Sexual Disorders

Sexual Disorders Aaron J. Blashill, M.S.

Lykins, Janssen & Graham (2006) • Do some individuals with depression and/or anxiety experience sexual arousal as opposed to sexual decline? • In their review, they found that for both depression and anxiety, there was a subset of individuals who experienced sexual arousal (both men and women).

Lykins, Janssen & Graham (2006) • Dual control model • Individuals vary in their propensity for both sexual excitation and inhibition

Lykins, Janssen & Graham (2006) • Generally, there were subgroups of both men and women who experienced sexual arousal during a negative mood state. • Why might some individuals be sexually aroused when distressed? • For women, the only variable which research significance in prediction was propensity for sexual excitation accounting for 3% of the variance. • Thoughts?

Clayton, Keller & McGarvey (2005) • Examining the prevalence of phase-specific SD in a depressed sample without global SD. • Comparing prevalence rates of SD for each phase (desire, arousal, orgasm) for men and women. • Comparing prevalence rates of phase-specific SD for different SSRI/SNRIs

Clayton, Keller & McGarvey (2005) • SD is a common side effect of SSRI/SNRIs • Rates from 22-43% to 30-60% • What might be some possible effects of deleterious side effects? • In their review, authors found that men experienced more impairment in desire than women, but no difference of arousal or orgasm (when on SSRIs and RIMAs)

Clayton, Keller & McGarvey (2005) • Evident from clinical practice that phase-specific SD can sig. reduce quality of life even when global SF is not impaired. • Results found numerous differences on variables between groups (those with Global SD vs. without) • Prevalence rates of phase-specific SD without Global SD: desire (82.4%) arousal (80%) orgasmic (56.6%)

Clayton, Keller & McGarvey (2005) • 80% had SD in more than one phase, but still didn’t met criteria for Global SD. • Men were sig. more likely to experience SD in the desire and orgasmic phase than women, although vice versa in arousal…Thoughts? • No sig. differences between SSRI/SNRIs with regard to phase-specific SD • The negative effects on SF appear to be chronic and interfere with the quality of patients life

Brotto & Klein (2007) • Sexual dysfunction • Problems in desire, arousal, orgasm, or pain • Based on Masters and Johnson’s Human Sexual Response Cycle (excitement, plateau, orgasm, and resolution) • Desire was added by Kaplan (1979) • Problems with this system… • DSM-IV divides disorders into 6 categories

Brotto & Klein (2007) • Prevalence rates for sexual difficulties in women 43% men 31% • Being married and having a higher level of education was associated with lower degrees of difficulties

Brotto & Klein (2007) • Hypoactive Sexual Desire Disorder • Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity • 15% of men aged 19-59 30% of women aged 19-59 • Hypothyroidism, cancers, cardio-diseases, psychiatric medications, medical drugs, illicit drugs have effects • ADAM (andropause…male menopause) • Fatigue, depression, reduced sex drive, ED, changes in mood and cognition

Brotto & Klein (2007) • Sexual Aversion Disorder • Persistent or recurrent extreme aversion to and avoidance of all (or almost all) genital sexual contact with a sexual partner • May experience panic attacks • Highly distressing (ego-dystonic)

Brotto & Klein (2007) • Male Erectile Disorder • Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate erection • Causes distress • 7% in men aged 18-29, 18% 50-59, 24% 66-74 • Anxiety or stress may lead to an overactive sympathetic nervous system…leads to loss of erection • Major Depressive Disorder strongly associated with ED

Brotto & Klein (2007) • Female Sexual Arousal Disorder • Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication, swelling response of sexual excitement • 12-21% • Persistent sexual arousal disorder • Spontaneous intrusive and unwanted genital arousal in the absence of sexual interest and desire…often only temporarily relieved by orgasm

Brotto & Klein (2007) • Female Orgasmic Disorder • Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase • 22-25%...highest prevalence in young women • A skill that perhaps develops over time • Associated with lower education, high religiosity, and sex guilt…no relationship between rel satisfaction and orgasmic ability • Myth of the “G-spot”?

Brotto & Klein (2007) • Male Orgasmic Disorder (retarded ejaculation) • Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase during sexual activity • Much less frequent than PE (premature ejaculation) • 8% men aged 19-59 • Idiosyncratic masturbatory style, variant sexual fantasy, predisposing factors…alcohol use related and performance anxiety

Brotto & Klein (2007) • Premature Ejaculation • Persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it • 30% of men aged 18-59 • Most prevalent male sexual dysfunction • Highly embarrassing condition • Serotonergic disruption likely primary etiological factor • 71% of first-degree relatives of men with PE also have the condition • situational/acquired PE may be more due to anxiety, early sexual experiences, low frequency of sex, or poor ejaculatory control techniques…new studies suggest that anxiety is more of a consequence rather than a cause

