Sexual dysfunction: Difference between revisions

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__NOTOC__
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{{DiseaseDisorder infobox |
{{DiseaseDisorder infobox |
   Name        = Sexual dysfunction |
   Name        = Sexual dysfunction |
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}}
}}
{{SI}}
{{SI}}
{{CMG}}; {{AE}} {{KS}}
{{CMG}}; {{AE}} {{KS}} {{SHA}}


==Overview==
==Overview==
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==Differential Diagnosis of Male Hypoactive Sexual Desire Disorder==
==Differential Diagnosis of Male Hypoactive Sexual Desire Disorder==
*Another medical condition
*Another medical condition
:*Central nervous system disease
:*Central nervous system disease
:*[[Diabetes mellitus]]
:*[[Diabetes mellitus]]
:*[[Hypogonadism]]
:*[[Hypogonadism]]
:*[[Thyroid disease|Thyroid dysfunction]]
:*[[Thyroid disease|Thyroid dysfunction]]
*lnterpersonal factors
*lnterpersonal factors
:*Severe relationship distress
:*Severe relationship distress
*Nonsexual mental disorders
*Nonsexual mental disorders
*Other sexual dysfunctions
*Other sexual dysfunctions
:*[[Premature ejaculation|Early ejaculation]]
:*[[Premature ejaculation|Early ejaculation]]
:*[[Erectile dysfunction|Erectile difficulties]]
:*[[Erectile dysfunction|Erectile difficulties]]
*Substance/medication use<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
 
*Substance/medication use<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>


==Risk Factors of Male Hypoactive Sexual Desire Disorder==
==Risk Factors of Male Hypoactive Sexual Desire Disorder==
*Age
*Age
*Attitudes
*Attitudes
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*Lack of adequate sex education
*Lack of adequate sex education
*Mood
*Mood
*Man's feelings about himself  
*Man's feelings about himself
*Partner's sexual desire  
*Partner's sexual desire
*Social and cultural contextual factors
*Social and cultural contextual factors
*Trauma from early life experiences<ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>
*Trauma from early life experiences<ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>


==Diagnosis==
==Diagnosis==
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The fourth edition of the [[Diagnostic and Statistical Manual of Mental Disorders]] lists the following psychological sexual disorders:
The fourth edition of the [[Diagnostic and Statistical Manual of Mental Disorders]] lists the following psychological sexual disorders:


* [[Hypoactive sexual disorder]] (see also [[asexuality]])
*[[Hypoactive sexual disorder]] (see also [[asexuality]])
* [[Bestiality]]
*[[Bestiality]]
* [[Sexual aversion disorder]] (avoidance of or lack of desire for sexual intercourse)
*[[Sexual aversion disorder]] (avoidance of or lack of desire for sexual intercourse)
* [[Female sexual arousal disorder]] (failure of normal lubricating arousal response)
*[[Female sexual arousal disorder]] (failure of normal lubricating arousal response)
* [[Erectile dysfunction|Male erectile disorder]]
*[[Erectile dysfunction|Male erectile disorder]]
* Female orgasmic disorder (see [[Anorgasmia]])
*Female orgasmic disorder (see [[Anorgasmia]])
* Male orgasmic disorder (see [[Anorgasmia]])
*Male orgasmic disorder (see [[Anorgasmia]])
* [[Premature ejaculation]]
*[[Premature ejaculation]]
* [[Dyspareunia]]
*[[Dyspareunia]]
* [[Vaginismus]]
*[[Vaginismus]]
* [[Secondary sexual dysfunction]]
*[[Secondary sexual dysfunction]]
* [[Paraphilia]]s
*[[Paraphilia]]s
* [[Gender identity disorder]]
*[[Gender identity disorder]]
* [[PTSD]] due to genital mutilation or childhood sexual abuse
*[[PTSD]] due to genital mutilation or childhood sexual abuse


====Other sexual problems====
====Other sexual problems====
* Sexual dissatisfaction (non-specific)
 
* Lack of sexual desire
*Sexual dissatisfaction (non-specific)
* [[Anorgasmia]]
*Lack of sexual desire
* [[Erectile dysfunction|Impotence]]
*[[Anorgasmia]]
* [[Sexually transmitted disease]]s
*[[Erectile dysfunction|Impotence]]
* Delay or absence of [[ejaculation]], despite adequate stimulation
*[[Sexually transmitted disease]]s
* Inability to control timing of ejaculation
*Delay or absence of [[ejaculation]], despite adequate stimulation
* Inability to relax [[vagina]]l muscles enough to allow [[intercourse]]
*Inability to control timing of ejaculation
* Inadequate vaginal lubrication preceding and during intercourse
*Inability to relax [[vagina]]l muscles enough to allow [[intercourse]]
* Burning pain on the [[vulva]] or in the vagina with contact to those areas
*Inadequate vaginal lubrication preceding and during intercourse
* Unhappiness or confusion related to [[sexual orientation]]
*Burning pain on the [[vulva]] or in the vagina with contact to those areas
* [[Transsexual]] and [[transgender]] people may have sexual problems (before or after [[sex reassignment surgery|surgery]]), though actually being transgendered or transsexual is not a sexual problem in itself.
*Unhappiness or confusion related to [[sexual orientation]]
* [[Persistent sexual arousal syndrome]]
*[[Transsexual]] and [[transgender]] people may have sexual problems (before or after [[sex reassignment surgery|surgery]]), though actually being transgendered or transsexual is not a sexual problem in itself.
* [[Post SSRI Sexual Dysfunction]]
*[[Persistent sexual arousal syndrome]]
* [[Sexual addiction]]
*[[Post SSRI Sexual Dysfunction]]
* [[Hypersexuality]]
*[[Sexual addiction]]
* [[Female genital cutting]] has occurred more in the USA than previously thought
*[[Hypersexuality]]
* [[Male circumcision]] alters the natural sexual function for both partners
*[[Female genital cutting]] has occurred more in the USA than previously thought
*[[Male circumcision]] alters the natural sexual function for both partners


