condition is most likely to cause a decrease in sexual desire?
What statement most accurately reflects the current understanding of laboratory testing in the diagnostic evaluation of sexual dysfunction?
What statement most accurately reflects the current understanding of laboratory testing in the diagnostic evaluation of sexual dysfunction?
What is the most accurate description of the 'squeeze technique' as it is applied in the treatment of premature ejaculation?
What is the most accurate description of the 'squeeze technique' as it is applied in the treatment of premature ejaculation?
Which of the following statements best reflects the clinical utility and limitations of testosterone therapy in women with hypoactive sexual desire disorder?
Which of the following statements best reflects the clinical utility and limitations of testosterone therapy in women with hypoactive sexual desire disorder?
What statement best accounts for the divergent regulatory pathways for Viagra versus contraceptive pills?
What statement best accounts for the divergent regulatory pathways for Viagra versus contraceptive pills?
What best explains the treatment for erectile disorder when medications are ineffective?
What best explains the treatment for erectile disorder when medications are ineffective?
Which of the following scenarios highlights a critical distinction between dyspareunia and vaginismus within genito-pelvic pain/penetration disorder?
Which of the following scenarios highlights a critical distinction between dyspareunia and vaginismus within genito-pelvic pain/penetration disorder?
Which etiological factor is most likely to differentiate between vaginismus and dyspareunia?
Which etiological factor is most likely to differentiate between vaginismus and dyspareunia?
In the context of the Masters and Johnson model of sex therapy, what is the central rationale behind the assignment of 'sensate focus' exercises?
In the context of the Masters and Johnson model of sex therapy, what is the central rationale behind the assignment of 'sensate focus' exercises?
A 45-year-old male presents with a chief complaint of decreased sexual desire and erectile dysfunction. He also reports fatigue, reduced muscle mass, and difficulty concentrating. His medical history is significant for type 2 diabetes, hypertension, and hyperlipidemia. He is currently taking metformin, lisinopril, and atorvastatin. Which of the following represents the most appropriate initial step in the diagnostic evaluation?
A 45-year-old male presents with a chief complaint of decreased sexual desire and erectile dysfunction. He also reports fatigue, reduced muscle mass, and difficulty concentrating. His medical history is significant for type 2 diabetes, hypertension, and hyperlipidemia. He is currently taking metformin, lisinopril, and atorvastatin. Which of the following represents the most appropriate initial step in the diagnostic evaluation?
A 32-year-old female presents with a chief complaint of persistent pain during intercourse. She reports that the pain is sharp and burning, and she experiences it with any attempt at vaginal penetration. She denies any history of trauma or abuse. On physical examination, the vulva appears normal, but gentle palpation elicits significant pain and muscle tension. Which of the following represents the most likely diagnosis?
A 32-year-old female presents with a chief complaint of persistent pain during intercourse. She reports that the pain is sharp and burning, and she experiences it with any attempt at vaginal penetration. She denies any history of trauma or abuse. On physical examination, the vulva appears normal, but gentle palpation elicits significant pain and muscle tension. Which of the following represents the most likely diagnosis?
A 62-year-old male presents with a new onset of erectile dysfunction. He has a history of well-controlled hypertension and takes hydrochlorothiazide. He denies any other medical problems and reports that he is happily married. He also reports feeling increasingly anxious about his sexual performance. Which of the following pharmacological interventions is the MOST appropriate INITIAL step, considering his medical history?
A 62-year-old male presents with a new onset of erectile dysfunction. He has a history of well-controlled hypertension and takes hydrochlorothiazide. He denies any other medical problems and reports that he is happily married. He also reports feeling increasingly anxious about his sexual performance. Which of the following pharmacological interventions is the MOST appropriate INITIAL step, considering his medical history?
What is the best order of treatment for premature ejaculation?
What is the best order of treatment for premature ejaculation?
What best accounts for the treatment for orgasmic disorders?
What best accounts for the treatment for orgasmic disorders?
