Human Sexuality: Function and Dysfunction Flashcards Preview

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Phases of Sexual Response Cycle

  • Desire (Phase I): circumstance-dependent
  • Excitement (Phase II): first amount of measurable physiologic responses
  • Plateau Phase (Phase III): Physiology remains unchanged for some time 
  • Orgasm Phase (Phase IV): Involuntary contractions, EEG changes
  • Resolution Phase (Phase V): Obligatory or non-obligatory physiologic changes to baseline


Components of desire phase

  • Desire for intercourse is a primary desire like that for food, water, or air.
  • Some degree of sexual desire is always present.
  • Like all appetites, sexual desire can be whetted or inhibited by circumstances.
  • Sexual desire is not lust


Physiologic components of excitement phase

  • Vasocongestion of the pelvis
  • ↑ heart rate and respiration.
  • Skin “mottling” + warmth from increased blood flow to the skin
  • Nipple erection occurs in both sexes.
  • male: penile erection
  • female: vaginal lubrication and expansion 


Major mechanism of penile erection (excitment phase)

  • caused by distension of the corpus callosum with blood
  • parasympathetic nervous system
  • Scrotal shortening occurs late in the excitement phase


Major mechanism of vaginal lubrication/increase in clitoral size (excitement phase)

  • vaginal lubrication and expansion both result from increased blood flow to the pelvis.
  • Clitoral vasocongestion leads to increase in clitoral size.
  • Vaginal lubrication results from direct transudation across the vaginal wall and not from secretion of any glands


Physiologic components of plateau phase

  • more advanced stage of arousal.
  • Physiology remains unchanged for some time with no further increase in heart rate and respiration, and no blood flow shifts.


Physiologic components of orgasm phase

  • Accompanied by a series of rhythmic contractions of the perineal muscles occurring every 0.8 seconds.
  • In the male it is accompanied by 3 to 7 ejaculatory spurts of seminal fluid.
  • In the female it is accompanied by elevation of the “orgasmic platform.”
  • In both sexes there are involuntary contractions of skeletal muscles and EEG changes.


Physiologic components of resolution phase

  • males: orgasm is followed by an obligatory resolution phase
    • physiologic changes return to baseline & further stimulation cannot produce excitement
    • length of the resolution phase varies with age
  • In females, resolution is not always obligatory—women may have repeated orgasm without resolution to a basal state, but some women do have an obligatory resolution phase.


Approach to tx of sexual dysfxn

  • Accept the patient’s problem as real
  • Assure patient that others have the problem
  • Assure patient that there is therapy available
  • Address anxiety
  • Address anger


Tx paradigms for sexual dysfxn

  • Most sexual dysfunctions are due to performance anxiety
  • Anxiety, pain, and anger interfere with sexual function
  • The same underlying issue may exhibit at different points in the sexual response cycle and may manifest as different disorders


Types of treatments for sexual dysfxn

  • sensate focus exercises
  • marital therapy
  • bibliotherapy
  • pharmacotherapy
  • vaginismus


Characteristics of sensate focus excerises

  • A series of defined behaviors and exercises; whole goal is to break the script
  • Focus on sensations and emotions
    • engage w/senses and associated emtiones
  • Training methods
    • Typically 12 - 16 visits
    • Involves behavioral modification
    • Involves marital therapy


Characteristics of marital therapy and bibliotherapy

  • Marital therapy - usually a part of sex therapy
  • Bibliotherapy - give patient something to read
    • Most successful in female orgasmic dysfunction


Pharmacotherapy tx for sexual dysfxn

  • PDE5 inhibitors = males for ED dysfxn
    • ↑ cGMP; add sexual stimulation and local release of NO
  • Estrogen
    • High association of sexual dysfunction and ↓ E2 levels in women
  • Testoterone
    • Transdermal testosterone has small effect on ↑ sexual desire
    • Not FDA approved


Antidepressants and sexual dysfxn

  • SSRIs ==>  treatment emergent dysfunction
  • Bupropion can improve hypoactive sexual desire associated with SSRI
    • Generally helps women, can improve desire and orgasm, but which women is unclear
    • Also not sure if just treating depression is what is fixing the problem


Common etiologies of sexual dysfxn

  • most common = pain (physical or psychic) 
  • True lack of desire is often associated with a chronic disease
    • depression, hyperprolactinemia, hypogonadism, malignancies, substance abuse
  • Inhibited desire is a learned behavior or a conditioned response.
    • may be secondary to another dysfunction, pain, boredom, anger, or marital discord.


Important questions for sexual history

  • How often do you have intercourse?
  • Do you have pain with intercourse?
  • How often do you have orgasms with intercourse? (females)
  • Do you ever have orgasm before you want to? (males)
  • Do you ever have trouble getting or keeping an erection? (males)
  • Are you generally satisfied with your sex life?


Common sexual dysfxn in desire phase

  • Hypoactive Sexual Desire Disorder
    • Low libido
      • often w/underlying dz state
  • Inhibited sexual desire
    • Sexual Aversion - persistent or recurrent extreme aversion and avoidance to all (or almost all) genital contact with a sexual partner
    • Result of pain or other dysfunction


Common sexual dysfxn of excitement phase

  • Arousal disorder
  • Vaginismus
  • Premature ejaculation


Characteristics of Arousal disorder


  • Male erectile disorder - inability to attain or maintain an erection
  • Female sexual arousal disorder - inability to maintain lubrication, soiling
  • disconnect between objective measures of vasocongestion and subjective arousal


Characteristics of vaginismus

  • Recurrent or persistent involuntary spasm of the musculature of the outer ⅓ of the vagina
  • Can make penetration impossible
  • Caused by severe religious orthodoxy, pain, severe negative parental attitudes
  • Patients are often hyper feminine, have bizarre images of their genitals, have a partner that supports their dysfunction
  • Primary: occurs at first try
  • Secondary: occurs later due to some other reason


Tx of vaginismus

  • Treat with dilators → best done with a female practitioner
  • Learn to have something in vaginal canal
  • Must involve partner


Characteristics of premature ejaculation

  • Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after the penetration and before the person wishes it
  • “Failure of excitement”


Characteristics of sexual dysfxn during orgasm phase

  • Orgasmic disorders
  • Male
  • Female
  • Etiologies
    • Boredom
    • Performance anxiety
    • Fear of loss of control