====Other related problems====
====Other related problems====
* [[Infertility]]
 
* [[Paraphilia]]
*[[Infertility]]
*[[Paraphilia]]


==Diagnostic Criteria==
==Diagnostic Criteria==
===DSM-V Diagnostic Criteria for Male Hypoactive Sexual Desire Disorder <ref name=DSMV>{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>===
===DSM-V Diagnostic Criteria for Male Hypoactive Sexual Desire Disorder <ref name="DSMV">{{cite book | title = Diagnostic and statistical manual of mental disorders : DSM-5 | publisher = American Psychiatric Association | location = Washington, D.C | year = 2013 | isbn = 0890425558 }}</ref>===
{{cquote|
{{cquote|


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Despite the work of Masters and Johnson the field in the US was quickly over-run by ethusiastic rather than systematic approaches, blurring the space between 'enrichment' and therapy. Although it has been argued that the impact of the work was such that it would be impossible to repeat such a clean experiment.
Despite the work of Masters and Johnson the field in the US was quickly over-run by ethusiastic rather than systematic approaches, blurring the space between 'enrichment' and therapy. Although it has been argued that the impact of the work was such that it would be impossible to repeat such a clean experiment.


<br />


==Overview==
==Overview==


==Historical Perspective==
==Historical Perspective==
[Disease name] was first discovered by [name of scientist], a [nationality + occupation], in [year]/during/following [event].
The association between [important risk factor/cause] and [disease name] was made in/during [year/event].
In [year], [scientist] was the first to discover the association between [risk factor] and the development of [disease name].
In [year], [gene] mutations were first implicated in the pathogenesis of [disease name].
There have been several outbreaks of [disease name], including -----.
In [year], [diagnostic test/therapy] was developed by [scientist] to treat/diagnose [disease name].


==Classification==
==Classification==
There is no established system for the classification of [disease name].
According to the [[Diagnostic and Statistical Manual of Mental Disorders]] 5 (DSM-5), the list of sexual dysfunctions include:<ref name="Diagnostic and statistical manual of mental disorders : DSM-5 2013 p.">{{cite book | title=Diagnostic and statistical manual of mental disorders : DSM-5 | publisher=American Psychiatric Association,American Psychiatric Association | publication-place=Arlington, VA Washington, D.C | year=2013 | isbn=0-89042-555-8 | oclc=830807378 | page=}}</ref>


OR
*[[Delayed ejaculation]]
 
*Erectile disorder
[Disease name] may be classified according to [classification method] into [number] subtypes/groups: [group1], [group2], [group3], and [group4].
*Female [[Orgasmic dysfunction|orgasmic]] disorder
 
*Female sexual interest/[[arousal]] disorder
OR
*[[Genito-pelvic pain]]/[[penetration disorder]]
 
*Male [[hypoactive sexual desire disorder]]
[Disease name] may be classified into [large number > 6] subtypes based on [classification method 1], [classification method 2], and [classification method 3].
*[[Premature ejaculation|Premature (early) ejaculation]]
[Disease name] may be classified into several subtypes based on [classification method 1], [classification method 2], and [classification method 3].
*[[Substance]]/[[medication]] induced sexual dysfunction
 
*Other specified sexual dysfunction
OR
*Unspecified sexual dysfunction.  
 
Based on the duration of symptoms, [disease name] may be classified as either acute or chronic.
 
OR
 
If the staging system involves specific and characteristic findings and features:
According to the [staging system + reference], there are [number] stages of [malignancy name] based on the [finding1], [finding2], and [finding3]. Each stage is assigned a [letter/number1] and a [letter/number2] that designate the [feature1] and [feature2].
 
OR
 
The staging of [malignancy name] is based on the [staging system].
 
OR
 
There is no established system for the staging of [malignancy name].


==Pathophysiology==
==Pathophysiology==
The exact pathogenesis of [disease name] is not fully understood.
OR
It is thought that [disease name] is the result of / is mediated by / is produced by / is caused by either [hypothesis 1], [hypothesis 2], or [hypothesis 3].
OR
[Pathogen name] is usually transmitted via the [transmission route] route to the human host.
OR
Following transmission/ingestion, the [pathogen] uses the [entry site] to invade the [cell name] cell.
OR
[Disease or malignancy name] arises from [cell name]s, which are [cell type] cells that are normally involved in [function of cells].
OR
The progression to [disease name] usually involves the [molecular pathway].
OR
The pathophysiology of [disease/malignancy] depends on the histological subtype.