A 35-year-old man presents with complaints of significantly reduced libido, erectile dysfunction, and difficulty achieving orgasm. He is otherwise healthy but admits to using cannabis daily for the past 10 years to manage anxiety and improve sleep. Which of the following is the MOST appropriate INITIAL recommendation:
A 35-year-old man presents with complaints of significantly reduced libido, erectile dysfunction, and difficulty achieving orgasm. He is otherwise healthy but admits to using cannabis daily for the past 10 years to manage anxiety and improve sleep. Which of the following is the MOST appropriate INITIAL recommendation:
A 58-year-old postmenopausal woman presents with complaints of dyspareunia and vaginal dryness, impacting her ability to engage in sexual activity with her husband. Her medical history is significant for breast cancer, treated with lumpectomy and radiation therapy 5 years ago, and she is currently taking tamoxifen. Which of the following interventions is MOST appropriate:
A 58-year-old postmenopausal woman presents with complaints of dyspareunia and vaginal dryness, impacting her ability to engage in sexual activity with her husband. Her medical history is significant for breast cancer, treated with lumpectomy and radiation therapy 5 years ago, and she is currently taking tamoxifen. Which of the following interventions is MOST appropriate:
A 28-year-old man presents with a long history of erectile dysfunction and premature ejaculation. When asked about his lifestyle, he says he spends a great deal of time at work. He does not endorse financial problems but states he is in constant competition with his peers and often feels he is falling short. His primary physician previously prescribed a number of medications but each had intolerable side-effects. What should be your next step?
A 28-year-old man presents with a long history of erectile dysfunction and premature ejaculation. When asked about his lifestyle, he says he spends a great deal of time at work. He does not endorse financial problems but states he is in constant competition with his peers and often feels he is falling short. His primary physician previously prescribed a number of medications but each had intolerable side-effects. What should be your next step?
A transgender man who has been on testosterone therapy for 3 years presents to your clinic complaining about the absence of sexual desire. He has a supportive partner but is concerned about the effect his lack of libido is having on their relationship. What intervention would be most appropriate?
A transgender man who has been on testosterone therapy for 3 years presents to your clinic complaining about the absence of sexual desire. He has a supportive partner but is concerned about the effect his lack of libido is having on their relationship. What intervention would be most appropriate?
A researcher is designing a study to investigate the efficacy of a new medication for treating female orgasmic disorder. What should the researcher do?
A researcher is designing a study to investigate the efficacy of a new medication for treating female orgasmic disorder. What should the researcher do?
A researcher hypothesizes a very unusual effect of an anti-ulcer medication (cimetidine), that the medication has unique aphrodisiac effects. This is in direct contradiction to the normal and understood side effects of the medication. What is the best experimental design to account for this?
A researcher hypothesizes a very unusual effect of an anti-ulcer medication (cimetidine), that the medication has unique aphrodisiac effects. This is in direct contradiction to the normal and understood side effects of the medication. What is the best experimental design to account for this?
What statement is true regarding treatment of sexual disorders?
What statement is true regarding treatment of sexual disorders?
Which statement is false?
Which statement is false?
A 46-year-old patient comes in and is convinced that someone is tampering with the tap water. When asked about the effect this has on his life he states his life is unchanged otherwise. At an intake in your office you are discussing options for treatment of his generalized anxiety and he endorses a number of sexual activities he and his wife engage in regularly, including vaginal and anal intercourse with satisfaction. He states no distress in any of these relationships other than his concern that someone is tampering with the water. What is the most accurate thing to do?
A 46-year-old patient comes in and is convinced that someone is tampering with the tap water. When asked about the effect this has on his life he states his life is unchanged otherwise. At an intake in your office you are discussing options for treatment of his generalized anxiety and he endorses a number of sexual activities he and his wife engage in regularly, including vaginal and anal intercourse with satisfaction. He states no distress in any of these relationships other than his concern that someone is tampering with the water. What is the most accurate thing to do?
A 24-year-old presents to his primary care physician complaining of premature ejaculation. After workup is negative, his physician recommends sertraline to control premature ejaculation. Several weeks goes by but he returns to the physician stating concerns the medication did not change anything and it may have become more difficult to have an erection. What is the most appropriate intervention should his physician should take?
A 24-year-old presents to his primary care physician complaining of premature ejaculation. After workup is negative, his physician recommends sertraline to control premature ejaculation. Several weeks goes by but he returns to the physician stating concerns the medication did not change anything and it may have become more difficult to have an erection. What is the most appropriate intervention should his physician should take?
In the context of substance/medication-induced sexual dysfunction, what best characterizes the temporal relationship between substance use and the manifestation of sexual symptoms, particularly considering the diagnostic criteria?
