Sexual Disorders
Sexual disorders as related to the phases of the human sexual response
Human Sexual Response Cycle--Occurences that typically take place
during each phase and disorders of each phase:
Desire phase (Kaplan's first
phase)
Desire phase males:
partial to full erection;
partial elevation of testes;
Desire phase females:
clitoral enlargement;
labia swelling;
vaginal lubrication
Desire phase males and females:
’urge’ to be sexual, coupled with
sexual fantasies or daydreams and sexual
attraction to others
Desire phase disorders
Hypoactive sexual desire: lack of interest and
consequential low level of sexual activity;
when s/he is sexual, usually enjoys the experience
and functions normally
15% of men and increasing in past
10 years
20-35% of women
Best diagnosed if patientt desires sex less
frequently than 1x/2wks
Sexual aversion: sexual advances arouse revulsion,
disgust, anxiety, and fear
Rare in men, more common in women
Biological causes:
Hormones: High
prolactin;
low testosterone;
high or low estrogen result in low sex drive
(abnormal hormone levels
account for small percentage of
cases)
Medications: pain relief
drugs and some psychotropics;
alcohol at high levels;
chronic physical illness
Psychological causes:
Anxiety and/or anger:
attitudes(e.g., sex is self-indulgent);
fear loss of
control
Sociocultural causes:
Situational stressors: (divorce,
death in family, job stress, infertility difficulties,
birth of a
baby)
Unhappy/conflicted relationship
Feelings of powerlessness and of
being dominated by partner
Unskilled/unenthusiastic lover
Consequence of sexual molestation
or assault:
sexual
aversion common in victims of sexual abuse
Arousal (Excitement) phase (Kaplan's
second phase and Masters and Johnson's
first phase)
Arousal phase males:
prostate enlarges, increase size
of testes;
testes fully elevated;
scrotum thickens;
color of penis deepens;
Cowper’s gland activates and
secretes fluid
Arousal phase females:
clitoral retraction;
labia changes in color;
uterus elevates; vagina expands
Arousal phase males and females:
increased physical arousal
(increased HR, BP, RR; blood pooling in pelvis)
Arousal phase disorders
Female sexual arousal disorder:
unable to
attain or maintain adequate lubrication or genital swelling;
concomitant
orgasm disorder;
rarely
diagnosed alone;
10-50% of
women;
usually tied
to orgasmic dysfunction and studied together
Male erectile disorder:
persistent
inability to attain or maintain an adequate erection during sexual
activity; 10%
of males;
most
sufferers are > 50 y/o;
5% of 40 y/o,
15% of 70 y/o
Biological causes:
Hormones:
abnormal levels of testosterone, estrogen,
prolactin, or thyroid hormone
(only small % of cases)
Vascular
abnormalities:
heart disease;
clogged arteries;
holes/tears in penile chambers;
diabetes, spinal cord injuries, MS, kidney failure
Medications
and alcohol
Abnormal or
absent nightly erections usually indicates an organic basis
for erection failure
Snap gauge, a
small, paper band, is placed on the penis at night. If the
band
is snapped, indications are that the individual has
had a nocturnal erection
and therefore, does not have a physiological
erectile disrorder.
Psychological
causes:
Mental disorders:
90% of men with severe depression
experience some kind of erectile
dysfunction;
performance anxiety and adopting
the spectator role
Sociocultural
causes:
Stressful life events: e.g., financial and marital
stress
Plateau phase (Masters and
Johnson's second stage--Kaplan does not distinguish between excitement
and plateau)
Plateau phase male and female:
This phase represents a leveling off of
all signs noted in the arousal/excitement phase;
Plateau phase may be of varying time
spans--typically dependent on level of
experience of the individual
Disorders occurring during the arousal/excitement
stage would carry over into this stage.
Orgasm phase (Kaplan's third and final
stage and Masters and Johnson's third stage)
Orgasm phase males:
penile and urethral contractions;
internal sphincter of bladder
closes;
seminal vesicles contract;
prostate gland contracts;
rectal sphincter contracts
Orgasm phase females:
uterine contractions;
rectal sphincter contracts;
rhythmic contractions in orgasmic
platform
Orgasm phase males and females:
peak of sexual pleasure and
release of sexual tension
Orgasm phase disorders
Premature Ejaculation:
orgasm and ejaculation with
minimal sexual stimulation before, on or shortly
after
penetration;
25-40% have these difficulties at
some time;
typical of young sexually
inexperienced men;
common with first sexual
encounter (not a disorder)
Biological causes:
not thought to
be primarily biological in etiology
Psychological causes:
sexual
inexperience;
heightened
anxiety
Male orgasmic disorder:
unable to reach orgasm or
significant delay after normal amounts of stimulation;
relatively rare (1-3% of men)
Biological causes:
low
testosterone, neurological diseases;
head/spinal
cord injuries;
drugs that
inhibit arousal of sympathetic nervous system (e.g., alcohol, bp meds,
some antidepressants; anti-anxiety/anti-psychotic
agents including PROZAC,
PAXIL, ZOLOFT
Psychological causes:
performance
anxiety and spectator role
Female orgasmic disorder:
repeated experience very delayed
orgasm or rarely has one at all;
20-30% of women;
15% premenopausal;
35% postmenopausal;
10-15% have never experienced an
orgasm (alone or in intercourse);
higher among single women than
those who are married or living with someone
Biological
causes:
diabetes;
MS and other neurological conditions;
same medications as inhibit ejaculation in men
Psychological
causes:
50-75% of molested women
Resolution phase (Masters and
Johnson's fourth and final stage)
Resolution phase females:
can move
immediately into additional orgasms
Resolution phase males:
refractory period occurs after orgasm during which additional orgasms
cannot
be achieved;
refractory
period is measured in seconds, minutes, or hours based on the
desire and condition of the individual
Resolution phase males and females:
both return to pre-excitement states once
stimulation has ceased.
Sex therapy: General components of
techniques used
-Thorough assessment and conceptualization of
potential causes of problem
-Principle of mutual responsibility (both share the
problem even though one may
‘have’ it)
-Education about sexuality and the human sexual
response cycle
-Attitude change about sexuality
-Eliminate performance anxiety and the spectator role
-Increase communication skills
-Increase effectiveness of techniques used in
intercourse
-Change destructive lifestyles/problematic marital
interactions
-Address physical and medical factors
-Problem-focused techniques
Hypoactive sexual desire/sexual
aversion
Affectual
awareness: visualize sexual scenes to uncover anxiety
Cognitive
self-instruction training to develop anxiety coping statements
Erectile disorder
Tease technique
Stuffing
technique
Penile
prosthesis
Viagra
Male orgasmic disorder
Stimulate to
arousal and then back off
Masturbate
almost to orgasm and then penetrate
Premature ejaculation
Stop-start
technique
Squeeze
technique
Female arousal and orgasmic
disorders
Directed
masturbation training