PSYCHOLOGY

EXIMIUS
ABNORMAL SEXUALITY AND SEXUAL DYSFUNCTIONS 2021
Dr. Pagaddu November 2019
ABNORMAL SEXUALITY AND SEXUAL DYSFUNCTIONS 3. Orgasm Peaking of sexual Female orgasmic
• essential feature of the sexual dysfunctions: inhibition in pleasure, with release of disorder; male orgasmic
one or more of the phases, including disturbance in the sexual tension and disorder; premature
subjective sense of pleasure or desire or in the objective rhythmic contraction of ejaculation; other sexual
performance: either alone or in combination the perineal muscles and dysfunction due to a
• can be lifelong or acquired, generalized or situational, and pelvic reproductive general medical
result from psychological factors, physiological factors, or organs condition (male or
combined factors female); substance-
• With the possible exception of premature ejaculation and induced sexual
anorgasmia, sexual dysfunctions are rarely found separate dysfunction with
from other psychiatric syndromes impaired orgasm
• can lead to or result from relational problems, and 4. Resolution A sense of general
patients invariably develop an increasing fear of failure relaxation, well-being,
and self-consciousness about their sexual performance and muscle relaxation;
• frequently associated with other mental disorders, such as men are refractory to
depressive disorders, anxiety disorders, personality orgasm for a period of
disorders, and schizophrenia time that increases with
• a sexual dysfunction is defined as a disturbance in the age, whereas women can
sexual response cycle or as pain with sexual intercourse have multiple orgasms
• 7 major categories of sexual dysfunction: sexual desire without a refractory
disorders, sexual arousal disorders, orgasm disorders, period
sexual pain disorders, sexual dysfunction caused by a
general medical condition, substance-induced sexual Sexual Dysfunction Not Correlated with Phases of the Sexual
dysfunction, and sexual dysfunction NOS Response Cycle
• Sexual function can be adversely affected by stress of any Category Dysfunctions
kind, by emotional disorders, or by ignorance of sexual Sexual pain disorders Vaginismus (female) Dyspareunia (female
function and physiology and male)
• dysfunction may be generalized or limited to a specific Other 1. Sexual dysfunctions not
partner or a certain situation otherwise specified. Examples:
DSM-5 Phases of the Sexual Response Cycle and Associated Sexual No erotic sensation despite
Dysfunctions normal physiological response to
Phases Characteristics Dysfunction sexual stimulation (e.g., orgasmic
anhedonia)
1. Desire Distinct from any Hypoactive sexual desire 2. Female analogue of premature
identified solely through disorder; sexual ejaculation
physiology and reflects aversion disorder; 3. Genital pain occurring during
the patient's hypoactive sexual desire masturbation
motivations, drives, and disorder due to a
personality; general medical
characterized by sexual condition (male or Sexual Desire Disorders
fantasies and the desire female); substance- o divided into two classes:
to have sex induced sexual — hypoactive sexual desire disorder
dysfunction with § characterized by a deficiency or
impaired desire absence of sexual fantasies and desire
2. Excitement Subjective sense of Female sexual arousal for sexual activity
sexual pleasure and disorder; male erectile § more common
accompanying disorder (may also occur § W>M
physiological changes; all in stages 3 and 4); male — sexual aversion disorder
physiological responses erectile disorder due to § characterized by an aversion to, and
noted in Masters and a general medical avoidance of, genital sexual contact
Johnson's excitement condition; dyspareunia with a sexual partner or by
and plateau phases are due to a general medical masturbation
combined in this phase condition (male or o patients with desire problems often use inhibition of
female); substance- desire defensively, to protect against unconscious fears
induced sexual about sex
dysfunction with o Freud conceptualized low sexual desire as the result of
impaired arousal inhibition during the phallic psychosexual phase of
development and of unresolved oedipal conflicts
o Some men, fixated at the phallic state of development, are
fearful of the vagina and believe that they will be castrated
if they approach it ( vagina dentata ) because men
unconsciously believe that the vagina has teeth, they avoid
contact with the female genitalia.