In the context of substance/medication-induced sexual dysfunction, what best characterizes the temporal relationship between substance use and the manifestation of sexual symptoms, particularly considering the diagnostic criteria?
Which statement most accurately delineates the diagnostic divergence between 'lifelong' and 'acquired' specifiers in the categorization of female orgasmic disorder, predicated on the phenomenological understanding of female sexual response?
Which statement most accurately delineates the diagnostic divergence between 'lifelong' and 'acquired' specifiers in the categorization of female orgasmic disorder, predicated on the phenomenological understanding of female sexual response?
Bearing in mind the interplay of psychological, interpersonal, and physiological dimensions, what constitutes the most ecologically valid approach to assess the severity of distress in a patient diagnosed with genito-pelvic pain/penetration disorder (GPPPD)?
Bearing in mind the interplay of psychological, interpersonal, and physiological dimensions, what constitutes the most ecologically valid approach to assess the severity of distress in a patient diagnosed with genito-pelvic pain/penetration disorder (GPPPD)?
In articulating the diagnostic criteria for male hypoactive sexual desire disorder, how does the DSM-5 endeavor to account for individual variability in sexual interest while maintaining diagnostic rigor?
In articulating the diagnostic criteria for male hypoactive sexual desire disorder, how does the DSM-5 endeavor to account for individual variability in sexual interest while maintaining diagnostic rigor?
When differentiating premature ejaculation (PE) from normative variation in ejaculatory latency, what constitutes the most critical factor in establishing a clinically significant diagnosis?
When differentiating premature ejaculation (PE) from normative variation in ejaculatory latency, what constitutes the most critical factor in establishing a clinically significant diagnosis?
Regarding the treatment of premature ejaculation, what represents the most precise conceptualization of the 'squeeze technique' and its proposed mechanism of action?
Regarding the treatment of premature ejaculation, what represents the most precise conceptualization of the 'squeeze technique' and its proposed mechanism of action?
In a detailed exploration of the etiology of orgasmic disorders, what factor most critically distinguishes delayed ejaculation from retrograde ejaculation?
In a detailed exploration of the etiology of orgasmic disorders, what factor most critically distinguishes delayed ejaculation from retrograde ejaculation?
How does the DSM-5 stipulate that a sexual dysfunction cannot be attributed to a substance or medication?
How does the DSM-5 stipulate that a sexual dysfunction cannot be attributed to a substance or medication?
Within Masters and Johnson's therapeutic framework for sexual dysfunction, what is the underlying rationale for the assignment of 'sensate focus' exercises?
Within Masters and Johnson's therapeutic framework for sexual dysfunction, what is the underlying rationale for the assignment of 'sensate focus' exercises?
A patient presents with symptoms indicative of a sexual dysfunction. What should be the first action taken?
A patient presents with symptoms indicative of a sexual dysfunction. What should be the first action taken?
What is the best definition of vaginismus?
What is the best definition of vaginismus?
What medication is indicated for low sexual desire?
What medication is indicated for low sexual desire?
A patient is taking antihypertensives and antidepressants, and reports loss of sexual interest and ED. What etiology should be explored?
A patient is taking antihypertensives and antidepressants, and reports loss of sexual interest and ED. What etiology should be explored?
What laboratory tests can be used to assess possible causes of sexual dysfunction?
What laboratory tests can be used to assess possible causes of sexual dysfunction?
Why is it important to know if a patient has spontaneous erections?
Why is it important to know if a patient has spontaneous erections?
Flashcards
Desire Phase
Desire Phase
Lasts minutes to hours, including sexual fantasies and the desire for sexual intimacy.
Excitement Phase
Excitement Phase
Consists of a subjective sense of pleasure and accompanying physiological changes.
Orgasm Phase
Orgasm Phase
Consists of a peaking of sexual pleasure, release of sexual tension and rhythmic contractions of the perineal muscles and reproductive organs.
