Week 10: Sexual Dysfunctions

What are sexual dysfunctions?

These dysfunctions are a heterogeneous group, typically characterized by a person’s inability to respond sexually or to experience sexual pleasure. An individual may have several sexual dysfunctions at the same time. The time of onset may indicate different etiologies and interventions.

What is lifelong onset in sexual dysfunction?

refers to a sexual problem that has been present from the first sexual experience.

What is acquired onset in sexual dysfunction?

applies to sexual difficulties that are not limited to certain types of stimulation, situations, or partners.

What is generalized onset in sexual dysfunction?

refers to difficulties that are not limited to certain types of stimulation, situations, or partners. Across the board dysfunctions.

What is situational onset in sexual dysfunction?

refers to difficulties that only occur with certain types of stimulation, situations, or partners).

Who is more likely to report sexual dysfunction?

Males are less apt to report dysfunction than females.

What are factors to consider with sexual dysfunctions?

Partner factors (e.g., partner’s sexual problems and health status).

Relationship factors (e.g., poor communication, discrepancies in desire for sexual activity).

Individual vulnerability (e.g., poor body image, history of sexual or emotional abuse).

Psychiatric comorbidity (e.g., depression, anxiety). Stressors (e.g., life transitions - job loss, bereavement).

Cultural or religious factors (e.g., inhibitions related to prohibitions against sexual activity).

Medical factors. Rule out other medical factors that could cause sexual dysfunction (e.g., nerve dysfunction).

What are the DSM sexual disorder diagnoses?

(10) Delayed ejaculation 302.74 (F52.32)

Erectile disorder 302.72 (F52.21)

Female orgasmic disorder 302.73 (F52.31),

Female sexual interest/arousal disorder 302.72 (F52.22),

Genito-Pelvic pain/Penetration disorder 302.76 (F52.6)

Male hypoactive sexual desire disorder 302.71 (F52.0),

Premature (early) ejaculation, 302.75 (F52.4),

Substance/Medication-induced sexual dysfunction XXX.XX,

Other specific sexual dysfunction 302.79 (F52.8), Unspecified sexual dysfunction 302.70 (F52.9)

What is Delayed ejaculation 302.74 (F52.32)?

Either of the following symptoms must be experienced on almost all or all occasions of partnered sexual activity (in situational contexts or, if generalized, in all contexts) and without the individual desiring delay. Marked delay in ejaculation (for min. of 6 months). Marked infrequency or absence of ejaculation

What are the delayed ejaculation specifiers?

Lifelong: Present since becoming sexually active. Acquired: Began after a period of relatively normal sexual function. Specify if Mild: Evidence of mild distress, Moderate: Evidence of moderate distress, Severe: Evidence of extreme distress

What is lifelong in delayed ejaculation?

Present since becoming sexually active

What is acquired in delayed ejaculation?

Began after a period of relatively normal sexual function

What is mild in delayed ejaculation?

Evidence of mild distress

What is moderate in delayed ejaculation?

Evidence of moderate distress

What is severe in delayed ejaculation?

Evidence of extreme distress

What is Delayed ejaculation Prevalence?

This is the least commonly complained about male sexual dysfunction. Only 75% of men report always ejaculating during sexual activity, and less than 1% of men will complain of problems reaching ejaculation that last more than 6 months.

What is Erectile disorder 302.72 (F52.21)?

At least 1 of the 3 symptoms must be experienced on almost all or all occasions of sexual activity (in identified situational contexts, or if generalized, in all contexts). Marked difficulty in obtaining an erection during sexual activity. Marked difficulty in maintaining an erection until the completion of sexual activity. Marked decrease in erectile rigidity. The symptoms have persisted for approximately 6 months. Specify if: Lifelong, Acquired). Specify if: (Generalized, Situational). Specify if: (Mild: Evidence of mild distress, Moderate: Evidence of moderate distress over the symptoms, Severe: Evidence of severe or extreme distress over the symptoms). Is the relationship strong/solid? The man will typically self-report.

