SUBMITTED TO: MISS.

SHAMSA BATOOL

SUBMITTED BY: RIMSHA FAZIL

PROGRAM: BS-APPLIED PSYCHOLOGY (SEM-VI)

COURSE TITLE: MENTAL HEALTH AND PSYCHOPATHOLOGY-II

SEXUAL DISORDERS

Sexual disorders are a category of mental health conditions characterized by disturbances

in sexual desire, response, or behavior, often causing significant distress or interpersonal

difficulties. The DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th

Edition, Text Revision) outlines the specific diagnostic criteria for these disorders. Here, we'll

explore the main types of sexual disorders, their criteria according to the DSM-5-TR.

1. Sexual Desire Disorders

Male Hypoactive Sexual Desire Disorder (HSDD)

Criteria:

 Persistent or recurrent deficient sexual thoughts or desire for sexual activity, lasting at

least six months.

 Causes significant distress in the individual.

 Not attributable to a medical condition, medication, or substance use.

Female Sexual Interest/Arousal Disorder

Criteria:

 Lack or significantly reduced sexual interest/arousal, indicated by at least three of the

following for six months:

o Absent or reduced interest in sexual activity.

o Absent sexual thoughts or fantasies.

o Decreased initiation of sexual activity.

o Reduced sexual excitement or pleasure during sexual activity.

o Reduced genital sensations during sexual activity.

 Causes significant distress.

 Not better explained by other mental health conditions or substance use.

2. Sexual Arousal Disorders

Erectile Disorder

Criteria:

 Difficulty achieving or maintaining an erection or decreased erectile rigidity during

sexual activity on almost all occasions, lasting for at least six months.

 Causes distress or interpersonal difficulty.

 Not due to medical conditions or substance use.

Genito-Pelvic Pain/Penetration Disorder

Criteria:
  Persistent or recurrent difficulties with one or more of the following for at least six

months:

o Vaginal penetration during intercourse.

o Marked vulvovaginal or pelvic pain during intercourse.

o Fear or anxiety about pain related to intercourse.

o Tensing of pelvic floor muscles during attempted penetration.

 Causes significant distress.

3. Orgasmic Disorders

Delayed Ejaculation

Criteria:

 Marked delay in or absence of ejaculation in almost all sexual encounters for at least six

months.

 Causes significant distress.

 Not explained by medical conditions or substance use.

Female Orgasmic Disorder

Criteria:

 Delay, infrequency, or absence of orgasm, or reduced intensity of orgasmic sensations

during sexual activity, lasting for at least six months.

 Causes significant distress.

Etiology of sexual disorders

1. Biological Factors

Biological influences on sexual disorders can involve genetic predispositions, medical

conditions, or the effects of medications.

a. Hormonal Imbalances

 Testosterone deficiency: In both men and women, low testosterone levels can lead to a

lack of sexual desire and arousal difficulties (e.g., male hypoactive sexual desire disorder,

female sexual interest/arousal disorder).

 Estrogen deficiency: Particularly in postmenopausal women, low estrogen levels can

lead to vaginal dryness and pain during intercourse, contributing to conditions like

genito-pelvic pain/penetration disorder.

 Prolactin levels: Elevated prolactin levels (hyperprolactinemia), often due to pituitary

tumors or certain medications, can reduce libido and interfere with sexual functioning.

b. Neurotransmitter Dysregulation

 Dopamine and serotonin imbalances can affect sexual desire and arousal. Low dopamine

may reduce pleasure and motivation for sexual activity, while excess serotonin (often due

to SSRIs) can inhibit orgasm.

 SSRIs (Selective Serotonin Reuptake Inhibitors): While useful in treating depression

and anxiety, SSRIs often have sexual side effects, such as delayed ejaculation,

anorgasmia, or reduced libido.

c. Medical Conditions

 Cardiovascular diseases: Poor blood flow due to heart disease or atherosclerosis can

lead to erectile dysfunction in men.

 Diabetes: Both men and women with diabetes are at higher risk for sexual dysfunction

due to nerve damage (neuropathy) and poor blood circulation.

 Chronic illnesses: Conditions like chronic kidney disease, multiple sclerosis, or cancer

can affect sexual function directly or through the psychological impact of dealing with a

chronic illness.

d. Substance Use

 Alcohol and drugs: Chronic alcohol abuse or the use of recreational drugs like cocaine,

heroin, or marijuana can reduce sexual desire and performance.

 Medications: Certain blood pressure medications (e.g., beta-blockers), antipsychotics,

and antidepressants may contribute to sexual disorders.