Resolution Phase
Resolution Phase
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Delayed Ejaculation
Delayed Ejaculation
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Erectile disorder
Erectile disorder
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Female Orgasmic Disorder
Female Orgasmic Disorder
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Female Sexual Interest/Arousal Disorder
Female Sexual Interest/Arousal Disorder
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Genito-Pelvic Pain Disorder
Genito-Pelvic Pain Disorder
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Male Hypoactive Sexual Desire Disorder
Male Hypoactive Sexual Desire Disorder
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Premature Ejaculation
Premature Ejaculation
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Substance/Medication Induced Sexual Dysfunction
Substance/Medication Induced Sexual Dysfunction
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Biological Causes of Low Desire
Biological Causes of Low Desire
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Psychological/cultural Causes of Low Desire
Psychological/cultural Causes of Low Desire
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Psychological/Psychiatric Illnesses Affecting Excitement
Psychological/Psychiatric Illnesses Affecting Excitement
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Medication/Drugs affecting Excitement
Medication/Drugs affecting Excitement
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Biological Causes of Orgasmic Phase Difficulties
Biological Causes of Orgasmic Phase Difficulties
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Psychological/cultural Causes of Orgasmic Phase Difficulties
Psychological/cultural Causes of Orgasmic Phase Difficulties
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Masters and Johnson's Therapy
Masters and Johnson's Therapy
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Premature Ejaculation Treatment
Premature Ejaculation Treatment
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Hypoactive desire medications
Hypoactive desire medications
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Treat vaginal dryness
Treat vaginal dryness
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Erectile disorder treatment
Erectile disorder treatment
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Study Notes
General Objectives
- Students should be able to diagnose sexual dysfunctions such as:
- Delayed ejaculation
- Erectile disorder
- Female orgasmic disorder
- Female sexual interest/arousal disorder
- Genito-pelvic pain disorder
- Male hypoactive sexual desire disorder
- Premature (early) ejaculation disorder
- Substance/medication-induced disorder
- Recommend initial treatment intervention as it applies to general medical practice.
Specific Objectives
- List common causes of sexual dysfunctions, including general medical and psychological etiologies
- Diagnose based on DSM 5 criteria for various sexual dysfunctions.
- Describe the specifiers for sexual dysfunction disorders.
- Compare and contrast the manifestations and differential diagnoses of various sexual dysfunctions.
- Recommend a treatment plan for patients with sexual dysfunction.
Sexual Human Response
- The sexual human response involves multiple phases including desire, excitement, orgasm, and resolution
- Desire Phase: Lasts minutes to hours sexual fantasies and the desire for sexual intimacy takes place
- Excitement Phase: Subjective sense of pleasure with accompanying physiological changes.
- Orgasm Phase: Peaking of sexual pleasure with release of sexual tension and rhythmic contractions of perineal muscles and reproductive organs.
- Resolution Phase: Consists of a sense of muscular relaxation and general well-being.
Epidemiology of Sexual Dysfunction
- The desire and arousal dysfunctions are the most frequent sexual dysfunctions for women.
- A large proportion of women experience multiple sexual dysfunctions.
- Premature ejaculation and erectile dysfunction are common sexual dysfunctions for men.
- Men have less comorbidity across sexual dysfunctions compared to women.
Sexual Dysfunction in Females
- In a survey of 50,001 US women aged 18-102 years, low desire was the most common sexual problem reported in 37.7% of participants
- Low desire with distress (HSDD) was present in approximately 10% of women
- Low desire with distress was more common than distressing arousal or orgasm difficulties.
- Global study found that female sexual dysfunction occurs in 38% of women
Sexual Dysfunction in Males
- The crude incidence rate for erectile dysfunction was 25.9 cases per 1,000 man-years (95% confidence interval [CI] 22.5 to 29.9).
- The annual incidence rate increased with each decade of age -12.4 cases per 1,000 man-years (95% CI 9.0 to 16.9) for men 40 to 49
- 29.8 (24.0 to 37.0) for men 50 to 59
- 46.4 (36.9 to 58.4) for men 60 to 69 years old
- The age-adjusted risk of erectile dysfunction was higher for men with lower education, diabetes, heart disease, and hypertension.
- It is projected that 17,781 new cases of erectile dysfunction (white males only) in Massachusetts and 617,715 in the United States are expected annually
- The global study shows male sexual dysfunction rates of 29%.
- Men who have sex with men have higher rates of erectile dysfunction than non-MSM counterparts
- MSM have unique activators of sexual pathologies, such as insertive anal intercourse for Peyronie's disease.
DSM 5 Criteria for All Sexual Dysfunction Diagnoses
- Symptoms have persisted for 6 months or longer.
