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Chapter 16. Human Sexuality and Sexual Dysfunctions

Judith V. Becker, Ph.D.; Jill D. Stinson, Ph.D.
DOI: 10.1176/appi.books.9781585623402.332920

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Excerpt

Clinicians see patients who have a variety of sexual dysfunctions. A woman who has previously been molested or sexually assaulted may no longer be desirous of sex or may have difficulty with arousal. A man who has recently been widowed may experience difficulty achieving erections when he enters the dating scene. A woman with multiple sclerosis may no longer have orgasms. A man who is taking antihypertensive medication may have difficulty obtaining an erection. Recently postmenopausal women may find intercourse painful. Patients who are on antidepressants or antipsychotic medication may report impairment in their sexual functioning. It is important that clinicians be knowledgeable about human sexuality, the stages of sexual arousal, and sexual dysfunctions so that they can appropriately evaluate and provide treatment to their patients who present with sexual dysfunctions.

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FIGURE 16–1. The male sex organs and reproductive structures.(A) External structure. (B) Internal structure.Source. Reprinted from An Invitation to Health (with ThomsonNOW(T) and InfoTrac(R) 1-Semester Printed Access Card), 12th Edition, by Hales, Dianne. 2007. Used with permission of Brooks/Cole, a division of Thomson Learning: www.thomsonrights.com. Fax 800-730-2215.

FIGURE 16–2. The female sex organs and reproductive structures.(A) External structure. (B) Internal structure.Source. Reprinted from An Invitation to Health (with ThomsonNOW(T) and InfoTrac(R) 1-Semester Printed Access Card), 12th Edition, by Hales, Dianne. 2007. Used with permission of Brooks/Cole, a division of Thomson Learning: www.thomsonrights.com. Fax 800-730-2215.

FIGURE 16–3. The human sexual response cycle, as seen in three different patients.Source.  Masters and Johnson 1966.
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TABLE 16–1. DSM-IV-TR classifications of sexual dysfunctions
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TABLE 16–2. Commonly used medications that may interfere with sexual functioning
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TABLE 16–3. Four stages of the sexual response cycle
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TABLE 16–4. Prevalence estimates for male and female sexual dysfunctions
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TABLE 16–5. Multicausal theory of sexual dysfunctions
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TABLE 16–6. DSM-IV-TR diagnostic criteria for hypoactive sexual desire disorder
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TABLE 16–7. DSM-IV-TR diagnostic criteria for sexual aversion disorder
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TABLE 16–8. DSM-IV-TR diagnostic criteria for female sexual arousal disorder
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TABLE 16–9. DSM-IV-TR diagnostic criteria for male erectile disorder
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TABLE 16–10. DSM-IV-TR diagnostic criteria for female orgasmic disorder
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TABLE 16–11. DSM-IV-TR diagnostic criteria for male orgasmic disorder
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TABLE 16–12. DSM-IV-TR diagnostic criteria for premature ejaculation
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TABLE 16–13. DSM-IV-TR diagnostic criteria for dyspareunia
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TABLE 16–14. DSM-IV-TR diagnostic criteria for vaginismus
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Sexual dysfunctions are divided into four primary categories: sexual desire disorders, sexual arousal disorders, orgasmic disorders, and sexual pain disorders. DSM-IV-TR diagnostic criteria for each of these categories are outlined in this chapter.

Sexual dysfunctions are relatively common disorders in both males and females, affecting up to 20%–30% of the population at some point in their lives. Improvements in assessment and diagnosis have increased our understanding of sexual dysfunction and its variation across the life span.

Causes of sexual dysfunction are numerous and varied, with external influences such as disease, medication, or substance use and internal influences such as anxiety, other psychological disorders, or lack of communication regarding sexual interests or desires all playing a role.

Treatments for sexual dysfunctions often involve a combination of psychological and behavioral interventions. Recent advances in pharmacological agents designed to affect sexual performance have also helped in the treatment of sexual dysfunctions, particularly male orgasmic disorders. Successful treatment may require addressing both psychogenic and physiological etiologies of the dysfunction.

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Sample questions:
1.
According to DSM-IV-TR (American Psychiatric Association 2000) classifications, sexual aversion disorder is an example of which of the following sexual dysfunctions?
2.
In comparative studies of clinical samples, which of the following sexual dysfunctions has decreased in frequency as a presenting problem over time?
3.
Which of the following statements concerning hypoactive sexual desire disorder is false?
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