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Sexual disorders

Disorder of sexual dysfunction

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Sexual disorders

  1. 1. by- dr.swati
  2. 2.  Sexual disorder can be classified into 4 main types… 1. Sexual dysfunctions 2. Gender identity disorder 3. Psychological and behavioural disorders associated with sexual development and maturation. 4. Paraphilias (disorder of sexual preference)
  3. 3.  The essential features of sexual dysfunctions are an inability to respond to sexual stimulation, or experience of pain during the sexual act.  Dysfunctions can be defined by disturbance in the subjective sense of pleasure or desire usually associated with sex, or by the objective performance.  IN DSM -5, the sexual dysfunctions include male hypoactive sexual desire disorder, female sexual interest/arousal disorder, erectile disorder, female orgasmic disorder, delayed ejaculation, premature ejaculation, genito-pelvic pain/penetration disorder, substance/medication induced sexual dysfunction, other specified sexual dysfunction and unspecified sexual dysfunctions.
  4. 4.  Sexual dysfunctions can be life long or acquired, generalized or situational and result from psychological factor, physiological factor, combined factors and numerous stressor including prohibitive cultural mores, health and partner issues, and relationship conflicts.
  5. 5.  Male hypoactive sexual desire disorders  This dysfunction is characterized by a deficiency or absence of sexual fantasies and desire for sexual activity for a minimum duration of approximately 6 month..  A reported with 6 % of men ages 18-24 ,and 40 % of men ages 66-74 have problems with sexual desire.
  6. 6.  A: persistently or recurrently deficient sexual/erotic thoughts or fantasies and desire for sexual activity. The judgement of deficiency is made by the clinician, taking into account factor that affect sexual functioning, such as age and socio-cultural contexts of the individual’s life.  The symptoms of criteria A have persisted for a minimum duration of 6 month.  The symptoms in criteria A cause clinical significant distress in the individual.
  7. 7.  The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequences 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 disturbances 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 with certain types of stimulation ,situations, or partners.  Specify whether: MILD,MODERATE,SEVERE
  8. 8.  Women may experiencing sexual dysfunction may experience either/or both inability to feel interest or arousal, and they may often have difficulty achieving orgasm or experience pain in addition.
  9. 9.  Lack of, or significantly reduced, sexual interest/arousal as manifested by at least 3 of the following: 1. Absent/reduced interest in sexual activity. 2. absent/reduced sexual/erotic thoughts or fantasies. 3. Reduced initiation of sexual activity and typically unresponsive to partner’s attempts to initiate. 4. Absent sexual excitement/pleasure during sexual activity in almost all. 5. Absent sexual interest/arousal in response to any internal or external sexual or erotic cues.(written, verbal,visual) 6. Absent /reduced genital or nongenital sensations during sexual activity in almost all
  10. 10.  B. The symptoms in criteria A have persisted for a minimum duration of 6month.  C. The symptoms in criterion A cause clinically significant distress in the individual.  D. The sexual dysfunction is not better explained by a nonsexual mental disorder or a consequence of a severe relationship distress. Or other significant stressor & 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 disturbance began after a period of relatively normal sexual sexual function  Specify whether: Generalized & situational  Specify whether: mild , moderate or severe
  11. 11. Male erectile disorder: • Male erectile disorder historically c/d impotence. The incidence of erectile disorder increases with age.it has been reported variously as 2 to 8 percent of the young adult population.  Alfred Kinsey reported that 75% of all men were impotent at the age of 80.  Male erectile disorder can be organic or psychological or combition of both, but in young and middle-aged men the cause is usually psychological.
  12. 12.  A: at least one of the three following symptoms must be experienced on almost all or all 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.  B. The symptoms in criterion A have persisted for a minimum duration of 6 month.  The symptoms in criteria A cause clinically significant distress in individual.  The sexual dysfunction is not better explained by a nonsexual mental disorder or a consequence of a severe relationship distress.  Specify whether:  Generalized, situational  Specify whether:  Mild ,moderate or severe
  13. 13.  MALE ORGASMIC DISORDER(MALE ANORGASMIA) • Failure or marked difficulty to have orgasm, despite normal sexual excitement, during coitus. • An uncommon disorder ,it often presents as retarted ejaculation. • Also c/d delayed ejaculation: a man achieves ejaculation during coitus with great difficulty. • The cause can be biological(post-prostate surgery, drug induced )or psychological(marital conflicts).
