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M05.09.49 Sexual Disorders
Sexual disorders encompass a range of conditions affecting sexual desire, arousal, orgasm, and pain. Understanding these disorders is crucial for medical students, as they involve complex interactions between physical, psychological, and social factors. Below is a detailed, organized overview of various sexual disorders, their definitions, examples, treatment, and associated points to remember.
Sexual Desire Disorders
Male Hypoactive Sexual Desire Disorder
Definition
A deficiency or absence of sexual fantasies and desire in men.
Causes
- Low testosterone
- CNS depressants
- Depression
- Marital discord
- Common post-surgery
Points to Remember
- Evaluate hormonal levels and psychological factors.
- Consider impact of medications and relationship issues.
Sexual Arousal Disorders
Female Sexual Interest/Arousal Disorder
Definition
Inability to achieve adequate vaginal lubrication.
Causes
- Hormonal connection (e.g., peak sexual desire just before menses)
- Antihistamine/anticholinergic medications
Male Erectile Disorder (Impotence)
Definition
Difficulty in achieving or maintaining an erection.
Prevalence
- Lifetime prevalence: 10–20%
- Point prevalence: 3%
- Incidence: 8% in young adults, 75% in men over 80
Risk Factors
- Smoking increases risk by 50%
- Alcohol usage
- Diabetes
- Marital conflict
Assessment
- Postage stamp test
- Snap gauge test
Treatment
- Sildenafil
- Vardenafil
- Tadalafil
Points to Remember
- Differentiate between organic and psychological causes.
- Assess lifestyle factors and medication side effects.
Orgasm Disorders
Female Orgasm Disorder
Definition
Inability to achieve orgasm.
Prevalence
- Overall: 30%
- 5% of married women over 35 have never achieved orgasm.
Treatment
- Fantasy
- Vibrators
Premature Ejaculation
Definition
Ejaculation occurring before or immediately after vaginal penetration.
Causes
- Early sexual experiences in inappropriate settings
- Anxiety about sexual performance
Treatment
- Stop-and-go technique
- Squeeze technique
- SSRIs
Paraphilic Disorders
Types and Definitions
| Disorder | Description |
|---|---|
| Pedophilia | Sexual urges toward children; most common paraphilia |
| Exhibitionism | Recurrent desire to expose genitals to strangers |
| Voyeurism | Sexual pleasure from watching others naked or engaged in sexual activity |
| Sadism | Sexual pleasure derived from inflicting pain on others |
| Masochism | Sexual pleasure derived from being abused or dominated |
| Fetishism | Sexual focus on objects (e.g., shoes, stockings) |
| Transvestite Fetishism | Dressing in clothes of the opposite sex for sexual arousal |
| Frotteurism | Rubbing genitals against a fully clothed person to achieve orgasm |
| Zoophilia | Sexual fantasies or practices involving animals |
| Coprophilia | Combining sex and defecation |
| Urophilia | Combining sex and urination |
| Necrophilia | Sexual preference for cadavers |
| Hypoxyphilia | Altered consciousness due to hypoxia during orgasm (e.g., autoerotic asphyxiation) |
Genito-Pelvic Pain Disorders
Definition
Involuntary muscle constriction of the outer third of the vagina, preventing penile insertion. It involves recurrent and persistent pain before, during, or after intercourse.
Characteristics
- Diagnosed only in women
- Not diagnosed if caused by medical conditions
Treatment
- Relaxation techniques
- Hegar dilators
Points to Remember
- Psychological origin; assess for psychological factors.
- Ensure thorough medical evaluation to rule out physical causes.
Bibliography
- American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.).
- Kaplan, H. S. (1979). Disorders of Sexual Desire and Other New Concepts and Techniques in Sex Therapy. Brunner/Mazel.
- Laumann, E. O., Paik, A., & Rosen, R. C. (1999). Sexual Dysfunction in the United States: Prevalence and Predictors. JAMA.
- Masters, W. H., & Johnson, V. E. (1966). Human Sexual Response. Little, Brown.
- Sadock, B. J., Sadock, V. A., & Ruiz, P. (2014). Kaplan & Sadock’s Comprehensive Textbook of Psychiatry (10th ed.). Wolters Kluwer Health.