Stress and Sexual Dysfunction 2014.pptx

Stress and Sexual Dysfunction Dr. Syd Miller Jackie Lemieux Peter Kajaks Monica Van Schaik Outline  Overview of Sexual Dysfunction  Stressors relevant to Sexual Dysfunction  Female Sexual Dysfunctions  Male Sexual Dysfunctions valence of Sexual Dysfunct  National Health and Social Life S...

Stress and Sexual Dysfunction Dr. Syd Miller Jackie Lemieux Peter Kajaks Monica Van Schaik Outline  Overview of Sexual Dysfunction  Stressors relevant to Sexual Dysfunction  Female Sexual Dysfunctions  Male Sexual Dysfunctions valence of Sexual Dysfunct  National Health and Social Life Survey Prevalence Rates for Sexual Dysfunction: ◦ 43% for women ◦ 31% for men  Lewis, R. W. (2010) ◦ 30-40% for women ◦ 20-30% for men  Rates increase with age hat is Sexual Dysfunctio Sexual dysfunctions are characterized by disturbances in sexual desire and in the psychophysiological changes associated with the sexual response cycle in men and women (DSM-IV-TR). The human sexual response cycle has traditionally been viewed as being comprised of four stages which are (1) Desire (2) Arousal (3) Orgasm and (4) Resolution (American Psychiatric Association, 2000). Sexual dysfunction can happen in any of these stages, however research has focused on the first three stages. Sexual dysfunctions  Classification according to which part of the sexual response cycle is disrupted Desir e Arousal Hypoactive Sexual Desire Disorder Sexual Arousal Disorder Orgasm Resolutio n (Masters & Johnson, 1966 and Kaplan, 1974) An alternate sexual response cycle (Basson, 2005) Female Sexual Disorders  Sexual Desire Disorders ◦ Hypoactive Sexual Desire Disorder ◦ Sexual Aversion Disorder  Sexual Pain Disorders ◦ Dyspareunia ◦ Vaginismus  Sexual Arousal Disorder  Orgasmic Disorder Male Sexual Disorders  Premature Ejaculation  Prolonged Ejaculation  Erectile Dysfunction  Orgasmic Disorder  Hypoactive Sexual Desire Disorder Other Sexual Disorders  Sexual Dysfunction due to a general medical condition  Substance Induced Sexual Dysfunction  Sexual Dysfunction (NOS) Sexual Dysfunctions are. Lifelong- Has been happening since sexual maturation. or Acquired- Sudden onset of sexual dysfunction after a period of normal sexual functioning. Generalized- Sexual dysfunction happens in all contexts. or Situational- Sexual dysfunction is context specific. Stress in the context of Sexual Dysfunction The four main factors are: Predisposing Factors: - Constitutional factors (biology) - Prior Life Experience (problematic attachment, poor parenting during childhood, sexual and physical abuse) Precipitating Factors: An element that causes or contributes to the occurrence of a disorder or problem. Stress in the context of Sexual Dysfunction Maintaining Factors: Internal Stress- Stress arising from within the relationship Contextual Factors: External Stress- Stress originating outside of the close relationship • Acute Stress- Short-term activation of the stress response • Chronic Stress- Long-term stress that one has no control over McCabe et al, (2010) Negative Feedback Loop rformance anxiety and Stre Performance anxiety A very common sexual problem in which men and women acquire anxiety when it comes time to engage in sexual activity. McCabe, (2005) Found that performance anxiety has a role in the development and maintenance of a broad range of sexual dysfunctions in both men and women. emale Sexual Dysfunctio Sexual Desire Disorders Hypoactive Sexual Desire Disorder (HSDD): Deficiency (or absence) of sexual fantasies/ thoughts, and/or desire for or receptivity to sexual activity, which causes personal distress. Sexual Aversion Disorder: Phobic aversion to and avoidance of sexual contact with a sexual partner, which causes personal distress. Sexual Pain Disorders Dyspareunia: Genital pain associated with sexual intercourse. Vaginismus: The involuntary spasm of the musculature of the outer third of the vagina that interferes with vaginal penetration, which causes personal distress. Clayton, (2007) emale