What is Erectile disorder Prevalence?

The lifelong prevalence is unknown. There is a strong age-related increase in both prevalence and incidence of problems with erection, particularly after age 50. Approximately 13%-21% of men age 40-80 complain of occasional problems with erections.

Approximately 2% of men younger than 40-50 complain of frequent problems with erections.

40% to 50% of men older than 60-70 have significant problems with erections. Note the overalpping ages in points 2 and 3.

What is Female orgasmic disorder 302.73 (F53.31)?

Presence of either of the following symptoms and experienced on almost all or all occasions of sexual activity: (Marked delay in, marked infrequency of, or absence of orgasm AND Markedly reduced intensity of orgasmic sensations).

What are the female orgasmic disorder specifiers?

if (Lifelong: The disturbance has been present since the individual became sexually active or Acquired: The disturbance began after a period of relatively normal sexual function). Specify whether: (Generalized, Situational). Specify if: (Never experienced an orgasm under any situation). Specify current severity: (Mild: Evidence of mild distress over the symptoms, Moderate: Evidence of moderate distress over the symptoms., Severe: Evidence of severe or extreme distress).

What is lifelong is female orgasmic disorder?

The disturbance has been present since the individual became sexually active.

What is acquired in female orgasmic disorder?

The disturbance began after a period of relatively normal sexual function.

What is mild in female orgasmic disorder?

Evidence of mild distress over the symptoms

What is moderate in female orgasmic disorder?

Evidence of moderate distress over the symptoms.

What is severe in female orgasmic disorder?

Evidence of severe or extreme distress.

What is the female orgasmic disorder prevalence?

Rates for female orgasmic problems in women vary widely, from 10% to 42%, depending on multiple factors. Only a small proportion of women experiencing orgasm difficulties also report associated distress. Variation in how symptoms are assessed also influence prevalence rates. Approximately 10% of women do not experience orgasm throughout their lifetime.

What is Female sexual interest/arousal disorder 302.72 (F52.22)?

Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least 3 of the following: (Absent/reduced interest in sexual activity. Absent/reduced sexual thoughts or fantasies. No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate. Absent/reduced sexual excitement/pleasure during sexual activity in almost all sexual encounters. Absent/reduced sexual interest in response to any internal or external sexual cues. Absent/reduced genital or nongenital sensations during sexual activity in almost all sexual encounters).

What are the specifiers of Female sexual interest/arousal disorder?

Specify if (Lifelong, Acquired). Specify whether (Generalized, Situational). Specify current severity (Mild, Moderate, Severe). Look for a history of trauma.

What is Female sexual interest/arousal disorder prevalence?

We don’t know!!! The prevalence of low sexual desire and of problems with sexual arousal may vary by age, cultural setting, duration of symptoms, and presence of distress.

What is Genito-Pelvic pain/Penetration disorder 302.76 (F52.6)?

Recurrent difficulties with one or more of the following: Vaginal penetration during intercourse. Marked vulvovagial or pelvic pain during vaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration. Ask the women if they are prepared for the sexual encounter.

What is the Genito-Pelvic pain/Penetration disorder specifiers?

Specify whether: Lifelong or Acquired. Specify current severity: Mild, Moderate, Severe).

What is Genito-Pelvic pain/Penetration disorder Prevalence?

The prevalence is unknown. However, approximately 15% of women in North America report recurrent pain during intercourse. Difficulties having intercourse appear to be a frequent referral to sexual dysfunction clinics and to specialist clinicians.

What is male hypoactive sexual desire disorder 302.71 (F52.0)?

Persistently or recurrently deficient sexual thoughts or fantasies and desire for sexual activity. The judgment is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts in the individual’s lives. The symptoms have persisted for 6 months.

What are the male hypoactive sexual desire disorder specifiers?