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 PSYCHOLOGY
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Dr. Pagaddu November 2019
o Equally, women may suffer from unresolved
developmental conflicts that inhibit desire.
o Lack of desire can also result from chronic stress, anxiety,
or depression.
o Abstinence from sex for a prolonged period sometimes
results in suppression of sexual impulses.
o Loss of desire may also be an expression of hostility to a
partner or the sign of a deteriorating relationship.
o The presence of desire depends on several factors:
— biological drive
— adequate self-esteem
— ability to accept oneself as a sexual person
— previous good experiences with sex
— availability of an appropriate partner
— a good relationship in nonsexual areas with a
partner.
o Damage to, or absence of, any of these factors can
diminish desire.
o In making the diagnosis, clinicians must evaluate a
patient's age, general health, and life stresses and must
attempt to establish a baseline of sexual interest before
the disorder began.
o Married couples have coitus three times a month, on
average.
o The diagnosis should not be made unless the lack of desire
is a source of distress to a patient.
DSM-5 Diagnostic Criteria for Hypoactive Sexual Desire Disorder
A. Persistently or recurrently deficient (or absent) sexual
fantasies and desire for sexual activity. The judgment of
deficiency or absence is made by the clinician, taking into
account factors that affect sexual functioning, such as age
and the context of the person's life.
B. The disturbance causes marked distress or interpersonal
difficulty.
C. The sexual dysfunction is not better accounted for by
another Axis I disorder (except another sexual dysfunction)
and is not due exclusively to the direct physiological
effects of a substance (e.g., a drug of abuse, a medication)
or a general medical condition.
o Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors
Female Sexual Arousal Disorder
o in terms of the physiological arousal response
o physiological studies of sexual dysfunctions indicate that a
hormonal pattern may contribute to responsiveness in
women who have excitement-phase dysfunction.
o William Masters and Virginia Johnson found women
particularly desirous of sex before the onset of the
menses.
o other women report feeling the greatest sexual
excitement immediately after the menses or at the time of
ovulation
o alterations in testosterone, estrogen, prolactin, and
thyroxin levels have been implicated in female sexual
arousal disorder
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o also, medications with antihistaminic or anticholinergic
properties cause a decrease in vaginal lubrication
DSM-5 Diagnostic Criteria for Female Sexual Arousal Disorder
A. Persistent or recurrent inability to attain, or to maintain
until completion of the sexual activity, an adequate
lubrication-swelling response of sexual excitement.
B. The disturbance causes marked distress or interpersonal
difficulty.
C. The sexual dysfunction is not better accounted for by
another Axis I disorder (except another sexual dysfunction)
and is not due exclusively to the direct physiological
effects of a substance (e.g., a drug of abuse, a medication)
or a general medical condition.
o Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors
Male Erectile Disorder
o also called erectile dysfunction and impotence
o A man with lifelong male erectile disorder has never been
able to obtain an erection sufficient for vaginal insertion
o In acquired male erectile disorder, a man has successfully
achieved vaginal penetration at some time in his sexual life
but is later unable to do so.
o In situational male erectile disorder, a man is able to have
coitus in certain circumstances but not in others
o Acquired male erectile disorder has been reported in 10-20
% of all men
o Impotence is the chief complaint of more than 50 % of all
men treated for sexual disorders
o Lifelong male erectile disorder is rare; it occurs in about 1
percent of men under age 35, but the incidence increases
with age
o can be organic or psychological or a combination of both,
but in young and middle-aged men the cause is usually
psychological
o a good history is of primary importance in determining the
cause of the dysfunction.
