Sexual Disorders

SEXUAL
DISORDERS
Shehryar Alam Khan
Romana Zahid
Fatmah Qayyum
Arooba Laraib
Fatima Anwar
Aqsa Rundhawa

DELAYED EJACULATION Shehryar Alam Khan

DSM-V CRITERIA
A. Either of the following symptoms must be experienced on
almost all or all occasion (approximately 75%-100%) of
partnered sexual activity (in identified situational contexts
or, if generalized, in all contexts), and without the individual
desiring delay:
1. Marked Delay in ejaculation.
2. Marked infrequency or absence of ejaculation.
B. The symptoms in Criterion A have persisted for a minimum
duration of approximately 6 months.
C. The symptoms in Criterion A cause clinically significant
distress in the individual.

DSM-V CRITERIA
D. The sexual dysfunction is not better explained by a
nonsexual mental disorder or as a consequence of severe
relationship distress or other significant stressor and is not
attributable to the effects of a substance/medication or
another medical condition.
Specify whether:
Lifelong: The disturbance has been present since the
individual became sexually active.
Acquired: The distance began after a period of relatively
normal sexual functioning.

DSM-V CRITERIA
Specify whether:
 Generalized: Not limited to certain types of stimulation,
situations, or partners.
 Situational: Only occurs with certain types of stimulation,
situations or partners.

DSM-V CRITERIA
Specify current severity:
Mild: Evidence of mild distress over the symptoms in Criteria A.
Moderate: Evidence of moderate distress over the symptoms of
Criterion A.
Severe: Evidence of severe or extreme distress over the
symptoms of Criterion A.

PREVALENCE
• Unclear because lack of precise definition.
• Least common male sexual complaint.
• Only 75% of men report always ejaculating during sexual activity.
• Less then 1% of men will complain of problems with reaching
ejaculation that lasts more then 6 months.

ERECTILE DISORDER Shehryar Alam Khan

DSM-V CRITERIA
A. At least one of the three following symptoms must be
experienced on almost all or all (approximately 75%-100%)
occasions of sexual activity (in identified situational contexts
or, if generalized, in all contexts):
1. Marked difficulty in obtaining an erection during sexual
activity.
2. Marked difficulty in maintaining an erection until the
completion of sexual activity.
3. Marked decrease in erectile rigidity.

DSM-V CRITERIA
relationship distress or other significant stressors and is not
attributable to the effects of a substance/medication or
another medical condition.

DSM-V CRITERIA
Specify whether:
Lifelong: The disturbance has been present since the
individual became sexually active.
Acquired: The disturbance began after a period of relatively
normal sexual function.
Specify whether:
Generalized: Not limited to certain types of stimulation,
Situational: Only occurs with certain types of stimulation,

DSM-V CRITERIA
Mild: Evidence of mild distress over the symptoms in Criterion
A.
Moderate: Evidence of moderate distress over the symptoms
in Criterion A.
symptoms in Criterion A.

PREVALENCE
• The prevalence of lifelong versus acquired erectile disorder is
unknown.
• There is a strong age-related increase in both prevalence and
incidence of problems with erection, particularly after age 50
years.
• Approximately 13%-21% of men ages 40-80 years complain of
occasional problems with erections.
• Approximately 2% of men younger than age 40-50 years
complain of frequent problems with erections.

PREVALENCE
• 40%-50% of men older than 60-70 years may have significant
problems with erections.
• About 20% of men fear erectile problems on their first sexual
experience.
• Approximately 8% experienced erectile problems that hindered
penetration during their first sexual experience.

FEMALE ORGASMIC
DISORDER
Shehryar Alam Khan

DSM-V CRITERIA
A. Presence of either of the following symptoms and
experienced on almost all or all (approximately 75%-100%)
occasions of sexual activity (in identified situational contexts
or, if generalized, in all contexts):
1. Marked delay in, marked infrequency of, or absence of orgasm.
2. Markedly reduced intensity of orgasmic sensations.

