Psychosexual disorders

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[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Man Woman Erection of penis Thickening of scrotal skin Testes rise toward the perineum Breasts enlargement Clitoris head swells Lubrication/expansion/distension of inner 2/3 of vagina Uterus body and cervix raised

[object Object],[object Object],[object Object],Man Woman Erection maintained Testes raised further Urethral sphincter contract (prevent urine from mixing with semen and against retrograde ejaculation) Labia engorgement Clitoris head withdraws Further lubrication Further distention of inner 2/3 of vagina, outer 1/3 swells Further elevation of uterus

[object Object],[object Object],[object Object],Man Woman Contraction of prostate & seminal vesicles Emission of seminal fluid to urethra Ejaculation of semen Contractions of outer 1/3 of vagina

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The sexual response cycle Phase Male response Female response Example of dysfunction Desire mental/physical stimulation Hypoactive sexual desire disorder Sexual aversion disorder Excitement Increasing sexual pleasure with pre-orgasm plateau Penile erection Retraction of testes Cowper’s gland secretion Clitoral enlargement Vaginal lubrication Breast engorgement Male erectile disorder Female sexual arousal disorder Orgasm Peaking of sexual pleasure Ejaculatory spurt Rhythmic contractions of seminal system Skin flushing Rhythmic vaginal and uterine contraction Skin flushing Delayed ejaculation Premature ejaculation Female preorgasmia Resolutions Relaxation, reversal of physiologic changes Refractory to orgasm for a period of time which increases with age No refractory period Postcoital dysphoria Postcoital headache

[object Object],[object Object],[object Object],[object Object],Hypoactive sexual desire disorder Sexual aversion disorder - Deficiency/absence of sexual fantasies and desire for sexual activity - An aversion/avoidance of genital sexual contact with a sexual partner or by masturbation More common Less common

Female Male erectile disorder Persistent/recurrent/complete failure to attain/maintain lubrication-swelling response Recurrent and persistent partial/complete failure to attain/maintain an erection Must rule out medications (antihypertensives, antihistamine), medical conditions (vascular, neurological, endocrine) Causes marked distress/interpersonal difficulty

Female orgasmic disorder (preorgasmia) Male orgasmic disorder (delayed ejaculation) Premature ejaculation ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Difficulty in achieving ejaculation during coitus Causes : Primary organic : congenital, neurological, endocrine Secondary organic : trauma, cord lesion, medication (sympatholytic) Psychological : poor partnership factors, repressed homosexuality Ejaculation occurs before or immediately after entering the vagina Psychological : usually due to anxiety caused by interrupted sexual experiences, intimacy fears

Dyspareunia Vaginismus ,[object Object],[object Object],[object Object],[object Object],[object Object]

[object Object],Abnormalities of the sexual object Abnormalities of the sexual act Sexual fetishism Exhibitionism Transvertism Voyeurism Paedophilia Sexual sadism Necrophilia Sexual masochism Frotteurism

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BIO PSYCHOSOCIAL Sildenafil (viagra ) for sexual dysfunction Prostaglandin injections Lubricating creams Anti-androgen medication (tamoxifen) Sexual reassignment surgery for transsexualism Psychotherapy for individual, couple Sex education Behaviour modification

Psychosexual disorders

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Psychosexual disorders