  14. 14.  Failure or marked difficulty to have orgasm, despite normal sexual excitement, during coitus.  A woman with life long female orgasmic disorder has never been experienced orgasm by any kind of stimulation. A woman with acquired orgasmic , disorder has previously experienced at least 1 orgasm, regardless of circumstances.  The causes can be biological(endocrinal disorder such as hypothyroidism, drug induced)or psychological(marital conflicts)
  15. 15. Premature ejaculation : • This disorder is defined as ejaculation before the completion of satisfactory sexual activity for both partners. • In severe cases, it is characterised by ejaculation either before penile entry into vagina or soon after penetration. • The cause can be biological or psychological(performance anxiety)
  16. 16.  Sexual dysfunction due to a general medical condition.  Substance/medication induced sexual dysfunction. Drugs •ANTIHYPERTENSIVES •Methyldopa •Clonidine •Propranolol •Thiazide diuretics •Spironolactone •HORMONAL PREPARATIONS: •Corticosteroids •Oestrogens •Androgens •PSYCHOTROPIC DRUGS •Tricyclic antidepressants & MAO inhibitors •SSRI •Haloperidol •Trazodone •Chlorpromazine •Barbiturates & benzodiazepine •PSYCHOACTIVE SUBSTANCE USE •Alcohol •Opiates & cocaine •ANTI-INFLAMMATORY DRUGS Effect on sexual desire •Inhibited •- •Inhibited •- •Inhibited •Inhibited •Inhibited •Inhibited •+/- •+/- •- •- •Inhibited •Increased(with low dose) •Decreased(with high dose) •Increased •Inhibited •Inhibited Effect on erectile function •Impaired •Impaired •Impaired •Impaired •Impaired •Impaired •Impaired •Impaired •Impaired •Impaired •Impaired •Impaired •Impaired •Impaired •impaired Effect on ejaculation impaired Impaired - - Impaired Impaired Impaired Impaired Delayed ejaculation Delayed ejaculation - - Impaired impaired Impaired impaired
  17. 17.  Diagnosis is clinical, a detailed physical examination and lab investigations(blood counts, blood sugar,LFT,thyroid profile, hormonal profile)coupled with a good history is must in every patient to rule out an underlying physical cause.  Certain lab technique (penile plethysmograph) may help in differentiating organic & nonorganic sexual dysfunctions.  A large majority of dysfunctions are psychosexual in nature. A detailed sexual & personal history is imp in finding out the underlying causes.  It should be specified whether the sexual dysfunction is psychogenic alone or biogenic factor co-exist, whether the dysfunction is lifelong or acquired and whether the dysfunction is situational or generalised.
  18. 18. 1. Psychoanalysis 2. Hypnosis 3. Group psychotherapy 4. Behavior therapy 5. Dual-sex therapy 6. Drug therapy
  19. 19.  Disorders of sexual development and maturation include disorder where sexual orientation(heterosexual, homosexual, bisexual) cause significant distress to the individual or disturbances in the relationships.  It is important to remember that any type of sexual orientation by itself is not a disorder unless it causes distress or disability.
  20. 20.  This disorder usually begins in adolescence and is characterised by uncertainty regarding the gender identity or sexual orientation. The uncertainty often leads to anxiety & depression. Ego dystonic sexual orientation:  In this disorder, the sexual orientation is clear. However the individual wishes to change the orientation b/z of the associated distress and or psychological symptoms.  Commonly seen in homosexuality
  21. 21.  The prevalence of homosexuality(in USA) is 4-6% of males & 1-2% of females. Another 5-10% may show bisexual orientation.  Female homosexual is c/d lesbians & male homosexual is c/d gay.  TREATMENT : 1. Psychotherapy: psychoanalytic & supportive depending on the personality character. 2. Drug therapy : antidepressants & BZP for associated depression & anxiety.
  22. 22.  This disorder is characterized by disturbance in gender identity: the sense of one’s masculinity or femininity is disturbed  This group includes:  Transexualism: male & female: primary & secondary.  Gender identity disorder of childhood  Intersexuality
  23. 23.  Normal anatomic sex.  Persistent and significant sense of discomfort..  Marked preoccupation with the wish to get rid of one’s genitals & sec sex characteristics.  Diagnosis is made after puberty.