o If a man reports having spontaneous erections at times
when he does not plan to have intercourse, having morning
erections, or having good erections with masturbation or
with partners other than his usual one, the organic causes
of his impotence can be considered negligible
o Freud ascribed one type of impotence to an inability to
reconcile feelings of affection toward a woman with
feelings of desire for her
o Men with such conflicting feelings can function only with
women whom they see as degraded (Madonna-Putana
complex).
o Other factors: include a punitive superego, an inability to
trust, and feelings of inadequacy or a sense of being
undesirable as a partner
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 PSYCHOLOGY
ABNORMAL SEXUALITY AND SEXUAL DYSFUNCTIONS
Dr. Pagaddu November 2019
DSM-5 Diagnostic Criteria for Male Erectile Disorder
A. Persistent or recurrent inability to attain, or to maintain
until completion of the sexual activity, an adequate
erection.
B. The disturbance causes marked distress or interpersonal
difficulty.
C. The erectile dysfunction is not better accounted for by
another Axis I disorder (other than a sexual dysfunction)
and is not due exclusively to the direct physiological
effects of a substance (e.g., a drug of abuse, a medication)
or a general medical condition.
o Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors
Orgasm Disorders
Female Orgasmic Disorder
— sometimes called inhibited female orgasm or anorgasmia
— the recurrent or persistent inhibition of female orgasm, as
manifested by the recurrent delay in, or absence of, orgasm
after a normal sexual excitement phase that a clinician
judges to be adequate in focus, intensity, and duration
— in short, a woman's inability to achieve orgasm by
masturbation or coitus
— A woman with lifelong female orgasmic disorder has never
experienced orgasm by any kind of stimulation.
— A woman with acquired orgasmic disorder has previously
experienced at least one orgasm, regardless of the
circumstances or means of stimulation, whether by
masturbation or while dreaming during sleep.
— Lifelong female orgasmic disorder is more common among
unmarried women than married women
— Acquired female orgasmic disorder is a common complaint
in clinical populations
— overall prevalence of female orgasmic disorder from all
causes is estimated to be 30 percent
— A recent twin study suggests that orgasmic dysfunction in
some females has a genetic basis and cannot be attributed
solely to cultural differences
— Numerous psychological factors are associated with female
orgasmic disorder
§ fears of impregnation
§ rejection by a sex partner
§ damage to the vagina
§ hostility toward men
§ feelings of guilt about sexual impulses
— Nonorgasmic women may be otherwise symptom free or
may experience frustration in a variety of ways; they may
have such pelvic complaints as lower abdominal pain,
itching, and vaginal discharge, as well as increased tension,
irritability, and fatigue.
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2021
Male Orgasmic Disorder
— sometimes called inhibited orgasm or retarded ejaculation
— a man achieves ejaculation during coitus with great
difficulty, if at all
— A man with lifelong orgasmic disorder has never been able
to ejaculate during coitus.
— diagnosed as acquired if it develops after previously normal
functioning
— the case of men who ejaculate but complain of a decreased
or absent subjective sense of pleasure during the orgasmic
experience (orgasmic anhedonia)
— incidence is much lower than the incidence of premature
ejaculation or impotence
— prevalence of 5 %
— Lifelong male orgasmic disorder indicates severe
psychopathology
§ may come from a rigid, puritanical background
§ he may perceive sex as sinful and the genitals as
dirty
§ he may have conscious or unconscious incest
wishes and guilt
§ aggravated by an ADHD
— acquired male orgasmic disorder frequently reflects
interpersonal difficulties
— may be a man's way of coping with real or fantasized
changes in a relationship, such as plans for pregnancy about
which the man is ambivalent, the loss of sexual attraction
to the partner, or demands by the partner for greater
commitment as expressed by sexual performance
— in some men, the inability to ejaculate reflects unexpressed
hostility toward a woman
— more common among men with obsessive-compulsive
disorder (OCD)
DSM-5 Diagnostic Criteria for Female Orgasmic Disorder
A. Persistent or recurrent delay in, or absence of, orgasm
following a normal sexual excitement phase. Women
exhibit wide variability in the type or intensity of
stimulation that triggers orgasm. The diagnosis of female
orgasmic disorder should be based on the clinician's
judgment that the woman's orgasmic capacity is less than
would be reasonable for her age, sexual experience, and
the adequacy of sexual stimulation she receives.
