Sexual Disorders

NORMAL SEXUALITY
Sexual response cycle: desire to EXPLORE desire,
EXcitement, PLateau, Orgasm, REsolution
Refractory period: post-resolution period in
which men cant reexperience orgasm
Sex male aging: desire unchanged but requires
stimulation and time to orgasm, intensity of
ejaculation, refractory period
Sex female aging: desire unchanged but estrogen
levels vaginal dryness and thinning
Sex drugs: libido cocaine, amphetamines,
marijuana, and acute alcohol use; libido narcotics
and chronic alcohol use
Sex NTs: DA libido, 5-HT inhibits sexual function
Sex hormones: testosterone libido, progesterone
libido, postmenopausal estrogen levels vaginal
dryness and thinning
Substance-induced sexual dysfunction: anti-HTN,
anticholinergics, antipsychotics, antidepressants
(esp. SSRIs), or substance abuse
Sexual dysfunction 2/2 GMC: atherosclerosis (ED),
diabetes (ED + neuropathy), pelvic adhesions
(dyspareunia), depression or anxiety

Orgasmic disorder: cant orgasm or achieves orgasm

w/ great difficulty
Male OD Tx: gradually progress from extravaginal
ejaculation (via masturbation) to intravaginal

Fetishism: sexual preference for inanimate

objects (e.g. womens shoes)

Female OD Tx: masturbation vibrator

Transvestic fetishism: sexual gratification in men

from wearing womens clothing

Dyspareunia: genital pain before, during, or after

sexual intercourse; women > men, often associated
w/ vaginismus
Dyspareunia Tx: gradual desensitization to
achieve intercourse (muscle relaxation erotic
massage sexual intercourse)
Vaginismus: involuntary muscle contraction of
outer 1/3 of vagina during insertion; incidence in
higher socioeconomic groups and strict religious
upbringing
Vaginismus Tx: manual dilation
Homosexuality: sexual/romantic desire for same sex,
not a sexual disorder, etiology unknown
Homosexual depression: consider MDD or
adjustment d/o due to conflict w/ societal values;
homosexuality is not a disorder
Homosexual prepuberty: same-sex exploratory
activities are common in prepubescent kids and
dont signify latent homosexuality

SEXUAL DISORDERS
Sexual disorders: problems involving any stage of
sexual response cycle or pain during intercourse, not
due to substance use or GMC
MC sexual disorders: premature ejaculation and 2
ED in men, HSDD and orgasmic disorder in women
Hypoactive sexual desire disorder: deficient or
absent libido
HSDD Tx: hormone replacement therapy
Sexual aversion disorder: avoidance of genital
contact w/ sexual partner
Erectile dysfunction: aka impotence, cant get it up,
either 1 (never had one) or 2 (had it but lost it)
ED Tx: PDE5-inhibitors (sildenafil) or alprostadil
injection are first-line; vacuum pumps, surgical
tube insertion, or constrictive rings
ED vs. psychological condition: men w/ psych
condition can get it up at other times (e.g. other
partners, masturbating, morning wood)
Sexual arousal disorder: cant get it wet
Premature ejaculation: ejaculation earlier than
expected
Premature ejaculation Tx: SSRIs or TCAs can
prolong time to ejaculation

Masochism: sexual excitement from being hurt

or humiliated

Transsexuality: aka gender identity disorder, strong

cross-gender identification + persistent discomfort
w/ own sex
Transsexuality Tx: therapy, family involvement
for younger pts, possibly sex reassignment
Transsexual vs. transvestite: transsexuals identify
with the other sex, transvestites like to wear other
genders vestments (clothing)
PARAPHILIAS
Paraphilias: engagement or preoccupation w/
unusual sexual urges or fantasies, must last >6
months and interfere w/ daily life
MC paraphilias: pedophilia, voyeurism, exhibitionism
Pedophilia: getting turned on by kids <13 y/o,
pedophile must be >16 y/o and at least 5 years
older than the child
Frotteurism: sexual pleasure from touching or
rubbing up against a nonconsenting person
Voyeurism: watching unsuspecting nude people
for sexual pleasure
Exhibitionism: exposing self to others
Sadism: sexual excitement from hurting or
humiliating others

Necrophilia: sexual pleasure from f-ing a corpse

Telephone scatologia: sexual excitement from
calling unsuspecting women and having phone
sex with them
Paraphilia Px: good prognosis w/ self-referral (vs.
police arrest), sense of guilt, and low frequency of
behavior
Paraphilia Tx: insight-oriented psychotherapy +
aversion therapy; antiandrogens for refractory
hypersexual paraphilias in men
Paraphilia vs. normal fantasy: occasional fantasies
are normal if <6 months and dont interfere w/ daily
functioning
Transvestic fetishism vs. homosexuality: dressing up
as a woman doesnt mean youre turned on by men
TREATMENT OF SEXUAL DISORDERS
Sexual disorder Tx: psychotherapy, medications,
and mechanical therapy all play a role
Psychotherapy: dual sex therapy for marriage or
couple issues, behavioral therapy for maladaptive
behaviors, hypnosis for anxiety
Pharmacotherapy: (see specific disorders)
Mechanical therapy: (see specific disorders)