Sexual and Gender Identity Disorders

1) Desire - involves an appetite or craving for sexual activity (affected by bio/psycho/social factors, to include libido, suggestive context, and sexual fantasizing) 2) Excitement (arousal) phase - subjective sense of arousal with associated physiological changes (male - penile tumescence and erection; female - pelvic vasocongestion, vaginal expansion and lubrication, swelling of external genitalia) 3) Orgasm phase - peaking of sexual pleasure, release of tension, slight clouding of consciousness, rythmic contraction of perineal muscles, anal sphincter, and reproductive organs, sense of ejaculatory inevitability and ejaculation of semen in the male 4) Resolution phase - muscular relaxation, sense of general well-being; males - physiologically refractory to another erection/orgams; females - remain responsive to additional stimuli

Neual - centeral or peripheral problems (MS, stroke, spinal stenosis, etc) Vascular - focal stenosis Endocrine/metabolic - hyper/hypothyroid, zinv deficiency, etc. Medications - anticholinergics, antihypertensives, antipsychotics, SSRIs, steroids, drugs of abuse (alcohol, opioids, psychostimulants)

Hypoactive sexual desire disorder Sexual aversion disorder

A persistent or recurrent deficiency in or absense of sexual fantasies and desire for sexual activity that does not result from major depression or another Axis I disorder. Global subtype: all forms of sexual expression Situational subtype: limited to a partner, activity, or context Primary versus secondary - often associated with other response phase, psychosocial, or psychiatric problems (life events included)

A persistent and recurrent aversion to and avoidance of genital contact with a secual partner. Many believe that persons with this disorder have been secually victimized in the past and harbor unpleasant memories or beliefs about sexual intimacy. Anxiety, fear, or disgust experienced when the opportunity for sex arises. Aversion may be to a specific activity or a generalized revlusion

Female sexual arousal disorder Male erectile disorder

Persistent or recurrent inability to attain or maintain an adequate lubrication-swelling response during the sexual excitement phase. The disorder can be due to physical factors (e.g.dyspareunia) and is usually associated with anorgasmia.

Persistent or recurrent inability to attain or maintain an erection adequate for completion of the desired sexual activity. Occurs in approximately 10% of adult males, especially older males, diabetics, and those with vascular disease, smoking, and hypercholesterolemia. Causes are due to medical illnesses, psychiatric illnesses, and drugs.

Female orgasmic disorder Male orgasmic disorder Premature ejaculation

Manifested by the delay in or absence of orgasm following a normal sexual excitement stage. The clinician also judges the woman's orgasmic capability to be less than expected for her age, secual experience, and amount of sexual stimulation received.

Occurs when a man achieves ejaculation during intercourse only with great difficulty, if at all. The clinician must take into account the man's age, sexual experience, and amount of sexual stimulation received.

Diagnosed when a man has persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after vaginal penetration and before the man wants to ejaculate. There is NO corresponding disoder in women.

Dyspareunia Vaginismus

Genital pain that occurs in association with sexual intercoursee (during, before, or after). Much more common in females than males. May be accompanied by vaginismus. Phobic avoidance of secual activity often develops.

Recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina when vaginal penetration is attempted. Psychological factors are often important!