PAS Sexual,Dysfunctions* Male hypoactive sexual desire disorder. The ppatient isn’t much interested in sex, though his performance may be adequate once sexual activity has been initiated + Erectile disorder. A man’s erection isn’t sufficient to begin or complete sexual relations + Premature (early) ejaculation. A man experiences repeated instances of climax before, during, or Just after penetration + Delayed ejaculation. Despite a normal period of ‘sexual excitement, a man’s climax is either delayed or does not occur at all *+ Female sexual interest/arousal disorder. A ‘woman lacks interest in sex or does not become aroused enough + Genito-pelvic pain/penetration disorder. Genital ppain occurs (only in women) during sexual intercourse, often during insertion + Female orgasmic disorder. Despite a normal period of sexual excitement, a woman's climax either is delayed or does not occur at all* people cannot respond normally in key areas of sexual SEXUAL functioning, make it difficult or impossible to enjoy DYSFUNCTIONS sexual intercourse, * desire, excitement, orgasm, and resolutiondesire phase The phase of the sexual response cycle consisting of an urge to have sex, sexual fantasies, and sexual attraction to others. ‘excitement phase The phase of the sexual response cycle marked by changes in the pelvic region, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing. ‘orgasm phase The phase of the sexual response cycle during which a person’s sexual pleasure peaks and sexual tension is released as muscles in the pelvic region contract rhythmically resolution consists simply of the relaxation and reduction in arousal that follow orgasm.vesnany endonnsag yaar* The sexual dysfunctions usually begin in early adulthood * Most of them are quite common. Any of them can be caused by psychological or biological factors or by a combination of these. Sexual * Lifelong or Acquired. D f . . Utelong (also called primary) means tat. this dysfunction has been present since the stun ctions begi Ting Gf active sexual fu nctioning. * Acquired means that at some time the patient has been able to have sex without that particular dysfunction. * Generalized or Situational * Generalized and situational don’t apply to genito-pelvic pain/penetration disorder.Partner factors (such as partner’s sexual problems or health status) Relationship factors (such as poor communication, relationship discord, discrepancies in desire for sexual activity) Individual vulnerability factors (such as a history of abuse or poor body image) Cultural/religious factors (for example, inhibitions related ta prohibitions against sexual activity) Medical factors relevant to prognosis, course, or treatment (any chronic illness could be an example* Men with male hypoactive sexual desire disorder persistently lack or have reduced Interest in sex and engage In little sexual activity + Nevertheless, when they do have sex, thel physical responses may be normal and the may enjoy the experience + 18 percent of men Je have thisEssential Features of Male Hypoactive Sexual Desire Disorder + Aman lacks erotic thoughts or wishes for sexual activity. + The clinician must judge the deficiency in light of age and other factors that can affect sexual function + Duration (6+ months) + Distress to the patientWomen with female sexual interest/arousal disorder also lack normal interest in sex and rarely initiate sexual In addition, many such women feel little excitement during sexual activity, are unaroused by erotic cues, and have few genital or nongenital sensations during sexual activity As many as 39 percent of women worldwide have reduced sexual interest and arousal There may be a history of painful intercourse, feelings of guilt, or rape or other sexual trauma occurring in childhood or in a patient's earlier sexual lifeEssential + A woman’ low sens interest o arousal is indicated by minimal interest in sexual ori} or of activity, erotic thoughts, response to 4 partner overtures, and enjoyment during sex. She will generally not initiate sexual activity and doesn’t “turn on” to erotic literature, movies, and the like * Duration (6+ months) + Distress to the patientErectile Disorder Men with erectile disorder persistently fail to attain or maintain an erection during sexual activity This problem occurs in 15 to 25 percent of the male population Nocturnal penile tumescence (NPT) - erection during sleep. Performance anxiety — the fear of performing inadequately and a related tension that are experienced during sex. + Spectator role ~a state of mind that some