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Sexual Dysfunctions

(10-26-09)

Differential Diagnosis

“The first differential to consider in diagnosing a Sexual Dysfunction is normality.” (Frances & Ross, 2001, p. 231). Frances and Ross point out that the individual’s age and experiences, the mores of their culture and religious background, the adequacy of the sexual stimulation, and whether the sexual problem is causing the person distress or interpersonal difficulty must all be considered in making a diagnosis of sexual dysfunction; “Often the differential diagnosis is between a Sexual Dysfunction in one individual and a diagnosis of V61.1 Partner Relational Problem in the couple.” (Frances & Ross, 2001, p. 232)

“The core concept of the Sexual and Gender Identity Disorders group is difficulty in the expression of normal sexuality.” (Fauman, 1994, p. 284)

“Currently, the most commonly encountered causes of orgasmic difficulties are probably medications (especially the selective serotonin reuptake inhibitors and antihypertensives) and Substance Use, and it is important to rule these out first.” (Frances & Ross, 2001, p. 234)

Ford, C.S. & Beach, F.A. (1951). Patterns of Sexual Behavior. New York: Harper.

Always consider:

  • medical problems (cardiovascular, hypertension, diabetes, etc.)
  • drugs, prescription and recreational (alcohol, cannabis, antihypertensive, SSRI’s, etc.)
  • depression, anxiety, ignorance, shame/guilt, negative attitudes
  • fatigue, routine/boredom, conflicting emotions, issues of personal hygiene in partner, absence of adequate and honest communication with partner

Phases of the human sexual response cycle

  • Appetitive
    • Hypoactive Sexual Desire Disorder
    • Sexual Aversion Disorder
    • Morrison (1995) notes that hypersexuality (excessive interest in sex) is not defined or described in DSM-IV but can occur as a symptom in several disorders: Manic Episode, Schizophrenia, Cognitive Disorders, Personality Disorders
  • Excitement
    • Female Sexual Arousal Disorder
    • Male Erectile Disorder
  • Orgasm
    • Female Orgasmic Disorder
    • Male Orgasmic Disorder
    • Premature Ejectulation
  • Resolution
    • no DSM-IV disorders are linked to the resolution phase
  • (Nonphasic: sexual pain disorders)
    • Dyspareunia
    • Vaginimus
  • (Nonphasic: secondary and other sexual dysfunctions)
    • Sexual Dysfunction Due to a General Medical Condition
    • Substance-Induced Sexual Dysfunction
    • Sexual Dysfunction NOS
      • examples from DSM-IV:
        • Absent erotic feelings
        • Undiagnosed

DSM-IV Qualifiers

  • Lifelong vs. Acquired Type
  • Generalized vs. Situational Type
  • Due to Psychological Factors
  • Due to Combined Factors

Other qualifiers seen in the literature

Primary Orgasmic Disorder (or Primary Anorgasmia) is used in some of the sexual dysfunction literature to refer to cases where the individual has been unable to achieve orgasm by any means versus Secondary Orgasmic Disorder, where the client can achieve orgasm with masturbation or sexual foreplay (manual or oral stimulation) but not during intercourse); Primary Anorgasmia would correspond (roughly) to DSM-IV Orgasmic Disorder, Lifetime, Generalized.

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