Sexual Dysfunction Disorders Overview

Sexual Dysfunction Disorders

• Sexual dysfunction occurs when significant distress is caused by ongoing issues with sexual pleasure or response.
• Approximately 43% of women and 31% of men experience sexual dysfunction (2000 review).
• Prevalence of erectile dysfunction in young men is as high as 30% (2017 study).
• A 2018 study indicated nearly half (46.3%) of women reported a lack of interest in sex, 43% experienced a lack of vaginal lubrication, and 37.5% had dyspareunia 6 months postpartum.

Types of Sexual Dysfunctions

• DSM-5-TR outlines several disorders related to sexual dysfunctions.
• Male disorders: premature/early ejaculation, erectile disorder, male hypoactive sexual desire disorder.
• Female disorders: female orgasmic disorder, female sexual interest/arousal disorder, genito-pelvic pain/penetration disorder.

Gender Differences

• Men are more likely to desire sex more often and think about sex more.
• Men masturbate more and have more partners.
• Men experience more sexual dysfunction as they age
• Women's desire for sex is often linked to their relationship status and social norms.
• Women tend to be more self-conscious about their appearance.
• Women are more likely than men to report sexual dysfunction at all ages.

Sexual Anatomy

• Diagrams of male and female anatomy are included but not detailed further. (see slide 7)

Four Main Categories of Sexual Dysfunction

• Desire disorders: low sexual interest or desire
• Arousal disorders: focused on the physical inability to become aroused
• Orgasm disorders: characterized by a delay or absence of orgasms
• Pain disorders: marked by physical discomfort and pain during sexual activity

DSM-5-TR Categories of Sexual Dysfunction

• Sexual desire, arousal, and interest disorders (in women: Sexual interest/arousal disorder; in men: Male hyposexual disorder and Erectile disorder)
• Orgasmic disorders (in women: Female orgasmic disorder; in men: Premature ejaculation and delayed ejaculation)
• Sexual pain disorders (in women: Genito-pelvic pain/penetration disorder)

Other Conditions Overlapping

• Several conditions, such as exhibitionistic, fetishistic, frotteuristic, sexual masochism and sadism, transvestic and voyeuristic disorders, sometimes overlap with sexual dysfunctions.

Disorders Involving Sexual Interest, Desire, and Arousal

• Sexual interest/arousal disorder in women: Persistent deficits in sexual interest (fantasies or urges), biological arousal, or subjective arousal.
• Hypoactive sexual desire disorder in men: Deficient or absent sexual fantasies and urges; Male erectile disorder: Failure to attain or maintain an erection of penis.

DSM-5 Criteria for Sexual Interest/Arousal Disorder in Women

• Diminished, absent, or reduced frequency of interest in sexual activity, sexual/erotic thoughts or fantasies, initiation of sexual activity, sexual excitement/pleasure during encounters and genital or nongenital sensations.

DSM-5 Criteria for Male Disorders

• Criteria for Hypoactive Sexual Desire Disorder in men and Male Erectile Disorder (involving a inability to attain erection for at least 75% of sexual encounters) are noted.

Orgasmic Disorders

• Female orgasmic disorder: Absence of orgasm after sexual excitement (many women achieve arousal but not orgasm).
• Early ejaculation disorder: Ejaculation occurring too quickly.
• Delayed ejaculation disorder: Persistent difficulty ejaculating.

Sexual Pain Disorders

• Genito-pelvic pain/penetration disorder: Persistent or recurrent pain during intercourse, diagnosable in both men and women (rare in men); related to medical conditions like infection, lack of vaginal lubrication, or menopause.

Predictors of Sexual Functioning

• Psychological factors (emotional health, attraction to partner, positive attitude toward partner, positive sexual attitude)
• Physical factors (physical health, exercise, and nutrition)
• Social and sexual history (positive sexual experiences, good relationship, sexual knowledge, skills)
• Poor sexual functioning (depression, anxiety disorders, focus on performance, too much routine, poor self-esteem, uncomfortable environment for sex, rigid, narrow attitudes toward sex, negative thoughts about sex.)

