Ricky Bonatio 1215130

Pembimbing :
dr. Ade Kurnia Sp.KJ
 Normal Sexuality

Classical Era Middle Age The End Of Renaissance MODERN

Hippocrates Islamic Physicians Linen Sheath • Contraception

• Aid Erection
• Replace hormones
Coitus Interruptus

Psychosexual  personality development and functioning as these are affected by sexuality

Psychosexual Factors

 Sexuality depends on four interrelated psychosexual factors:

 sexual identity,
 gender identity,
 sexual orientation, and
 sexual behavior
 These factors affect
 Personality,
 Growth,
 Development, and
 Functioning.
Sexual Dysfunction

 Sexual Dysfunction (SD) ICD 10 include :

 Desire, interest, arousal disorder
 Male hypoactive sexual desire disorder
 Female sexual interest/ arousal disorder,
 Erectile disorder

 Orgasm Disorder
 Female orgasmic disorder
 Delayed ejaculation
 Early ejaculation

 Genito-pelvic pain / penetration disorder

 Medication induced dysfunction
Male Hypoactive Sexual Desire Disorder

 Characteristic  a deficiency or absence of sexual fantasies

and desire for sexual activity for a minimum duration of
approximately 6 months
 Freud  vagina dentata  the men avoid contact with the
vagina when they unconsciously believe that the vagina has
teeth..!!!
 Abstinence from sex for a prolonged period  suppression of
sexual impulses
 Loss of desire  expression of hostility to a partner, sign of
deteriorating relationship
Male Hypoactive Sexual Desire Disorder
 DSM V Criteria :
 Persistently or recurrently deficient (absent)
sexual erotic thought or fantasies or desires for
sexual activity
 The symptoms in Criterion A have persisted for a
minimum duration of approximately 6 months.
 The symptoms in Criterion A cause clinically
significant distress in the individual
 Lifelong  present since individual became
sexually active
 Acquired  began after a period of relatively
normal sexual function
 Generalized  not limited of certain types of
stimulations, situations, or partners
 Situational  occurs with certain types of
stimulation, situations, or partners
 Mild  evidence of mild distress
 Moderate  evidence of moderate distress
 Severe  evidence of severe or extreme
distress
Female Sexual Interest/Arousal Disorder

 Complaints in this dysfunction category present variously as :

 A decrease or paucity of erotic feelings, thought, or fantasies;
 A decreased impulse to initiate sex;
 A decreased or absent receptivity to partner overtures;
 An inability to respond to partner stimulation
 Physiological studies of sexual dysfunction  hormonal pattern may contribute to
responsiveness in women
 William Masters and Virginia Johnson  desirous of sex before the onset of the menses;
others  after menses or at the time of ovulation
 Medication with antihistaminic or anticholinergic cause a decrease in vaginal lubrication
Female Sexual Interest/Arousal Disorder

 DSM-5 Criteria :
 Lack of, or significantly reduced, sexual interest/arousal at least three of the following:
 Absent/reduced interest in sexual activity
 Absent/reduced sexual/erotic thought or fantasies
 No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate
 Absent/reduced sexual excitement/pleasure during sexual activity (75-100%)
 Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (written,
verbal, visual)
 Absent/reduced genital or nongenital sensation during sexual activity (75-100%)

 The symptoms have persisted for a minimum duration  6 months

Male Erectile Disorder

 Male erectile disorder  impotence

 In situational  able to have coitus effectively with a prostitute but be unable to have an
erection when with his partner
 Result of fear, anxiety, anger, or moral prohibition.

