Clinical 11

Chapter 11: 

1. Sexual Disorders Overview

• Sexual Dysfunctions: Disorders that make it difficult or impossible to enjoy sexual intercourse, affecting 30% of men and 43% of women over their lifetimes.

  1. Causes significant distress and interpersonal problems.

• Phases of the Human Sexual Response Cycle:

  1. Desire

  2. Excitement

  3. Orgasm

  4. Resolution

2. Disorders of Desire

2.1 Male Hypoactive Sexual Desire Disorder

• Characteristics: Persistent lack of interest in sex; may experience normal sexual response when they do engage.

• Checklist: For at least 6 months, few or no sexual thoughts, leading to significant distress.

  • Affects 10-15% of men globally, with increasing demand for therapy.

2.2 Female Sexual Interest/Arousal Disorder

• Overlap with Disorders: Considered one disorder due to overlap between desire and arousal in women.

• Checklist: For at least 6 months, reduced or absent sexual interest, pleasure, and responses, leading to distress.

  • 26-43% of women experience reduced sexual interest; significant distress qualifies for diagnosis.

3. Causes of Low Sexual Desire

3.1 Biological Factors

• Hormonal imbalances (elevated prolactin, low testosterone, estrogen fluctuations).

• Certain medications, physical illnesses, and lifestyle factors may impair desire.

3.2 Psychological Factors

• Increased anxiety, depression, or negative attitudes toward sex can lead to low desire.

3.3 Sociocultural Factors

• Situational pressures (divorce, job stress) and relationship issues impact desire.

  • Trauma from sexual abuse can create aversion to sexual activity.

4. Disorders of Excitement

4.1 Erectile Disorder (ED)

• Definition: Persistent difficulty in achieving or maintaining an erection.

• Checklist: For at least 6 months, difficulty with erectile function causing distress, affecting 16% of men worldwide.

• Causes: Can stem from biological (vascular issues) or psychological factors (anxiety, relationship stress).

5. Disorders of Orgasm

5.1 Premature Ejaculation

• Definition: Ejaculation occurring within 1 minute of sexual activity, leading to distress.

  • Common in younger men, affecting a significant portion of the population.

5.2 Delayed Ejaculation

• Definition: Significant delay or absence of ejaculation during sexual activity for at least 6 months.

  • Affects 3-10% of men.

5.3 Female Orgasmic Disorder

• Characteristics: Persistent inability to achieve orgasm or very delayed orgasms for at least 6 months, leading to distress.

  • Affects about 21% of women, often linked to biological, psychological, and sociocultural factors.

6. Disorders of Sexual Pain

6.1 Genito-Pelvic Pain/Penetration Disorder

• Definition: Recurrent difficulties in vaginal penetration causing significant pain or fear.

  • Checklist: At least one of the following for 6 months: difficulty with penetration, significant pain, or muscle tension during intercourse.

6.2 Dyspareunia

• Definition: Pain during intercourse without involuntary muscle contraction (14-16% of women).

7. Treatment Approaches for Sexual Dysfunctions

• Sex Therapy: Short-term, typically 15-20 sessions focusing on relationship dynamics, education, and sexual communication skills.

  • Incorporates CBT techniques and biological treatment options for various disorders.

• Specific Treatments:

  • Erectile Disorder: Therapies emphasizing performance anxiety reduction, including medication like Viagra.

  • Premature Ejaculation: Behavioral techniques (stop-start method), SSRIs.

  • Female Orgasmic Disorder: CBT methods emphasizing body awareness and self-exploration, including directed masturbation training.

  • Genito-Pelvic Pain/Penetration Disorder: Behavioral therapy using gradual exposure and techniques to relieve muscle tension.

8. Modern Trends in Sex Therapy

• Focus on inclusivity and addressing the needs of diverse populations, including older adults, LGBTQ+ individuals, and those with disabilities.

9. Paraphilic Disorders

• Definition: Patterns of intense sexual urges or fantasies involving non-human objects or non-consenting partners.

  • Diagnosed only when they cause distress or impairment.

9.1 Pedophilic Disorder

• Characteristics: Sexual contact with children; often initiated by legal issues.

• Checklist: Intense sexual urges or activities involving children for at least 6 months.

9.2 Fetishistic Disorder

• Characteristics: Sexual arousal from non-living objects or non-genital body parts. Common in men, often requires therapy for non-destructive coping.

9.3 Transvestic Disorder

• Definition: Sexual arousal through dressing in clothing of a different gender, only a disorder if it causes distress.

9.4 Exhibitionistic Disorder

• Definition: Arousal from exposing one’s genitals to an unsuspecting person, generally begins in adolescence.

10. Treatment Approaches for Paraphilic Disorders

• Therapeutic Options: Include cognitive-behavioral therapy, insight-oriented treatment, and sometimes pharmacological intervention (SSRIs, antiandrogens) to reduce sexual arousal.

11. Complexity of Personality Disorders

• Types and Causes: Characterized by long-term patterns of thoughts and behaviors. May involve genetic, psychological, and sociocultural factors. Biological and psychological treatments can be combined effectively.