people experience during sex, focusing on their sexual performance to such an extent that their performance and their enjoyment are reduceFeatures of «repent ayn marked trouble achieving or . maintaining an erection adequate E re ctl le to consummate sex * Duration (6+ months) * Distress to the patient+ Aman suffering from premature ejaculation (also called early, or rapid, ejaculation) persistently reaches orgasm and ejaculates within 1 minute Premature of beginning sexual activity with a partner and before he wishes to Ejaculation * As many as 30 percent of men worldwide ejaculate early at some time * Anxiety during adolescence* The patient almost always ejaculates before he + wants to, within moments of penetration. Essential * Duration (6+ months) Features of * Distress to the patient * Specify severity: Premature ® Mild, The patient eaculates 30-60 seconds after penetration. (Early) 2 alert. 16 50 tacos db . cs penetration. Ejaculation «Rrcnaeas pasridv anes pana less (perhaps before penetration).* Aman with delayed ejaculation (previously called male orgasmic disorder or inhibited male orgasm) persistently is unable to ejaculate or Delayed has very delayed ejaculations during Ejaculation sexual activity with a partner * As many as 10 percent of men worldwide have this disorderEssential Features of Delayed Ejaculation * The man experiences pronounced delay or infrequency of climax. * Duration (6+ months) * Distress to the patientWomen with female orgasmic disorder persistently fail to reach orgasm, have very low intensity orgasms, or have a very delayed orgasm Around 21 percent of women apparently experience this pattern ta some degree Studies indicate that 10 percent or more. of women have never had an orgasm, either alone or during intercourse, and at least another 9 percent rarely have orgasms Psychological factors: fear of pregnancy, hostility of the patient toward her partner, and feeling guilty about sex in general, Age, previous sexual experience, and the adequacy of foreplay must also be considered in diagnosing FOD.i . Essential + Awoman has been troubled by orgasms that are too slow, too rare, or too weak. * Duration (6+ months) * Distress to the patient * Specify if: Never experienced an orgasm under any situationFor some women with genito-pelvic pain/penetration disorder the muscles around the outer third of the vagina involuntarily contract, preventing entry of the penis * Vaginismus or Pelvic Floor HypertanusEssential Features of A patient has major, repeated pain or other problems with efforts at vaginal intercourse; she may experience anxiety, fear, or pelvic muscle tension. * Duration (6+ months) * Distress to the patientWhat Are the (eteiatel| Features of Sex Therapy? * Modern sex therapy is short-term and instructive * Therapy typically lasts 15 to 20 sessions * It is centered on specific sexual problems rather than on broad. personality issuesMae RTS (Tal ie] Features of Sex Bi it-ie-] Via Quick Guide to the Paraphilic Disorders ‘+ Modern sex therapy focuses on: '* Assessment and conceptualization of the problem ‘© Mutual responsibility ‘© Education about sexuality ‘© Emotion identification * Attitude change ‘© Elimination of performance anxiety and the spectator role «Increasing sexual and general communication skills ‘© Changing destructive lifestyles and ‘marital interactions '* Addressing physical and medical factors + Aparaphic disorders dlagnosed when a person fels distressed ‘ris impaired by such a behavior Neary al of them are proceed largely perhaps exclusively, by males. + Fetsisic disorder. The patient has senso urges elated to the use of inanimate objects (ental against person wh has not consented to this + Pedoohilc disorder. The patient has urges ivcvng sexual ‘cts with ciéren + Sexual masochism disorder The pationt has senal urges related + Sexual sadim disorder. The patent has sexual urges related to + Tanwvesticdlsordet An individual has senual urges related to cose dressing + Voyeuritic disorder. The patient has urges relate to viewing‘ Paraphilias are characterized by intense sexual urges, fantasies or behaviors that involve objects or situations outside the usual sexual norms, including: Nonhumans Disorders Children ‘© Nonconsenting adults ‘The experience of suffering or humiliation Paraphilic * In descending order, the most common paraphilic dsorders are pedophile, txhibtionstic, voyeuriste, and frotteurist. aH * Frotteurs, voyeurs, sadists, and exhibitionists Paraphilic are acutely aware of thie precarious legal , State ond usualy take