Understanding & Discussing Women's Sexual Functioning: How to ...

Female/Male Sexual Arousal
Disorder (302.72)
A. Persistent or recurrent inability to attain,
or to maintain until completion of the
sexual activity, an adequate lubrication-
swelling response of sexual excitement
B. The disturbance causes marked distress or
interpersonal difficulty
C. The orgasmic dysfunction is not better accounted for
by another Axis I disorder (except another Sexual
Dysfunction) and is not due exclusively to the direct
physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition
Vaginismus (306.51)
A. Recurrent or persistent involuntary
spasm of the musculature of the outer
third of the vagina that interferes with
sexual intercourse
B. The disturbance causes marked distress or
interpersonal difficulty
C. The disturbance is not better accounted for by
another Axis I disorder (e.g., Somatization Disorder) and
is not due exclusively to the direct physiological effects
of a general medical condition
Female Orgasmic Disorder (302.73)
A. Persistent or recurrent delay in, or absence of,
orgasm following a normal sexual excitement phase.
Women exhibit wide variability in the type or intensity
of stimulation that triggers orgasm. The diagnosis of
Female Orgasmic Disorder should be based on the
clinician’s s judgment that the woman’s s orgasmic
capacity is less than would be reasonable for her age,
sexual experience, and the adequacy of sexual
stimulation she receives.
B. The disturbance causes marked distress or interpersonal
difficulty
C. The orgasmic dysfunction is not better accounted for by
another Axis I disorder (except another Sexual Dysfunction) and
is not due exclusively to the direct physiological effects of a
substance (e.g., a drug of abuse, a medication) or a general
medical condition
Factors affecting sexual functioning
Medical Conditions
– Genitourinary
– Vascular
– Neurological
– Endocrine
Medications
– Psychotropic (e.g. SSRIs)
– OCPs
Psychosocial factors
– Sexual history (eg(
trauma)
– Messages about sexuality
– Dyadic stress
– Body Image
– Mental Health (eg(
depression, anxiety, “stress”)
Dyspareunia (302.76)
A. Recurrent or persistent genital pain
associated with sexual intercourse
B. The disturbance causes marked distress or
interpersonal difficulty
C. The orgasmic dysfunction is not caused exclusively
by Vaginismus or lack of lubrication, is not better
accounted for by another Axis I disorder (except another
Sexual Dysfunction) and is not due exclusively to the
direct physiological effects of a substance (e.g., a drug of
abuse, a medication) or a general medical condition
Prevalence of Female Sexual
Dysfunctions
For women (as opposed to men) Hypoactive Sexual Desire Disorder
(HSDD) decreases with age
Vaginismus
– 1% prevalence
Dyspareunia –
– 18-72% (US)
– Likelihood may increase post-menopause
Orgasmic disorder
– Kinsey (1953) 10% lifetime prevalence anorgasmia
– Laumann et al (1999) 24% 1-yr 1
prevalence of problems
– Depending on definition: 4-24% 4
– Lower SES and less education related to lower likelihood to experience
orgasm. (Laumann(
et al, 1994)
Sexual Arousal disorder
– Problems with lubrication:14-43% 43% US, (1-yr prevalence); 6% Iceland
(lifetime prevalence); 8% Sweden (1-yr prevalence)…..
– Increases with age for both men and women
2