==Causes==
==Causes==
Disease name] may be caused by [cause1], [cause2], or [cause3].
OR
Common causes of [disease] include [cause1], [cause2], and [cause3].
OR
The most common cause of [disease name] is [cause 1]. Less common causes of [disease name] include [cause 2], [cause 3], and [cause 4].
OR


The cause of [disease name] has not been identified. To review risk factors for the development of [disease name], click [[Pericarditis causes#Overview|here]].
==Differentiating Sexual Dysfunction from other Diseases==
 
==Differentiating ((Page name)) from other Diseases==
[Disease name] must be differentiated from other diseases that cause [clinical feature 1], [clinical feature 2], and [clinical feature 3], such as [differential dx1], [differential dx2], and [differential dx3].
 
OR
 
[Disease name] must be differentiated from [[differential dx1], [differential dx2], and [differential dx3].


==Epidemiology and Demographics==
==Epidemiology and Demographics==
The incidence/prevalence of [disease name] is approximately [number range] per 100,000 individuals worldwide.
OR
In [year], the incidence/prevalence of [disease name] was estimated to be [number range] cases per 100,000 individuals worldwide.
OR
In [year], the incidence of [disease name] is approximately [number range] per 100,000 individuals with a case-fatality rate of [number range]%.
Patients of all age groups may develop [disease name].
OR


The incidence of [disease name] increases with age; the median age at diagnosis is [#] years.
=== Prevalence ===
The US National Health and Social Life Survey (NHSLS) showed that the prevalence of sexual problems among the individuals in the US include:<ref name="pmid10022110">{{cite journal| author=Laumann EO, Paik A, Rosen RC| title=Sexual dysfunction in the United States: prevalence and predictors. | journal=JAMA | year= 1999 | volume= 281 | issue= 6 | pages= 537-44 | pmid=10022110 | doi=10.1001/jama.281.6.537 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10022110  }} </ref>


OR
==== Women ====


[Disease name] commonly affects individuals younger than/older than [number of years] years of age.
* The [[prevalence]] of sexual complaints is approximately 43% and the most common problems include:
** [[Desire]] (33%)
** [[Orgasm]] (24%)
** [[Lubrication]] (19%)


OR
==== Men ====


[Chronic disease name] is usually first diagnosed among [age group].
* The [[prevalence]] of sexual complaints is approximately 31% and the most common problems include:
 
** [[Premature ejaculation]] (21%)
OR
** [[Erectile dysfunction]] (5%)
 
** Low [[desire]] (5%)
[Acute disease name] commonly affects [age group].
 
 
 
There is no racial predilection to [disease name].
 
OR
 
[Disease name] usually affects individuals of the [race 1] race. [Race 2] individuals are less likely to develop [disease name].
 
 
 
[Disease name] affects men and women equally.
 
OR
 
[Gender 1] are more commonly affected by [disease name] than [gender 2]. The [gender 1] to [gender 2] ratio is approximately [number > 1] to 1.
 
 
 
The majority of [disease name] cases are reported in [geographical region].
 
OR
 
[Disease name] is a common/rare disease that tends to affect [patient population 1] and [patient population 2].


==Risk Factors==
==Risk Factors==
There are no established risk factors for [disease name].
According to a consensus statement from the 4th International Consultation on Sexual Medicine in 2015, the risk factors of sexual dysfunction include:<ref name="pmid26953830">{{cite journal| author=McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD | display-authors=etal| title=Risk Factors for Sexual Dysfunction Among Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015. | journal=J Sex Med | year= 2016 | volume= 13 | issue= 2 | pages= 153-67 | pmid=26953830 | doi=10.1016/j.jsxm.2015.12.015 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26953830  }} </ref>


OR
====Risk Factors for Women====


The most potent risk factor in the development of [disease name] is [risk factor 1]. Other risk factors include [risk factor 2], [risk factor 3], and [risk factor 4].
*[[Biological]] factors:
**Poor [[health]]
**Lower levels of physical activities  
**[[Diabetes mellitus|Diabetes Mellitus (DM)]]
**[[Hypertension]]  
**[[Antihypertensive drugs]] 
**[[Chronic diseases]]:
***[[Hyperthyroidism]],  [[hypothyroidism]], and [[thyroid disease]]
***[[Fibromyalgia]]
***[[Arthritis]]
***[[Multiple sclerosis]]
***[[Systemic sclerosis]]
***[[Spinal cord injury]]
***[[Metabolic syndrome]]  
***Untreated [[obstructive sleep apnea]]  
**Stress [[urinary incontinence]]  
**[[Urinary tract]] symptoms 
**[[Hysterectomy]]  
**Female genital mutilation or cutting   
*[[Psychology|Psychological]] and [[psychiatric]] factors:  
**[[Mood Disorder|Mood]] or [[anxiety disorders]]  
**[[Antidepressants]]  
**[[Schizophrenia]]  
**[[Antipsychotic drugs]]
*Sociocultural factors:  
**History of [[sexual abuse]]  
**Emotional and [[physical abuse]] during childhood 
**Sexual dysfunctions in the male partner
**Low education  
**[[Stress]] at work or unemployment
**[[Substance abuse]] ([[alcohol]], [[tobacco]], and [[opioids]])


