Sexual function is influenced by psychological and physiological factors
Historically, female sexual satisfaction has been considered unimportant or something that could not exist.
Barriers to addressing sexual dysfunction include Physician and/or Patient issues with topic; it is a low priority of HMOs
Historical Perspective
Masters and Johnson
were the first to try empirically study sexuality. They observed negative cultural attitudes toward woman as playing a role in their sexual dysfunction
Infrequent masturbation of girls relative to boys
Women become comfortable with sexuality later in life, often under pressure to maintain a relationship via sex.
Women can have a fear of pregnancy that affects sexual experience (use of contraception interrupting coitus)
Margaret Mead
observed that in cultures where women’s sexuality was accepted, the women were orgasmic; however, cultures where female sexuality was not accepted, the women were not orgasmic.
Current view of Sexual cycle: order not rigid (i.e. woman may experience desire after arousal)
Desire
Arousal
Orgasm
Satisfaction
incorporates psychological aspect
Classification
DSM IV
(1994): the first 3 a re the most common complaints reported to physicians
(1) Hypoactive Sexual Desire:
Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity or receptivity to it
Sexual Desire comprised of three distinct interrelated components
(1) Drive
: The biological component based on neuroendocrine mechanisms and evidenced by spontaneous sexual interest. Least important to sexual desire.
(2) Cognitive
: Expectations, beliefs and values about sex.
(3) Motivation
: The emotional, interpersonal and psychological factors underlying one’s willingness to be sexual. This is the most important factor in determining sexual desire.
(2) Female Orgasmic Disorder
Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase.
(3) Dyspareunia
(Not due to a General Medical Condition)
Recurrent or persistent genital pain associated with sexual intercourse. - - Vulvolitis associated with this.
(4) Female Sexual Arousal
Persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication-swelling response of sexual excitement. Needs to cause personal stress to be considered a diagnosis.
(5) Sexual Aversion Disorder
Persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a partner.
(6) Vaginismus
(Not due to a General Medical Condition)
Recurrent or persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with sexual intercourse.