Sexology College 6: Female Sexual Disorders

Question 1

female sexual complaints

Answer 1

most about pain

Question 2

DSM-V: female sexual problems

Answer 2

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

Question 3

DSM-V criteria

Answer 3

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

Question 4

the 5 sexual complaints in women

Answer 4

1: reduced desire
2: arousal

3: orgasmic

4: vaginismus
5: dyspareunia

Question 5

1) sexual interest/arousal disorder

Answer 5

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

Question 6

2) orgasmic disorder

Answer 6

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%

Question 7

Rutgers (2017): sexual problems

Answer 7

15% has at least one problem

Question 8

Incentive Motivation Model (Toates, 2010)

Answer 8

see image

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

sexual motivation
-> behavior
-> genital response, feelings

(regulation/inhibition) -> sexual motivation

Question 9

How does sex work? sex = emotion

Answer 9

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

Question 9

physical state: arousability

Answer 9

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

Question 10

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

Answer 10

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

Question 11

Incentive Motivation Model

Answer 11

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

Question 12

Frederick et al., 2018: Orgasmic Disorder

Answer 12

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

Question 13

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

Answer 13

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

Question 14

psychological factors orgasmic disorder

Answer 14

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

Question 15

psychosocial factors orgasmic disorder

Answer 15

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

Question 16

treatment of desire/arousal/orgasmic problems

Answer 16

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

Question 17

3) sexual pain/penetration disorders

Answer 17

vulvodynia
vaginismus
dyspareunia

Question 18

vulvodynia

Answer 18

chronic vulvair pain
- somatic symptom disorder

Question 19

genito-pelvic pain and penetration disorder (GPPPD)

Answer 19

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)

Question 20

dyspareunia

Answer 20

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

Question 21

PVD: provoked vestibulodynia

Answer 21

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

Question 22

biopsychosocial factors in dyspareunia

Answer 22

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

Question 23

superficial dyspareunia patient profile

Answer 23

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

Question 24

treatment of PVD

Answer 24

medication/surgery - irritation vulvar skin CBT - catastrophizing thoughts - pain-related fear pelvic floor physiotherapy

Question 25

lifelong (or primary) vaginismus

Answer 25

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

Question 26

biopsychosocial factors vaginismus

Answer 26

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

Question 27

fear avoidance model of vaginismus

Answer 27

penetration attempt -> catastrophizing thoughts -> fear (-> avoidance) -> increased pelvic floor muscle tension -> penetration impossible

Question 28

treatment of vaginismus

Answer 28

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