- The disorder causes clinically significant distress.
- The disorder is not due to severe relationship stress, another mental disorder or to the effects of a substance, medication or medical condition like diabetes mellitus.
Delayed Ejaculation (Male)
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Either of the following symptoms must be experienced on almost all or all occasions (approximately 75%-100%) of partnered sexual activity and without the individual desiring delay:
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Marked delay in ejaculation.
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Marked infrequency or absence of ejaculation.
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Specifiers of the disorder
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Lifelong: Is present since the individual became sexually active
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Acquired: began after a period of normal sexual function
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Generalized: not limited to certain types of stimulation, situations, or partners
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Situational: only occurs in certain types of stimulation, situations, or partners
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Intensity of distress levels
- Mild: Evidence of mild distress
- Moderate: Evidence of moderate distress
- severe: Evidence of severe or extreme distress
Erectile Disorder
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At least one of the following symptoms must be experienced on almost all or all (approximately 75%-100%) occasions of sexual activity:
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Marked difficulty in obtaining an erection during sexual activity.
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Marked difficulty in maintaining an erection until the completion of sexual activity.
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Marked decrease in erectile rigidity.
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Specifiers of the disorder
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Lifelong: Is present since the individual became sexually active
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Acquired: began after a period of normal sexual function
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Generalized: not limited to certain types of stimulation, situations, or partners
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Situational: only occurs in certain types of stimulation, situations, or partners
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Intensity of distress levels
- Mild: Evidence of mild distress
- Moderate: Evidence of moderate distress
- severe: Evidence of severe or extreme distress
Female Orgasmic Disorder
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Presence of either of the following symptoms experienced on almost all occasions (approximately 75%-100%) of sexual activity:
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Marked delay in, marked infrequency of, or absence of orgasm.
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Markedly reduced intensity of orgasmic sensations.
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Specifiers of the disorder
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Lifelong: Is present since the individual became sexually active
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Acquired: began after a period of normal sexual function
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Generalized: not limited to certain types of stimulation, situations, or partners
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Situational: only occurs in certain types of stimulation, situations, or partners
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Never experienced an orgasm under any situation.
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Intensity of distress levels
- Mild: Evidence of mild distress
- Moderate: Evidence of moderate distress
- severe: Evidence of severe or extreme distress
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Anorgasmia is a alternate name for this condition
Female Sexual Interest/Arousal Disorder
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Lack of or significantly reduced sexual interest/arousal. Manifested by at least 3 of the following:
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Absent/reduced interest in sexual activity
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Absent/reduced sexual/erotic thoughts or fantasies
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No/reduced initiation of sexual activity, and typically unreceptive to a partner's attempts to initiate.
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Absent/reduced sexual excitement/pleasure during sexual activity in almost all encounters (75-100%)
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Absent/reduced sexual interest/arousal in response to any internal or external cues.
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Absent/reduced genital or non-genital sensations during sexual activity in almost all encounters (75-100%)
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Specifiers of the disorder
- Lifelong: Is present since the individual became sexually active
- Acquired: began after a period of normal sexual function
- Generalized: not limited to certain types of stimulation, situations, or partners
- Situational: only occurs in certain types of stimulation, situations, or partners
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Intensity of distress levels
- Mild: Evidence of mild distress
- Moderate: Evidence of moderate distress
- severe: Evidence of severe or extreme distress
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It occurs in 1/3 of married females
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Women may experience painful intercourse, sexual avoidance, unsatisfying marital and sexual relationships.
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Temporary low sexual interest can result from stressful situations such as overwork or lack of privacy.
Genito-Pelvic Pain/Penetration Disorder
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Persistent or recurrent difficulties with one (or more) of the following:
- Vaginal penetration during intercourse.
- Marked vulvovaginal or pelvic pain during vaginal intercourse or attempts.
- Marked fear or anxiety about vulvovaginal or pelvic pain.
- Marked tensing or tightening of the pelvic floor muscles.
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Specifiers of the disorder
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Lifelong: Is present since the individual became sexually active
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Acquired: began after a period of normal sexual function
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Intensity of distress levels
- Mild: Evidence of mild distress
- Moderate: Evidence of moderate distress
- severe: Evidence of severe or extreme distress
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The woman may have sufficient desire and interest in sexual activity, but only for activities that are not painful or do not require penetration (e.g., oral sex).