2. Psychological Factors

Psychological issues play a significant role in the development and maintenance of sexual

disorders.

a. Anxiety and Stress

 Performance anxiety: Fear of sexual failure can lead to erectile dysfunction in men or

orgasmic disorders in both sexes.

 Generalized anxiety: People with high levels of anxiety may experience reduced sexual

desire and arousal.

 Stress: Chronic stress can lead to decreased libido and sexual function due to elevated

cortisol levels and distraction from sexual stimuli.

b. Depression

 Depression is strongly associated with sexual dysfunction. Depressed individuals often

have lower libido, difficulty achieving orgasm, and in men, erectile difficulties.

 The use of antidepressants, particularly SSRIs, further exacerbates these issues.

c. Trauma and Abuse

 Sexual trauma: Individuals with a history of sexual abuse or trauma may develop sexual

aversion, fear of intimacy, or genito-pelvic pain/penetration disorder.

 Emotional abuse or neglect during childhood may lead to attachment issues, affecting

adult sexual relationships.

d. Body Image and Self-Esteem

 People who suffer from poor body image or low self-esteem may avoid sexual activity or

experience reduced sexual satisfaction.

 This is often seen in individuals with eating disorders or those with negative perceptions

of their physical appearance.

3. Social and Interpersonal Factors

Social dynamics and relationship issues can significantly influence sexual disorders.

a. Relationship Problems

 Lack of communication: Poor communication between partners about sexual desires or

preferences can result in dissatisfaction and sexual dysfunction.

 Conflict or resentment: Ongoing relationship stress, conflicts, or unresolved emotional

issues can dampen sexual desire and contribute to disorders like hypoactive sexual desire

disorder.

b. Cultural and Religious Beliefs

 Cultural norms or religious beliefs that stigmatize sexuality may cause guilt, shame, or

fear surrounding sexual activity.

 In conservative or restrictive environments, people may suppress their sexual desires,

leading to disorders like sexual aversion or hypoactive sexual desire.

c. Sexual Education and Experience

 Lack of adequate sex education may result in misconceptions or unrealistic expectations

about sex, contributing to sexual difficulties.

 Sexual inexperience or inadequate sexual knowledge can lead to anxiety or

embarrassment, which may manifest in dysfunctions like premature ejaculation or

orgasmic disorders.

4. Age-Related Factors

Sexual disorders can also be influenced by aging.

a. Men

 With age, men often experience a gradual decline in testosterone levels, which can affect

libido and erectile function. Erectile dysfunction becomes more common due to age-

related vascular changes.

b. Women

 Menopause is a significant factor in female sexual dysfunction. Decreased estrogen levels

can cause vaginal dryness, pain during intercourse, and reduced sexual desire.

c. Psychosocial Impact of Aging

 Both men and women may feel less attractive or experience reduced self-esteem with

aging, which can affect sexual desire and functioning.

5. Cognitive and Behavioral Factors

a. Negative Sexual Beliefs

 Holding negative beliefs about sex, often learned during childhood or through societal

norms, can result in sexual avoidance or dysfunction.

b. Conditioning and Learning

 Early sexual experiences, whether negative or positive, shape an individual’s sexual

responses. Those who have experienced trauma may have conditioned responses that lead

to dysfunction.

General Treatment Approaches for Sexual Disorders

1. Psychotherapy:

o Cognitive Behavioral Therapy (CBT) is one of the most effective treatments for many

sexual disorders. It helps individuals address negative thought patterns, performance

anxiety, and relationship difficulties.

o Couples therapy or sex therapy focuses on improving communication and intimacy

between partners.

2. Pharmacotherapy:

o Medications such as PDE5 inhibitors (e.g., Viagra), hormonal treatments

(testosterone or estrogen), and antidepressants may be used depending on the

disorder.
 o In some cases, off-label use of medications like flibanserin (Addyi) for female sexual

desire disorder or antiandrogens for paraphilic disorders may be considered.

3. Education and Communication:

o Educating individuals and couples about sexual function and anatomy can reduce

anxiety and misconceptions about sexual performance.

4. Behavioral Interventions:

o Techniques like the stop-start method for premature ejaculation or sensate focus

exercises for arousal and orgasmic disorders can be effective non-pharmacological

treatments.
References:

American Psychiatric Association. (2022). Diagnostic and Statistical Manual of

Mental Disorders, 5th Edition, Text Revision (DSM-5-TR). American Psychiatric Publishing.

Brotto, L. A., & Luria, M. (2014). Sexual interest/arousal disorders in women.

Canadian Journal of Human Sexuality

Jannini, E. A., Lenzi, A., Isidori, A. M., & Gravina, G. L. (2013). Disorders of

ejaculation. Nature Reviews Urology.