Sexual Disorders

This lesson explores the DSM-5 framework for identifying and treating sexual dysfunctions. Sexual disorders fall into four broad categories: **disorders of sexual desire**, **arousal**, **orgasm**, and **sexual pain**. These disorders must cause **distress** or **relationship strain** to be clinically diagnosed.

• Hypoactive Sexual Desire Disorder (HSDD): Persistent low/absent interest in sex, most common in women. May be treated with **hormonal therapy** or **psychotherapy**.
• Sexual Aversion Disorder: Intense fear or disgust at the idea of sex; very rare and now grouped under broader categories.
• Sexual Interest/Arousal Disorder: New DSM-5 label combining desire and arousal issues, especially in females.

• Male Erectile Disorder (ED): Persistent inability to achieve or maintain an erection. Risk factors include **cardiovascular disease**, **diabetes**, and **medications**.
• Female Sexual Arousal Disorder: Inadequate lubrication, swelling, or subjective arousal during sex. May result from hormonal decline, anxiety, or trauma.

• **Pharmacological**: Viagra, Cialis (PDE5 inhibitors).
• **Mechanical Devices**: Vacuum erection devices, **penile implants**.
• **Psychological**: Couples therapy, sensate focus, CBT.

• Premature Ejaculation: Ejaculation sooner than desired, often within one minute of penetration.
• Delayed Ejaculation: Difficulty or inability to climax despite stimulation and arousal.
• Female Orgasmic Disorder (Anorgasmia): Delay or absence of orgasm in women, despite adequate stimulation.

• Start-Stop Method: Alternating stimulation and pausing to delay orgasm.
• Sensate Focus: Non-demand touching exercises to reduce anxiety and pressure.
• Kegel Exercises: Pelvic floor strengthening to improve orgasmic response.
• SSRIs: May help delay ejaculation but can worsen orgasmic function.

• Dyspareunia: Pain during intercourse in any sex. Causes can include infections, hormonal changes, or psychological factors.
• Vaginismus: Involuntary tightening of vaginal muscles, often linked to trauma or fear of pain.
• Vulvar Vestibulitis Syndrome: Pain at the vulva’s entrance, especially during pressure or touch.

• Pain management, desensitization, physical therapy, and therapy for trauma-related concerns.

• Primary: Disorder is lifelong, not preceded by normal functioning.
• Secondary: Appears after a period of normal sexual function.
• Situational: Occurs only in certain contexts or with certain partners.