OR
====Risk Factors For Men====


Common risk factors in the development of [disease name] include [risk factor 1], [risk factor 2], [risk factor 3], and [risk factor 4].
*[[Biology|Biological]] factors:
 
**Poor [[health]]  
OR
**Age  
 
**[[Diabetes mellitus|Diabetes Mellitus (DM)]] 
Common risk factors in the development of [disease name] may be occupational, environmental, genetic, and viral.
**[[Obesity]], [[metabolic syndrome]], and [[Erectile dysfunction|erectile dysfunction (ED)]]
**[[Cardiovascular disease]] and [[hypertension]]  
**[[Smoking]] or other [[tobacco]] use  
**[[Hormone|Hormonal]] or [[endocrine]] factors  
**[[Urinary tract]] diseases and lower [[urinary tract]] symptoms  
**Other [[chronic diseases]]:
***[[Polyneuropathy]]  
***[[Parkinson disease]]  
***[[Multiple sclerosis]]  
***[[Anxiety]] and [[depression]]  
***[[Spinal cord injury]]  
***[[Sleep apnea]]
***[[Chronic obstructive pulmonary disease|Chronic obstructive pulmonary disease (COPD)]]
***[[Scleroderma]]  
***[[Hypertension]]  
**[[Surgery]] and [[trauma]]:
***[[Spinal cord injury]]  
***[[Radical prostatectomy]] for [[prostate cancer]]  
*[[Psychology|Psychological]] and [[psychiatric]] factors:  
**[[Medication|Medications]] and [[recreational drugs]]:
***[[Cardiovascular]], [[hormonal]], [[anticholinergic]], [[cytotoxic]], and [[Psychotropic drugs|psychotropic]] drugs
***[[Alcohol]], [[marijuana]], and [[narcotics]]
**[[Anxiety]] and [[depression]]  
*Sociocultural factors:
**Early childhood experiences
**Lack of physical activity
**Not being married
**[[Sexual]] problems in the partner
**Unemployment
**Lower level of education  


==Screening==
==Screening==
There is insufficient evidence to recommend routine screening for [disease/malignancy].
OR
According to the [guideline name], screening for [disease name] is not recommended.
OR
According to the [guideline name], screening for [disease name] by [test 1] is recommended every [duration] among patients with [condition 1], [condition 2], and [condition 3].


==Natural History, Complications, and Prognosis==
==Natural History, Complications, and Prognosis==
If left untreated, [#]% of patients with [disease name] may progress to develop [manifestation 1], [manifestation 2], and [manifestation 3].


OR
==Diagnosis==


Common complications of [disease name] include [complication 1], [complication 2], and [complication 3].
OR
Prognosis is generally excellent/good/poor, and the 1/5/10-year mortality/survival rate of patients with [disease name] is approximately [#]%.
==Diagnosis==
===Diagnostic Study of Choice===
===Diagnostic Study of Choice===
The diagnosis of [disease name] is made when at least [number] of the following [number] diagnostic criteria are met: [criterion 1], [criterion 2], [criterion 3], and [criterion 4].


OR
*[[Diagnostic and statistical manual of mental disorders|DSM-5]] is used to diagnose different types of sexual dysfunction.<ref name="Diagnostic and statistical manual of mental disorders : DSM-5 2013 p.">{{cite book | title=Diagnostic and statistical manual of mental disorders : DSM-5 | publisher=American Psychiatric Association,American Psychiatric Association | publication-place=Arlington, VA Washington, D.C | year=2013 | isbn=0-89042-555-8 | oclc=830807378 | page=}}</ref>
 
*According to [[Diagnostic and statistical manual of mental disorders|DSM-5]], sexual dysfunction is a group of [[disorders]] that cause clinical impairment in the ability to respond sexually or experience [[sexual pleasure]]. Most disorders are diagnosed with persisted symptoms for at least 6 months on least 75% of sexual occassions.<ref name="Diagnostic and statistical manual of mental disorders : DSM-5 2013 p.">{{cite book | title=Diagnostic and statistical manual of mental disorders : DSM-5 | publisher=American Psychiatric Association,American Psychiatric Association | publication-place=Arlington, VA Washington, D.C | year=2013 | isbn=0-89042-555-8 | oclc=830807378 | page=}}</ref>
The diagnosis of [disease name] is based on the [criteria name] criteria, which include [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
The diagnosis of [disease name] is based on the [definition name] definition, which includes [criterion 1], [criterion 2], and [criterion 3].
 
OR
 
There are no established criteria for the diagnosis of [disease name].


===History and Symptoms===
===History and Symptoms===
The majority of patients with [disease name] are asymptomatic.


OR
===Physical Examination===
 
The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].


