Sexual Dysfunctions

What are different types of Sexual Dysfunctions?

A sexual dysfunction can be defined as a disturbance in the sense of pleasure or desire usually associated with sex. The essential features of sexual dysfunctions are an inability to respond to sexual stimulation, or the experience of pain during the sexual act.

Sexual dysfunction diagnoses include:

• Male Hypoactive Sexual Desire Disorder
  Persistent lacking of sexual desire including erotic thoughts or fantasies. The judgment of deficiency is made the by the clinician, taking into account factors that affect sexual functioning, such as age and sociocultural contexts of the individual’s life.
  
  
• Female Sexual Interest/Arousal Disorder
  Lack of, or significantly reduced, sexual interest/arousal as shown by at least three of the following:
  • Absent/reduced interest in sexual activity.
  • Absent/reduced sexual/erotic thoughts or fantasies.
  • Absent/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempt to initiate.
  • Absent/reduced sexual excitement/pleasure during sexual activity in all or almost all sexual encounters (in identified situational contexts).
  • Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual).
  • Absent/reduced genital or nongenital sensations during sexual activity in all or almost all sexual encounters.

The symptoms have persisted for a minimum of approximately 6 months and cause significant distress in the individual. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress (e.g., partner violence) or other significant stressors, and is not attributable to the effects of a substance/medication or another medical condition.

• Male Erectile Disorder
  Acquired male erectile disorder, historically called impotence,has been reported in 10 to 20 percent of all men. For a diagnosis of “erectile disorder,” at least one of the three following symptoms must be experienced in all or almost all (75-100 percent) occasions of sexual activity:
  
  
  • Marked difficulty in obtaining an erection during sexual activity.
  • Marked difficulty in maintaining an erection until the completion of sexual activity.
  • Marked decrease in erectile rigidity.

The symptoms have persisted for a minimum of approximately 6 months and cause significant distress in the individual. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors, and is not attributable to the effects of a substance/medication or another condition.

• Female Orgasmic Disorder
  Women experiencing sexual dysfunction may experience an inability to feel sexual interest/arousal and/or have difficulty achieving orgasm, and may also experience pain. A diagnosis of “female orgasmic disorder” is based on:
  
  
  • Marked delay in, infrequency of, or absence of orgasm.
  • Markedly reduced intensity of orgasmic sensations.

The symptoms have persisted for a minimum of approximately 6 months and cause significant distress in the individual. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress (e.g., partner violence) or other significant stressors, and is not attributable to the effects of a substance/medication or another condition.

• Delayed Ejaculation
  A diagnosis of “delayed ejaculation” is based on either of the following symptoms on almost all or all (75-100 percent) occasions of partnered sexual activity, and without the individual desiring delay:
  
  
  • Marked delay in ejaculation.
  • Marked infrequency or absence of ejaculation.

The symptoms have persisted for at least 6 months and cause significant distress in the individual. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress, other significant stressors, the effects of a substance/medication, or another medical condition.

• Premature (Early) Ejaculation
  A diagnosis of “premature ejaculation” is based on a persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it.
  
  The symptom must have been present for at least 6 months during all or almost all (75-100 percent) occasions of sexual activity. The sexual dysfunction causes significant distress in the individual and is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress, other significant stressors, the effects of a substance/medication, or another medical condition.

• Genito-Pelvic Pain/Penetration Disorder
  A diagnosis of “genito-pelvic pain” or “penetration disorder” is based on 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 the pelvic floor muscles during attempted vaginal penetration.
    

The sexual dysfunction causes significant distress in the individual and is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress, other significant stressors, the effects of a substance/medication, or another medical condition.

• Substance/Medication Induced Sexual Dysfunction
  A diagnosis of “substance- or medication-induced sexual dysfunction” is based on a significant disturbance in sexual function occurring as a result of exposure to a substance or medication capable of producing sexual dysfunction symptoms. 
  
  The disturbance causes significant distress in the individual and is not better explained by another type of sexual dysfunction.
  
  
• Other Specific Sexual Dysfunction
  The diagnosis of “other specific sexual dysfunction” may be used when a person’s sexual  problem does not meet the full criteria for any other sexual dysfunction diagnosis but still causes significant distress in the individual.
  
  

Unspecified Sexual Dysfunction
The diagnosis of “unspecified sexual dysfunction” may be used when a person’s sexual problem does not meet the full criteria for any other sexual dysfunction diagnosis but still causes significant distress in the individual. This diagnosis is used when there is insufficient information to make a more specific diagnosis.

Almost every prescription medication, particularly those used in psychiatry, has been associated with an effect on sexuality. In men, these effects include decreased sex drive, erectile failure, decreased volume of ejaculate, and delayed or retrograde ejaculation. In women, decreased sex drive, decreased vaginal lubrication, inhibited or delayed organs, and decreased or absent vaginal contractions may occur. Drugs may also enhance a persons’ sexual responses and increase one’s sex drive, but this is less common than adverse effects.

• Antidepressant drugs can interfere with erection and delay ejaculation. However, some patients report improved sexual functioning as their depression improves or as a result of antidepressant therapy.
• Antipsychotic drugs may cause a dry, but still pleasurable, orgasm. When urinating after organs, the urine may be milky white because it contains the ejaculate. The condition is startling but harmless.
• Lithium (Eskalith) may cause impaired erection.
• Psychostimulants, which are sometimes used in the treatment of depression, include amphetamines, methylphenidate, and pemoline (Cylert). Libido is increased; however, with prolonged use, men may experience a loss of desires and erections.
• A-Adrenergicand B-Adrenergic Receptor Antagonists are used in the treatment of hypertension, angina, and certain cardia arrhythmias. They can cause impotence, decrease the volume of ejaculate, and produce retrograde ejaculation. Changes in libido have been reported in both men and women.
• Anticholinergics, such as amantadine (Symmetrel) and benztropine (Cogentin), cause vaginal dryness and erectile disorder. 
• Antihistamines, such as diphenhydramine (Benadryl), may inhibit sexual function.
• Antianxiety drugs, such as diazepam (Valium), may improve sexual function in individuals inhibited by anxiety.
• Alcohol can produce erectile disorders in men. While alcohol decreases testosterone levels in men, it can produce a slight rise in testosterone levels in women, which may account for women who report increased libido after drinking small amounts of alcohol. The long-term use of alcohol reduces the ability of the liver to metabolize estrogenic compounds. In men, this produces signs of feminization such as swelling of breast tissue and testicular atrophy.
• Opioids, such as heroine, have adverse sexual effects, such as erectile failure and decreased libido.
• Hallucinogens include LSD, PCP, psilocybin (from mushrooms), and mescaline (from peyote cactus). Some users report that sexual experience is enhanced, while others experience anxiety, delirium or psychosis, which clearly interfere with sexual function.

A variety of treatment modalities may be used to treat sexual dysfunction. These include psychotherapy, hypnotherapy, behavior therapy, mindfulness, group therapy, and analytically oriented sex therapy. Medications used to treat erectile disorder include sildenafil (Viagra), phentolamine (Vasomax), alprostadil (Caverject, Idex), papaverine, prostaglandin E1, phentolamine, and others. Hormone therapy may be used to increase sex drive in women and in men with low testosterone concentrations.