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Sexology College 6: Female Sexual Disorders Flashcards

(29 cards)

1
Q

female sexual complaints

A

most about pain

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2
Q

DSM-V: female sexual problems

A

1) sexual interest/desire arousal
2) orgasmic disorder
3) sexual pain/penetration disorder

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3
Q

DSM-V criteria

A
  • significant distress
  • 75-100% of situations
  • not attributable to another disorder or relationship distress or medication etc.
  • > 6 months
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4
Q

the 5 sexual complaints in women

A

1: reduced desire
2: arousal

3: orgasmic

4: vaginismus
5: dyspareunia

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5
Q

1) sexual interest/arousal disorder

A

lack/decrease in sexual interest/arousal
prevalence:
- lack of desire: 20-30%
- sexual arousal problems: 11-31%
high co-morbidity of desire and arousal problems

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6
Q

2) orgasmic disorder

A

marked delay in, infrequency of, or absence of orgasm/marked reduced intensity of orgasmic sensations
prevalence:
- problems reaching orgasm: 3.5-35%
- often/always orgasms during sex: 25-30%

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7
Q

Rutgers (2017): sexual problems

A

15% has at least one problem

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8
Q

Incentive Motivation Model (Toates, 2010)

A

see image

stimulus
-> memory and + or - experiences
-> sexual motivation
-> physical state, hormones, neurotransmitters

sexual motivation
-> behavior
-> genital response, feelings

(regulation/inhibition) -> sexual motivation

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9
Q

How does sex work? sex = emotion

A

stimulus -> (automatic) physiological response
-> awareness (feeling)
-> behavior (fight, flight, freeze, approach)

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9
Q

physical state: arousability

A

hormone levels: estrogen and androgen
- cancer ovaries, surgical menopause, low estrogen/testosterone
somatic diseases
- neurological: mulitple sclerosis, spinal cord injury
- endocrine: hypothyroidism, hyperprolactine
medication
- SSRI’s, anti-androgens, antipsychotics

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10
Q

Laan et al., 2008: Arousability of healthy women with sexual interest/arousal disorder

A

genital and subjective arousal response to erotic film
results:
- genital: patients had higher (-) affects
- subjective: lower in patients

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11
Q

Incentive Motivation Model

A

sexual system X sexual competent stimuli = motivatoin (arousal, desire, action, further response)

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12
Q

Frederick et al., 2018: Orgasmic Disorder

A

women: always orgasm
- lesbians 86%
- bi 66%
- hetero 65%
men: always orgasm
- hetero 95%
- gay 89%
- bi 88%

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13
Q

aversive learning (Brom et al., 2015; Pawlowska et al., 2020)

A

association sex and negative stimulus –> lower sexual arousal
sexual response restores when negative stimulus stops, but negative feeling and avoiding tendency are more persistent

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14
Q

psychological factors orgasmic disorder

A
  • lack of rewarding experience
  • negative sexual experiences
  • restrictive upbringing
  • negative mood, stress
  • fear of failure
  • negative body image, relationship problem
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15
Q

psychosocial factors orgasmic disorder

A
  • strict religousness
  • feelings of guilt regarding sex
  • fear of losing control
  • inability to focus
  • negative interaction with partner
  • inadequate communication
16
Q

treatment of desire/arousal/orgasmic problems

A

1) sensitivity of sexual stimuli (arousability)
- intervention: medication change, hormone substitution
2) sexual stimuli (meaning)
- intervention: trauma therapy, sex therapy, CBT, psychoeducation (female sexuality)
3) psychological/relational context (relationship satisfaction, communication)
- intervention: couple therapy

17
Q

3) sexual pain/penetration disorders

A

vulvodynia
vaginismus
dyspareunia

18
Q

vulvodynia

A

chronic vulvair pain
- somatic symptom disorder

19
Q

genito-pelvic pain and penetration disorder (GPPPD)

A

vaginismus and dyspareunia
DSM-V: persistent or recurrent difficulties with at least one of the following:
- vaginal penetration/intercourse
- vaginal/pelvic pain during (attempt at) penetration
- fear/anxiety about pain in anticipation of/during vaginal penetration
- tightening/tensing of pelvic floor muscles during attempted penetration

prevalence:
- young women 14-34%, older women 6-45% (often related to menopause)

20
Q

dyspareunia

A

persistent/recurrent pain associated with sexual intercourse
pain:
- inserting, during, and after penetration (also fingers or tampons)
- during cycling, wearing tight clothes
- burning, aching sensation
- 75% of dyspareunia: PVD

physical pathology: lichem sclerosis, infection, VIN

21
Q

PVD: provoked vestibulodynia

A

see images
- most common form of dyspareunia
- no physical pathology

22
Q

biopsychosocial factors in dyspareunia

A

1: psychosexual
- depression, anxiety’
- lowered sexual self-esteem
- decreased sexual arousal
- sexual abuse
2: bio-medical
- pelvic floor muscles
- infection
3: interpersonal
- intimacy
- emotional expression
- attachment
- partners ‘beliefs’
- reaction of partner
- (sexual) communication
4: cognitive/emotional
- hypervigilance
- self-efficacy
- catastrophizing
- fear of pain

23
Q

superficial dyspareunia patient profile

A

25 years, 5 year relationship
nochildren
symptoms persist for 4 years
psychologically healthy
sexual abuse
live with partner
other sexual problems

24
treatment of PVD
medication/surgery - irritation vulvar skin CBT - catastrophizing thoughts - pain-related fear pelvic floor physiotherapy
25
lifelong (or primary) vaginismus
inability to have sexual intercourse, despite the wish/attempts, somatic cause excluded lifelong = woman has never experienced penetration in her life - NOT a pelvic floor dysfunction
26
biopsychosocial factors vaginismus
1: psychosexual - depression, anxiety - lack of sex education - decreased sexual arousal - sexual abuse 2: bio-medical - pelvic floor muscles - infection - hormonal/neural changes - co-morbid complaints 3: interpersonal - intimacy - emotional expression - attachment - sexual communication - motivation - partner's beliefs - reaction of partner 4: cognitive/emotional - hypervigilance - self-efficacy - religious beliefs - catastrophizing - fear of pain - avoidance, disgust
27
fear avoidance model of vaginismus
penetration attempt -> catastrophizing thoughts -> fear (-> avoidance) -> increased pelvic floor muscle tension -> penetration impossible
28
treatment of vaginismus
CBT - psychoeducation - relaxation and pelvic floor exercises - gradual exposure - sexual response - communication with partner therapist aided exposure - reducing avoidance behavior - this works way better: 89% has sex