===Physical Examination===
===Physical Examination===
Patients with [disease name] usually appear [general appearance]. Physical examination of patients with [disease name] is usually remarkable for [finding 1], [finding 2], and [finding 3].
OR
Common physical examination findings of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
The presence of [finding(s)] on physical examination is diagnostic of [disease name].
OR
The presence of [finding(s)] on physical examination is highly suggestive of [disease name].
===Laboratory Findings===
An elevated/reduced concentration of serum/blood/urinary/CSF/other [lab test] is diagnostic of [disease name].
OR
Laboratory findings consistent with the diagnosis of [disease name] include [abnormal test 1], [abnormal test 2], and [abnormal test 3].
OR
[Test] is usually normal among patients with [disease name].
OR
Some patients with [disease name] may have elevated/reduced concentration of [test], which is usually suggestive of [progression/complication].
OR
There are no diagnostic laboratory findings associated with [disease name].


===Electrocardiogram===
===Electrocardiogram===
There are no ECG findings associated with [disease name].
OR
An ECG may be helpful in the diagnosis of [disease name]. Findings on an ECG suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===X-ray===
===X-ray===
There are no x-ray findings associated with [disease name].
OR
An x-ray may be helpful in the diagnosis of [disease name]. Findings on an x-ray suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no x-ray findings associated with [disease name]. However, an x-ray may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Echocardiography or Ultrasound===
===Echocardiography or Ultrasound===
There are no echocardiography/ultrasound  findings associated with [disease name].
OR
Echocardiography/ultrasound  may be helpful in the diagnosis of [disease name]. Findings on an echocardiography/ultrasound suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no echocardiography/ultrasound  findings associated with [disease name]. However, an echocardiography/ultrasound  may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===CT scan===
===CT scan===
There are no CT scan findings associated with [disease name].
OR
[Location] CT scan may be helpful in the diagnosis of [disease name]. Findings on CT scan suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no CT scan findings associated with [disease name]. However, a CT scan may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===MRI===
===MRI===
There are no MRI findings associated with [disease name].
OR
[Location] MRI may be helpful in the diagnosis of [disease name]. Findings on MRI suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
There are no MRI findings associated with [disease name]. However, a MRI may be helpful in the diagnosis of complications of [disease name], which include [complication 1], [complication 2], and [complication 3].


===Other Imaging Findings===
===Other Imaging Findings===
There are no other imaging findings associated with [disease name].
OR
[Imaging modality] may be helpful in the diagnosis of [disease name]. Findings on an [imaging modality] suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].


===Other Diagnostic Studies===
===Other Diagnostic Studies===
There are no other diagnostic studies associated with [disease name].


OR
==Treatment==


[Diagnostic study] may be helpful in the diagnosis of [disease name]. Findings suggestive of/diagnostic of [disease name] include [finding 1], [finding 2], and [finding 3].
OR
Other diagnostic studies for [disease name] include [diagnostic study 1], which demonstrates [finding 1], [finding 2], and [finding 3], and [diagnostic study 2], which demonstrates [finding 1], [finding 2], and [finding 3].
==Treatment==
===Medical Therapy===
===Medical Therapy===
There is no treatment for [disease name]; the mainstay of therapy is supportive care.
OR
Supportive therapy for [disease name] includes [therapy 1], [therapy 2], and [therapy 3].
OR
The majority of cases of [disease name] are self-limited and require only supportive care.
OR
[Disease name] is a medical emergency and requires prompt treatment.
OR
The mainstay of treatment for [disease name] is [therapy].
OR
 
The optimal therapy for [malignancy name] depends on the stage at diagnosis.
OR
[Therapy] is recommended among all patients who develop [disease name].
OR
Pharmacologic medical therapy is recommended among patients with [disease subclass 1], [disease subclass 2], and [disease subclass 3].
OR
Pharmacologic medical therapies for [disease name] include (either) [therapy 1], [therapy 2], and/or [therapy 3].
OR
Empiric therapy for [disease name] depends on [disease factor 1] and [disease factor 2].
OR
Patients with [disease subclass 1] are treated with [therapy 1], whereas patients with [disease subclass 2] are treated with [therapy 2].


===Surgery===
===Surgery===
Surgical intervention is not recommended for the management of [disease name].
OR
Surgery is not the first-line treatment option for patients with [disease name]. Surgery is usually reserved for patients with either [indication 1], [indication 2], and [indication 3]
OR
The mainstay of treatment for [disease name] is medical therapy. Surgery is usually reserved for patients with either [indication 1], [indication 2], and/or [indication 3].
OR
The feasibility of surgery depends on the stage of [malignancy] at diagnosis.
OR
Surgery is the mainstay of treatment for [disease or malignancy].


===Primary Prevention===
===Primary Prevention===
There are no established measures for the primary prevention of [disease name].
OR
There are no available vaccines against [disease name].
OR
Effective measures for the primary prevention of [disease name] include [measure1], [measure2], and [measure3].
OR
[Vaccine name] vaccine is recommended for [patient population] to prevent [disease name]. Other primary prevention strategies include [strategy 1], [strategy 2], and [strategy 3].


