Psychopathology
Lecture 1 Sexual dysfunction (Charmaine Borg)- 13 September
- Exams; thinking as a clinician in scenario’s. Different than other years, without 50 MC.
Thinking outside the box before diagnoses, when not all criteria are followed.
- 9 October extra session online for extra questions
Human sexual behavior - Different to put persons issues in diagnoses, due the other factors that play
a role. Today;
- Presentation of sexual problems & assessment
- Aetiologies (prognoses) & theories of sexual dysfunctions
- DSM: relevance and changes
- Types of sexual psychopathologies according to DSM-5
o Women
o Men’s sexual dysfunction
o Other sexual dysfunction
- Current topical issues and myths
- General treatment/ interventions
o Psycho-sexual education
o Sensate focused
o CBT
Sexual problems
Sexual dysfunctions are complexed. It can be the same symptom experienced by two persons, for one
is het dysfunction and other normal.
- If a person is distressed and uncomfortable it is qualified as a dysfunction.
- Relationship in discordance if partner unsatisfied, but not sexual dysfunction
- DSM: different royers that are made but does not contain all..
o Needed for diagnoses, prioritize, insurance
Sexual diversion is not more in the DSM
o Classification system is relevant but not ideal.
- What is arousal and what is desire. Man are slidely easier than women. Differences in the
DSM IV DSM V;
1. Desire/ arousal are combined as female sexual interest/ arousal disorder
2. 6 months requirement for all the labels
a. except for the substance-/ medication-induces sexual dysfunction)
3. Gentito-pelvic pain/ penetration disorder (GPPPD)
a. Vaginismus and dyspareunia are combined
b. Generalized in all situations, nothing can go in the vagina
4. Subtypes for all disorders
a. Lifelong vs acquired
b. Generalized vs situational
c. Sexual aversion disorder are removed of DSM
What causes/ maintain SD? Body and mind synchronized for sexual activity.
- Coordinated by neurologic (cells), vascular (blood flow in penis and vagina), endocrine (FSH,
LH).
, - Individual sexuality incorporates; family, societal, religious (beliefs, experiences)
o Some cultures belief anal sex is wrong. Partner gives cues of anal sex. You think is not
done.
o Be aware of the culture sensititvity of the client when you suggests something
- Sexual activity in corporates; inter-personal relationships, each partner (attitudes, need,
responses)
It changes of the age, phase and state the person is in. People vary in respond in their
emotions and expressing it.
Causal factors in sexual dysfunction (SD)
1. Predisposing factors (vulnerability factors)
2. Precipitants (trigger)
a. Trauma, ageing, partner dysfunctions
3. Maintaining factors (what keeps you hooked in that disorder)
Bio-psycho-social assessment
Phases of sexual activity
- Master & John model/EPOR model; what is happening in your body. Sexual response is not
linear & uniform process.
o Excitement (fantasy) in your body and
, o Preparing for in (level of control). On the plateau
o Just before the peak of sexual pleasure and sexual release (orgasm),
o Resolution of your body (recovering and can not having a orgasm yet)
Phases are not lineair in the sames phases.
Men needs longer resolution time.
Some people skip the excitement
Some don’t have orgasm
- The sexual tipping point
o Excitation; sexual tipping point <- inhibition
- Specific sexual dysfunction (men)
o Delayed ejaculation (DE) More common in older (+50 years) men, than younger
Inability or difficulty to achieve desired ejaculation
Men by increasing as (even with sporty), declined in testosterones the need
more tactile information. Not only visualization of a partner is enough, but
they need more stimulation.
Maybe in menopause.
Encourage people and couples that it is a normal process. Tactile
stimulation in stronger stimulation is necessary.
Many theories about aetiology/prognosis, but little empirical data to support
any theories
3 common factors
Higher frequency masturbation
Idiosyncratic masturbatory style
Disparity between the reality of sex with this partner compared to
this preferred sexual fantasy during masturbation.
o Most people with DE don’t have it when masturbation, but
when the partner is there.
o Try to bring the gap of reality and the fantasy closer!!
o Masturbate less often
In clinical settings;
DE is diagnoses mistakenly ED – Erectile disorder.
Focus on pleasure instead of functioning
Learn to focus attention on sexual stimuli
Cognitive restructuring
Suspend (opschorten) masturbatory activity temporarily
Use condoms during masturbation
Check relationship
o Erectile disorder (ED)
Failure to obtain or maintain erections during partner sexual activities
More common in men over 50.
