PS280 Lecture Notes - Lecture 11: Hypoactive Sexual Desire Disorder, Vaginal Photoplethysmograph, Anorgasmia
Sexual Dysfunctions
● Difficulty with sexual functioning
○ Lifelong or acquired - after sexual activity has been normal for a period of time
○ Generalized or situational - all sexual encounters vs certain times/partners
○ Psychological factors alone or combined factors - psych vs medical factor such
as SSRI leading to low sex drive
Sexual Response Cycle
● Appetitive
● Excitement (arousal)
● Orgasm
● Resolution
Sexual Dysfunctions
● Sexual desire disorders
● Sexual arousal disorders
● Orgasm disorders
● Sexual pain disorders
Sexual Desire Disorders
● Male hypoactive sexual desire disorder
○ No interest in any sex activity
○ Low sex drive is common presenting problem
● Sexual Aversion Disorder
○ More extreme - avoided anything sexual
○ Removed from DSM-5 - was diagnosed very infrequently, might be better
categorized by lack of desire
● What about sex addiction?
○ Was almost added to DSM-5 but was not, decided there was not enough
evidence - what is normal level of desire?
Sexual Arousal Disorders
● Erectile Disorder
○ ‘Impotence’
○ Difficulty maintaining/achieving erection
● Female Sexual Interest/Arousal Disorder
○ ‘Frigidity’
○ Maintain/achieve lubrication
○ Plus low desire
Orgasm Disorders
● Orgasmic Disorders
○ Inhibited Orgasm
○ Inability to Achieve Orgasm
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○ Common in women
■ Female Orgasm Disorder
○ Rare in men
■ Delayed ejaculation
○ Premature Ejaculation
■ Occurs too quickly - 1 minute
■ Perception of lack of control
■ Common - about ⅓ of men are concerned, but prevalence is much lower
with 1 min requirement
Sexual Pain Disorders
● Genito-Pelvic Pain/Penetration Disorder
○ Diagnosed only in women
○ Four areas
■ 1. Difficulty with vaginal penetration
■ 2. Pain - dyspareunia (pain before/during/after intercourse)
■ 3. Anxiety/fear of pain
■ 4. Vaginismus - involuntary spasms in outer third of the vagina (not just
during intercourse but with use of tampon, during gyno exam)
Assessment of Sexual Behaviour and Dysfunction
● Interviews and thorough medical evaluation
● Psychophysiological assessment
○ Listen to or view erotic material
○ Measure arousal directly
○ Men: penile strain gauge
○ Women: vaginal photoplethysmograph (greater bloodflow = less light reflection
from device)
Causes of Sexual Dysfunctions
● Biological contributions
○ Diabetes and kidney disease can reduce sensitivity in genital area
○ Cardiovascular diseases
○ Chronic illness - fatigue for instance can lead to decreased interest
○ Prescription medications - can impact desire/arousal
○ Using alcohol and other drugs - for instance alcohol can increase desire but
reduce arousal
● Psychosocial contributions
○ Masters and Johnson (1970)
■ Sexual behaviour to the lab
■ Direct observations - recordings of couples, masturbation, able to
describe sexual dysfunctions, suggest treatment
■ People question if sample is representative bc who would agree to be
watched - is this accurate to society in general
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■ Performance anxiety (identified as core feature) - spectator role (people
are concerned about watching themselves and wondering if they are
doing a good job - increases likeliness of sexual dysfunction)
■ Theoretical model (in textbook) - diff factors
Religious - if sex is viewed as only for reproduction, may affect taking on of spectator role
Trauma - can play role
Homosexual - trying to be in heterosexual relationship, will play role
Counselling - being told sex issues don’t matter if certain age for eg
Alc - high desire low arousal
Physio - health probs
Socio cultural - gender diffs/expectations
Treatments of Sexual Dysfunctions
● Psychosocial Treatments
○ Education
○ Performance anxiety
■ Sensate focus (focus on sensations/experience)
● Gradual process of building intimacy (for instance focus might be
on touch)
○ Communication training
○ Premature ejaculation (focus on identifying sensations that precede orgasm)
■ Stop-start method (stop stimulation if he feels orgasm is near, wait for
feeling to subside and start again)
● Medical Treatments
○ Medications
■ Viagra - relaxes the smooth muscles allowing blood to flow more easily
for erection
○ Implants - insertion of rod or pump
○ Vacuum Device Therapy - draws blood to penis
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Lifelong or acquired - after sexual activity has been normal for a period of time. Generalized or situational - all sexual encounters vs certain times/partners. Psychological factors alone or combined factors - psych vs medical factor such as ssri leading to low sex drive. Low sex drive is common presenting problem. Removed from dsm-5 - was diagnosed very infrequently, might be better categorized by lack of desire. Common - about of men are concerned, but prevalence is much lower with 1 min requirement. Vaginismus - involuntary spasms in outer third of the vagina (not just during intercourse but with use of tampon, during gyno exam) Women: vaginal photoplethysmograph (greater bloodflow = less light reflection from device) Diabetes and kidney disease can reduce sensitivity in genital area. Chronic illness - fatigue for instance can lead to decreased interest. Using alcohol and other drugs - for instance alcohol can increase desire but reduce arousal.
