Sexual Dysfunction Disorders PDF

SEXUAL DYSFUNCTION DISORDERS Ms. Aimee B. Maloles, RPsy, RPm If you’re experiencing ongoing issues with sexual pleasure or sexual response that are causing you significant distress, you may have sexual dysfunction. About 43% of women and 31% of men, Trusted Source say they experience sexual dysfun...

SEXUAL DYSFUNCTION DISORDERS Ms. Aimee B. Maloles, RPsy, RPm If you’re experiencing ongoing issues with sexual pleasure or sexual response that are causing you significant distress, you may have sexual dysfunction. About 43% of women and 31% of men, Trusted Source say they experience sexual dysfunction, according to 2000 review. A large multinational study from 2017Trusted Source estimated the prevalence of erectile dysfunction in young men to be as high as 30%. This 2018 article Trusted Source states that “nearly half of the women (46.3%) reported a lack of interest in sexual activity, 43% experienced a lack of vaginal lubrication and 37.5% of included women had dyspareunia 6 months after birth.”  There are several disorders related to sexual dysfunctions outlined in the DSM-5-TR. These include delayed ejaculation, erectile disorder, female orgasmic disorder, female sexual interest/arousal disorder, genito-pelvic pain/penetration disorder, male hypoactive sexual desire disorder, premature ejaculation, substance or medication-induced sexual dysfunction, other and unspecified sexual dysfunction. Sexual disorders that only affect males There are other sexual disorders exclusive to males: premature or early ejaculation erectile disorder male hypoactive sexual desire disorder  These sexual disorders occur only Sexual in females: disorders -female orgasmic disorder that only affect -female sexual interest/arousal disorder females -genito-pelvic pain/penetration disorder  Men Think more about sex and want more sex Masturbate more Want more and have more partners Consistency across cultures Gender and Have more sexual dysfunction as they age Sexuality Women Desire for sex more often linked to relationship status and social norms Tend to be more ashamed of appearance flaws May interfere with sexual satisfaction At all ages, women more likely than men to report sexual dysfunction Male and Female Sexual Anatomy Sexual dysfunctions Sexual dysfunction is when you’re facing significant challenges related to your ability to experience pleasure or respond sexually. If you’re having difficulty with sexual activity, getting aroused, or experiencing pleasure during sexual activity, you might be experiencing sexual dysfunction. It’s important to note that not everyone who is experiencing changes in their sexual thoughts or behavior has sexual dysfunction. Your sexual feelings and behaviors may change as you age or your circumstances change. Also, keep in mind that what’s normal to you in terms of sexual activity might be different from what’s normal for someone else. This applies to different sexual preferences and frequency of sexual activity.  There are four main categories of sexual dysfunction: Desire disorders: characterized by low sexual interest or desire 4 Main Arousal disorders: focused on the physical categories inability to become sexually aroused Orgasm disorders: characterized by a delay or absence of orgasms Pain disorders: marked by physical discomfort and pain during sexual activity  1. Sexual desire, arousal, and interest disorders In women: Sexual interest/arousal disorder In men: Male hyposexual disorder and Erectile DSM-5 TR disorder has three 2. Orgasmic disorders categories of In women: Female orgasmic disorder sexual In men: Premature ejaculation and delayed dysfunction: ejaculation 3. Sexual pain disorders In women: Genito-pelvic pain/penetration disorder Other conditions that overlap There are also other conditions that sometimes overlap with sexual dysfunctions: exhibitionistic disorder fetishistic disorder frotteuristic disorder sexual masochism and sadism transvestic disorder voyeuristic disorder 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 DSM-5 Criteria for Male Disorders Orgasmic Disorders Female orgasmic disorder Absence of orgasm after sexual excitement Many women achieve arousal but not orgasm Early ejaculation disorder Ejaculation that occurs too quickly Delayed ejaculation disorder Persistent difficulty ejaculating Orgasmic Disorders DSM-5 Criteria for Female Orgasmic Disorder: On at least 75 percent of sexual occasions: Marked delay, infrequency, or absence of orgasm Markedly reduced intensity of orgasmic sensation Causes marked distress or interpersonal problems Not due to a medical illness, another psychological disorder (except another sexual dysfunction), or the effects of a drug DSM-5 Criteria for Delayed Ejaculation: Marked delay, infrequency or absence of orgasm on at least 75 percent of sexual occasions Causes marked distress or interpersonal problems Not due to a medical illness, another psychological disorder (except another sexual dysfunction), or the effects of a drug DSM-5 Criteria for Premature Ejaculation: Tendency to ejaculation during partnered sexual activity within 1 minute of penile insertion on at lest 75 percent of sexual occasions Causes marked distress or interpersonal problems Not due to a medical illness, another psychological disorder (except another sexual dysfunction), or the effects of a drug Sexual Pain Disorders DSM-5: Genitopelvic pain/penetration disorder Persistent or recurrent pain during intercourse Diagnosable in both men and women Rare in men R/O medical cause (e.g., infection), lack of vaginal lubrication, or menopausal problems Most women experience sexual