Madonna-Putana Complex  can function only with women whom they see as degraded
Male Erectile Disorder

 DSM-5 Criteria
 At least one of the three following
symptoms :
 Marked difficulty in obtaining an
erection during sexual activity
 Marked difficulty in maintaining an
erection until the completion of sexual
activity
 Marked decrease in erectile rigidity

 Persisted for a minimum duration  6

months
Female Orgasmic Disorder

 Sometimes called inhibited female orgasm or anorgasmia

 Defined as 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
 A women’s inability to achieve orgasm by masturbation or coitus
 Psychological factors associated with female orgasmic disorder :
 Fears of impregnation
 Rejection by a sex partner
 Hostility toward men
 Poor body image
 Feelings of guilt about sexual impulses
Female Orgasmic Disorder

 DSM-5 Criteria
 Presence of either of the following symptoms :
 Marked delay in, marked infrequency of, or absence of orgasm
 Markedly reduced intensity of orgasmic sensation

 Minimum duration  6 months

Delayed Ejaculation

 Sometimes called retarded ejaculation  achieves ejaculation during coitus with great
difficulty
 Rarely present with masturbation, but sometimes appears with sex partner
 Antidepressant and high use of internet pornography sites prolonged ejaculation
Delayed Ejaculation

 DSM-5 Criteria
 Either of the following symptoms :
 Marked delay in ejaculation
 Marked infrequency or absence of ejaculation

 Minimum duration  6 months

Premature (Early) Ejaculation

 The diagnosis is made when a man regularly ejaculates before or within 1 minute after
penetration…!!!!  vaginal penetration
 Mild  30 seconds to 1 minute
 Moderate  15 – 30 seconds
 Severe  start of sexual activity or within 15 seconds of vaginal penetration
 Premature ejaculation is more commonly reported among college-educated men than
among men with less education
 Difficulty in ejaculatory control can be associated with anxiety, unconscious fears about
vagina, contact with prostitutes (demanded for quick sex), some situation in which
discovery would be embarrassing (shared dormitory room, parental home)
Premature (Early) Ejaculation

 DSM-5 Criteria
 A persistent or recurrent pattern of ejaculation within 1 minute following vaginal penetration and
before the individual wishes it
 Minimum duration 6 months
Genito-Pelvic Pain/Penetration Disorder

 This disorder refers to one or more of the following complaints :

 Difficulty having intercourse
 Genito-pelvic pain
 Fear of pain or penetration
 Tension of the pelvic floor muscles
 Dyspareunia  recurrent or persistent genital pain occurring before, during, or after
intercourse
 Chronic pelvic pain because of a history of rape or childhood sexual abuse
 Painful coitus can result from tension and anxiety about sex act cause women to involuntarily
contract their pelvic floor muscles
 Vaginismus  constriction of the outer vagina due to involuntary pelvic floor muscle
tightening or spasm, vaginismus interferes penile insertion and intercourse
 Often afflicts highly educated mowen and those in high socioeconomic groups
Male Erectile Disorder Due to a General
Medical Condition

 Castration (removal of the testes) doesn’t always lead to sexual dysfunction, because
erection may still occur.
 Procedure differentiate organically caused erectile disorder from functional erectile
disorder :
 Monitoring nocturnal penile tumescence (erection that occur during sleep)  strain gauge
 Measuring blood pressure in the penis with penile plethysmograph or a Doppler USG  assess
blodd flow in the internal pudendal artery
Dyspareunia Due To Medical Condition

 Organic abnormalities leading to dyspareunia and vaginismus :

 Irritated or infected hymenal remnants
 Episiotomy scars
 Bartholin’s gland infection
 Vaginitis
 Cervicitis
 Endometriosis
 Adenomyosis
 Postmenopausal dysoareunia resulting from thinning the vaginal mucosa and reduced
lubrication
Male Hypoactive Sexual Disorder And Female
Interest/Arousal Disorder Due To GMC

 Sexual desire commonly decreases after major illness or surgery  mastectomy, ileostomy,
hysterectomy, and prostatectomy
Oral contraceptives are reported to
decrease libido in some women

Prolonged use of oral contraceptives

cause physiologic menopausal like
change
Pharmacological Agents Implicated In
Sexual Dysfunction

