• gender identity disorder
• disorders of sexual response cycle
• sexual pain disorders
• paraphilias

• persistent or recurrently deficient (or absent) sexual fantasies and desire for sexual activity
• marked distress or interpersonal difficulty
• not better account for elsewhere, except another sexual dysfunction or due to affect of substance or general medical condition

• hypoactive sexual desire disorder
• sexual aversion disorder

• persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner
• marked distress or interpersonal dysfunction
• not better accounted for elsewhere, except another sexual dysfunction, or due to the effects of a substance or a general medical conditions

• unconscious fears about sex
• masking another sexual dysfunction
• stress, anxiety, depression
• relationship problems
• hormonal problems
• medications

• tx underlying cause
  • hormone therapy as indicated
  • discontinue or reduce dose of the offending agent/medication
  • bupropion in women
  • individuals or couples therapy, sex therapy
  • folk remedy

• tx
  • TCA's
  • MAOI
  • SSRI
  • reduce patients fears and avoidance of sex (systemic desensitization)
• prognosis- generally poor, stable, marital discord, social isolation

• persistent or recurrent inability to attain, or to maintain until completion of sexual activity, an adequate lubrication/swelling response of sexual excitement
• marked distress or interpersonal difficulty
• not better accounted for elsewhere, except another sexual dysfunction, or due to effects of a substance or a general medical condition

• characteristics
  • develops following arousal failure
  • leads to fears about performance and mild dissociation from ongoing sexual act
  • this leads to distraction and loss/ inability to obtain/maintain adequate swelling/lubrication response or erection
• long term effects
  • avoidance or decrease interest in sex
  • thinking of sex as work performance
  • decreased intimacy and spontaneity, stifling the physical response
  • effects on partner

• tx pain d/o
• look at fantasy
• encourage experimentation with different sexual stimuli
• sensate focus therapy

• persistent or recurrent inability to attain or maintain until completion of of sexual activity an adequate erection
• marked distress or interpersonal difficulty
• not better accounted for elsewhere, except another sexual dysfunction, or due to effects of a substance or a general medical condition

• psychological conflicts
• organic (prostate surgery, vasc. disease)
• differentiate as much as possible by history: masturbation, morning erections, with other partners

• nocturnal penile tumescence
• dynamic infusion cavernosography
• duplex doppler penile ultrasound
• arteriography
• dorsal N. conduction latency
• bulbocavernous reflex latency

• medication (didenafil, tadalafil)
• mechanical- penis pump, constrictive rings
• hypnotherapy (behavioral therapy esp. couples)
• sensate focus therapy

• persistent/recurrent delay in or abscense of orgasm following normal sexual excitement phase (based on clinicians judgement based on age, sexual experience, adequacy of sexual stimulation)
• marked distress or interpersonal difficulty
• not better accounted for elsewhere, except another sexual dysfunction, or due to effects of a substance or a general medical condition

• genetics
• psychological
  • fear of impregnation
  • fear of rejection by partner
  • fear of damage to vagina
  • sexual guilt
  • fear of loss of control with orgasm

• encourage women to explore her body in a relaxed, undemanding fashion
• improve sexual communication with partner
• use fantasy
• educate women on most effective techniques for orgasm (clitoral stimulation)
• sensate focus therapy

• persistent/recurrent delay in or abscence of orgasm following normal sexual excitement phase during sexual activity
• marked distress or interpersonal difficulty
• not better accounted for elsewhere except another sexual dysfunction or due to effects of substance or general medical condition

causes of male orgasmic disorder

• cannot allow self to be swept away in arousal by another person
• usually describe dby partner and therapist as controlling, unemotional, untrusting, hostile, obsessive compulsive, paranoid

• tx- psychotherapy, spontaneous improvement
• prognosis- for some, dysfunction leads to cessation of aspiration for sex with a partner

• persisten or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it

• common among college educated men
• 30% of male population
• 40% of men tx for sexual disorder

• organic
  • biological predisposition (esp. in life long suffers have greater vulnerability to symp. stimulation)
  • urological path
  • trauma to symp. NS
  • narcotic withdrawal
• psychological
  • psychoanalytic theory
    • secondary to GAD
    • passive aggressive personality
    • castration anxiety
    • unconcious negative feelings towards women
  • behavior theory
    • increased anxiety resulting from increased symp arousal
    • learning and conditioning (cultural conditioning)
  • spectator role

• squeeze technique
• stop start technique (variant)
• pharmacotherapy
• SSRI
• topical anesthetics

• dyspareunia
• vaginismus

• recurrent or pesistent genital pain associated with sexual intercouse in either a male or a female
• marked distress or interpersonal difficulty
• disturbance not caused exclusively by vaginismus or lack of lubrication, not accounted for another axis I disorder, and not due to direct physiological effects of substance or general medical condition

• prevalence- unknown, but is association with surgeries on female genitalia
• cause
  • psychodynamic factors usually causative
    • rape
    • other causes of pelvic pain
    • childhood sexual abuse

• recurrent or persistent involuntary spasm of musculature of the outer third of vagina that interferes with sexual intercouse

• prevalance- less frequent than anorgasmia, more common among college educated women
• causes
  • psychological
  • fear of penis as weapon
  • strict religious upbringing that associates sex with sin
  • prior sexual and painful nonsexual trauma

• psychotherapy exploring the meaning of need for symptom
  • when problem entered woman's life and how it got started
• supplement with relaxation techniques, sensate focus, dilatation, marital therapy, medication

• goal- eliminate spectator role
• stages
  1. focuses on sensation of touch or being touched
     • emphasize that it is not massage or attempt to arouse
     • encourage silence
  2. genital touching is okay, but not the focus
     • no intercouse
     • use hand riding, one person's hand leading the other
  3. mutual touching
  4. intercourse

• recurrent, intens, sexual arousing fantasies, urges, or behaviors
• over period of at least six months
• acted on sexual urges or fantasies causes marked distress or interpersonal difficulty or impairment in social, occupational, or other areas of functioning

• sexual sadism
• sexual masochism
• exhibitionism
• voyeurism
• fetishism
• frotteurism
• pedophilia
• transvestic fetishism

• at least six months
• recurrent, intense, sexual arousing fantasies, urges, or behaviors involving acts (REAL) in which psyc. or physical suffering (including humiliation) of victim is sexually exciting to person
• acted on sexual urges with nonconsenting person, or sexual urges cause marked distress or interpersonal difficulty

• at least 6 months
• involve act of BEING humiliated, beaten, bound, or otherwise made to sufffer
• cause impairment to other areas of functioning

• involve exposing one's geneitals to unsuspecting stranger
• person has acted on sexual urges or urges cause marked distress or interpersonal difficulty

• involve act of observing unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity
• acted on urge

• involve use of nonliving objects
• cause marked distress and impairment
• fetish objects not limited to articles of female clothing or devices designed for purpose of genital stimulation

• involve touching and rubbing against non consenting person
• person acted on urges

• involve seuxal activity with prepubescent child or children (age 13 or younger)
• acted on sexual urges
• person at least 16 yrs of age and at least 5 yrs older than child or children
• specifiy if
  • sexual attracted to males, females, or both
  • limited to incest
  • if exclusive or nonexclusive

• in a heterosexual man, recurrent intense sexually arousing fantasies, urges or behaviors involving cross dressing