Marked decrease in erectile rigidity
Most problems remit without professional intervention – Psychotherapy
must included of the treatment (Viagra)
Cobra study; when people present themselves in erectile disorder, but not fit
the profile to the symptoms. It can be a red flag for cardiovascular issues
(arteriosclerosis in coronary arteries) heart diseases
, Medication and relational drugs with a negative impact on erectile function
(antihypertensives, antidepressants)
Assessment;
o Sexual development in childhood/ adolescence
o Masturbatory experiences?
o Rule out PE?
o Chronic/ permanent? Partner-/ situation dependent?
o Partner/ family/ business/ financial problems?
o Depressive symptoms
o ED existing with masturbatory activities?
o General health conditions competing with sexual life?
o Male hypoactive sexual desire disorder (MHSDD)
Persistent deficient or absent sexual thoughts, fantasies or desires.
A lot of expectations are on men and focuses on performances,
rather than pleasure.
Many are often treated for different sexual diagnoses while they
suffer from MHSDD
Desire and arousal are overlapping constructs , both focuses on ability of an
induvial to process sexual information during sexual activity.
MHSDD limited to a single partner is not SD (sexual dysfunction) but
a relationship problem
Erection and satisfaction are different things
Epidemiology MHSDD men
Prevalence is greater in older men in all literature 3-50%
Forget percentages and numbers; context is more important
o Middle age and old age men have natural decline in sexual
desire, sexual capacity.
o Sexual feelings diminished (verminderd) during repeated
erotic stimulation, and increased with the introduction of
novel situation
Novelty important in longterm relationship and not
the sexual ridged.
Need to find way to include the novelty (because less
sexual arousal) in LT
Side note;
Sex plays role in all phases of relationship
Sexual desire is important to relationship satisfaction and stability
Most complaint in LT is low sexual desire
Look at the process sexual pleasure as flavour
o Premature early ejaculation (PE);
Persistent or recurrent partner of ejaculation during partnered sexual activity
within 1 minute following penetration before individual wishes it
Conditions can be frustrating/ painful for person and partner
Put less pressure on premature early ejaculation
People with depression on treatment with SSRI… people realize get the drugs
and the side effects will have a more minutes to enjoy penetration. SSRI have
effects on DNA, what can hold people of becoming pregnant.
Distracting away from sexual stimulus and disrupting for a longer ejaculation.
, Biology is the chimpaze is coming in 6 seconds. So there is a lot of
work to learn
Phases; from the stimulus to trigger. To increase the plateau phase, to
prolonged that period.
- Sexual dysfunctions (female)
o Female orgasmic disorder
Delay, infrequency or absence of orgasm or reduced intensity of orgasm
sensation.
Prevalence is difficult to determine. Wide estimates 10-42%
NOT having orgasms problems related to;
Manual genital caressing (strelen)
Self-use of vibrator
Perception that sex is important
Early age of first orgasm
Cunnilingus (beffen)
Orgasm by penile motion (beweging van de penis)
Directed masturbation;
Efficacy to obtain orgasm during masturbation in lifelong pre/ an
orgasmic (slecht communiceren) women. Guidelines for erotic zones,
dialogue that in relationship with partner
Body awareness; Women raised that we give sex to our partner. But
we are now empowerment enough we enjoy our own bodies.
Psycho-sexual treatment
o Female sexual interest/arousal disorder (FSAD)
Absent/ reduced interest/ arousal related to sexual activities , thoughts, cues
etc. Persistent problems in relationships
Risk factors;
Abuse, partner with PE, poor communication
Clinically FSAD;
Lack of genital arousal/response, lubrication, tingling, warmth
Lack of body sensations in the rest of the body (subjective arousal)
Lesbian couples pursued of pleasure lesbian sex where the women reached
more intense orgasms. Relevance that we should not focus on penetration
and there are other ways of sex in broader way.
Risk factors
Psychological (inter- and intrapersonal)
o Sexual abuse and traumatic experiences
o Acute/ chronic stress
o Relationship problems
o Genito-pelvic disorder/ penetration disorder (GPPPD)
Difficulties with;
Vaginal penetration during intercourse (gemeenschap)
Pain during intercourse
Fear or anxiety about pain or penetration, or contraction of pelvic
floor muscles during sex.
Not looking forward to have sex again 15% women have some pain during
intercourse
Treatment