B. The disturbance causes marked distress or interpersonal
difficulty.
C. The orgasmic dysfunction is not better accounted for by
another Axis I disorder (except another sexual dysfunction)
and is not due exclusively to the direct physiological
effects of a substance (e.g., a drug of abuse, a medication)
or a general medical condition.
— Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors
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Dr. Pagaddu November 2019
Premature Ejaculation
— men persistently or recurrently achieve orgasm and
ejaculation before they wish to
— the diagnosis is made when a man regularly ejaculates
before or immediately after entering the vagina
— consider factors that affect the duration of the excitement
phase:
§ Age
§ the novelty of the sex partner
§ the frequency and duration of coitus
— Masters and Johnson conceptualized the disorder in terms
of the couple and considered a man a premature ejaculator
if he could not control ejaculation sufficiently long enough
during intravaginal containment to satisfy his partner in at
least half their episodes of coitus
— more commonly reported among college-educated men
than among men with less education
— the chief complaint of about 35 to 40 percent of men
treated for sexual disorders.
— Some researchers divide men who experience premature
ejaculation into two groups:
§ those who are physiologically predisposed to
climax quickly because of shorter nerve latency
time
§ those with a psychogenic or behaviorally
conditioned cause
— Difficulty in ejaculatory control can be associated with
anxiety regarding the sex act, with unconscious fears about
the vagina, or with negative cultural conditioning.
— In ongoing relationships, the partner has a great influence
on a premature ejaculator, and a stressful marriage
exacerbates the disorder
DSM-5 Diagnostic Criteria for Premature Ejaculation
A. Persistent or recurrent ejaculation with minimal sexual
stimulation before, on, or shortly after penetration and
before the person wishes it. The clinician must take into
account factors that affect duration of the excitement
phase, such as age, novelty of the sexual partner or
situation, and recent frequency of sexual activity.
B. The disturbance causes marked distress or interpersonal
difficulty.
C. The premature ejaculation is not due exclusively to the
direct effects of a substance (e.g., withdrawal from
opioids).
— Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors
Sexual Pain Disorders
Dyspareunia
— recurrent or persistent genital pain occurring in either men
or women before, during, or after intercourse
— much more common in women than in men
— dyspareunia is related to, and often coincides with,
vaginismus
— repeated episodes of vaginismus can lead to dyspareunia
and vice versa
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2021
— should not be diagnosed when an organic basis for the pain
is found or when, in a woman, it is caused exclusively by
vaginismus or by a lack of lubrication
— incidence is unknown
— in most cases, dynamic factors are considered causative
— chronic pelvic pain is a common complaint in women with a
history of rape or childhood sexual abuse
— painful coitus can result from tension and anxiety about the
sex act that cause women to involuntarily contract their
vaginal muscles
— can also occur in men, but it is uncommon and is usually
associated with an organic condition, such as herpes,
prostatitis, or Peyronie's disease, which consists of sclerotic
plaques on the penis that cause penile curvature
DSM-5 Diagnostic Criteria for Dyspareunia
A. Recurrent or persistent genital pain associated with sexual
intercourse in either a male or a female.
B. The disturbance causes marked distress or interpersonal
difficulty.
C. The disturbance is not caused exclusively by vaginismus or
lack of lubrication, is not better accounted for by another
Axis I disorder (except another sexual dysfunction), and is
not due exclusively to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general
medical condition.
