Sexual Disorders

Sexual Disorders
Cornelia Pinnell, Ph.D.
Argosy University/Phoenix
Lecture Outline
 Culture and sexuality
 Sexual dysfunction
– Epidemiology
– Etiology
– Treatment
Cultural issues regarding sexuality
Four primary factors involving cultural
schemas about ‘proper’ sexual activity:
– Proper sexual technique
– Proper morality
– Proper ability to be orgasmic
– Proper amount of (previous) sexual experience
Culture & sexuality
Cultural norms guide the perception of what
is considered normal and desirable in sexual
behavior & experience.
Certain activities are considered normal in
one culture and deviant in others
Cultural variations in sexual values
Castillo (1997) notes that extremely male
dominant societies have the most rigidity
about gender roles & are most likely to
regulate female sexuality, whereas male
sexuality has fewer restrictions
New Guinea (Sambia tribe)
 Sex with females is defined as ‘polluting’
Inis Beag (off the coast of Ireland)
 During the 1950s and 1960s, sexual
renunciation was considered virtuous
 A woman who enjoyed sex was ‘bad’ and
one who disliked sex was ‘good’
Mangaia (South Pacific island)
 Sex for pleasure is a great concern in this
culture
 A society in which females have achieved a
great degree of sexual freedom
Culture and sexual dysfunction
The meaning
attached to events
is related to manifestations
of sexual dysfunctions
Sexual Dysfunctions
 Are inhibitions of desire or psychophysiological
changes that occur in the sexual response cycle
 Involve and aberration or abnormality (such as
pain) in an individual’s sexual responsiveness and
reactions
 Associated with the desire, arousal, and orgasm
phases of the sexual response cycle which cause
marked distress and interpersonal difficulties
Culture-bound sex syndromes
 KORO (India, Southeast Asia, Malaysia,
China) = Sudden & intense anxiety that the
penis will recede into the body
 D’HAT (Bangladesh) = Marked obsession
with or anxiety over excessive loss of semen
Diagnosis of a sexual disorder
 The frequency of sexual contact an degree
of satisfaction vary over time
 The clinician makes a determination based
on evidence that a person’s sexual behavior
results in either
– Personal distress
– Harm to others
Sexual Dysfunctions Epidemiology
No reliable data on
the incidence and prevalence
of sexual dysfunctions
among ethnic groups in US
Sexual Dysfunctions
 Sexual Desire Disorders
– 302.71 Hypoactive Sexual Desire Disorder
– 302.79 Sexual Aversion Disorder
 Sexual Arousal Disorders
– 302.72 Female Sexual Arousal Disorder
– 302.72 Male Erectile Disorder
Sexual Dysfunctions
 Orgasmic Disorders
– 302.73 Female Orgasmic Disorder
– 302.74 Male Orgasmic Disorder
– 302.75 Premature Ejaculation
 Sexual Pain Disorders
– 302.76 Dyspareunia (Not Due to a General Medical
Condition)
– 306.51 Vaginismus(Not Due to a General Medical
Condition)
Sexual Dysfunctions
 Sexual Dysfunction Due to a General Medical
Condition
–
–
–
–
–
–
–
–
625.8 Female Hypoactive Sexual Disorder…
608.89 Male Hypoactive…
607.84 Male Erectile Disorder Due…
625.0 Female Dyspareunia Due to…
608.89 Male Dyspareunia Due to…
625.8 Other Female Dysfunction Due to…
608.89 Other Male Dysfunction Due to…
302.70 Sexual Dysfunction NOS
Sexual Dysfunctions - Etiology
 Abstinence from sex for a prolonged
period of time sometimes results in
suppression of sexual impulses
Female sexual dysfunctions
 Likely related to:
– History of sexual trauma
– Meaning attached to events (e.g., cultural
beliefs about sinfulness & dirtiness of sex)
– Ignorance regarding techniques of sexual
stimulation & arousal to produce orgasm
– Biological factors
– Chronic stress, anxiety, depression
Male sexual dysfunctions
 Likely to be related to:
– Biological/medical conditions
– Performance anxiety
– Ignorance pertaining to sexual techniques.
