ANISHA STUDIES

Sexual Dysfunctions:

The Sexual Response Cycle is a model that describes the sequence of physiological and
psychological changes that occur during sexual activity and response. It consists of four
phases:
1. Excitement/Arousal Phase
 Physical changes:
o Males: Penile erection, testicles elevate
o Females: Vaginal lubrication, swelling of vagina/labia
o Both: Increased heart rate, blood pressure, breathing rate
 Psychological changes:
o Heightened sexual interest/desire
o Increased focus on sexual stimuli
2. Plateau Phase
 Continuation and intensification of physical/psychological changes from excitement
phase
 Males: Testicles further elevated, increased penile swelling
 Females: Vaginal lips become further swollen, breast enlargement
 Both: Muscle tension increases, "sex flush" may appear
3. Orgasmic Phase
 Shortest phase, representing peak of sexual pleasure/release of tension
 Physical changes:
o Males: Rhythmic contractions of reproductive organs, ejaculation
o Females: Rhythmic contractions of outer vagina
 Psychological changes:
o Intense pleasure, loss of control
4. Resolution Phase
 Return to the unaroused state
 Physical changes reverse (e.g. swelling reduces, erections subside)
 Refractory period in males where arousal cannot be readily reinstated
Sexual Interest/Arousal Disorders
A. Female Sexual Interest/Arousal Disorder
Criteria: Lack of sexual interest/arousal as manifested by 3 of the following for a minimum of
6 months:
- Lack of interest in sexual activity
- Reduced/no sexual thoughts or fantasies
- Reduced/no initiation of sexual activity and typically unreceptive to a partner's attempts
- Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (75%-
100%) encounters
- Interest/arousal is absent/diminished from a persistent or recurring state, and not better
accounted for by another condition
Etiology: Psychological factors (e.g. depression, body image), medical factors (e.g.
medications, illnesses), interpersonal difficulties
Treatment: Cognitive behavioral therapy, mindfulness, couples therapy, hormonal treatment
B. Male Hypoactive Sexual Desire Disorder
Similar criteria as above regarding lack of sexual thoughts, fantasies, desire for sexual
activity
Etiology: Similar psychological, medical and interpersonal factors
Treatment: Similar therapies as above, hormonal therapy (testosterone)
Orgasmic Disorders
A. Female Orgasmic Disorder
Criteria: Presence of either marked delay, infrequency, or absence of orgasm and feeling of
orgasmic inevitability
Etiology: Psychological factors, medical factors (e.g. medications), interpersonal difficulties
Treatment: Cognitive behavioral therapy, mindfulness, couples therapy
B. Delayed Ejaculation (Male)
Criteria: Marked delay or inability to achieve ejaculation during partnered sexual activity
Etiology: Psychological factors, medical factors (e.g. medications), interpersonal difficulties
Treatment: Cognitive behavioral therapy, medication (e.g. antidepressants)
C. Premature (Early) Ejaculation (Male)
Criteria: Ejaculation occurring during partnered sexual activity sooner than desired
Etiology: Psychological factors, biogenic amine neurotransmitters
Treatment: Behavioral techniques, topical anesthetics, medication (e.g. antidepressants)
Sexual Pain Disorders
A. Genito-Pelvic Pain/Penetration Disorder (Females)
Criteria: Persistent or recurrent pain during vaginal intercourse or penetration
Etiology: Medical factors (e.g. endometriosis, injuries), psychological factors, interpersonal
difficulties
Treatment: Cognitive behavioral therapy, couples therapy, pelvic floor physical therapy
B. Erectile Disorder (Males)
Criteria: Marked difficulty in obtaining/maintaining erection during sexual activity
Etiology: Vascular, neurogenic, hormonal, psychological factors
Treatment: Phosphodiesterase type 5 inhibitors, hormonal therapy, vascular surgery,
psychotherapy

Gender Dysphoria
 Diagnostic Criteria:
o Marked incongruence between one's experienced/expressed gender and their
assigned gender, lasting at least 6 months
o Manifested by at least 2 of the following:
 Marked incongruence between experienced/expressed gender and
primary/secondary sex characteristics
 Strong desire to be rid of one's primary/secondary sex characteristics
 Strong desire for the primary/secondary sex characteristics of the other
gender
 Strong desire to be of the other gender
 Strong desire to be treated as the other gender
 Strong conviction that one has the typical feelings/reactions of the
other gender
 Specifiers:
o With or without a disorder of sex development
o Posttransition - individual has transitioned through medical intervention and/or
desired gender role changes
  Epidemiology:
o Prevalence estimates range from 0.005% to 0.014% for adult natal males
o From 0.002% to 0.003% for adult natal females
o Higher than previous estimates due to increased awareness and disclosure
 Development and Course:
o Often becomes apparent in early childhood
o Representation across all ages, ethnicities, cultures
o More common in natal males than females
 Risk and Prognostic Factors:
o Coexisting mental health illnesses - anxiety, depression
o Abuse, rejection, lack of support heighten risk
o If supported, good outcomes
 Differential Diagnosis:
o Body Dysmorphic Disorder
o Non-Conforming Gender Behaviors
 Etiology:
o Precise causes unknown
o Biologically-based and influenced by environmental factors
o Likely involves genetic, prenatal hormone exposure, brain structure factors
 Treatment:
o Psychotherapy
o Hormone therapy
o Surgery
o Family/Social support crucial

Paraphilias
 Characterized by atypical/intense sexual interests and behaviors
 May potentially cause personal distress or impairment, or psychological/physical
harm to others
 Types:
 1. Voyeuristic Disorder
o Recurrent and intense sexual arousal from observing unsuspecting
naked/engaged in sexual activity
2. Exhibitionistic Disorder
o Recurrent and intense sexual arousal from exposing genitals to unsuspecting
person(s)
3. Frotteuristic Disorder
o Recurrent and intense sexual arousal from touching/rubbing against a non-
consenting person
4. Sexual Masochism Disorder
o Recurrent and intense sexual arousal from the act of being humiliated, beaten,
bound or suffering
5. Sexual Sadism Disorder
o Recurrent and intense sexual arousal from the physical or psychological
suffering of another person
6. Pedophilic Disorder
o Recurrent, intense sexually arousing fantasies, urges or behaviors involving
sexual activity with prepubescent child(ren)
7. Fetishistic Disorder
o Recurrent, intense sexual arousal from non-living objects or a highly specific
focus on inanimate objects
8. Transvestic Disorder
o Recurrent, intense sexually arousing fantasies, urges or behaviors involving
cross-dressing
General Considerations:
 Causes not entirely clear, likely involve psychological, biological, and sociocultural
factors
 Distress or impairment is a requirement for a diagnosis
 Paraphilic disorder diagnoses exclude normative atypical sexual interests
 Treatment may involve psychotherapy, medication, prevention strategies