Sexual Dysfunctions

Question 1

DSM-5 Sexual Dysfunctions? Name them (7)

Answer 1

1. Delayed ejaculation
2. Erectile disorder (ED)
3. Female orgasmic disorder
4. Female sexual interest/arousal disorder (FSIAD)
5. Genito-pelvic pain/penetration disorder (GPPPD)
6. Male hypoactive sexual desire disorder
7. Premature (early) ejaculation

Question 2

Difference between sexual difficulties and dysfunction?

Answer 2

The problem has to be persistent (at least 6 months), consistent (most of the time), and the person had to be distressed by it.

Question 3

Male DSM-5 sexual dysfunctions mapped onto the 4 stages of sexual response cycle? (Masters & Jonsson)

Answer 3

Desire:
Male Hypoactive Sexual Desire Disorder

Excitement - Plateau:
Erectile Disorder

Orgasm - Resolution:
Delayed Ejaculation
Early Ejaculation

Question 4

Female DSM-5 sexual dysfunctions mapped onto the 4 stages of sexual response cycle? (Masters & Jonsson)

Answer 4

Desire- Excitement:
Female Sexual Interest/Arousal Disorder (lack of differentiation between interest and arousal)

Excitement - Plateau - Orgasm:
Genito-Pelvic Pain/Penetration Disorder (Pain/fear of insertion of things into the vagina)

Resolution:
Female Orgasmic Disorder

Question 5

Study: Sexual difficulties are common

N = 11,509 male and female Brits aged 16-74 years
Interviewed between Sep 2010 and Aug 2012

Answer 5

Women:
Lacked interest and arousal 6.5%
Difficulty in reaching climax 16.3%
Felt physical pain as a result of sex 7.4%
Experienced 1= of these problems 22.8%

Men:
Lacked interest in having sex 15%
Trouble getting or keeping an erection 12.9%
Difficulty in reaching climax 9.2%
Reached climax more quickly than desired 14.9%

Question 6

Sexual difficulties are common

N = 2,400 midlife Canadians aged 40-59 years
Online survey between Sep and Oct 2015

Answer 6

Women:
Low desire 39.6%
Orgasm difficulties 14.5%
Vaginal oan 17.1%
Experienced 1+ of these problems 56.7%

Men:
Low desire 29.6%
Erection problems 23.8%
Ejaculations problems 24.7%
Experienced 1+ of these problems 54.2%

Question 7

DSM-5 Specifiers?
Generalized

Answer 7

Not limited to certain types of stimulation, situations, or partners

It is either generalised or situational

Question 8

DSM-5 Specifiers?
Situational

Answer 8

Only occurs with certain types of stimulation, situations, or partners

It is either situational or generalized

Question 9

DSM-5 Specifiers?
Lifelong

Answer 9

Difficulty present since the individual became sexually active

It is either lifelong or acquired

Question 10

DSM-5 Specifiers?
Acquired

Answer 10

Difficulty began after a period of relatively intact sexual function

It is either lifelong or acquired

Question 11

Sexual Dysfunction, strong body focus, it is a bodily issue.

Answer 11

There are multiple different factors that are important in understanding and treating sexual dysfunctions. -> Biopsychosocial model

Only looking at biomedical drawback of like (GPPPD) fear cannot be seen physically, missing contextual cues.

Question 12

Etiology: Biopsychosoical

Demonstrate that?

Answer 12

• Biological (organic)
• Psychological (intrapsychic)
• Social (contextual, cultural)

Sexual difficulties tend to co-occur with various health issues

Question 13

Biological?

Answer 13

• Aging
• Life-stages: puberty/adolescence, pregnancy and postpartum, fertility problems, menopause
• Diseases affecting the vascular, neurological, and/or endocrine systems (important for pushing blood to genitals)
• Damage to the central nervous system (e.g., MS, spinal cord injuries)
• Hormonal problems including hypothyroidism, anaemia, and diabetes

Question 14

Biological - Prescription drugs are a common cause for sexual difficulties?

Answer 14

• Medications used to treat cardiovascular disease, arthritis, high cholesterol, and cancer have known sexual side effects.
• Medication for psychiatric conditions also have sexual side effects.
• Some hormonal contraceptives have adverse effects on arousal and desire (e.g., depo-proverb is linked with low desire)

Question 15

Psychological? Distal factors (happened in the past)

Answer 15

Distal factors:
- Childhood sexual abuse and maltreatment
- Attachment style: insecure; anxious/avoidant

Question 16

Psychological? Proximal factors (what is going on day to day, right now)

Answer 16

• Mental health concerns (e.g., depression, anxiety)
• Emotion regulation difficulties
• Life stress
• Performance anxiety, spectating (thinking about having sex ‘viewing it from the outside’, instead of being in the moment thinking about how it feels)

Question 17

Social?

Answer 17

• School-based sex education*
• Family-based teachings (or lack thereof)
• Religious teachings about sexuality*
• Cultural sexual scripts*
  *Cis/heteronormativity

Question 18

Psychosocial - sexual schemas?