Specify whether: Lifelong or Acquired. Specify whether Generalized, Situational. Specify current severity: Mild, Moderate, Severe

What is the male hypoactive sexual desire disorder prevalence?

Varies depending on country of origin and method of assessment! - This is one of the few disorders in this chapter that really takes into account cultural issues. Approximately 6% of younger men (ages 18-24) and 41% of older men(ages 65-74) have problems with sexual desire. However a persistent lack of interest, lasting 6 months or more affects only a small proportion of men ages 16-44 (1.8%).

What is premature (early) ejaculation 302.75 (F52.4)?

A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it. Note: Although the diagnosis applies to individuals engaged in nonvaginal intercourse, the specific duration criteria have not been established.

What are the Premature (early) ejaculation specifiers?

Specify whether Lifelong or Acquired. Specify whether Generalized, Situational. Specify current severity: Mild, Moderate, Severe.

What is Premature (early) ejaculation Prevalence?

Estimates vary widely depending of the definition used. Internationally, more than 20%-30% of men ages 18-70 report concern about how rapidly they ejaculate. With the new definition, only 1%-3% of men would be diagnosed with the disorder. Some indicate the prevalence may increase with age. “…can happen at any age. Aging is not a direct cause of PE, though aging does cause changes in erections and ejaculation. For older men, erections may not be as firm or as large. Erecetions may not last as long before ejaculation occurs. The feeling that ejaculation is about to happen may be shorter. These changes can natually lead to an older man ejaculating earlier.

What is Substance/Medication-induced sexual dysfunction?

A clinically significant disturbance in sexual function is predominant in the clinical picture. There is evidence from the history, physical examination, or lab findings of: (The symptoms during or soon after substance intoxication or withdrawal or after exposure to medication. The involved substance/medication is capable of producing symptoms). The symptoms precede the onset of the substance/medication; they persist for a substantial period of time (about 1 month) after the cessation of acute withdrawal or intoxication; or there is other evidence suggesting the existence of an independent non-substance/medication-induced sexual dysfunction (e.g., a history of recurrent non-substance/medication-related episodes).

What are the different substances that can induce sexual dysfunction?

There is an ICD-9, with use disorder, mild, with use disorder moderate/severe, without use disorder. Alcohol 291.89, F10.181, F10.281, F10.981. Opioid 292.89, F11.181, F11.281, F11.981. Sedative 292.89, F13.181, F13.281, F13.981. Stimulant 292.89, F15.181, F15.281, F15.981. Cocaine 292.89, F19.181, F19.281, F19.981. Other 292.89, F19.181, F19.281, F19.981

What is Substance/Medication-induced sexual dysfunction Prevalence?

The prevalence is unclear, likely due to underreporting. Most of the data concern specific drugs such as blood pressure, antidepressants, and anti-cholesterol. Approximately, 25%-80% of individuals taking MAOs, tricyclics, SSRIs, report side effects. Approximately 50% of individuals taking antipsychotic meds experience side effects. Other meds such as cardiovascular, cytotoxic, GI and hormonal agents may cause side effects.

What is Other specific sexual dysfunction 302.79 (F52.8)?

This category applies when symptoms characteristic of a sexual dysfunction that cause clinically significant distress in the individual predominate but do not meet the full criteria for any of the disorders in the sexual dysfunctions diagnostic class. The other category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific sexual dysfunction. This is done by recording “other specific sexual dysfunction” followed by the specific reason (e.g., sexual aversion)

What is Unspecified sexual dysfunction 302.79 (F52.9)?

This category applies to presentations in which symptoms characteristic of a sexual dysfunction that cause significant distress in the individual but do not meet the criteria for any of the disorders. The unspecified sexual dysfunction category is used in situations in which the clinician chooses not to specify the reason that the criteria are not met for a specific sexual dysfunction, and includes presentations for which there is insufficient information to make a more specific diagnosis.