  24. 24.  Primary Transexualism: 1. Early childhood onset 2. Homogeneous category 3. 2 main types- Male primary Transexualism & female Transexualism  Secondary Transexualism: 1. Later onset 2. Heterogeneous category 3. Majority of these patients are male transexuals
  25. 25. 1. Making the person reconcile with anatomic sex 2. Arrange sex-change to the desired gender.  DUAL-ROLE TRANSVESTISM- • It is characterized by wearing of clothes of opposite sex in order to enjoy the temporary experience of membership of the opposite sex. • No desire of permanent sex change • No sexual excitement accompanies the cross-dressing
  26. 26.  This is a disorder similar to Transexualism with a very early age of onset(2-4 year of age).  Persistent & significant desire to be of the other gender  Marked distress regarding the anatomic sex  Involvement in traditional activities  Onset before puberty  INTERSEXALITY: • The patients with this disorder have gross anatomical & physiological aspects of other sex. 1. External genitals 2. Internal sex organs 3. Hormonal disturbances,(testicular feminisation syndrome) 4. chromosomes,(turner’s syndrome)
  27. 27.  Paraphilias(sexual deviations: perversions) are disorder of sexual preference in which sexual arousal occurs persistently and significantly in response to objects which are not a part of normal sexual arousal.  DSM-5 list these disorder:  Pedophilia  Frotteurism  Voyeurism  Exhibitionism  Sexual sadism  Sexual masochism  Fetishism  transvestism
  28. 28. Psychosocial factor Biological factor
  29. 29.  It is the recurrent urge to expose the genitals to a stranger or to an unsuspecting person.  Sexual excitement occurs in anticipation of the exposure & orgasm is brought about by masturbation during or after the event.  Specifiers added to exhibitionistic disorder by DSM-5 differentiate arousal from exposing genitals to prepubertal children, to physically mature individuals or to both prepubertal children & physically mature person.
  30. 30.  In fetishism the sexual focus on objects(shoes, gloves, stockings) that are intimately associated with the human body or on nongenital body parts.  Sexual activity may be directed toward the fetish itself(masturbation with or into a shoe) or the fetish may be incorporated into sexual intercourse(high heeled shoes be worn)  According to Freud, fetish serves as symbol of the phallus to person with unconscious castration fears.  Learning theorists believe that the object was associated with sexual stimulation at an early age.
  31. 31.  Frotteurism is usually characterized by a man’s rubbing his male genital parts against the buttocks or other body parts of a fully clothed woman to achieve orgasm.  The acts usually occur in crowed places, particularly in subways and buses.  The is often seen in adolescent males.
  32. 32.  Pedophilia involves recurrent intense sexual urges towards ,or arousal by children 13 year of age or younger over a period of at least 6 month.  Most child molestations involve genital fondling or oral sex.  Vaginal or anal penetration occurs infrequently, except in case of incest.  DSM-5 added Specifiers to a diagnosis of pedophilic disorder: sexually attracted to males; sexually attracted to females; or sexually attracted to both.
  33. 33.  According to DSM-5 ,person with sexual masochism have a recurrent preoccupation with sexual urges and fantasies involving the act of being humiliated, beaten, bound or otherwise made to suffer.  More common among men than among women  Freud believed masochism resulted from destructive fantasies turned against the self.  Persons with sexual masochism may have had childhood experiences that convinced them that pain is a prerequisite for sexual pleasure.
  34. 34.  DSM-5 defines sexual sadism as the recurrent and intense sexual arousal from physical and psychological suffering of another person.  The method used range from restraining by tying, beating,burning,cutting,stabbing, to rape and even killing.  A person must have experienced these feelings for at least 6 months & must have acted on sadistic fantasies to receive a diagnosis of sexual sadism disorder.  Onset before the age of 18 years, mostly male.
  35. 35.  Also k/n as scopophilia.  Persistent or recurrent tendency to observe unsuspecting persons(usually of the other sex) naked, disrobing or engaged in sexual activity.  This is often followed by masturbation to achieve orgasm without the observed person being aware.  Almost seen in male
  36. 36.  This disorder exclusively in heterosexual males.  Fantasies and sexual urges to dress in opposite gender clothing as a means of arousal and ad a adjust to masturbation or coitus.  The diagnosis is given when the transvestism fantasies have been acted upon for at least 6 month.  DSM-5 Specifiers with a diagnosis of transvestism disorder: with fetishism is added if the patient is aroused by fabrics, materials, or garments; with autogynephilia is added if the patient is sexually aroused by thoughts or images of himself as a female.
  37. 37.  Zoophilia: persistent and significant involvement in sexual activity with animal is rare.  Urophilia: sexual arousal with urine  Coprophilia: sexual arousal with faeces  Necrophilia : obsession and obtaining sexual gratification from cadaver.  Hypoxyphilia: desire to archive an altered state of consciousness sec to hypoxia while experiencing orgasm.
  38. 38. Telephone or computer scotologia: it is characterized by obscene phone calling & involving an unsuspected partner. Tension and arousal begin in anticipation of phoning; the recipient of the call listens while the telephoner verbally exposes his preoccupations or induces her to talk about her sexual activity. Masturbation: masturbation is abnormal when it is the only type of sexual activity performed in adulthood if a partner is or might be available, when it’s frequency indicate a compulsion or sexual dysfunction or when it is consistently preferred to sex with a partner.
  39. 39.  Psychoanalysis and psychoanalytic psychotherapy  Behaviour therapy  Drug therapy

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