DSM-V CRITERIA
relationship distress (e.g., partner violence) or other
significant stressors and is not attributable to the effects of a
substance/medication or another medical condition.

DSM-V CRITERIA
Specify if:
Never experienced an orgasm under any situation.
Mild: Evidence of mild distress over the symptoms in Criterion
A.
Moderate: Evidence of moderate distress over the symptoms
in Criterion A.

PREVALENCE
• Reported prevalence rates for female orgasmic problems in
women vary widely, from 10% to 42%, depending on multiple
factors (e.g., age, culture, duration, and severity of symptoms).
• These estimates do not take into account the presence of
distress.
• Only a proportion of women experiencing orgasm difficulties
also report associated distress.
• Approximately 10% of women do not experience orgasm
throughout their lifetime.

FEMALE SEXUAL
INTEREST/AROUSAL
DISORDER
Romana Zahid

DIAGNOSTIC CRITERIA
A. Lack of, or significantly reduced, sexual interest/arousal, as
manifested by atleast three of the following:
1. Absent/reduced interest in sexual activity.
2. Absent/reduced sexual/erotic thoughts or fantasies.
3. No/reduced initiation of sexual activity, and typically unreceptive
to a partners attempts to initiation.
4. Absent/reduced sexual excitement/pleasure during sexual activity
in almost all or all (approximately 75% - 100%) sexual encounters
(in identified situational contexts or, if generalized, in all
contexts).

1. Absent/reduced sexual interest/arousal in response to any
internal or external sexual/erotic cues (e.g. written, verbal, visual).
2. Absent/reduced genital or nongenital sensations during sexual
activity in almost all or all (approximately 75% - 100%) sexual
encounters (in identified situational contexts or, if generalized, in
all contexts).
B. The symptoms in Criterion A have persisted for a minimum duration
of approximately 6 months.
C. The symptoms in Criterion A cause clinically significant distress in
the individual.
D. The sexual dysfunction is not better explained by a non sexual
mental disorder or as a consequence of severe relationship distress
(e.g., partner violence) or other significant stressors and is not
attributable to the effects of a substance/medication or another
medical condition.

DIAGNOSTIC CRITERIA
Specify whether:
Lifelong: The disturbance has been present since the individual
became sexually active.
Acquired: The disturbance began after a period of relatively normal
sexual function.
Specify whether:
Generalized: Not limited to certain types of stimulation, situations or
partners.
Situational: Only occurs when certain types of stimulation, situation,
or partners.

DIAGNOSTIC CRITERIA
Specify if:
Never experienced an orgasm under any situation.
Mild: Evidence of mild distress over the symptoms in Criterion A
Moderate: Evidence of moderate distress over the symptoms in
Criterion A
Severe: Evidence of severe or extreme distress over the symptoms in
Criterion A

PREVALENCE
• Low sexual desire and problems with sexual arousal (with or
without associated distress), may very markedly in relation to
age, cultural setting, duration of symptoms and presence of
distress.

GENITO- PELVIC
PAIN/PENETRATION
DISORDER
Romana Zahid

DIAGNOSTIC CRITERIA
A. Persistent or recurrent difficulties with one (or more) of the
following:
1. Vaginal penetration during intercourse.
2. Marked vulvovaginal or pelvic pain during vaginal intercourse or
penetration attempts.
3. Marked fear or anxiety about vulvovaginal or pelvic pain in
anticipation of, during, or as a result of vaginal penetration.
4. Marked tensing or tightening of pelvic floor muscles during
attempted vaginal penetration.

DIAGNOSTIC CRITERIA
D. The sexual dysfunction is not better explained by a non
sexual mental disorder or as a consequence of severe
relationship distress (e.g., partner violence) or other significant
stressors and is not attributable to the effects of a
substance/medication or another medical condition.