arousal and orgasms from manual or oral stimulation that does not involve penetration 10-30% prevalence rates DSM-IV-TR: Vaginismus and Dyspareunia DSM-5 Criteria for Genitopelvic Pain/Penetration Disorder Persistent or recurrent difficulties with at least one of the following: Inability to have vaginal intercourse/penetration Marked vulvar, vaginal, 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 Causes clinically significant distress or interpersonal problems Not due to another psychological disorder, a medical condition, or the effects of a drug Figure 12.5: Predictors of Sexual Functioning Etiology of Sexual Dysfunction: Biological Factors The DSM-5 includes separate diagnoses for sexual dysfunctions that are caused by medical illnesses Somewhat controversial because many sexual dysfunctions have a biological contribution Diseases of vascular system Diseases of the nervous system Low levels of testosterone or estrogen Heavy alcohol consumption before sex History of chronic alcoholism Heavy cigarette smoking Medications Antihypertensives SSRIs Etiology of Sexual Dysfunction: Psychosocial Factors Rape Early childhood sexual abuse Relationship problems Anger, hostility, poor communication Underlying anxiety about relationship security Psychological disorders Major depression, anxiety, or panic disorder Low physiological arousal Stress and exhaustion Negative cognitions Treatments of Sexual Dysfunction Anxiety reduction Directed masturbation Procedures to change thoughts and attitudes Sensory awareness procedures Rational-emotive therapy Sexual skills and communication training Couples therapy Medications and physical treatments Squeeze technique for early ejaculation PDE-5 inhibitors for erectile dysfunction Phosphodiesterase type 5 inhibitors: sildenafil (Viagra), tadafil (Cialis) and vardenafil (Levitra) The Paraphilias Recurrent sexual attraction to unusual objects or sexual activities For at least 6 months Deviation (para) in what the person is attracted to (philia) Should only be diagnosed when they cause marked distress or are done with nonconsenting persons Transvestic behaviors (cross-dressing for sexual gratification) rarely marked by distress or involves nonconsenting persons Divided categories based on source of arousal: Sexual attractions based on inanimate objects Sexual attractions based on children Paraphilias Included in DSM-5 DSM-5 Diagnosis Object of Sexual Attraction Fetishistic disorder An inanimate object Transvestic disorder Cross-dressing Pedohebephilic disorder Children Voyeuristic disorder Watching unsuspecting others undress or have sex Exhibitionistic disorder Exposing one’s genitals to an unwilling stranger Frotteuristic disorder Sexual touching of an unsuspecting person Sexual sadism disorder Inflicting pain Sexual masochism disorder Receiving pain  Fetishistic Disorder Diagnostic criteria  Prevalence For at least 6 months, Occurs most often in recurrent and intense men sexually arousing fantasies, urges, or behaviors involving Object often necessary the use of nonliving objects for sexual arousal or nongenital body parts.  Attraction to object e.g., shoes, stockings, underwear, rubber garments, hair, feet, etc. irresistible and The sexually arousing objects are involuntary not limited to articles used in cross-  Fetishes often co-occur dressing or to devise designed to provide tactile genital stimulations, with other paraphilias such as a vibrator Pedohebephilic Disorder and Incest Pedohebephilic disorder Pedos = “child”, hebe = “pubescence”, philia = “attraction” Diagnostic criteria: Sexually arousing urges, fantasies or behaviors involving sexual contact with a prepubertal or pubescent child Offender at least 16 years old and 5 years older than victim Child pornography is widely used Person has acted on urges or the urges and fantasies cause marked distress or interpersonal problems Victims usually known to pedophile Neighbors, family members, friends, clergy Most pedophilia does not involve violence other than the sexual activity Incest  Subtype of pedohebephilic disorder Most common Brother and sister Less common but more pathological Father and daughter Incest taboo almost culturally universal Genetically adaptive Offspring of father-daughter or brother-sister have a greater likelihood of inheriting pairs of recessive genes with possible negative biological effects Voyeuristic Disorder Sexually arousing fantasies, urges, or behaviors while observing other who are unclothed or engaging in sexual activity Almost always men Excitement comes from knowing the victim is unaware of the voyeur; element of risk important Seldom results in physical contact Orgasm achieved by masturbation Victims unaware that they are being watched Diagnostic Criteria: Voyeuristic Disorder For at least 6 months, recurrent and intense sexually arousing fantasies, urges, or behaviors involving the observation of unsuspecting others who are naked, disrobing, or engaged in sexual activity Person has acted on these urges with a nonconsenting person, or the urges and fantasies cause marked distress or interpersonal problems Exhibitionistic Disorder Intense desire to obtain sexual gratification by exposing one’s genitals to unwilling strangers Victims can be children Seldom results in physical contact Usually involves desire to shock or alarm victim Often comorbid with voyeuristic and frotteuristic disorders Diagnostic Criteria: Exhibitionistic Disorder For at least 6 months, recurrent, intense, and sexually arousing fantasies, urges, or behaviors involving showing one’s genitals to an unsuspecting person Person has acted on these urges to a