Psychiatry (6)(7) Sexual Dysfunction

disturbance in the sexual response cycle or pain assc. with sexual activity.

sexual health and function can give you hints to the patient status in other areas of their well being. Or hint to cause of a problem (STD's)

F. evaluate partner if possible.

embarrassment, time constraints, unprepared for it, belief that its not important. Age differences, gender, over all taboo.

be to the point but sensitive, assure confidentiality, avoid being judgemental, ask orientation, neutral terms, be receptive.

way to go through treating sexual dysfunction.
P= permission
LI= limited information
SS= specific suggestion
IT= intensive therapy

Dx will drive the type/level of Tx

mood disorders, anxiety, somatoform, history of physical/sexual abuse, sleep , substance use, psychotic disorders.

hypoactive desire or sexual aversion disorder.

female sexual arousal disorder, male erectile disorder.

currently Dx use the same sexual cycle for male and female but now starting to use specific sex.
Male is big business, female not so much por que !?

Dyspareunia, vaginismus, due to medical conditions and drug induced dysfunction.

lifelong or acquired, situational or generalized, psychological, multifactorial.

persistenl or recurrently deficient sexual fantasies and desire for sex. Assc. w/ arousal and orgasm problems. Can cause problems maintaining stable sexual relationships. intimacy and commitment problems.

Can be bc of abnormal total or available testosterone and prolactin.

Persistent/recurrent extreme aversion to and avoidance of most genital sexual contact w/ partner. Can show panic/anxiety when faced with sexual activity.

Look for degree of avoidance, avoidance strategies, history of trauma.

inability to attain or maintain during sex adequate lube/swelling response . often assc. with orgasm disorder.

Look for medical and drug induced problems. Maybe partner.

inability to attain or maintain an adequate erection. until completion. Maybe assc. w/ low desire or premature ejaculation,

Assess quality of stimulation.

delay in or absence of orgasm following a normal sexual excitement. No particular assc. with personality or psychopathology.
Uncommon for :O to be lost once capacity learned.

Can affect body image, self-esteem, relationship satisfaction.

Not correlated with Vag size or pelvic muscle strenght (keigles)

delay in or absence of orgasm following normal excitement.

consider paraphilic pattern, medical/substance induced factor, gender preference, age.

splat with minimal sexual stimulation before on or shortly after entering OR b4 the person wishes it . ( < 3 pump chump )

look for distancing in relationship, social isolation,

genital pain assc. w/ sexual intercourse in either male or female. NOT caused be vaginismus or lack of lube. Avoidance of intercourse common, tends to be chronic.

involuntary spasm of the muscles of outer 3rd of vagina messes w/ intercourse. various severity, sexual responses may not be impaired unless penetration is attempted or anticipated. usually younger women

Tx can be pushing (as in labor)

intense sexual arousal involving nonhuman objects, suffering/humiliation, children. Often more than 1. Object may be necessary for erotic arousal.

Can exhibit guilt, or little/no distress. Can be assc. with personality disorder, depression, OCD,
>6mnths. can be consistent or episodic ( inc. to stress) but chronic. social and sexual relationships can suffer. 50%married

Sexual excitement from being seen in a sexual situation. can have intended victim.



increase dec after 40. Onset tends to be b4 age 18.

Chronic. sexual excitement from objects not limited to articles of female clothing used in cross dressing or vibrators.

like to rub against "victim" freq highest between 15-25. dec after age 25. sometimes associated partialism (specific body part)

Sexual attraction to children. beings in adolescence. chronic. recidivism rates are higher for male attraction. must be >16 yo and 5yrs older than victim.

specify- attracted to male female or both, incest, exclusive or non.

Can be Ego-syntonic- little or no distress, seems normal to them.

M- likes to be hurt, act tend to be repeated.
S- likes to hurt. fantasize inflicting pain.

severity of acts tents to increas.

Cross dressing, can be assc. with a gender dyphoria but not necessarily. Sexual arousal can dec with age. Behavior maybe antidote for stress depression anxiety.

Sexual arousal from watching others. onset usually b4 15. tends to be chronic.