DIAGNOSTIC CRITERIA
Specify whether:
Lifelong: The disturbance has been present since the individual became
sexually active.
Acquired: The disturbance began after a period of relatively normal sexual
function.
Moderate: Evidence of moderate distress over the symptoms in Criterion A
Severe: Evidence of severe or extreme distress over the symptoms in Criterion
A

PREVALENCE
• Approximately 15% of women in North America report
recurrent pain during intercourse.
• Difficulties having intercourse appear to be frequent referral to
sexual dysfunction clinics and to specialists clinicians.

MALE HYPOACTIVE SEXUAL
DESIRE DISORDER
Romana Zahid

DIAGNOSTIC CRITERIA
A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or
fantasies and desire for sexual activity. The judgment of deficiency is made
by the clinician, taking into account factors that affect sexual functioning,
such as age and general and socio-cultural contexts of the individual’s life.
B. The symptoms in Criterion A have persisted for a minimum duration of
approximately 6 months.
C. The symptoms in Criterion A cause clinically significant distress in the
individual.
D. The sexual dysfunction is not better explained by a non sexual mental
disorder or as a consequence of severe relationship distress (e.g., partner
violence) or other significant stressors and is not attributable to the effects of
a substance/medication or another medical condition.

DIAGNOSTIC CRITERIA
Specify whether:
sexual function.
Specify whether:
Generalized: Not limited to certain types of stimulation, situations or
partners.
Situational: only occurs when certain types of stimulation, situation,
or partners.

DIAGNOSTIC CRITERIA
Moderate: Evidence of moderate distress over the symptoms in
Criterion A
Severe: Evidence of severe or extreme distress over the symptoms in
Criterion A

PREVALENCE
• Depends on country of origin and method of assessment.
• Approximately 6% of younger men (ages 18-24years) and 41%
of older men (ages 66-74 years) have problems with sexual
desire.
• However, a persistent lack of interest in sex, persistent 6
months or more, affects only a small proportion of men ages
16-44 (1.8%).

PREMATURE (EARLY)
EJACULATION
Fatmah Qayyum

DIAGNOSTIC CRITERIA
A. 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 of premature (early) ejaculation
may be applied to individuals engaged in non-vaginal sexual
activities, specific duration criteria have not been established for
these activities.
B. The symptom in Criterion A must have been present for at
least 6 months and must be experienced on almost all or all
(approximately 75%-100%) occasions of sexual activity (in
identified situational contexts or, if generalized, in all contexts).

DIAGNOSTIC CRITERIA
C. The symptom in Criterion A causes clinically significant
relationship distress or other significant stressors and is not
attributable to the effects of a substance/medication or another
medical condition.

SPECIFIERS
Specify whether;
sexual function.
Specify whether:
Generalized: Not limited to certain types of stimulation, situations, or
partners.
Situational: Only occurs with certain types of stimulation, situations,
or partners.

SPECIFIERS
Mild: Ejaculation occurring within approximately 30 seconds to 1
minute of vaginal penetration.
Moderate: Ejaculation occurring within approximately 15-30 seconds
of vaginal penetration.
Severe: Ejaculation occurring prior to sexual activity, at the start of
sexual activity, or within approximately 15 seconds of vaginal
penetration.

SUBSTANCE/ MEDICATION-
INDUCED
SEXUAL DYSFUNCTION
Fatmah Qayyum

DIAGNOSTIC CRITERIA
A. A clinically significant disturbance in sexual function is
predominant in the clinical picture.
B. There is evidence from the history, physical examination, or
laboratory findings of both
(1)and (2):
1. The symptoms in Criterion A developed during or soon after
substance intoxication or withdrawal or after exposure to a
medication.
2. The involved substance/medication is capable of producing the

DIAGNOSTIC CRITERIA
C. The disturbance is not better explained by a sexual dysfunction
that is not substance/medication-induced. Such evidence of an
independent sexual dysfunction could include the following:
The symptoms precede the onset of the substance/medication use;
the symptoms persist for a substantial period of time (e.g., about 1
month) after the cessation of acute withdrawal or severe
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).