===Secondary Prevention===
===Secondary Prevention===
There are no established measures for the secondary prevention of [disease name].


OR
==See also==


Effective measures for the secondary prevention of [disease name] include [strategy 1], [strategy 2], and [strategy 3].
*[[Sexual function]] for information about assessing sexual dysfunction
 
*[[Sexual arousal disorder]]
==See also==
*[[Female sexual arousal disorder]]
* [[Sexual function]] for information about assessing sexual dysfunction
*[[Post SSRI Sexual Dysfunction]]
* [[Sexual arousal disorder]]
*[[Agony aunt]]
* [[Female sexual arousal disorder]]
*[[Anorgasmia]]
* [[Post SSRI Sexual Dysfunction]]
*[[Premature ejaculation]]
* [[Agony aunt]]
*[[Dapoxetine]]
* [[Anorgasmia]]
*[[Sexless marriage]]
* [[Premature ejaculation]]
* [[Dapoxetine]]
* [[Sexless marriage]]


==References==
==References==
{{reflist|2}}
{{reflist|2}}


== Further reading ==
==Further reading==
 
*Kaplan, Helen Singer, ''The New Sex Therapy: Active Treatment Of Sexual Dysfunctions'', New York, Brunner/Mazel, 1974. ISBN 0876300832
*Kaplan, Helen Singer, ''The New Sex Therapy: Active Treatment Of Sexual Dysfunctions'', New York, Brunner/Mazel, 1974. ISBN 0876300832


==External links==
==External links==
*[http://www.nlm.nih.gov/medlineplus/ency/article/001951.htm NIH site on sexual problems]
*[http://www.nlm.nih.gov/medlineplus/ency/article/001951.htm NIH site on sexual problems]
*[https://web4health.info/eu/kom/sex-menu.htm 100 FAQs about sexual dysfunction]
*[https://web4health.info/eu/kom/sex-menu.htm 100 FAQs about sexual dysfunction]
*[http://www.vaginismus-awareness-network.co.uk/index.html Vaginimus Awareness Network: A non-profit site offering facts and advice to women with vaginismus, their partners and gynaecologists]
*[http://www.vaginismus-awareness-network.co.uk/index.html Vaginimus Awareness Network: A non-profit site offering facts and advice to women with vaginismus, their partners and gynaecologists]
*[http://recover.forumup.org Sexual Dysfunction Research Community ]
*[http://recover.forumup.org Sexual Dysfunction Research Community]
*[http://www.healthystrokes.com Traumatic Masturbatory Syndrome and other masturbation issues]
*[http://www.healthystrokes.com Traumatic Masturbatory Syndrome and other masturbation issues]
*[http://www.sexhealthmatters.org/index.html Sexual Medicine Society of North America's website: SexHealthMatters.org]
*[http://www.sexhealthmatters.org/index.html Sexual Medicine Society of North America's website: SexHealthMatters.org]

Latest revision as of 17:00, 14 July 2021


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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2] Shakiba Hassanzadeh, MD[3]

Overview

Sexual dysfunction or sexual malfunction (see also sexual function) is difficulty during any stage of the sexual act (which includes desire, arousal, orgasm, and resolution) that prevents the individual or couple from enjoying sexual activity.

Onset

Emotional factors affecting sex include both interpersonal problems (such as marital/relationship problems, or lack of trust and open communication between partners) and psychological problems within the individual (depression, sexual fears or guilt, past sexual trauma, sexual disorders,[1] and so on).

Physical factors include drugs (alcohol, nicotine, narcotics, stimulants, antihypertensives, antihistamines, and some psychotherapeutic drugs); injuries to the back, problems with an enlarged prostate gland, problems with blood supply, nerve damage (as in spinal cord injuries); or disease (diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis); failure of various organ systems (such as the heart and lungs); endocrine disorders (thyroid, pituitary, or adrenal gland problems); hormonal deficiencies (low testosterone, estrogen, or androgens); and some birth defects.

Classification

Sexual dysfunction disorders are generally classified into four categories: sexual desire disorders, sexual arousal disorders, orgasm disorders, and sexual pain disorders.

  1. Sexual desire disorders or decreased libido can be caused by a decrease in normal estrogen (in women) or testosterone (in both men and women) production. Other causes may be aging, fatigue, pregnancy, medications (such as the SSRIs) or psychiatric conditions, such as depression and anxiety. Loss of libido from SSRIs usually reverses after SSRIs are discontinued, but in some cases it does not. This is known as PSSD.
  2. Sexual arousal disorders were previously known as frigidity in women and impotence in men, though these have now been replaced with less judgmental terms. Impotence is now known as erectile dysfunction, and frigidity has been replaced with a number of terms describing specific problems with, for example, desire or arousal.
    For both men and women, these conditions can manifest as an aversion to, and avoidance of, sexual contact with a partner. In men, there may be partial or complete failure to attain or maintain an erection, or a lack of sexual excitement and pleasure in sexual activity.
    There may be medical causes to these disorders, such as decreased blood flow or lack of vaginal lubrication. Chronic disease can also contribute, as well as the nature of the relationship between the partners. As the success of sildenafil (Viagra) attests, most erectile disorders in men are primarily physical, not psychological conditions.
  3. Orgasm disorders are a persistent delay or absence of orgasm following a normal sexual excitement phase. The disorder can occur in both women and men. Again, the SSRI antidepressants are frequent culprits -- these can delay the achievement of orgasm or eliminate it entirely.
  4. Sexual pain disorders affect women almost exclusively and are known as dyspareunia (painful intercourse) and vaginismus (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse). Dyspareunia may be caused by insufficient lubrication (vaginal dryness) in women.

