Sexology College 6: Female Sexual Disorders Flashcards
(29 cards)
female sexual complaints
most about pain
DSM-V: female sexual problems
1) sexual interest/desire arousal
2) orgasmic disorder
3) sexual pain/penetration disorder
DSM-V criteria
- significant distress
- 75-100% of situations
- not attributable to another disorder or relationship distress or medication etc.
- > 6 months
the 5 sexual complaints in women
1: reduced desire
2: arousal
3: orgasmic
4: vaginismus
5: dyspareunia
1) sexual interest/arousal disorder
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
2) orgasmic disorder
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%
Rutgers (2017): sexual problems
15% has at least one problem
Incentive Motivation Model (Toates, 2010)
see image
stimulus
-> memory and + or - experiences
-> sexual motivation
-> physical state, hormones, neurotransmitters
sexual motivation
-> behavior
-> genital response, feelings
(regulation/inhibition) -> sexual motivation
How does sex work? sex = emotion
stimulus -> (automatic) physiological response
-> awareness (feeling)
-> behavior (fight, flight, freeze, approach)
physical state: arousability
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
Laan et al., 2008: Arousability of healthy women with sexual interest/arousal disorder
genital and subjective arousal response to erotic film
results:
- genital: patients had higher (-) affects
- subjective: lower in patients
Incentive Motivation Model
sexual system X sexual competent stimuli = motivatoin (arousal, desire, action, further response)
Frederick et al., 2018: Orgasmic Disorder
women: always orgasm
- lesbians 86%
- bi 66%
- hetero 65%
men: always orgasm
- hetero 95%
- gay 89%
- bi 88%
aversive learning (Brom et al., 2015; Pawlowska et al., 2020)
association sex and negative stimulus –> lower sexual arousal
sexual response restores when negative stimulus stops, but negative feeling and avoiding tendency are more persistent
psychological factors orgasmic disorder
- lack of rewarding experience
- negative sexual experiences
- restrictive upbringing
- negative mood, stress
- fear of failure
- negative body image, relationship problem
psychosocial factors orgasmic disorder
- strict religousness
- feelings of guilt regarding sex
- fear of losing control
- inability to focus
- negative interaction with partner
- inadequate communication
treatment of desire/arousal/orgasmic problems
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
3) sexual pain/penetration disorders
vulvodynia
vaginismus
dyspareunia
vulvodynia
chronic vulvair pain
- somatic symptom disorder
genito-pelvic pain and penetration disorder (GPPPD)
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)
dyspareunia
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
PVD: provoked vestibulodynia
see images
- most common form of dyspareunia
- no physical pathology
biopsychosocial factors in dyspareunia
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
superficial dyspareunia patient profile
25 years, 5 year relationship
nochildren
symptoms persist for 4 years
psychologically healthy
sexual abuse
live with partner
other sexual problems