Sexual dysfunctions Notes

NOTES NOTES SEXUAL DYSFUNCTION GENERALLY, WHAT IS IT? PATHOLOGY & CAUSES SIGNS & SYMPTOMS ▪ Sexual function disturbances, often causing distress ▪ May be lifelong/acquired, mild/moderate/ severe, generalized/situational ▪ Sexual dysfunction ▫ E.g. ↓/absent orgasmic function, altered libido ▪ Anxiety, distress Associated factors ▪ Medical diagnoses ▫ E.g. diabetes mellitus, thyroid dysfunction ▪ Relationship issues ▫ E.g. impaired interpersonal communication, intimate partner violence ▪ Cultural/religious factors ▫ E.g. negative attitudes/prohibitions regarding sexual activity ▪ Individual vulnerabilities ▫ E.g. history of abuse, psychiatric comorbidity—anxiety, depression, intrapsychic conflict, psychosocial stressors ▪ Partner issues ▫ E.g. mental, physical, sexual health issues DIAGNOSIS OTHER DIAGNOSTICS ▪ Based on specific sexual-disturbance presence ▫ Causing individual distress ▫ Not better explained/accounted for by another medical condition, non-sexual psychological disorder, interpersonal stress, substance TREATMENT MEDICATIONS ▪ See individual disorders PSYCHOTHERAPY ▪ See individual disorders OSMOSIS.ORG 739

FEMALE SEXUAL INTEREST/ AROUSAL DISORDER osms.it/female-arousal-disorder PATHOLOGY & CAUSES ▪ Disorder characterized by either absence or ↓ frequency/intensity of sexual/erotic activity or thoughts in biological females SIGNS & SYMPTOMS ▪ Self-reported ↓/absent sexual pleasure, genital/nongenital sensations, ↓ vaginal lubrication → anxiety/distress DIAGNOSIS OTHER DIAGNOSTICS ▪ Absence of/↓ frequency/intensity of at least three of following; persisting for ≥ six months → distress; not better explained by non-sexual factors ▫ Interest in sexual activity ▫ Sexual/erotic thoughts ▫ Sexual activity initiation; partner initiation receptivity ▫ Pleasure/excitement during ≥ 75% of sexual encounters ▫ Interest/arousal in sexual/erotic-cue settings ▫ Genital/non-genital sensation during ≥ 75% of sexual encounters TREATMENT MEDICATIONS ▪ Flibanserin, bupropion PSYCHOTHERAPY ▪ Cognitive-behavioral and/or psychosexual therapy GENITO-PELVIC PAIN AND/OR PENETRATION DISORDER osms.it/genito-pelvic-pain PATHOLOGY & CAUSES ▪ Disorder characterized by difficulty with intercourse due to vulvovaginal/pelvic pain, anticipatory fear of pain during penetration, pelvic floor muscle tension during penetration ▪ Penetration concerns may be related to vaginal intercourse/other situations 740 OSMOSIS.ORG (gynecological exams, tampon insertion) Associated factors ▪ Medical conditions ▫ E.g. anatomic anomalies, atrophic vaginitis, obstetric perineal injury (e.g. episiotomy) ▪ Sexually-transmitted disease history ▪ Vulvodynia (persistent idiopathic vulvar pain)

Chapter 102 Sexual Dysfunction ▪ Low estrogen levels SIGNS & SYMPTOMS ▪ Dyspareunia ▫ Pain described as superficial/deep; throbbing, shooting, burning ▪ Pelvic floor muscle guarding, reflexive spasms ▪ Avoidance of intimate sexual activity/ recommended gynecological exams ▪ Resulting anxiety/distress DIAGNOSIS OTHER DIAGNOSTICS ▪ Recurring one/more difficulties persisting for ≥ six months → distress, not better explained by non-sexual factors ▫ Vaginal penetration during intercourse ▫ Vulvovaginal/pelvic pain during intercourse/penetration attempts ▫ Fear/anxiety in anticipation of, during, after penetration ▫ Pelvic floor muscle tensing during penetration attempts TREATMENT PSYCHOTHERAPY ▪ Cognitive-behavioral and/or psychosexual therapy OTHER INTERVENTIONS ▪ Pelvic physical therapy ▪ Address underlying cause ▫ E.g. ospemifene for dyspareunia (vulvovaginal atrophy) MALE HYPOACTIVE SEXUAL DESIRE DISORDER osms.it/male-hypoactive-desire PATHOLOGY & CAUSES ▪ ↓/non-existent sexual desire, interest, arousal in biological males, persisting for ≥ six months → distress, not better explained by non-sexual factors Associated factors ▪ Medical conditions ▫ E.g. impaired erectile/ejaculatory function; diabetes mellitus; hyperprolactinemia; low testosterone levels ▪ Psychological/social conditions ▫ E.g. depression, stress, substance abuse SIGNS & SYMPTOMS ▪ Persistent, ↓/non-existent sexual desire, interest, arousal → anxiety/distress DIAGNOSIS OTHER DIAGNOSTICS ▪ Absence of/↓ frequency/intensity of sexual desire or sexual/erotic thoughts; persisting for ≥ six months → distress; not better explained by non-sexual factor OSMOSIS.ORG 741

TREATMENT MEDICATIONS ▪ Bupropion PSYCHOTHERAPY ▪ Cognitive-behavioral/psychosexual therapy ORGASMIC DYSFUNCTION osms.it/orgasmic-dysfunction PATHOLOGY & CAUSES ▪ Orgasmic sensation absence, infrequency, ↓ intensity, delay Female ▪ Female orgasmic disorder: difficulty experiencing normal orgasmic function Male ▪ Erectile dysfunction (ED): persistent inability to obtain/maintain erection ▪ Abnormal ejaculation (premature, delayed) Male ▪ ED: presence of one of following symptoms experienced during ≥ 75% of sexual activity; persisting for ≥ six months → distress; not better explained by nonsexual cause ▫ Difficulty obtaining erection ▫ Difficulty maintaining erection ▫ ↓ erectile rigidity ▪ Abnormal ejaculation ▫ Delayed ejaculation ▫ Ejaculation infrequency/absence ▫ Premature ejaculation SIGNS & SYMPTOMS ▪ Reported impaired orgasmic function during sexual activity ▪ Low self-esteem, ↓ sense of sexual self → depressed affect DIAGNOSIS OTHER DIAGNOSTICS Female ▪ Presence of one of following symptoms experienced during ≥ 75% of sexual activity; persisting for ≥ six months → distress; not better explained by nonsexual cause ▫ Orgasm delay, infrequency, absence (specify if orgasm never experienced) ▫ ↓ orgasmic intensity 742 OSMOSIS.ORG TREATMENT MEDICATIONS ▪ Sildenafil PSYCHOTHERAPY ▪ Cognitive-behavioral/psychosexual therapy