Sexual Dysfunctions

What are sexual dysfunctions?

A heterogeneous group of disorders involving clinically significant disturbance in sexual response or pleasure.

Can someone have multiple sexual dysfunctions?

Yes—diagnose all that apply.

When should a sexual dysfunction NOT be diagnosed due to stimulation issues?

When problems are due to inadequate sexual stimulation (e.g., lack of knowledge).

What are the two subtype dimensions for sexual dysfunctions?

• Lifelong vs. Acquired

• Generalized vs. Situational

Define lifelong vs. acquired.

• Lifelong: Present since first sexual experiences

• Acquired: Develops after normal functioning

Define generalized vs. situational.

• Generalized: Occurs in all contexts

• Situational: Only in specific contexts/partners

What duration is required for most sexual dysfunction diagnoses?

~6 months

What frequency is typically required?

~75%–100% of sexual encounters

What must always be present for diagnosis?

Clinically significant distress

What must be ruled out before diagnosing a sexual dysfunction?

• Nonsexual mental disorders

• Substances/medications

• Medical conditions

• Severe relationship distress/stressors

List key factors to assess in sexual dysfunction.

• Partner factors

• Relationship factors

• Individual vulnerabilities (e.g., trauma, mental health)

• Cultural/religious factors

• Medical factors

How do culture and aging affect diagnosis?

They may influence expectations and normal decreases in sexual response.

Core symptoms of delayed ejaculation?

• Marked delay OR

• Infrequency or absence of ejaculation

Key qualifier for delayed ejaculation?

Occurs without the individual desiring delay

Three symptom options for erectile disorder?

• Difficulty obtaining erection

• Difficulty maintaining erection

• Reduced rigidity

(at least 1 of the above)

Symptoms of female orgasmic disorder?

• Delay, infrequency, or absence of orgasm OR

• Reduced intensity

Unique specifier for female orgasmic disorder?

Never experienced orgasm

How many symptoms are required for female asexual interest/arousal disorder?

At least 3

Examples of female asexual interest/arousal disorder symptoms?

• Low interest

• Few/no sexual thoughts

• Reduced initiation

• Reduced pleasure/arousal

• Reduced response to cues

• Reduced sensations

Core features of genito-pelvic pain/penetration disorder?

• Difficulty with penetration

• Pain during vagial intercourse/penetration

• Fear/anxiety about pain

• Pelvic floor tightening

(1 or more)

Core symptom of male hypoactive sexual desire disorder?

Deficient or absent sexual thoughts/fantasies and desire

What determines “deficiency” of sexual desire?

Clinical judgment considering age and sociocultural context

Key timing criterion of premature ejaculation?

Ejaculation within ~1 minute of penetration

Severity levels of premature ejaculation?

• Mild: 30–60 sec

• Moderate: 15–30 sec

• Severe: <15 sec or before penetration

What is required for diagnosis of substance/medication-induced sexual dysfunction?

• Sexual dysfunction symptoms

• Evidence symptoms are caused by substance/medication

When is substance-induced sexual dysfunction NOT diagnosed?

If symptoms existed before substance use or persist long after

What if relationship distress explains the sexual dysfunction?

Use Z codes instead

Can sexual dysfunction coexist with other conditions?

Yes, if not fully explained by them

How are diagnoses applied to gender-diverse individuals?

Based on clinical judgment, not strictly sex assigned at birth

For anatomy-based diagnoses, what matters?

Current anatomy (not sex assigned at birth)