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It's not unusual for women who have not succeeded in having sexual intercourse to seek treatment only when they wish to conceive.
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Superficial pain during sexual intercourse is tied to a history of vaginal infections.
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Religious and cultural factors also predispose to the disorder
Male Hypoactive Sexual Desire Disorder
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Persistently or recurrently deficient sexual/erotic thoughts or fantasies and desire for sexual activity
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Clinician makes the judgment of deficiency, and considers age and general and sociocultural contexts.
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Specifiers of the disorder
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Lifelong: Is present since the individual became sexually active
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Acquired: began after a period of normal sexual function
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Generalized: not limited to certain types of stimulation, situations, or partners
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Situational: only occurs in certain types of stimulation, situations, or partners
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Intensity of distress levels
- Mild: Evidence of mild distress
- Moderate: Evidence of moderate distress
- severe: Evidence of severe or extreme distress
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Can coexist with erectile problems or abnormal ejaculation.
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Sufferers often no longer initiate sexual activity and are minimally receptive to a partner's attempt to initiate sexual activity.
Premature Ejaculation
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A persistent or recurrent pattern of ejaculation during partnered sexual activity within approximately 1 minute following vaginal penetration/before the individual wishes it.
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The diagnosis of premature (early) ejaculation may be applied to individuals engaged in nonvaginal sexual activities
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Specific duration criteria have not been established. Specifiers of the disorder
- Lifelong: Is present since the individual became sexually active
- Acquired: began after a period of normal sexual function
- Generalized: not limited to certain types of stimulation, situations, or partners
- Situational: only occurs in certain types of stimulation, situations, or partners
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Intensity of distress levels
- Mild: Ejaculation within approximately 30 seconds to 1 minute of vaginal penetration.
- Moderate: Ejaculation occurs within approximately 15–30 seconds of vaginal penetration.
- Severe: Ejaculation occurring prior to sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetration.
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From 20–30% of men age 18-70 express concern about how rapidly they ejaculate.
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Some men develop the disorder during their initial sexual encounters but gain ejaculatory control over time.
Substance/Medication-Induced Sexual Dysfunction
- Clinically significant dysfunction predominating in the clinical picture.
- History, physical exam and labs should be consistent with:
- Symptom in criterion A develops during or soon after intoxication, withdrawal, or after exposure to a medicine
- Not better explained by a sexual dysfunction unrelated to substance use.
- Does not precede onset of substance use
- Symptoms persist for >1 month after cessation of acute withdrawal or severe intoxication
- No evidence of a history of depressive disorder.
- The substance/medicine is capable of producing the symptom.
- Substances like Cocaine, opiates, amphetamines, sedatives, hypnotics decrease sexual interest and cause arousal difficulties, or interfere with orgasm
- Antihypertensives, histamine h2 receptor Antagonist, antidepressants, anabolic steroids, stimulants, anxiolytics cause a decrease in sexual interest, cause erectile difficulties, or interfere with orgasm
- The symptoms developed during or soon after substance intoxication/withdrawal or after exposure to a medication.
Etiology of Sexual Dysfunctions
- Sexual dysfunction can be caused by psychological factors, medical conditions, medications or substances of abuse, or sometimes a combination of these.
Causes of Desire Phase
- Physical illnesses, spinal cord injury, or surgery can also depress sexual desire
- Biological Factors: Medications that depress the central nervous system or lower testosterone.
- SSRI, imbalance in testosterone, prolactin, and estrogen.
- Prolonged abstinence can suppress desire.
- Psychological/Cultural Factors: Body image secondary to illnesses like mastectomy, cultural standards, stress, and older age.
- Lack of desire associated with chronic stress, anxiety or depression, fear of pregnancy, history of molestation or abuse, anxiety, and lack of self-esteem.
- Erectile dysfunction
- Orgasmic disorders (anorgasmia, premature ejaculation)
- Sexual pain disorders (dyspareunia, vaginismus).
Differential DX Includes PENIS
- Psychological (if nighttime erections still occur)
- Endocrine (e.g., diabetes, low testosterone)
- Neurogenic (e.g.)
