Sexual Response Cycle
Sexual dysfunction disorders are due to problems in the sexual response cycle.
Sexual Response Cycle: The sexual response cycle refers to the sequence of physical and emotional changes that occur as a person becomes sexually aroused and participates in sexually stimulating activities.
Sexual response cycle stages
- Desire
- Excitement phase
- lubrication of the vagina
- erection of the penis
- enlargement of the breast
- increase in heart rate and respiration
- Orgasmic Phase
- release of sexual tension
- Resolution Phase
- men go into refractory phase
- Women do not enter this stage
Sexual Dysfunctions
involves severe psychological impact that the problem persists for a fairly long time and cannot be due to medical condition or substance use.
difficult to define bc it is a complex interaction b/w biological, sociocultural, and psychological factors
can only be diagnosed if the individual feels distressed enough to seek help or a partner is negatively affected (couples)
Other factors/variables to consider in sexual dysfunctions (3)
- partners libido
- relationship factors (communication, trust,
- individual vulnerability factors (poor body image, hx of sexual/emotional abuse, cultural/religious factors, attitudes towards sex, medical factors relevant to course and treatment –perhaps diabetes)
Things to rule out in dx of sexual dysfunction disorders
- organic factors
- individual distress
- hormonal levels
- drug/medication factors (SSRIs)
- Psychological factors
aggression; hx of sexual abuse; stress in romantic relationship ; anxiety/guilt
Male hypoactive sexual desire disorder
- Deficient or absent sexual thoughts/fantasies
- Deficient or absent desire for sex, as long as sx occur for more than 6 months
cannot be explained by a nonsexual mental disorder or due to something else (substance or medical condition)
*deficiency is defined by the clinician based on age, general sociocultural contexts or the individuals life.
Female Sexual Interest/Arousal Disorder
Must meet three of six sx:
• Absent/reduced interest in sex
• Absent/reduced erotic thoughts or fantasies
• Difficulties initiating sexual activity/receptivity to it
• Lack of sexual excitement/pleasure during it
• Lack of sexual arousal/interest to sexual triggers
• Lack of genital/non-genital sensations during sex
***must cause significant distress in the individual
***no other explanations (stress, medical, substance…etc)
Erectile Disorder (common in men )
At least one of the following:
• Difficulty obtaining erection during sex
• Difficulty maintaining erection until completion
• Decrease in erectile rigidity
- as usual, cannot be diagnosed if can be explained by medical condition or substance use
- 52% of men 40-70 complain about this in their life
Spectator Role in Sexual Dysfunction
A mind issue- people who experience these dysfunctions are taking themselves out of the experience because they are afraid of how hard they are, is she enjoying herself? They feel so much inadequacy and cuts down on their ability to enjoy the moment
Impairment in erection is due to the psychological factors that distract from the sexual act itself. Interferes with the natural process
- self-perpetuating cycle of anxiety & failure
Female orgasmic Disorder
- Marked delay, infrequency, or absence of orgasm
- Reduced intensity of orgasmic sensations
- Do not dx if can reach organsm via clitoral stimulation but not penetration
Female orgasmic disorder : stats
8.9% between 18-89 report difficulty reaching an orgasm
50% of women experience anywhere from : occasional difficulty to never reaching orgasms.
Most studies show that many women don’t ALWAYS reach orgasm
4 Factors that have received attention in Female Orgasmic issues
4 factors have received attention:
- Pubococcygeus muscle
- Controls the vagina and urethra
- Allow women to gain more control over the muscle
- Increases arousal
- Allows women to enjoy sex - Hormones disorders/imbalances or changes
- Menopause
- Both men and women have estrogen & testosterone that controls emotions and feelings.
- Alcohol & Drugs
- Increasing blood alcohol level correlated to inability to orgasm
- Psychosocial factors
- Age
- Length of marriage
- Education
- Past hx of sexual abuse
which factor is mostly consistently with orgasmic dysfunction ?
Age !
Delayed Ejaculation Disorder (formerly known as male orgasmic disorder)
- Marked delay of ejaculation or marked infrequency/absence of it
- Must occur on the majority of partnered sexual encounters
- Male must not desire the delay
about 1-8% of males experience.
possibly due to : lacking arousal… or having conflicts with the partner
Premature Ejaculation
• Persistent or recurring pattern of ejaculation less than 1 minute following vaginal penetration – must occur despite the man’s wish (present for at least 6 months)
- issue- how do we know whats appropriate time and whats not?
- what could help this? SSRI’s could delay ejaculation
Genito Pelvic- Pain/Penetration Disorder
Woman experiences persistent/recurrent difficulties in any of the following for 6 months (pain of penetration at the pelvic)
• Vaginal penetration
• Pain with actual or attempted penetration
• Fear or anxiety about vaginal pain
• Tensing of the pelvic floor muscles during attempted penetration
-Assessment must be made by a skilled pelvic floor physiotherapist or gynecologist
- No valid physiological measures so solely based on self-report
30% of women report pain during intercourse
Factors that may explain whats going on in Genito Pelvic Pain/Penetration Disorder
Organic pain such as
- ( UTI, tumors)
- Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis…
Most pain for men is due to prostatitis (Swelling of the prostate) herpes
Hypersexual Disorder ( is not an actual disorder in the DSM V, it was proposed by quickly rejected)
- encompasses people who actively seek out sex with strangers (prostitutes), strip clubs, phone sex, pornography, tend to have affairs
- almost like a sexual addiction
- has an impulsivity component
- the issue with this disorder is that it tended to pathologize behaviors that are extreme and often seen in men.
- again–> who is to say what is normal? and what is not? Lacked empirical evidence