 Antipsychotic Drug
 The seminal fluid backs up into the bladder, patients still have a pleasurable sensation, but the orgasm is
dry. When urinating after orgasm, the urine will be milky white because it contains the ejaculate
 Antidepressant Drug
 Tricyclic and tetracyclic antidepressants interfere the erection and delay ejaculation.
 Some case  the tricyclic causes painful ejaculation caused by smooth muscle contraction
 MAOI  impaired ejaculation, delayed or retrograde ejaculation, vaginal dryness, inhibited orgasm
 Lithium
 Regulates mood, in the manic state  reduce hyper sexuality
 Sympathomimetic
 Prolonged use result a loss of desire and erection
 ∝-Adrenergik and ß-Adrenergik Receptor Antagonists
 Used for hypertension, angina, and certain cardiac arrhythmias  decrease tonic sympathetic nerve
outflow  impotence, decrease the volume of ejaculate, produce retrograde ejaculation
Pharmacological Agents Implicated In
Sexual Dysfunction

 Anticholinergics
 Block cholinergic receptor  dryness of the mucous membrane and erectile disorder
 Antihistamines
 (+) anticholinergic activity + mild hypnotic  inhibit sexual function
 Cyproheptadine  potent activity as a serotonin antagonist  serotonergic sexual adverse effects produced
by SSRI  delayed orgasm
 Antianxiety Agent
 Benzodiazepines  decrease plasma epinephrine concentrations, diminish anxiety  improve sexual function in
person inhibited by anxiety
 Alcohol
 Alcohol suppresses CNS activity  erectile disorders
 Alcohol has a direct gonadal effect  decrease testosterone levels in men, increase testosterone in women 
increase the libido
 Long term use  reduce the ability of liver to metabolize estrogenic compounds  feminization
 Opioid
 Heroin  erectile failure and decreased libido
Pharmacological Agents Implicated In
Sexual Dysfunction

 Hallucinogens
 Induce hallucinations  loss of contact with reality and expand and heightening of conciousness
 delirium, anxiety, psychosis  interfere sexual function
 Cannabis
 Altered state of consciousness  diminish sexual plesure
 Long term use  depresses testosterone levels
 Barbiturates and similarly acting drugs
 Enhance sexual responsiveness
Treatment

 Treatment focuses on the exploration of unconscious conflicts, motivation, fantasy, and various interpersonal difficulties
 Dual-Sex Therapy
 The treatment is based on a concept that the couple must be treated when a dysfunctional person is in a relationship.
 Method : therapist and patients discuss the psychological and physiological aspect of sexual functioning  therapists suggest specific sexual activities for
the couple
 Treatment is short term and behaviorally oriented
 Specific Techniques and Exercises
 Vaginismus  dilate using fingers or size-graduated dilators  dyspareunia
 Premature ejaculation  squeeze technique  raise the threshold of penile excitability  the woman forcefully squeezes the coronal ridge of the glans 
the erections is diminished  inhibits the ejaculation
 Hypnotherapy
 Treat for anxiety-producing situation
 Enables patients to gain control over the symptoms that has been lowering self-esteem and disrupting psychological homeostasis
 Behavior Therapy
 Design for the treatment of phobias  used to treat other problem
 Using traditional tech  hierarchy of anxiety-provoking situations
Treatment

 Pharmacotherapy
 Sildenafil (Viagra)  a nitrit oxide enhancer  facilitates the inflow of blood to the penis necessary for an
erection.
 The drug takes effect about 1 hour after ingestion and its effect can last up to 4 hours.
 Side effect headache, flushing, dyspepsia.
 Nonarteritic Ischemic Optic Neuropathy (NAION)  vision loss within 24 hours after use of sildenafil

 Oral Phentolamine  reduce sympathetic tone and relaxes corporeal smooth muscle
 Hormone therapy
 Androgen increase the sex drive in women and in men with low testosterone levels. Long term use make virilization,
hypertension and prostatic enlargement
 Testosterone and estrogen combination
 Antiandrogen (estrogen and progesterone)  Clomiphene (Clomid) and Tamoxifen (Nolvadex) compulsive sexual
behavior  sex offenders
Treatment

 Surgical therapy
 Vacuum pump – EROS
 Male Prostheses
 Vascular Surgery
Thank You…