- Insufficient blood flow (e.g., atherosclerosis)
- Substances (e.g., antihypertensives, antidepressants, ethanol)
Causes Related to Excitement Phase
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Acromegaly, Addison's disease, Diabetes, Hyperthyroidism, Hypothyroidism, Klinefelter's syndrome, Multiple sclerosis, Parkinson's disease, Pelvic surgery or irradiation are all biological causes
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Peripheral vascular disease/low blood flow (CAD), Pituitary adenoma Spinal cord injury, Syphilis, and Temporal lobe epilepsy and spinal cord injury also cause the excitement phase Psychological/Psychiatric Illness:
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Anxiety disorders, Dementia, Major depression, Schizophrenia Medication/Drugs:
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Alcohol, Antiandrogens, Anticholinergics, Antidepressants, Antihypertensives (especially centrally acting ones), and Antipsychotics Barbiturates, Finasteride, Marijuana, Opioids S, and Stimulants
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Laboratory workup: FBS, Fasting lipid profile, Thyroid function tests, serum testosterone
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Doctors can check for whether spontaneous erections occur at times when the man does not plan to have intercourse such as morning erection and erections with masturbation
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If erections occur at these times, the disorder is more likely to have a psychological origin.
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Nocturnal penile tumescence testing was used to separate neurogenic from psychogenic erectile dysfunction but has recently been recognized as unreliable.
Etiology of the Sexual Dysfunctions: Causes of Orgasmic Phase
- Delayed ejaculation should be differentiated from retrograde ejaculation, where ejaculation occurs but seminal fluid goes backward into the bladder.
- Delayed ejaculation and retrograde ejaculation have physiological causes, such as medication effects, genitourinary surgery, or neurological disorders in the lumbosacral section of the spinal cord.
- Medications can either be centrally action acting antihypertensives, tricyclic antidepressants and antipsychotics.
- Psychological/Cultural: history of sexual abuse, guilt of pleasure in a sexual relationship, depression, anxiety, relationship issues, unresolved conflicts, lack of trust, cultural/religious beliefs.
Causes of Genito Pelvic Disorder
- Dyspareunia and Vaginismus combines to becomes the disorder, which involves painful sex and vaginal muscle spasms
- Biological Causes:
- Vaginal atrophy: from medication, menopause or hormonal disorders
- Infections: yeast infections, Pelvic Inflammatory Disease
- Problems with the uterus: fibroids
- Endometriosis
- Problems with ovaries: ovarian cysts, ectopic pregnancy and intercourse too soon after childbirth
- Sexually transmitted infections
- vulvodynia/skin disorders
- Injury to the vulva or vagina: These injuries could include a tear from childbirth or from a cut during labor creating pain as well Psychological issues:
- History of sexual abuse can cause significant pain
- Vaginismus: fear of being hurt or being traumatized causes spasms of vaginal muscles
Clinical Management of Sexual Dysfunctions
- Masters and Johnson pioneered dual sex therapy in the 1960's
- Involves educating the couple about normal sex functioning and evaluating their ability to connect on sex/intimacy, and correcting irrational beliefs/ dysfunctional thoughts
- Sensate focus as therapy for erectile disorder involves non-genital caressing to increase awareness of erogenous zones.
- May involve training woman with female orgasmic disorder to first have an orgasm by masturbation
- For Vaginismus: individual therapy, meditation, relaxation
- For Premature ejaculation- Squeeze method applies, partner can squeeze penis to help man
- Medications:*
- SSRIs used off-label for premature ejaculation (paroxetine 20 mg/day).
- Nupercaine 1% ointment can be used for premature ejaculation
- Flibanserin (Addyi) and bremelanotide (Vyleesi) are FDA-approved medications for hypoactive sexual desire in women.
- Testosterone may be prescribed in men and women with sexual dysfunction and in clear cases of hypogonadism
- Ospemifene (Osphena) is a nonhormonal FDA-approved treatment for vaginal dryness.
- FDA may prescribe Sildenafil, vardenafil, and tadalafil for erectile disorder because they are phosphodiesterase-5 inhibitors that enhance nitric oxide, which relaxes smooth muscles in the penis
- Erectile Medications can cause headaches, upset stomach, nausea, and muscle aches.
- A prostadil, a synthetic version of the hormone prostaglandin is another FDA-approved drug and the injection is placed on the base and side penus using syringes
Other Procedures
- Surgical Treatments: -Only indicated when other medications are ineffective
- A vacuum pump device produces an erection by increasing blood flow to the penis.
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