nonconsenting person, or the urges and fantasies cause clinically significant distress or interpersonal problems Frotteuristic Disorder Sexually oriented touching of a nonconsenting person The individual rubs his genitals against a women’s body or fondles her breast or genitals Often occurs in crowded subway or other public place  Sexual sadism disorder Intense and recurrent desire to obtain or increase sexual gratification by inflicting pain or psychological suffering on Sexual Sadism another person Must cause clinically significant distress or the person has and Sexual acted on these urges with a nonconsenting person Masochism Sexual masochism disorder Disorders Intense and recurrent desire to obtain or increase sexual gratification through receiving pain or humiliation Must cause marked distress or impairment in functioning Asphyxiophilia Sexual arousal by oxygen deprivation Can result in death or serious brain damage Debate over inclusion in DSM-5 Etiology of the Paraphilias Neurobiological factors Male hormones or androgens Almost all individuals with paraphilias are men Do not have unusual levels of testosterone Classical conditioning Research has not supported orgasm conditioning hypothesis Operant conditioning Poor social skills or reinforcement of unconventionality  History of childhood physical and sexual abuse  Alcohol and negative affect are common triggers  Cognitive distortions “Because the child doesn’t run away, she must want me to fondle her” Treatment of Paraphilias Incarceration and court-ordered treatment are common (prison) Enhance motivation Denial and minimization of problem often present Some blame the victim Lack of motivation for treatment Drop out of treatment Cognitive behavioral treatment Aversion therapy Covert sensitization Counter distorted thinking Often combined with social skills and empathy training Biological treatments Castration used in past Medications Hormonal agents to reduce androgens Depo-Provera SSRIs Premature or early ejaculation Premature or early ejaculation is a disorder where a person with a penis orgasms and releases semen much sooner than they expect or want during sex. About 1 in 3 people who are biologically male from ages 18 to 59 experience this issue, according to experts. The condition often has a psychological cause, but at times, it can also be biological. Delayed ejaculation Delayed ejaculation occurs when people with a penis have trouble reaching ejaculation or take a longer time than they would like to ejaculate. There are physical and psychological factors that may cause delayed ejaculation, such as a medical condition or fear of intimacy.  Erectile disorder Erectile disorder is also known as erectile dysfunction. You might have this condition if you have trouble maintaining an erection throughout sexual intercourse. Erectile disorder is common in people with a penis as they get older. About 30 million people who identify as menTrusted Source in the United States experience it. The good news is you can reduce your chances of erectile disorder by taking steps to maintain your health. Consider eating healthier meals, limiting your alcohol intake, and exercising regularly. Your doctor can also prescribe medication to increase blood flow in your genitals and increase sexual stimulation. Female orgasmic disorder Female orgasmic disorder happens when people with a vulva have difficulty reaching orgasm. There may be biological or psychological factors influencing this, or both. If you experience female orgasmic disorder, a healthcare professional may help you treat the condition with a combination of cognitive behavioral therapy (CBT) and physical therapy. Female sexual interest/arousal disorder The DSM-5 now considers hypoactive sexual interest and female sexual arousal disorder to be the same condition, called female sexual interest/arousal disorder. This condition involves a low level of — or a lack of — sexual excitement or pleasure. People also have trouble feeling physically aroused during sex. Genito-pelvic pain/penetration disorder This occurs when people with a vagina feel pain during vaginal intercourse. You might have this disorder if you experience one of the following symptoms: pelvic pain during intercourse pain during penetration recurring fear or anxiety of possible pain during sex pelvic muscles that tend to become tense during penetration Male hypoactive sexual desire disorder A diagnosis of this disorder means you have little to no interest in thinking about or having sex. The lack of sexual desire needs to persist for 6 months and cause you significant distress.  Substance/medication- induced sexual dysfunction If you’re on medication and having problems with having sex, you may be experiencing substance/medication-induced sexual dysfunction. Research reports that using some drugs regularly, can cause delayed orgasms and erectile dysfunction. Heavy alcohol use can reduce sexual arousal in females and suppress testosterone in males, making it hard to maintain an erection. Prescribed medications can also produce sexual dysfunction. These can include antidepressants and blood pressure medication.  Treatment Cognitive behavioural therapy (CBT) is perhaps one of the most useful forms of The DSM-5 does not specify treatment therapy for addressing ED, especially options for Erectile Disorder; but both related to performance anxiety, low psychotherapeutic and pharmacological self-esteem, and loss of sexual arousal. treatment approaches have increased CBT is a proactive and actionable markedly in the last two decades. therapy targeted at helping you change the way you think and behave.