– In the case of generalized male orgasmic
disorder, some form of paraphiliac sexual
practice may be occurring
Sexual Desire Disorders
 Lack of interest in sexual activity
– 302.71 Hypoactive Sexual Desire Disorder:
absence of sexual fantasies and desire for
sexual activity
– 302.79 Sexual Aversion Disorder: persistent or
recurrent extreme aversion to and avoidance of
all (or almost all) genital contact with a partner
Sexual Arousal Disorder
People desire sexual intimacy, and
are frustrated by body’s failure to
arouse
Sexual Arousal Disorder
– 302.72 Female Sexual Arousal Disorder: Persistent or
recurrent inability to attain or maintain until completion
of sexual activity an adequate lubrication-swelling
response of sexual excitement
– Underestimated
– Women are more interested in sex before the onset of
menses, immediately after, or at the time of ovulation –
possibly due to alterations in testosterone, estrogen,
prolactin, & thyroxin levels.
Sexual Arousal Disorder
 302.72 Male Erectile Disorder (Impotence):
Persistent or recurrent inability to attain or
maintain until completion of sexual activity an
adequate erection
– It is the chief complaint in 50% of men treated
for sexual disorders.
– May be organic; often it is psychological.
Sexual Arousal Disorder
 302.72 Male Erectile Disorder
– It is not universal in aging men.
– Having an available sexual partner, consistent
sexual activity, and absence of vascular disease
are related to continuing potency.
Sexual Arousal Disorder
 Subtypes:
– Lifelong vs. Acquired (onset)
– Generalized vs. Situational (context)
 Specify: (etiology)
– Due to Psychological Factors
– Due to Combined Factors
Male Erectile Disorder
 Lifelong – never been able to obtain an erection
 Acquired - sometimes able to obtain erection,
later unable to do so (10-20% of men)
 Situational - able to have coitus in certain
circumstances, but not in others
Orgasmic Disorders
 Inability to experience the pleasure normally
associated with sexual release
– 302.73 Female Orgasmic Disorder: Persistent
or recurrent delay in or absence of orgasm
following a normal sexual excitement phase
 Cultural expectations & social restrictions are
relevant
Orgasmic Disorders
 302.74 Male Orgasmic Disorder - Persistent or
recurrent delay in or absence of orgasm following
a normal sexual excitement phase
 Specify type:
– Lifelong (indicates severe psychopathology) or Acquired
(may reflect interpersonal difficulties
– Generalized or situational
 Specify:
– Due to psychological or combined factors
Orgasmic Disorders
 302.75 Premature Ejaculation: Persistent or
recurrent achievement of orgasm and ejaculation
before desired.
– The complaint may be related to a concern with
partner satisfaction
Sexual Pain Disorders
 Individuals experience pain during sexual
intercourse.
– 302.76 Dyspareunia (genital pain associated
with sexual intercourse)
More common in women.
– 306.51 Vaginismus (recurrent, persistent
involuntary contraction of the perineal muscles
when vaginal penetration is attempted)
Treatment of
sexual dysfunctions
Most sexual problems are
multifaceted,
require attention to
relational and
intrapsychic factors
Treatment of
sexual dysfunctions
 Dual-sex therapy (male-female therapy
team) recommended – discussion of
physiological and psychological aspects of
sexual functioning; specific sexual activities
are suggested to be performed at home
Treatment of
sexual dysfunctions
 Circumscribed behavioral interventions – sensate
focus; desensitization to master anxiety
 Graduated dilators for women with vaginismus
 Stop-start technique in treatment of premature
ejaculation
 Group therapy; hypnotherapy
 Biological treatments
REFERENCES
 American Psychiatric Association (2000).
Diagnostic and statistical manual of mental
disorders, (4th ed., Text Revision).
Washington, DC: Author.
 Castillo, Richard J. (1997). Culture &
mental illness. A client-centered approach.
Pacific Grove: Brooks/Cole Publishing
Company.
REFERENCES
 Sadock, B. J., & Sadock, V. A. (2007).
Kaplan & Sadock’s synopsis of psychiatry
(10th ed.). Baltimore, Maryland: Williams
and Wilkins.