— Specify type:
Lifelong type
Acquired type
Specify type:
Generalized type
Situational type
Specify:
Due to psychological factors
Due to combined factors
Vaginismus
— an involuntary muscle constriction of the outer third of the
vagina that interferes with penile insertion and intercourse
— may occur during a gynecological examination when
involuntary vaginal constriction prevents the introduction of
the speculum into the vagina
— less prevalent than female orgasmic disorder
— most often afflicts highly educated women and those in high
socioeconomic groups
— women with vaginismus may consciously wish to have coitus,
but unconsciously wish to keep a penis from entering their
bodies.
o sexual trauma, such as rape
o with psychosexual conflicts, may perceive the penis as a
weapon
o a strict religious upbringing in which sex is associated
with sin
o if women feel emotionally abused by their partners,
they may protest in this nonverbal fashion
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Dr. Pagaddu November 2019
DSM-5 Diagnostic Criteria for Vaginismus feature is predominant (e.g., orgasmic disorder) or
A. Recurrent or persistent involuntary spasm of the no feature predominates
musculature of the outer third of the vagina that interferes § Coding note: Include the name of the general
with sexual intercourse. medical condition on Axis I, e.g., male erectile
B. The disturbance causes marked distress or interpersonal disorder due to diabetes mellitus; also code the
difficulty. general medical condition on Axis III.
C. The disturbance is not better accounted for by another
Axis I disorder (e.g., somatization disorder) and is not due Diseases and Other Medical Conditions Implicated in Male Erectile
exclusively to the direct physiological effects of a general Disorder
medical condition. — Infectious and parasitic diseases
— Specify type: Elephantiasis
Lifelong type Mumps
Acquired type — Cardiovascular diseasea
Specify type: Atherosclerotic disease
Generalized type Aortic aneurysm
Situational type Leriche's syndrome
Specify: Cardiac failure
Due to psychological factors — Renal and urological disorders
Due to combined factors Peyronie's disease
Chronic renal failure
Sexual Dysfunction due to a General Medical Condition Hydrocele and varicocele
— The category sexual dysfunction due to a general medical — Hepatic disorders
condition covers sexual dysfunction that results in marked Cirrhosis (usually associated with alcohol dependence)
distress and interpersonal difficulty; the history, physical — Pulmonary disorders
examination, or laboratory findings must provide evidence of Respiratory failure
a general medical condition judged to be causally related to — Genetics
the sexual dysfunction. Klinefelter's syndrome
Congenital penile vascular and structural abnormalities
DSM-5 Diagnostic Criteria for Sexual Dysfunction Due to a General — Nutritional disorders
Medical Malnutrition
A. Clinically significant sexual dysfunction that results in Vitamin deficiencies
marked distress or interpersonal difficulty predominates in Obesity
the clinical picture. — Endocrine disordersa
B. There is evidence from the history, physical examination, Diabetes mellitus
or laboratory findings that the sexual dysfunction is fully Dysfunction of the pituitary-adrenal-testis axis
explained by the direct physiological effects of a general Acromegaly
medical condition. Addison's disease
C. The disturbance is not better accounted for by another Chromophobe adenoma
mental disorder (e.g., major depressive disorder). Adrenal neoplasia
o Select, code and term based on the predominant sexual Myxedema
dysfunction: Hyperthyroidism
§ Female hypoactive sexual desire disorder due to — Neurological disorders
…[indicate the general medical condition]: if Multiple sclerosis
deficient or absent sexual desire is the predominant Transverse myelitis
feature Parkinson's disease
§ Male hypoactive sexual desire disorder due to Temporal lobe epilepsy
…[indicate the general medical condition]: if Traumatic and neoplastic spinal cord diseasesa
deficient or absent sexual desire is the predominant Central nervous system tumor
feature Amyotrophic lateral sclerosis
§ Male erectile disorder due to …[indicate the Peripheral neuropathy
general medical condition]: if male erectile General paresis
dysfunction is the predominant feature Tabes dorsalis
§ Female dyspareunia due to …[indicate the — Pharmacological factors
general medical condition]: if pain associated with Alcohol and other dependence-inducing substances (heroin,
intercourse is the predominant feature methadone, morphine, cocaine, amphetamines, and
§ Male dyspareunia due to …[indicate the general barbiturates)
medical condition]: if pain associated with Prescribed drugs (psychotropic drugs, antihypertensive
intercourse is the predominant feature drugs, estrogens, and antiandrogens)
§ Other female sexual dysfunction due to Poisoning
…[indicate the general medical condition]: if Lead (plumbism)
some other feature is predominant (e.g., orgasmic Herbicides
disorder) or no feature predominates — Surgical proceduresa
§ Other male sexual dysfunction due to …[indicate Perineal prostatectomy
the general medical condition]: if some other Abdominal-perineal colon resection

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ABNORMAL SEXUALITY AND SEXUAL DYSFUNCTIONS 2021
Dr. Pagaddu November 2019
Sympathectomy (frequently interferes with ejaculation) agents. It is difficult to separate those effects from the
Aortoiliac surgery underlying condition or from improvement of the condition.