Poor lubrication may result from insufficient excitement and stimulation, or from hormonal changes caused by menopause, pregnancy, or breast-feeding. Irritation from contraceptive creams and foams can also cause dryness, as can fear and anxiety about sex.

It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma (such as rape or abuse) may play a role. Another female sexual pain disorder is called vulvodynia or vulvar vestibulitis. In this condition, women experience burning pain during sex which seems to be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown.

Sexual dysfunctions are more common in the early adult years, with the majority of people seeking care for such conditions during their late twenties through thirties. The incidence increases again in the geriatric population, typically with gradual onset of symptoms that are associated most commonly with medical causes of sexual dysfunction.

Sexual dysfunction is more common in people who abuse alcohol and drugs. It is also more likely in people suffering from diabetes and degenerative neurological disorders. Ongoing psychological problems, difficulty maintaining relationships or chronic disharmony with the current sexual partner can also interfere with sexual function.

Differential Diagnosis of Male Hypoactive Sexual Desire Disorder

  • Another medical condition
  • lnterpersonal factors
  • Severe relationship distress
  • Nonsexual mental disorders
  • Other sexual dysfunctions
  • Substance/medication use[2]

Risk Factors of Male Hypoactive Sexual Desire Disorder

  • Age
  • Attitudes
  • Alcohol
  • Anxiety
  • Emotional connection
  • Hypogonadism
  • Hyperprolactinemia
  • Interpersonal problems
  • Lack of adequate sex education
  • Mood
  • Man's feelings about himself
  • Partner's sexual desire
  • Social and cultural contextual factors
  • Trauma from early life experiences[2]

Diagnosis

Symptoms

Psychological sexual disorders

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders lists the following psychological sexual disorders:

Other sexual problems

Other related problems

Diagnostic Criteria

DSM-V Diagnostic Criteria for Male Hypoactive Sexual Desire Disorder [2]

“
  • A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and socio cultural contexts of the individual’s life.

AND

  • B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

AND

  • C. The symptoms in Criterion A cause clinically significant distress in the individual.

AND

  • D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.


Specify whether:

  • Lifelong: The disturbance has been present since the Individual became sexually active.
  • Acquired; The disturbance began after a period of relatively normal sexual function.

Specify whether:

  • Generaiized: Not limited to certain types of stimulation, situations, or partners.
  • Situational: Only occurs with certain types of stimulation, situations, or partners.

Specify current severity:

  • Mild: Evidence of mild distress over the symptoms in Criterion A.
  • Moderate: Evidence of moderate distress over the symptoms In Criterion A.
  • Severe: Evidence of severe or extreme distress over the symptoms in Criterion A.
 ”

Clinical studies

Since people tend not to talk to one another about their sexual problems, many people imagine that they are "abnormal", or that their sexual problems are unique or shameful. Images of sexuality presented by society and the media often present people with unrealistic ideals of sexual behavior, whether of the ideals of chastity and sexual fidelity presented by religion, or the ideal of sexual inexhaustibility and promiscuous availability presented by pornography. Neither image appears to be representative of human behavior in real life: this has been summed up in the phrase "everyone lies about sex".

The earliest attempts at treating sexual dysfunctions, especially erectile dysfunction, date back to Muslim physicians and pharmacists in the medieval Islamic world. They were the first to prescribe medication for the treatment of this problem, and they developed several methods of therapy for this issue, including a single-drug therapy method where a drug was prescribed and a "combination method of either a drug or food." Most of these drugs were oral medication, though a few patients were also treated through topical and transurethral means. Sexual dysfunctions were being treated with clinically tested drugs in the Islamic world since the 9th century until the 16th century by a number of Muslim physicians and pharmacists, including Muhammad ibn Zakarīya Rāzi, Thabit bin Qurra, Ibn Al-Jazzar, Avicenna (The Canon of Medicine), Averroes, Ibn al-Baitar, and Ibn al-Nafis (The Comprehensive Book on Medicine).[3]

In modern times, the genuine clinical study of sexual problems is usually dated back no further than 1970 when Masters and Johnson's Human Sexual Inadequacy was published. It was the result of over a decade of work at the Reproductive Biology Research Foundation in St. Louis, involving 790 cases. The work grew from Masters and Johnson's earlier Human Sexual Response (1966).

Prior to Masters and Johnson the clinical approach to sexual problems was largely derived from the thinking of Freud. It was held with psychopathology and approached with a certain pessimism regarding the chance of help or improvement. Sexual problems were merely symptoms of a deeper malaise and the diagnostic approach was from the psychopathological. There was little distinction between difficulties in function and variations nor between perversion and problems. Despite work by psychotherapists such as Balint sexual difficulties were crudely split into frigidity or impotence, terms which too soon acquired negative connotations in popular culture.

