Phases
Desire phase:
- sexual urges occur in response to sexual cues or fantasies
Arousal stage:
- a subjective sense of sexual pleasure and physiological signs of sexual arousal
Plateau phase:
- brief period occurs before orgasm
Orgasm phase:
- Males: ejaculation
- Females: contractions of the walls of the lower third of the vagina
Male hypoactive sexual desire disorder
- Criteria
(sexual desire/ arousal disorders)
- A. persistently or recurrently deficient or absent sexual/ erotic thoughts. Judgement of deficiency made by clinician who takes into account other features
- B. Criteria A symptoms persisted for a min. of 6 mths.
- C. Criteria A symptoms causes clinically significant distress
- D. dysfunction is not better explained by a non sexual mental disorder or a consequence of sever relationship distress or other stressors or medication
Erectile Disorder (Male) - Criteria
(sexual desire/ arousal disorders)
- A. At least one of the following three on almost or all sexual activity (75-100%)
- marked difficulty in obtaining an erection during sexual activity
- marked difficulty in maintaining an erection until completion of sexual activity
- Marked decrease in erectile rigidity
B. Criteria A persisted for a min. of 6 mths.
C. cause clinically significant distress
D. Not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other sig. stressors or medication
Female Sexual Interest/ Arousal Disorder
sexual desire/ arousal disorders
A. lack of or sig. reduced sexual interaction/ arousal as manifested by at least 3 of the following:
- absent/ reduced interest
- absent/ reduced thoughts
- no/ reduced attempts to initiate and typically unreceptive to partners attempts
- absent/ reduced sexual excitement/ pleasure (75-100)
- absent/ reduced sexual interest in response to any internal or external sexual erotic cues
- absent/ reduced genital sensations (75-100)
B. Criteria A persisted for a min. of 6 mths.
C. cause clinically significant distress
D. Not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other sig. stressors or medication
(sexual desire/ arousal disorders)
- Male hypoactive sexual desire disorder
- Erectile Disorder (Male)
- Female Sexual Interest/ Arousal Disorder
Orgasm Disorders
Male:
- delayed ejaculation
- premature ejaculation
Female:
- Female orgasmic disorder
Delayed Ejaculation
A. Either of the following symptoms must be experienced on almost all or all occasions (75 – 100%) of partnered sexual activity and without the individual desiring delay:
- Marked delay in ejaculation.
- Marked infrequency or absence of ejaculation.
B. Criteria A persisted for a min. of 6 mths.
C. cause clinically significant distress
D. Not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other sig. stressors or medication
8% of males reported having delayed/ absent orgasms–> diagnosis is rare
Premature Ejaculation
A. A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes.
NOTE can be applied to non-vaginal sexual activities however specific duration criteria have not bee established for these activities
B. Criteria A persisted for a min. of 6 mths.
C. cause clinically significant distress
D. Not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other sig. stressors or medication
Occurs in 21% of men, declines with age (more common in inexperienced males)
Female orgasmic disorder
A. Presence of either of the following symptoms and experienced on almost all or all (75 – 100%) occasions of sexual activity (in identified situational contexts or, if generalised, in all contexts):
- Marked delay in, marked infrequency of, or absence of orgasm.
- Markedly reduced intensity of orgasmic sensations.
B. Criteria A persisted for a min. of 6 mths.
C. cause clinically significant distress
D. Not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other sig. stressors or medication
Sexual Pain Disorders
Genito-pelvic Pain/Penetration Disorder
A. Persistent or recurrent difficulties with one (or more) of the following:
- Vaginal penetration during intercourse.
- Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.
- Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration.
- Marked tensing or tightening of pelvic floor muscles during attempted vaginal penetration.
B. Criteria A persisted for a min. of 6 mths.
C. cause clinically significant distress
D. Not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other sig. stressors or medication
Occurs in 7 % of females
Assessing sexual behaviour:
Interviews
- Clinicians must demonstrate comfort/put the patient at ease
- Use the vernacular of the patient
- Cover nonsexual relationship issues and physical and psychological health
- Inclusion of partners in interview