Etiology of Sexual Dysfunction

• Biological factors: diseases of the vascular system, diseases of the nervous system, low levels of testosterone or estrogen, heavy alcohol use before sex, history of chronic alcoholism, heavy cigarette smoking, medications (antihypertensives, SSRIs)
• Psychosocial factors: rape, early childhood sexual abuse, relationship problems, anger, hostility, poor communication, underlying anxiety, psychological disorders (major depression, anxiety, or panic disorder, low physiological arousal, stress, exhaustion, negative cognitions).

Treatments of Sexual Dysfunction

• Anxiety reduction, directed masturbation, procedures to change thoughts and attitudes, sensory awareness procedures, rational-emotive therapy, and sexual skills and communication training.
• Couple's therapy, medications (squeezing technique for early ejaculation, PDE-5 inhibitors for erectile dysfunction like Viagra, Cialis, Levitra)

The Paraphilias

• These are recurrent sexual attractions to unusual objects or sexual activities lasting at least 6 months; involves non-consenting person, or cause marked distress or interpersonal problems
• Categories: divided by the source of arousal (inanimate objects, children)
• Examples inclue: fetishistic disorder, transvestic disorder, pedohebephilic/voyeuristic disorder, exhibitionistic disorder and frotteuristic disorder, sexual sadism and masochism disorder

Etiology of the Paraphilias

• Neurobiological factors: Hormones (male hormones or androgens, most individuals with paraphilias are men), not usually unusual levels of testosterone.
• Classical conditioning: not supported
• Operant conditioning, poor social skills or reinforcement of unconventionality, a history of childhood physical and sexual abuse, alcohol use and negative affect are common triggers or distortions
• Examples of cognitive distortions: "Because the child doesn't run away, she must want me to fondle her"

Treatment of Paraphilias

• Common treatments include incarceration and court-ordered treatment.
• Motivation enhancement, addressing denial and minimization of the problem, lack of motivation for treatment and dropping out of treatment.
• Cognitive behavioral treatments: aversion therapy, covert sensitization, counter distorted thinking often also combined with social skills and empathy training.
• Biological treatments: castration, hormonal agents, reducing androgens, and medications (depo-provera, SSRIs)

Specific Types of Sexual Dysfunction (further details)

• Premature or early ejaculation: a disorder where a person with a penis orgasms and ejaculates sooner than expected or wanted during sex (common in men 18-59 years old). Sometimes has psychological or biological causes.
• Delayed ejaculation: occurs when a person with a penis has trouble reaching ejaculation or takes longer than desired. May be caused by medical conditions or fear of intimacy.
• Erectile disorder: (also known as erectile dysfunction) is difficulty maintaining an erection during sexual intercourse (common in older men, estimates vary).
• Female orgasmic disorder: difficulty reaching orgasm.
• Female sexual interest/arousal disorder: low level or lack of sexual excitement or pleasure. Trouble feeling aroused during sex.
• Genito-pelvic pain/penetration disorder: pain during vaginal intercourse (common symptoms include: pelvic pain, pain during penetration, recurring fear or anxiety of pain, tense pelvic muscles during penetration).
• Male hypoactive sexual desire disorder: little to no interest in sex, persisting for six months and causing significant distress.
• Substance/medication-induced sexual dysfunction: sexual problems due to medication use (delayed orgasms, erectile, dysfunction and heavy alcohol use).
• Treatment: DSM-5 does not specify treatments for Erectile Disorder, but psychotherapeutic and pharmacological treatment increases. CBT may be very helpful for addressing ED, especially for performance anxiety, low self-esteem, and low sexual arousal.

Explore the complexities of sexual dysfunction disorders, which affect a significant portion of both men and women. This quiz delves into the types of disorders, their prevalence, and the differences in sexual desire and behavior across genders. Gain insights from studies and the classifications outlined in the DSM-5-TR.