The achievement of Human Sexual Inadequacy was to move thinking from psychopathology to learning, only if a problem did not respond to educative treatment would psychopathological problems be considered. Also treatment was directed at couples, whereas before partners would be seen individually. Masters and Johnson saw that sex was a joint act. They believed that sexual communication was the key issue to sexual problems not the specifics of an individual problem. They also proposed co-therapy, a matching pair of therapists to the clients, arguing that a lone male therapist could not fully comprehend female difficulties and vice versa.

The basic Masters and Johnson treatment program was an intensive two week program to develop efficient sexual communication. Couple-based and therapist led the program began with discussion and then sensate focus between the couple to develop shared experiences. From the experiences specific difficulties could be determined and approached with a specific therapy. In a limited number of male only cases (41) Masters and Johnson had developed the use of a female surrogate, an approach they soon abandoned over the ethical, legal and other problems it raised.

In defining the range of sexual problems Masters and Johnson defined a boundary between dysfunction and deviations. Dysfunctions were transitory and experience by the majority of people, dysfunctions bounded male primary or secondary impotence, premature ejaculation, ejaculatory incompetence; female primary orgasmic dysfunction and situational orgasmic dysfunction; pain during intercourse (dyspareunia) and vaginismus. According to Masters and Johnson sexual arousal and climax are a normal physiological process of every functionally intact adult, but despite being autonomic it can be inhibited. Masters and Johnson treatment program for dysfunction was 81.1% successful.

Despite the work of Masters and Johnson the field in the US was quickly over-run by ethusiastic rather than systematic approaches, blurring the space between 'enrichment' and therapy. Although it has been argued that the impact of the work was such that it would be impossible to repeat such a clean experiment.



Overview

Historical Perspective

Classification

According to the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5), the list of sexual dysfunctions include:[4]

Pathophysiology

Causes

Differentiating Sexual Dysfunction from other Diseases

Epidemiology and Demographics

Prevalence

The US National Health and Social Life Survey (NHSLS) showed that the prevalence of sexual problems among the individuals in the US include:[5]

Women

Men

Risk Factors

According to a consensus statement from the 4th International Consultation on Sexual Medicine in 2015, the risk factors of sexual dysfunction include:[6]

Risk Factors for Women

Risk Factors For Men

Screening

Natural History, Complications, and Prognosis

Diagnosis

Diagnostic Study of Choice

  • DSM-5 is used to diagnose different types of sexual dysfunction.[4]
  • According to DSM-5, sexual dysfunction is a group of disorders that cause clinical impairment in the ability to respond sexually or experience sexual pleasure. Most disorders are diagnosed with persisted symptoms for at least 6 months on least 75% of sexual occassions.[4]

History and Symptoms

Physical Examination

Physical Examination

Electrocardiogram

X-ray

Echocardiography or Ultrasound

CT scan

MRI

Other Imaging Findings

Other Diagnostic Studies

Treatment

Medical Therapy

Surgery

Primary Prevention

Secondary Prevention

See also

References

  1. ↑ Michetti, Paolo Maria (2006). "Male sexuality and regulation of emotions: a study on the association between alexithymia and erectile dysfunction (ED)". International Journal of Impotence Research. 18 (2): 170–174. PMID 16151475. Retrieved 2007-02-02. Unknown parameter |coauthors= ignored (help)
  2. ↑ 2.0 2.1 2.2 Diagnostic and statistical manual of mental disorders : DSM-5. Washington, D.C: American Psychiatric Association. 2013. ISBN 0890425558.
  3. ↑ A. Al Dayela and N. al-Zuhair (2006), "Single drug therapy in the treatment of male sexual/erectile dysfunction in Islamic medicine", Urology 68 (1), p. 253-254.
  4. ↑ 4.0 4.1 4.2 Diagnostic and statistical manual of mental disorders : DSM-5. Arlington, VA Washington, D.C: American Psychiatric Association,American Psychiatric Association. 2013. ISBN 0-89042-555-8. OCLC 830807378.
  5. ↑ Laumann EO, Paik A, Rosen RC (1999). "Sexual dysfunction in the United States: prevalence and predictors". JAMA. 281 (6): 537–44. doi:10.1001/jama.281.6.537. PMID 10022110.
  6. ↑ McCabe MP, Sharlip ID, Lewis R, Atalla E, Balon R, Fisher AD; et al. (2016). "Risk Factors for Sexual Dysfunction Among Women and Men: A Consensus Statement From the Fourth International Consultation on Sexual Medicine 2015". J Sex Med. 13 (2): 153–67. doi:10.1016/j.jsxm.2015.12.015. PMID 26953830.

Further reading

  • Kaplan, Helen Singer, The New Sex Therapy: Active Treatment Of Sexual Dysfunctions, New York, Brunner/Mazel, 1974. ISBN 0876300832

External links

bs:Poremećaji seksualnog nagona ca:Disfunció sexual de:Sexuelle Dysfunktion is:Kynlífsraskanir

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