Brotto & Klein (2007) • Dyspareunia • Recurrent or persistent genital pain associated with sexual intercourse • 3-5% men in Western cultures 10-12% in Middle East and Southeast Asia…14% in gay men (anodyspareunia)…most experiencing it lifelong • Psychological factors play a primary role in the etiology in men • In women, psychological factors are considered secondary, but can exacerbate pain (anxiety, depression, self-esteem, harm avoidance, somatization, shyness, and pain catastrophization)

Brotto & Klein (2007) • Vaginismus • An unwanted involuntary spasm of the vaginal muscles that prevents intercourse • Often a phobic avoidance and anticipation or fear of pain • 1-6% of women • Highly comorbid with dyspareunia • Behavioral theory views it as a conditioned reaction during a single sexual encounter (sexual assault) or over reapted trials (having sex with dyspareunia) • Physiological view considers it a pelvic floor dysfunction • Interactional view suggests it maintains balance between partners • Male partners are passive, dependent, anxious, and lacking in self-confidence, who often suffer from their own SD, therefore vaginismus maintains a balance in a sexless relationship • Multidimensional view looks at many factors

Brotto & Klein (2007) • Paraphillas • Recurrent, intense sexual urges, fantasies, or behaviors that involve unusual objects, activities, or situations and cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

Brotto & Klein (2007) • Exhibitionism • Recurrent and intense sexually arousing fantasies, sexual urges, or behaviors of exposing ones genitals to an unsuspecting stranger over a period of at least 6 months • Most commonly reported paraphilia • Victims usually women, including children • It’s the victims shock that is sexually arousing to the perpetrator • Don’t appear to differ from the general population on various traits

Brotto & Klein (2007) • Fetishism • Recurrent sexual arousal toward nonliving objects that are present for at least 6 months and accompanied by impairment • Largely a disorder of men • Pretty much any object you can think of can be an object of fetish

Brotto & Klein (2007) • Frotteurism • Sexual arousal involving touching and rubbing against nonconsenting individuals • Distress and impairment not necessary if the individual acted on it (similar to exhibitionism in this regard) • Generally takes place in crowded places • Typically fantasizes about having a sig. relationship with victim • Mainly occurs in men

Brotto & Klein (2007) • Pedophilia • Sexual arousal toward a prepubescent child, over the course of 6 months, must have experienced distress, or have acted on the urges • Must be at least 16, and at least 5 years older than the prepubescent target of arousal • Child molesters do not suffer from higher rates of psychopathology than non-molesters, although about 50% experienced sexual abuse as a child • May lack empathy towards their victims, but not in general • Originally viewed to be only a disorder of men, data now emerging on females

Brotto & Klein (2007) • Sexual Masochism • Sexual arousal in response to being humiliated, bound, or beaten, for at least 6 months and suffer impairment, the arousal must be in response to actual, not simulated humiliation, bondage, or beatings • Most sexual masochists use little or no pain, more so through the loss of control • Can lead to serious injury and death (especially in the case of hypoxyphilia) • 20:1 males: females • Appears to be modern compared to other paraphilias, as well as limited to Western cultures • More common with individual with higher income • No relationship between sexual masochism and non-sexual forms of masochism • Tend to be well-adjusted, and often quite successful, and above norms on measures of mental health

Brotto & Klein (2007) • Sexual Sadism • Recurrent sexual arousal over 6 months in response to fantasies, urges, or behaviors involving the psychological or physical suffering of another, these must have been carried out, must be distressing, or cause interpersonal difficulty • Can lead to serious injury of death (specifically when there is comorbid ASPD) • More common in men than women

Brotto & Klein (2007) • Transvestic Fetishism • Specific to heterosexual men, 6 months of recurrent sexual arousal associated with wearing women’s clothing and accompanied by sig. distress • May experience gender dysphoria, although many are happy with their gender and only cross-dress in sexual situations • Tend to be relatively masculine

Brotto & Klein (2007) • Voyeurism • Recurrent, intense sexual arousal of seeing unsuspecting people naked, in the process of undressing, or engaging in sexual activity • Must have acted on the urges, or has caused impairment • Tend to have deficits in social and assertiveness skills as well as sexual knowledge

Brotto & Klein (2007) • Theories • All lacking in data, however, provides some theoretical explanations • Neurological deficits • Neurological abnormalities in the temporal lobe and limbic area • Although, many studies have found temporal lobe disorders are associated with hyposexuality, as opposed to hypersexuality

Brotto & Klein (2007) • Social • Childhood abuse • Doesn’t account for the many individuals who suffered child abuse and did not go on to develop paraphilias • Cognitive-Behavioral • Operant and classical conditioning • Sexual arousal can be conditioned, however, extinction occurs easily • Role of cognitions • Minimization and denial of harm, which disinhibits individuals to act on their initial paraphilic interests and then serves to maintain them

Sexual Disorders