Female sexual dysfunctions

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WALID SARHAN. A Brief History. Psychoanalytic approach -sexual problems were linked to unresolved, unconscious conflicts during specific developmental periods. . Rise of behavioral techniques involving systematic desensitization pairing relaxation & exposure methods. ID: 724558 Download Presentation

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Female sexual dysfunctions

WALID SARHAN. A Brief History. Psychoanalytic approach -sexual problems were linked to unresolved, unconscious conflicts during specific developmental periods. . Rise of behavioral techniques involving systematic desensitization pairing relaxation & exposure methods.

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Female sexual dysfunctions




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Slide1

Female sexual dysfunctions

WALID SARHAN

Slide2

A Brief History

Psychoanalytic approach -sexual problems were linked to unresolved, unconscious conflicts during specific developmental periods

Rise of behavioral techniques involving systematic desensitization pairing relaxation & exposure methods

1900-1950

1950-1970

Masters & Johnson initiated a more biopsychosocial model consisting of physical examinations, history of dysfunction, education, behavioral & cognitive tasks, interpersonal issues; proposed brief, problem focused solutions

1970 - 1974

Slide3

A Brief History continued

1974-1980

1980 - current

Neo-Masters & Johnson Era

Helen Singer Kaplan’s The New Sex Therapy integrating M&J approach with psychodynamic methods

Mid-1980’s dawned the medicalization era; including combined CBT & pharmaceutical treatments; but has not had as significant an impact on female sexual dysfunction

Slide4

Healthy Sexuality

Lack of

training

Time

Personal

issues

Women’s sexuality is complex

It is less studied, understood than male sexuality

Many theories, beliefs about female sexuality are inaccurate or outdated

Clinicians may find

topic difficult to address

Berman

Fertil Steril

2003

Kingsberg

Sexuality, Reproduction & Menopause

2004

Slide5

Phases of the Sexual Response

As a function of “normal” sexual responding

:

Desire

: Defined by an interest in being sexual and in having sexual relations by oneself or with an appropriate partner

Arousal

: Refers to the physiological, cognitive & affective changes that serve to prepare an individual for sexual activity (vaginal lubrication, expansion & swelling of vulva)Orgasm: Refers to climatic phase with release of sexual tension and rhythmic contraction of the perineal muscles and reproductive organs:

Contractions in the outer third of the vaginaResolution: Refers to sense of muscular relaxation and general well-being; men are physiologically refractor while women may respond to further stimulation (APA, 2000)

Slide6

Excitement

Linear Model of Female Sexual Response

Plateau

Orgasm

Resolution

Resolution

Resolution

A B C

(C)

(A)

(B)

Masters and Johnson

Human Sexual Response

1966

Kaplan

Disorders of Sexual Desire and Other New Concepts and Techniques in Sex Therapy

1979

Slide7

Circular Model of

Female Sexual Response

Emotional Intimacy

Sexual Stimuli

Sexual Arousal

Spontaneous

Sexual Drive

Emotional and

Physical Satisfaction

Arousal and

Sexual Desire

Psychological

Seeking Out

and Being Receptive to

Biologic

Basson

Obstet Gynecol

2001

Slide8

Variables Affecting Female Sexual Response: Physiologic & Psychosocial

Basson

Menopause

2004

Past sexual

experiences

or

sexual abuse

Sexual self-image

and/or

body image

Relationship with

sexual partner

(male or female)

Slide9

W SARHAN

Female Sexual Response Cycle

Masters and Johnson characterized cycle with four phases:

Excitement

Plateau

Orgasmic

ResolutionKaplan proposed idea of “desire” and a three-phase model.DesireArousal

Orgasm

Slide10

Female Sexual

Response

Physiological indicators of arousal

Vasocongestion in the pelvis

Vaginal lubrication

Labia minora may darken

Clitoris hardens leading the vaginal hood (prepuce of clit) to appear enlargedCausing the vulva to lengthen and widen Areola hardens & nipples become erectBreast tumescence

Slide11

Female Sexual Response

Experts on female anatomy contend that there is an area in the outer third of the vagina, also responsible for orgasm, the Grafenberg or the G-spot

Located in the front of the body, 2” from entrance of the vagina

Clitoral vs. vaginal orgasm??

Slide12

Female sexual disorders include:

Sexual desire disorders:

Hypoactive sexual desire disorderSexual aversion disorderSexual arousal disorder

Orgasmic disorder

Sexual pain disorders:

Dyspareunia

Vaginismus

Slide13

W SARHAN

Sexual Desire Disorders:

Hypoactive sexual desire disorder

Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person's life. 