Sexual Dysfunctio Sexual Arousal Disorder: Inability to attain or maintain sufficient sexual excitement, causing personal distress, which may be expressed as a lack of subjective excitement, or genital (lubrication/swelling) or other somatic responses. Orgasmic Disorder: Difficulty, delay in, or absence of attaining orgasm following sufficient sexual stimulation and arousal, which causes personal distress. Clayton, (2007) male Sexual Dysfunction Prevalen The National Health and Social Life Survey (NHSLS), a population-based survey of sexual behaviour in men and women aged 18 to 59, results showed that • 33.4% of women had persistent complaints of low sexual desire • 20% of women reported difficulty becoming lubricated during sexual stimulation. • 14.4% of women have experienced pain during sexual activity • 24% of women reported a lack of orgasm • Approximately 10% of women reported early climax Figure 1. Prevalence of sexual dysfunction, as reported by the National Health and Social Life Survey. (Rosen, 2000). emale Sexual Dysfunctio Lightner, (2002) poactive Sexual Desire Disord • Synonyms include sexual aversion, inhibited sexual desire, sexual apathy, and sexual anorexia. • HSDD is the most frequent sexual problem among women. • In its extreme form, the person not only lacks sexual desire but may find sex to be repulsive, revolting, and distasteful. • Phobic or panic responses may be present in extreme cases. Hypoactive Sexual Desire Disorder. (2007). In Encyclopedia of Mental Disorders. Retrieved Jan 20, 2011, from http://www.minddisorders.com/Flu-Inv/Hypoactive-sexual-desire-disorder.html s and Hypoactive Sexual Desire Diso Colson, et al. (2005) • Found that in the 63% of subjects with jobs, sexual desire was reported to decrease during periods of work-related stress, especially in women (72.3% vs. 55.5% in men). • At such times, men indicated that erectile problems were more frequent (76% vs. 22% in other periods), while 63% of women said that they would like more foreplay. s and Hypoactive Sexual Desire Diso Traeen, et al. (2007) found that the most frequently reported causes of distressing reduced sexual desire among women was stress (40%). s and Hypoactive Sexual Desire Diso Yoon, et al. (2005) • Investigated whether prolonged stress interferes with sexual behaviour and changed biological and physiologic mechanisms. • Found that female rats in the stress condition showed significantly reduced sexual receptivity to their male partners and more aggressive irritable behaviour. Sexual Arousal Disorder • When a woman becomes aroused, the blood vessels in her genitals dilate. • There is increased blood flow in the vaginal walls, resulting in fluid passing through them. This is the main source of lubrication, which makes the vagina wet. • Her external genitalia become engorged due to the increased blood supply and it is these changes taken together that make up the what is known as the lubricationswelling response, which is designed to facilitate the entry of the penis into the vagina. • A woman with sexual arousal disorder either does not have these physical responses or does not maintain them during sexual activity. Female Sexual Arousal Disorder. (2007). In Encyclopedia of Mental Disorders. Retrieved Jan 20, 2011, from http://www.minddisorders.com/Del-Fi/Female-sexual-arousal-disorder.html tress and Sexual Arousal Disorde Fig. 1. Variations in vaginal pulse amplitude (in millivolts [mV]) relative to preceding baseline for the acute stress condition and control condition in women with low and high levels of chronic stress. Data are averaged over 30-s epochs. Kuilea, Vigevenoa, & Laanb (2007) • Found that women in the acute stress condition responded with lower levels of genital and subjective sexual arousal to an erotic stimulus than women in the control condition. • In addition, women with high levels of chronic stress responded with lower levels of genital sexual arousal to an erotic stimulus than women with low levels of chronic stress. ess and Female Sexual Dysfuncti Dunn, Croft, & Hackett (1999) Found that in women, the predominant association with arousal, orgasmic, and enjoyment problems was marital difficulties (stressor). Male Sexual Dysfunction  The most prevalent male sexual dysfunctions are Premature Ejaculation (PE) and Erectile Dysfunction (ED).  