Answer 18

• Shaped by the information and messaging we receive, as well as our own sexual experiences
• Childhood messaging that sex is a sin, bad dirty can influence how people feel about sex as an adult
• Negative messaging about self-touch can create problems with intimacy and pleasure
• Sex-negative education (focus on risks, ignore pleasure)

Question 19

What is missing from the biopsychosocial model?

Answer 19

Interpersonal (relational)

Question 20

Interpersonal?

Answer 20

• Low relationship satisfaction, low intimacy, relational distress
• Partners’ sexual function
• Partners’ response to the sexual problem (Solicitous response “Are you in pain? Are you ok?” brings more focus to the pain instead of the pleasure. Facilitative response, focus more on the pleasure and interaction)
• Communication difficulties, including problems with conflict resolution

Question 21

Example of Biological (organic) from case study?

Answer 21

Medication: SSRI
Medication: birth control

Question 22

Example of Psychological (intrapsychic) from case study?

Answer 22

• Anxiety disorder
• Discomfort talking about sex
• Low self-esteem
• Fears about partner rejcetion

Question 23

Example of Social (contextual, cultural) from case study?

Answer 23

• No family-based sex ed
• Catholic teachings?
• Sex negative messages

Question 24

Example of Interpersonal (relational) from case study?

Answer 24

+ Both highly committed to relationship
- Lack of sexual intimacy
- Sexual avoidance
- Limited sexual menu

Question 25

Sexual stimulation?

Answer 25

- Sexual technique can be an important contributor to sexual problems. - Resoling the sexual problem could be changing the sexual technique, ex adding clitoris stimulation. - According to the DSM-5, it is important to consider the adequacy of sexual stimulation in diagnosing sexual disorders.

Question 26

A note on couples?

Answer 26

- Sexual problems affect both members of couple. - Sometimes one person presents with the sexual problem. - Reconceptualize sexual difficulties as couple issue. - It can be very isolating feeling like an issue is a sole responsibility of one person

Question 27

Delayed ejaculation

Answer 27

Marked delay in ejaculation or the marked infrequency or absence of ejaculation. Occurs on at least 75%–100% of partnered sexual encounters and without the person desiring such a delay.

Question 28

Erectile disorder

Answer 28

Presence of at least one of three symptoms, 75%–100% of the time: (1) marked difficulty in obtaining an erection during sexual activity; (2) marked difficulty in maintaining an erection until the completion of sexual activity; or (3) marked decrease in erectile rigidity.

Question 29

Female orgasmic disorder

Answer 29

Presence (on 75%–100% of occasions of sexual activity) of either (1) marked delay in, marked infrequency of, or absence of orgasm; or (2) markedly reduced intensity of orgasmic sensations.

Question 30

Female sexual interest/arousal disorder

Answer 30

Presence of any three of six symptoms: (1) absent or reduced interest in sex; (2) absent or reduced erotic thoughts or fantasies; (3) difficulties with initiation of sexual activity and receptivity to sex; (4) lack of sexual excitement/pleasure during sex (75%–100% of the time); (5) lack of sexual interest/arousal in response to sexual triggers (e.g., erotica); and (6) lack of genital or nongenital sensations during sex (75%–100% of the time).

Question 31

Genito-pelvic pain/penetration disorder

Answer 31

Persistent or recurrent difficulties in any one of the following areas: (1) during vaginal penetration; (2) marked pain with attempted or actual penetration; (3) marked fear or anxiety about vaginal pain; or (4) marked tensing of the pelvic floor muscles during attempted penetration.

Question 32

Male hypoactive desire disorder

Answer 32

Deficient or absent sexual thoughts/fantasies and deficient or absent desire for sex as determined by clinical judgment, taking into account age, relationship duration, and other contextual factors.

Question 33

Premature (early) ejaculation

Answer 33

Persistent or recurrent pattern (on at least 75%–100% of partnered sexual activities) of ejaculation occurring less than 1 min following the onset of vaginal penetration, and occurs despite the man’s wish.

Question 34

Partner Response to pain (GPPPD)? Facilitative Response?

Answer 34

When a partner encourages efforts to cope with the pain. For example, a partner might express happiness about engaging in sexual activity as a couple or share that they are feeling pleasure.

Question 35

Partner Response to pain (GPPPD)? Solicitous Response?

Answer 35

When a partner responds to the pain with an exaggerated expression of sympathy, attention, or support. For example, a partner might suggest stopping the sexual activity, offer comfort, or ask how they can help.

Question 36

Partner Response to pain (GPPPD)? Negative Response?

Answer 36

When a partner responds negatively to the pain. For example, a partner might express anger, irritation, disappointment, or frustration towards the person experiencing pain.

Question 37

Article: Genito-Pelvic Pain Through a Dyadic Lens: Moving Towards an Interpersonal Emotion Regulation Model of Women's Sexual Dysfunction. Explain this model?

Answer 37

Consider Distal and proximal factors, that can interact -> Leading to Couple Emotion Regulation -> Couple outcome