The disturbance causes marked distress or interpersonal difficulty. 

The sexual dysfunction is not better accounted for by another

disorder It is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. 

Slide14

W SARHAN

Sexual Desire Disorders:

Sexual aversion disorder

Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner. 

The disturbance causes marked distress or interpersonal difficulty. 

Slide15

W SARHAN

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. 

The disturbance causes marked distress or interpersonal difficulty. 

The sexual dysfunction is not better accounted for by another

disorder

It is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. 

Slide16

W SARHAN

Orgasmic Disorder

Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. Women exhibit wide variability in the type or intensity of stimulation that triggers orgasm.

The disturbance causes marked distress or interpersonal difficulty. 

The orgasmic dysfunction is not better accounted for by

disorder

It is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition. 

Slide17

W SARHAN

Sexual Pain Disorders:

Dyspareunia

Recurrent or persistent genital pain associated with sexual intercourse in either a male or a female. 

The disturbance causes marked distress or interpersonal difficulty. 

The disturbance is not caused exclusively by Vaginismus or lack of lubrication,

It is not better accounted for by another disorder it is not due exclusively to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition.

Slide18

W SARHAN

Sexual Pain Disorders:

Vaginimus

Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse. 

The disturbance causes marked distress or interpersonal difficulty. 

The disturbance is not better accounted for by another

disorder It is not due exclusively to the direct physiological effects of a general medical condition.

Slide19

W SARHAN

Populations who may experience female sexual dysfunction (FSD):

Abused

Perimenopausal

Pregnancy

Multiple sclerosis

Childhood sex abuseChemotherapyGenital mutationPost menopausalLack of sensitivity

Gynecological cancerRadiationBatteredNuerogenic diseaseSexual traumaSpinal cord injuryVascualr diseasePost-hysterectomyPost-partum

Slide20

W SARHAN

Etiology

“The etiologies of female sexual dysfunction affect a variety of populations and may be caused by psychological, emotional, or physiological reasons. Often, the etiology is multifactorial And interrelated.”

Slide21

Psychological Causes

As with most disorders, female sexual dysfunction can be caused and aggravated by psychological causes.

Slide22

W SARHAN

There are five main Psychological Causes to FSD.

Sexual or Emotional Abuse

Depression

Relationship Issues

Stress

Self Esteem Cultural factors in the Arabic society

Slide23

Depression

Depression is a prevalent cause of sexual dysfunction in both men and women.

Most women, when grieving, experience a loss of sexual desire.Depression can be a double edged sword for some, due to the increase of sexual dysfunction caused by anti-depressants.

Slide24

W SARHAN

Relationship

A healthy relationship is based on trust, intimacy, and communication.

sexual

dysfunction is highly associated with negative experiences in sexual relationships and overall well-being.

Slide25

Relationship (cont.)

Other factors that can affect the sexual health of a relationship are conflicts about cultural, social or religious beliefs

.

These can invoke feelings of guilt during sexual activity and affect the ability of a women to be aroused, obtain an orgasm, or have any desire to have sex.

Slide26

Female Orgasmic DisorderDelay, infrequency or absence of orgasm or reduced intensity of orgasm sensations lasting more than 6 months

Wide estimates of prevalence: 10%-42%

10% of women do not report experience of orgasmLifelong vs. acquired; generalized v. situational, also never; mild, moderate or severe

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013

Slide27

Female Sexual Interest/Arousal DisorderAbsent/reduced interest/arousal related to sexual activities, thoughts, encounters, cues, etc.

Becomes persistent problem for relationships

Lifelong vs. acquired; generalized v. situational; mild, moderate or severe

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013

Slide28

Genito

-Pelvic Pain/Penetration DisorderDifficulties with

1vaginal penetration during intercourse, 2 pain during intercourse,

3

fear or anxiety about pain or penetration, or contraction of pelvic floor muscles during sex

lasting more than 6 months

15% of women report some pain during intercourseLifelong vs. acquired; mild, moderate or severe

Diagnostic and Statistical Manual of Mental Disorders DSM-5 2013

Slide29

How common is sexual dysfunction?

Laumann

, Paik,& Rosen

1999 estimate

about

43% of women

and about 31% of men

have experienced

sexual

dysfunction

based on a

national survey of Americans

.

This makes sexual dysfunction the most common psychological problem in US.

Slide30

How Common is Inadequate Lubrication?

Approximately

40% of females in the United States have reported inadequate lubrication during sexual activity, making it the second most common sexual difficulty reported by females after low arousal.