DIAGNOSTIC CRITERIA
D. The disturbance does not occur exclusively during the course
of a delirium.
E. The disturbance causes clinically significant distress in the
individual.
Note: This diagnosis should be made instead of a diagnosis of
substance intoxication or substance withdrawal only when the
symptoms in Criterion A predominate in the clinical picture and
are sufficiently severe to warrant clinical attention.

Specify if (see Table 1 in the chapter “Substance-Related and Addictive
Disorders” for diagnoses associated with substance class):
 With onset during intoxication: If the criteria are met for intoxication with the substance and
the symptoms develop during intoxication.
 With onset during withdrawal: If criteria are met for withdrawal from the substance and the
symptoms develop during, or shortly after, withdrawal.
 With onset after medication use: Symptoms may appear either at initiation of medication or
after a modification or change in use.
 Mild: Occurs on 25%-50% of occasions of sexual activity.
 Moderate: Occurs on 50%-75% of occasions of sexual activity.
 Severe: Occurs on 75% or more of occasions of sexual activity.

ETIOLOGICAL FACTORS
FOR SEXUAL DYSFUNCTIONS
Arooba Laraib

PHYSIOLOGICAL FACTORS
• Stress
• Anxiety
• Depression
• Concern about sexual performance
• Marital or relationship problems; conflicts with your partner
• Feelings of guilt, concerns about body image
• Effects of a past sexual trauma
• History of sexual abuse
• Age is a significant risk factor for low desire in both men and
women.

PHYSICAL FACTORS
• Lack of physical exercise
• Heart disease, kidney disease or liver failure
• Clogged blood vessels (atherosclerosis)
• Diabetes
• Metabolic syndrome — a condition involving increased blood
pressure, high insulin levels, body fat around the waist and
high cholesterol
• Tobacco use

PHYSICAL FACTORS
• Alcoholism and other forms of substance abuse
• Sleep disorder
• Surgeries or injuries that affect the pelvic area or spinal cord
• A stroke – a serious condition that occurs when the blood
supply to the brain is interrupted
• Infections such as UTI

HORMONAL
• For Females:
• Lower estrogen levels after menopause may lead to changes in
your genital tissues and sexual responsiveness.
• A decrease in estrogen leads to decreased blood flow to the
pelvic region, which can result in needing more time to build
arousal and reach orgasm, as well as less genital sensation.

• For Men (Specifically in Erectile Dysfunction):
• Hypogonadism – a condition that affects the production of the
male sex hormone, testosterone, causing abnormally low
levels
• An overactive thyroid gland (hyperthyroidism) – where too
much thyroid hormone is produced
• An underactive thyroid gland (hypothyroidism) – where not
enough thyroid hormone is produced

TEMPERAMENTAL
• Neurotic Personality traits may be associated with erectile
disorder.
• Submissive Personality.
• Anxiety and concerns about pregnancy can interfere with a
woman's ability to experience orgasm.
• History of psychiatric symptoms may have moderate or severe
loss of desire.

ENVIRONMENTAL AND SOCIO-CULTURAL
FACTORS
• Relationship difficulties.
• Childhood stressors.
• Gender role expectations.
• Religious norms.
• Religious background that makes the person view sex as
sinful.
• Lack of adequate sex education.

PHARMACOLOGICAL FACTORS
• Antidepressants.
• Antihistamines.
• Antihypertensives.
• Antipsychotics.
• Hypnotics.
• Antianxiety Agent.

PHARMACOLOGICAL FACTORS
• Anticonvulsants – used to treat epilepsy.
• Diuretics – increase the production of urine and are often used
to treat high blood pressure (hypertension), heart failure and
kidney disease.
• Medications to treat high blood pressure, such as Propranolol
(Inderal).