The global prevalence of PE is around 30% across age groups and different cultures (Montorsi, 2005)  Prevalence for ED was found to be around 40% (Quek et al. 2008) Male Sexual Dysfunction Broderick, G. A. (2006) Erectile Dysfunction  Erectile Dysfunction (ED) is a male sexual dysfunction that is characterized by the inability to obtain/and or maintain penile erection sufficient for satisfactory sexual performance Anxiety and Erectile Dysfunction Sugimori et al. (2005) examined anxiety and depression in Japanese men with ED Erectile Dysfunction Risk Factors  Psychological stress ◦ Anxiety ◦ Depression  Metabolic ◦ Diabetes ◦ Heart diseases ◦ Hypertension ◦ GI disorders  Lifestyle ◦ Obesity ◦ smoking Tai Young Ahn et al., (2007) Erectile Dysfunction as a Predictor of other Disorders  ED may be a precursor for many other disorders ◦ Diabetes ◦ Hypertension ◦ Obesity Tai Young Ahn et al., (2007)  ED is increasingly being recognized as the single greatest risk factor for PE Carson C. & Gunn K. (2006) remature Ejaculation  DSM IV criteria for PE is characterized by: ◦ Reduced intravaginal ejaculatory latency time (IELT) ◦ Diminished control over ejaculation ◦ Decreased satisfaction with sexual intercourse ◦ The condition also needs to be:  Persistent or recurrent  Cause “marked distress or interpersonal difficulty”  Not be due to the use of a substance (DSM-IV) Premature Ejaculation  Limitations: ◦ Difficult to determine what is “normal” ejaculatory latency ◦ Perception of what is “normal” ejaculatory latency varies across cultures ysiology of Premature Ejacula • Increased heart rate during sexual arousal • Also a noticeable acceleration in heart rate before premature ejaculation • Shorter latency to maximum penile tumescence • Alteration in male sexual response ess and Premature Ejaculat  Men with PE and their partners reported to be “extremely” or “quite a bit” distressed compared to non-PE groups (43.9% vs. 1.4% for men; 30.2% vs. 1.0% partners) Giuliano et al. (2006)  Difficulty relaxing in sexual situations (30.7% vs. 7.7%) Porst et al. (2007)  Anxiety, depression, and psychological distress (24.4% vs. 12.9% for anxiety) Rowland et al. (2004) ess and Premature Ejaculat  Quek et al. (2008) examined a number of different factors relevant to PE ◦ Medical ◦ Social ◦ Psychological  Anxiety contributed the most Anxiety ess and Premature Ejaculat  Symonds et al (2003) found strong associations between sexual confidence and anxiety, with PE  When men with PE are engaged in sexual activity, they reported that: ◦ They were preoccupied with ejaculatory control ◦ Experienced anxiety during sex Hartman et al, (2005) Additional Information Ahn, T., Park, J., Lee, S., Hong, J., Park, N., Kim, J., Hyun, J., & et al. (2007). Prevalence and risk factors for erectile dysfunction in Korean men: Results of an epidemiological study. Journal of Sexual Medicine, 4(5), 1269-1276. Kuile, M.M., Vigeveno, D., & Laan, E. (2007). Preliminary evidence that acute and chronic daily psychological stress affect sexual arousal in sexually functional women. Behaviour Research and Therapy, 45, 2078–2089. McCabe, M., Althof, A.E., Assalian, P., Chevret-Measson, M., Leiblum, S.R., Simonelli, C., & et al. (2010). Psychological and Interpersonal Dimensions of Sexual Function and Dysfunction. The Journal of Sexual Medicine, 7(1pt2), 327-336. Rosen, R. C., & Althof, S. (2008). Impact of premature ejaculation: The psychological, quality of life, and sexual relationship consequences. Journal of Sexual Medicine, 5(6), 1296-1307. Traeen, B., Martinussen, M., O’Berg, K., & Konkavli, H. (2007). Reduced sexual desire in a random sample of Norwegian couples. Sexual and Relationship Therapy, 22(3), 1468-1749.