Stress & Sexual Dysfunction PDF

Thursday, March 28, 2024 Stress & Sexual Dysfunction Overview of Sexual Dysfunction PREVALENCE OF SEXUAL DYSFUNCTION - 43% for women - 31% for men - Lewis, R. W. (2010) 30-40% for women 20-30% for men - Rates increase with age (for dysfunction, not sexual activity/desire) WHAT IS SEXUAL DYSFUNCTION?...

Thursday, March 28, 2024 Stress & Sexual Dysfunction Overview of Sexual Dysfunction PREVALENCE OF SEXUAL DYSFUNCTION - 43% for women - 31% for men - Lewis, R. W. (2010) 30-40% for women 20-30% for men - Rates increase with age (for dysfunction, not sexual activity/desire) WHAT IS SEXUAL DYSFUNCTION? Sexual dysfunctions: characterized by disturbances in sexual desire and in the psychophysiological changes associated with the sexual response cycle in men and women Masters & Johnson’s Human sexual response cycle, comprised of 4 stages: 1. Desire 2. Arousal 3. Orgasm 4. Resolution Sexual dysfunction can happen in any of these stages, however research has focused on the rst three stages - Desire = Hypoactive Sexual Desire Disorder - Arousal = Sexual Arousal Disorder - Orgasm = Orgasmic Disorder But Masters & Johnson got it wrong, too simplist ALTERNATE SEXUAL RESPONSE CYCLE - willingness: need to want to have desire - Different kinds of arousals: - Subjective arousal: “I feel aroused” - Physiological arousal - Desire & arousal in uence each other - Orgasm is not necessary for satisfaction - Rewards come from other aspects than orgasm/sex - Nonsexual rewards increase desire fi fl 1 Thursday, March 28, 2024 - Problems in sex life arise from relationship problems FEMALE SEXUAL DISORDERS — FROM MASTERS & JOHNSON 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) MOST PRESCRIBED DRUG = VIAGRA 2ND MOST PRESCRIBED: SSRIS (LEADING TO SEXUAL DYSFUNCTION; LOW SEXUAL DESIRE) 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 2 Thursday, March 28, 2024 Stressors relevant to Sexual Dysfunction THE FOUR MAIN FACTORS ARE: 1. Predisposing Factors: Constitutional factors (biology) — Some people have structural issues Prior Life Experience (problematic attachment, poor parenting during childhood, sexual and physical abuse) 2. Precipitating Factors: An element that causes or contributes to the occurrence of a disorder or problem - i.e. losing job, cheating, etc. 3. Maintaining Factors: Internal Stress: Stress arising from within the relationship 4. 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 NEGATIVE FEEDBACK LOOP If one is stressed = decrease in sexual functioning = more stress = more sexual dysfunction Stress Factor Stress 3 Sexual Dysfunction Thursday, March 28, 2024 PERFORMANCE ANXIETY AND STRESS 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 Female Sexual Dysfunctions All female sexual dysfunction is related to stress In women 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 - 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 Based on norms, but what is the “right” amount? Different for everyone Studies — Stress and Hypoactive Sexual Desire Disorder #1 ✓ Majority of subjects with jobs, sexual desire was reported to decrease during periods of workrelated 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 #2 ✓ Stress is biggest cause of reduced sexual desire across all age groups #3 ✓ female rats in the stress condition showed significantly reduced sexual receptivity to their male partners and more aggressive irritable behaviour Sexual Aversion Disorder: Phobic aversion to and avoidance of sexual contact with a sexual partner, which causes personal distress - most likely caused by sexual trauma 4 Thursday, March 28, 2024 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. 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 (equivalent to ED) - When a woman becomes aroused, a physiological response process leads to 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 Study — Stress and Sexual Arousal Disorder ✓ 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 ✓ 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 Orgasmic Disorder: Difficulty, delay in, or absence of attaining orgasm following sufficient sexual stimulation and arousal, which causes personal distress FEMALE SEXUAL DYSFUNCTION PREVALENCE 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 ✓ 24% of women reported a lack of orgasm INCREASED RISK FACTORS Biological factors are not present in the age group that is studied Psychological factors & Life stressors Sexual abuse Relationships Study — Stress and Female Sexual Dysfunction 5 Thursday, March 28, 2024 ✓ in women, the predominant associations with arousal, orgasmic, and enjoyment problems were marital difficulties (stressor), depression, and anxiety ✓ Age has no effect Male Sexual Dysfunctions - 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 culture Prevalence for ED was found to be around 40% ERECTILE DYSFUNCTION Erectile Dysfunction (ED): characterized by the inability to obtain/and or maintain penile erection sufficient for satisfactory sexual performance Study — Anxiety and Erectile Dysfunction ✓ Men who reported anxiety & depression (rather then A or D alone or none) reported more ED ERECTILE DYSFUNCTION RISK FACTORS - Psychological stress Anxiety Depression - Metabolic Diabetes Heart diseases Hypertension GI disorders - Lifestyle Obesity (consequence of stress) Smoking (stress behaviours) Sexual dysfunction is mostly related to stress in men PREMATURE EJACULATION Premature Ejaculation: 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 6 Thursday, March 28, 2024 Limitations: - Dif cult to determine what is “normal” ejaculatory latency - Perception of what is “normal” ejaculatory latency varies across cultures PHYSIOLOGY OF PREMATURE EJACULATION - 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 Studies — Stress and Premature Ejaculation #1 ✓ 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) ✓ Not being able to relax leads to PE ✓ Difficulty relaxing in sexual situations (30.7% vs. 7.7%) ✓ Anxiety, depression, and psychological distress (24.4% vs. 12.9% for anxiety) #2 ✓ Anxiety contributed the most #3 ✓ 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 Main causes of sexual dysfunctions 1. Stress and stress-related problems 2. Work stressors fi 7