Radical cystectomy Sexual dysfunction associated with the use of a drug
Retroperitoneal lymphadenectomy disappears when use of the drug is discontinued.
— Miscellaneous
Radiation therapy DSM-5 Diagnostic Criteria for Substance-Induced Sexual
Pelvic fracture Dysfunction
Any severe systemic disease or debilitating condition A. Clinically significant sexual dysfunction that results in
marked distress or interpersonal difficulty predominates in
Neurophysiology of Sexual Dysfunction the clinical picture.
DA 5-HT NE ACh Clinical Correlation B. There is evidence from the history, physical examination,
or laboratory findings that the sexual dysfunction is fully
explained by substance use as manifested by either (1) or
Erection Inc Minimal Alpha M Antipsychotics may (2):
1,bet lead to erectile
— the symptoms in Criterion A developed during, or
a dec, dysfunction (DA
within a month of, substance intoxication
inc block): DA agonists
may lead to — medication use is etiologically related to the
enhanced erection disturbance
and libido; priapism C. The disturbance is not better accounted for by a sexual
with trazodone dysfunction that is not substance induced. Evidence that
(alpha1, block); the symptoms are better accounted for by a sexual
beta2-blockers may dysfunction that is not substance induced might include
lead to impotence the following: the symptoms precede the onset of the
substance use or dependence (or medication use); the
Ejaculation minimal Some dec Alpha M alpha1-Blockers
and orgasm 1 inc (tricyclic drugs,
symptoms persist for a substantial period of time (e.g.,
MAOls, thioridazine) about a month) after the cessation of intoxication, or are
may lead to substantially in excess of what would be expected given
impaired the type or amount of the substance used or the duration
ejaculation; 5-HT of use; or there is other evidence that suggests the
agents may inhibit existence of an independent non–substance-induced
orgasm sexual dysfunction (e.g., a history of recurrent
non–substance-related episodes).
↑, facilities; ↓, inhibits or decreases; ±, some; ACh, acetylcholine; DA
dopamine; 5-HT serotonin; M, modulates; NE, norepinephrine; , minimal
Note: This diagnosis should be made instead of a diagnosis of
substance intoxication only when the sexual dysfunction is in
Some Antipsychotic Drugs Implemented in Inhibited Female excess of that usually associated with the intoxication
Orgasm syndrome and when the dysfunction is sufficiently severe to
warrant independent clinical attention.