pains to avold PI elgel ie) detection or to plan their escape. '* Pedophiles may delude themselves that what they ae doing somehow benefits the children they target.ua ale Pelco —g * Key features of this disorder are recurrent intense sexual urges, sexually arousing fantasies, or behaviors that involve the use of a nonliving object or nongenital body part, often to the exclusion of all other stimuli Usually the disorder, which is far more eRe ne peered Sun ace conan d to collect as many of the desired objects as possible. Seeder ee a Ce Ca ae hue! et eg eae! Cae earn? sex. Bilao ae Disorder Denno ra cy Se RCo anes eee ae tne renee et heat ai) Cee cetera e Be eee Rae aun oe Meee esExhibitionistic Pol gel-1g Seu Cun ace experiences recurrent and intense sexual Pee eae te ace unsuspecting individual—arousal reflected by fantasies, urges, or behaviors Oe un eo cd Se Rue Pearce Voyeuristic Disorder tecurrent and intense sexual ousal from ‘observing an unsuspecting individual who Is staked, dsrobing, oF engaging in seal activity. [swith other paraphite disorders, this arousal takes the form of fantasies, urges, or behaviors + The disorder usualy begins before the age of Sond tends to pers + Masturbate ducing the act of observing ot + The vuerablity ofthe people being observed and the probability that they would. feel humiliated’ they “knew they were under observation are often part of the enjoyment.Frotteuristic Disorder Pedophilic Disorder One aese e kg Cet Ea Sort arousal from touching or rubbing against a Cena tir + Frottage (from French frotter, “to rub") is Perec a et tet Beret eo meee rc + This paraphilia usually begins in the teenage Neue mut ote observes others committing an act of ers ST oe eo eT coy Cee eet eed cc AA person with pedophilic disorder experiences equal fr greater sexual arousal from children than from physically mature people. Those with the disorder may be attracted to prepubescent children (classic type), early pubescent children (hebephile type), or both (pedohebephilic type. Some people with pedophile disorder are satisfied by child pornography or seemingly innocent material such as children’s underwear ads; others are driven to Some people with the disorder are attracted only to children; others are attracted to adults 2s well Both boys and girs can be pedophilc victims, but there is evidence suggesting that two-thirds are girsSalt) Features of Pedophilic Disorder SOUT Masochism Disorder + The patient is senually aroused by prepubescent children and has acted on the urge (o feels ‘istress/interpersonal impairment at the idea). + Duration (6+ months) + Demographics (the patient must be at least 16 years ‘ld and at least 5 years older than the vitim) + Specty + Exclusive type (aroused solely by children) + Monexclusive type + Specity if: + Sexualy attracted to males + Sexualy attracted to females + Soxualy attracted to both + Specty if: Limited to incest * Aperson with sexual masochism disorder is repeatedly and intensely sexually aroused by the act of being humiliated, beaten, bound, or otherwise made to suffer + Some people with the disorder act on the ‘masochistic urges by themselves, perhaps tying, sticking pins into, or even cutting themselves. + Others have their sexual partners restrain, tie up, blindfold, spank, paddle, whip, beat, electrically shock, “pin and pierce,” or humiliate themSIoT]) Masochism 1D) Ke] gol) SUE) Sadism Disorder + Hypoxyphilia - people strangle or smother themselves (or ask their partner to strangle them) in order to enhance their sexual pleasure. + Based on cinical reports of autoerotic asphyxia, in which people, usually males and as young as 10 years old, may accidentally induce a fatal lack cof oxygen by hanging, suffocating, or strangling themselves while masturbating + Most masochistic sexual fantasies begin in childhood. However, the person does not act out the urges until later, usualy by early adulthood. + Sexual masochism disorder seems to have developed through the learning process of classical conditioning + Aperson with sexual sadism disorder, usually male, is repeatedly and intensely sexually aroused by the physical or psychological suffering of another individual * This arousal may be expressed through fantasies, urges, or behaviors, including acts such as dominating, restraining, blindfoiding, cutting, strangling, mutilating, or even killing the victim + Cognitive-behavioral theorists also propose that the disorder may result from modeling, when adolescents observe others achieving sexual satisfaction by inflicting pain.