Inadequate

lubrication is a physiological sign that a female is insufficiently sexually aroused. Sexual arousal is both a psychological and physiological

response.

Without proper vaginal lubrication, intercourse can be painful and can result in bodily injuries, such as chaffing or tearing of the vaginal mucosa (inner vaginal wall)

Slide31

Female Sexual Disorders: Prevalence

Bancroft

Arch Sex Behav

2003

Geiss

Urology

2003

Laumann

JAMA

1999

Nazareth

BMJ

2003

Interest

Lubrication/Arousal

Orgasm

Total

Laumann

31.6%

20.6%

25.7%

43%

Bancroft

7.2%

31.2%

9.3%

45%

Geiss

28.8%

23.0%

17.8%

48%

Nazareth

16.8%

3.6%

18.9%

39.6%

Slide32

National Health and Social Life

Survey (NHSLS)

In-person surveysexually active

18-59 years

Asked if problems in any one of seven areas of sexual function

Laumann

JAMA

1999

0

10

20

30

40

50

60

70

80

90

100

Women

Men

43%

31%

% of respondents

Slide33

Distress About Sex:

Kinsey 2000 Survey

Telephone survey987 white and black

20

–65 years oldBest predictors of distress: General emotional well-beingEmotional relationship with partner during sexual activity

Bancroft

Arch Sex Behav

2003

Women reporting marked distress

0

10

20

30

40

50

60

70

80

90

100

% of respondents

24.4%

Slide34

Patients, physicians, and asking about sex

25% of primary care physicians take a sex history

(Jonassen, et al 2002)75% patients believe that their physicians would dismiss their sexual health concerns or embarrass the physician (Marwick 1999)

Over 90% of patients believe it is physician’s role to address sexual health concerns and are grateful when this happens

(Ende, et al 1984)

Slide35

Reluctance to seek help

Studies show that over 50 % of individuals with sexual problems do not ask for help from health care provider

Studies indicate that of those seeking help (from any health care provider), less than 50% found the assistance helpful

Slide36

Patient Perceptions

Although 85% of adults want to discuss sexual functioning with their physicians…

71% believe their physicians doesn’t have the time

68% don’t want to embarrass their physician

76% thought no treatment was available for their problems

They also report…

Non-empathic and/or judgmental responses

Physician discomfort

Concern about privacy and/or confidentiality

Lack of cultural sensitivity

Marwick C. JAMA 1993; 281:2 173-4

Maurice WI, Bowman MA, Sexual Medicine in Primary Care 1999:1-41

Slide37

Treatment Approaches

Sex Therapy (CBT + Master’s & Johnson)

Pharmacotherapy & Medical DevicesA Systemic ApproachBibliotherapy

Slide38

Bibliography

Basson, R., Berman, J., Burnett, A., Derogatis, L., Ferguson, D., Fourcroy, J., Goldstein, I., Graziottin, A., Heiman, J., Laan, E., Leiblum, S., Padma-Nathan, H., Rosen, R., Segraves, K., Segraves, R. T., Shabsigh, R., Sipski, M., Wagner, G., & Whipple, B. (2001). Report of the International Consensus Development Conference on Female Sexual Dysfunction: Definitions and classifications.

Journal of Sex & Marital Therapy

,

27

, 83-94.

Berman, J.R., Berman, L., and Goldstein, I. (1999). Female Sexual Dysfunction: incidence, Pathophysiology, evaluation, and treatment options.Urology, 45, 385-391.Brassil, D.F, Keller, M. (2002). Female Sexual Dysfunction: Definitions, Causes, and Treatment. Urologic Nursing, 22, 237-242.Laumann, E.O, Paik, A., Rosen, R.C. (1999). Sexual Dysfunction in the United States.

Journal of the American Medical Association, 281, 537-544.Sarwer, D.B, Durlak, J.A. (1996). Childhood Sexual Abuse as a Predictor of Female Sexual Dysfunction: A Study of Couples Seeking Sex Therapy. Child Abuse & Neglect, 20, 963-972.Segraves, R.T. (2002). Female Sexual Disorders: Psychiatric Aspects. Canadian Journal of Psychiatry, 419-426. Retrieved April 6, 2004 from Ebsco host.Tiefer, L., Hall, M., & Travis, C. (2002). Beyond dysfunction: A new view of women’s sexual problems. Journal of Sex & Marital Therapy,

28, 225-232.http://www.behavenet.com/ (2004). Behavenet Clinical Capsule: DSM-IV-TR (Text Revision). Reprinted with permission from the

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (2000).

Slide39

Thank you

wsarhan34@gmail.com

Slide40