— Tricyclic antidepressants
— Code [Specific substance]-induced sexual dysfunction:
Imipramine (Tofranil)
Alcohol; amphetamine [or amphetamine-like
Clomipramine (Anafranil)
substance]; cocaine; opioid; sedative, hypnotic, or
Nortriptyline (Aventyl)
anxiolytic; other [or unknown] substance
— Monoamine oxidase inhibitors
— Specify if:
Tranylcypromine (Parnate)
With impaired desire
Phenelzine (Nardil)
With impaired arousal
Isocarboxazid (Marplan)
With impaired orgasm
— Dopamine receptor antagonists
With sexual pain
Thioridazine (Mellaril)
— Specify if:
Trifluoperazine (Stelazine)
With onset during intoxication: if the criteria are
— Selective serotonergic receptor inhibitors
met for intoxication with the substance and the
Fluoxetine (Prozac)
symptoms develop during the intoxication syndrome
Paroxetine (Paxil)
Sertraline (Zoloft)
Pharmacological Agents Implicated in Sex Dysfunction
Fluvoxamine (Luvox)
Citalopram (Celexa) — Antipsychotic Drugs
— The interrelation between female sexual dysfunction and § Chlorpromazine
pharmacological agents has been less extensively evaluated § Thioridazine
than male reactions. Oral contraceptives are reported to § Trifluoperazine
decrease libido in some women, and some drugs with — Antidepressant Drugs
anticholinergic side effects may impair arousal as well as § tricyclic and tetracyclic antidepressants
orgasm. Benzodiazepines have been reported to decrease § Venlafaxine and the SSRIs
libido, but in some patients the diminution of anxiety caused § MAOIs
by those drugs enhances sexual function. Both increase and — Lithium
decrease in libido have been reported with psychoactive — Psychostimulants,
§ amphetamines,

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Dr. Pagaddu November 2019
§ Methylphenidat
§ pemoline
— Alpha1-Adrenergic and beta2-Adrenergic Receptor
Antagonists
— Anticholinergics
§ Amantadine and benztropine
— Antihistamines
§ Diphenhydramine
— Antianxiety Agents
§ Benzodiazepines
— Alcohol
— Opioids
§ heroin
— Hallucinogens
§ LSD, PCP, psilocybin, and mescaline
— Cannabis
— Barbiturates and Similarly Acting Drugs
§ Methaqualone - as a sexual enhancer
Sexual Dysfunction not Otherwise Specified
— Examples include persons who experience the physiological
components of sexual excitement and orgasm, but report
no erotic sensation or even anesthesia (orgasmic
anhedonia).
— Women with conditions analogous to premature
ejaculation in men are classified here.
— Orgasmic women who desire, but have not experienced,
multiple orgasms can be classified under this heading as
well.
— Also, disorders of excessive, rather than inhibited,
dysfunction, such as compulsive masturbation or coitus (sex
addiction), or those with genital pain occurring during
masturbation may be classified here.
— Other unspecified disorders are found in persons who have
one or more sexual fantasies about which they feel guilty or
otherwise dysphoric, but the range of common sexual
fantasies is broad.
DSM-5Diagnostic Criteria for Sexual Dysfunction Not Otherwise
Specified
A. This category includes sexual dysfunctions that do not
meet criteria for any specific sexual dysfunction. Examples
include: No (or substantially diminished) subjective erotic
feelings despite otherwise normal arousal and orgasm
B. Situations in which the clinician has concluded that a
sexual dysfunction is present but is unable to determine
whether it is primary, due to a general medical condition,
or substance induced
Postcoital Headache
— characterized by headache immediately after coitus
— may last for several hours
— throbbing and is localized in the occipital or frontal area
— cause is unknown
— may be vascular, muscle-contraction (tension), or
psychogenic causes
— coitus may precipitate migraine or cluster headaches in
predisposed persons
Orgasmic Anhedonia
— a condition in which a person has no physical sensation of
orgasm, even though the physiological component (e.g.,
ejaculation) remains intact
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— Organic causes, such as sacral and cephalic lesions that
interfere with afferent pathways from the genitalia to the
cortex, must be ruled out.
— These feelings produce a dissociative response that isolates
the affective component of the orgasmic experience from
consciousness.
Treatment
— Before 1970, the most common treatment of sexual
dysfunctions was individual psychotherapy
— Treatment focuses on the exploration of unconscious
conflicts, motivation, fantasy, and various interpersonal
difficulties.