DIFFERENTIAL DIAGNOSIS Fatima Anwar

ANOTHER
MEDICAL
CONDITION
SUBSTANCE
ABUSE
NON SEXUAL
MENTAL
DISORDERS
INTERPERSONAL
FACTORS AND
OTHER SEXUAL
DYSFUNCTIONS
INADEQUATE OR
ABSENT SEXUAL
STIMULI
DELAYED
EJACULATION
DELAYED
EJACULATION
FEMALE
ORGASMIC
DISORDER
MALE
HYPOACTIVE
SEXUAL DESIRE
FEMALE SEXUAL
INTEREST
ERECTILE
DISORDER
ERECTILE
DISORDER
FEMALE SEXUAL
INTEREST
FEMALE
ORGASMIC
DISORDER
PENETRATION
DISORDER
FEMALE
ORGASMIC
DISORDER
FEMALE
ORGASMIC
DISORDER
MALE
HYPOACTIVE
SEXUAL DESIRE
FEMALE SEXUAL
INTEREST
FEMALE SEXUAL
INTEREST
FEMALE SEXUAL
INTEREST
PENETRATION
DISORDER
MALE
HYPOACTIVE
SEXUAL DESIRE
MALE
HYPOACTIVE
SEXUAL DESIRE
EARLY
EJACULATION

DIFFERENTIAL DIAGNOSIS
• Delayed Ejaculation should also be differentiated with
dysfunction with orgasm. This means we need to see whether
the complaints concern delayed ejaculation or sensation of
orgasm or both.
• Erectile Disorder should also be differentiated with normal
erectile function. This means we should also see for normal
erectile function in men with a lot of expectations.
• Penetration Disorder should also be differentiated with somatic
symptoms and related disorders but till now it is not yet clear
as these are new diagnosis.

DIFFERENTIAL DIAGNOSIS
• Medication Induced Sexual Dysfunction should also be
differentiated with non substance/ medication induced sexual
dysfunctions. This means disturbances in sexual functions can
also be due to depression, bipolar, anxiety and psychotic
disorders.
• So it is hard to differentiate between a substance medication
induced sexual dysfunction from an underlying mental
disorder.

TREATMENT
•Talk and listen. Open communication with your partner makes a
world of difference. Even if you're not used to talking about your likes
and dislikes, learning to do so and providing feedback in a
nonthreatening way sets the stage for greater intimacy.
•Practice healthy lifestyle habits. Go easy on alcohol — drinking too
much can blunt your sexual responsiveness. Be physically active —
regular physical activity can increase your stamina and elevate your
mood, enhancing romantic feelings. Learn ways to decrease stress so
you can focus on.

• Seek counseling. Talk with a counselor or therapist who specializes
in sexual and relationship problems. Therapy often includes
education about how to optimize your body's sexual response, ways
to enhance intimacy with your partner, and recommendations for
reading materials or couples exercises.

TREATMENT
 Adjust or change medication that has sexual side effects.
 Treat a thyroid problem or other hormonal condition.
 Optimize treatment for depression or anxiety.
 Try strategies for relieving pelvic pain or other pain problems.

LACK OF DESIRE
• Treatment is a multi-step process.
• Therapists begin by helping clients identify negative attitudes,
explore the origins of those ideas and find new ways of
thinking.
• The focus then shifts to behavior: therapists may ask clients to
keep diaries of their sexual thoughts.
• Therapists also address any relationship problems.

TREATMENT
1. Erectile dysfunction:
• The cause is typically a mix of physical and psychological
factors.
• Physical causes include illnesses like diabetes or medication
side effects.
• One of the main psychological causes is performance anxiety.
After the first incident, men sometimes get so nervous the
problem occurs again.
• Therapy focuses on reducing anxiety by taking the focus off
intercourse. For men with physical problems, medication or
devices can help.

TREATMENT
2. Premature ejaculation:
• While the causes still aren't understood, treatment works in
almost all cases. Therapy focuses on behavioral training. With
his partner's help, the man learns to withstand stimulation for
longer and longer periods.
3. Painful intercourse:
• Most cases — especially among men — involve a physical
problem. A urologist or gynecologist should rule out or address
any medical concerns. For women, the typical treatment focuses
on relaxation training.

THANK YOU Adult Psychopathology

Sexual Disorders

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