— One of the assumptions of therapy is that removal of the
conflicts allows the sexual impulse to become structurally
acceptable to the ego, and thereby the patient finds
appropriate means of satisfaction in the environment.
Dual-Sex Therapy
— The theoretical basis of dual-sex therapy is the concept of
the marital unit or dyad as the object of therapy; the
approach represents the major advance in the diagnosis
and treatment of sexual disorders in the 20th century.
— treatment is based on a concept that the couple must be
treated when a dysfunctional person is in a relationship
— The keystone of the program is the roundtable session in
which a male and female therapy team clarifies, discusses,
and works through problems with the couple.
— Therapists and patients discuss the psychological and
physiological aspects of sexual functioning, and therapists
have an educative attitude. Therapists suggest specific
sexual activities, which the couple follow in the privacy of
their home.
— The aim of the therapy is to establish or reestablish
communication within the marital unit.
— treatment is short-term and behaviorally oriented.
Specific Techniques and Exercises
— In cases of vaginismus, a woman is advised to dilate her
vaginal opening with her fingers or with size graduated
dilators.
— In cases of premature ejaculation, an exercise known as
the squeeze technique is used to raise the threshold of
penile excitability. In this exercise, the man or the woman
stimulates the erect penis until the earliest sensations of
impending ejaculation are felt. At this point, the woman
forcefully squeezes the coronal ridge of the glans, the
erection is diminished, and ejaculation is inhibited. Sex
therapy has been most successful in the treatment of
premature ejaculation.
— A man with a sexual desire disorder or male erectile
disorder is sometimes told to masturbate to prove that full
erection and ejaculation are possible.
— Male orgasmic disorder is managed initially by extravaginal
ejaculation and then by gradual vaginal entry after
stimulation to a point near ejaculation. Most importantly,
the early exercises forbid ejaculation to remove the
pressure to climax and allow the man to immerse himself
in sexual pleasuring.
— In cases of lifelong female orgasmic disorder, the woman is
directed to masturbate, sometimes using a vibrator. The
shaft of the clitoris is the masturbatory site most preferred
by women, and orgasm depends on adequate clitoral
stimulation
7
 PSYCHOLOGY
EXIMIUS
ABNORMAL SEXUALITY AND SEXUAL DYSFUNCTIONS 2021
Dr. Pagaddu November 2019
§ Hypnotherapy
§ Behavior Therapy
§ Group Therapy
§ Analytically Oriented Sex Therapy
§ Biological Treatments
— pharmacotherapy, surgery, and mechanical devices, are
used to treat specific cases of sexual disorder

Pharmacotherapy
— sildenafil (Viagra) and its congeners, oral phentolamine
(Vasomax); alprostadil (Caverject), an injectable
prostaglandin; and a transurethral alprostadil (MUSE), all
used to treat erectile disorder
— Other Pharmacological Agents
— Intravenous methohexital sodium (Brevital) has been used
in desensitization therapy
— Hormone Therapy
— Androgens
— two new forms of estrogen, vaginal rings and vaginal
tablets, provide alternate administration routes to treat
women with arousal problems or genital atrophy.
— Antiandrogens and Antiestrogens
— Clomiphene (Clomid) and tamoxifen (Nolvadex) are both
antiestrogens
— Mechanical Treatment Approaches
— by decreasing pelvic thrusting, which is also aided by the
woman's superior coital position
— Vacuum Pump
— Vacuum pumps are mechanical devices that patients
without vascular disease can use to obtain erections. The
blood drawn into the penis following the creation of the
vacuum is kept there by a ring placed around the base of
the penis.
— A similar device, called EROS, has been developed to
create clitoral erections in women.
— Surgical Treatment
— Male Prostheses
— Vascular Surgery
— When vascular insufficiency is present due to
atherosclerosis or other blockage, bypass surgery of penile
arteries has been attempted in selected cases with some
success.

TRANSCRIBERS Group 9 8