{"id":817,"date":"2020-08-10T20:32:19","date_gmt":"2020-08-10T20:32:19","guid":{"rendered":"https:\/\/courses.lumenlearning.com\/abnormalpsych\/?post_type=chapter&#038;p=817"},"modified":"2022-07-26T20:06:24","modified_gmt":"2022-07-26T20:06:24","slug":"sexual-dysfunction-disorders","status":"publish","type":"chapter","link":"https:\/\/courses.lumenlearning.com\/wm-abnormalpsych\/chapter\/sexual-dysfunction-disorders\/","title":{"raw":"Sexual Dysfunction Disorders","rendered":"Sexual Dysfunction Disorders"},"content":{"raw":"<div class=\"textbox learning-objectives\">\r\n<h3>Learning Objectives<\/h3>\r\n<ul>\r\n \t<li>Describe sexual dysfunction disorders, including sexual desire disorders, arousal disorders, orgasm disorders, and pain disorders<\/li>\r\n<\/ul>\r\n<\/div>\r\n<span style=\"font-size: 1rem; text-align: initial;\">We first look into the four proposed categories of<strong> sexual dysfunction disorders<\/strong>: sexual desire disorders, arousal disorders, orgasm disorders and pain disorders as well as some proposed biological and psychological causes of these disorders. Sexual dysfunction among men and women is specifically studied in the fields of andrology and gynecology respectively.<\/span>\r\n\r\nThere are several disorders related to sexual dysfunctions outlined in the DSM-5. These include\r\n<ul>\r\n \t<li>delayed ejaculation,<\/li>\r\n \t<li>erectile disorder,<\/li>\r\n \t<li>female orgasmic disorder,<\/li>\r\n \t<li>female sexual interest\/arousal disorder,<\/li>\r\n \t<li>genito-pelvic pain\/penetration disorder,<\/li>\r\n \t<li>male hypoactive sexual desire disorder,<\/li>\r\n \t<li>premature ejaculation,<\/li>\r\n \t<li>substance or medication-induced sexual dysfunction, or<\/li>\r\n \t<li>other and unspecified sexual dysfunction.<\/li>\r\n<\/ul>\r\nWe will not go into exhaustive detail about each disorder, but you should be familiar with the basic descriptions of each. They are summarized in the table below.\r\n<div class=\"textbox key-takeaways\">\r\n<h3>Key Takeaways:\u00a0Sexual Dysfunctions<\/h3>\r\n<table style=\"width: 865px; height: 432px;\">\r\n<thead>\r\n<tr style=\"height: 10px;\">\r\n<th style=\"width: 851.875px; height: 10px;\" colspan=\"3\">Table 1. Sexual Dysfunctions as Described in the\u00a0DSM-5<\/th>\r\n<\/tr>\r\n<tr style=\"height: 10px;\">\r\n<th style=\"width: 147.431px; height: 10px;\">Disorder<\/th>\r\n<th style=\"width: 499.653px; height: 10px;\">Description<\/th>\r\n<th style=\"width: 181.875px; height: 10px;\">Prevalence<\/th>\r\n<\/tr>\r\n<\/thead>\r\n<tbody>\r\n<tr style=\"height: 57px;\">\r\n<td style=\"width: 147.431px; height: 57px;\">Male hypoactive sexual desire disorder (MHSDD)<\/td>\r\n<td style=\"width: 499.653px; height: 57px;\">Persistently or recurrently deficient (or absent) sexual\/erotic thoughts or fantasies and desire for sexual activity, as judged by a clinician with consideration for the patient's age and cultural context, and persisting for at least six months.<\/td>\r\n<td style=\"width: 181.875px; height: 57px;\">Unknown, although 6% of men between ages eight and 24 and 41% of men between 66 and 74 report problems with sexual desire.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 93px;\">\r\n<td style=\"width: 147.431px; height: 93px;\">Female sexual interest\/arousal disorder (FSIAD)<\/td>\r\n<td style=\"width: 499.653px; height: 93px;\">Lack of interest or significantly reduced interest in sexual activity. At least three of the following symptoms occur for a minimum of six months: reduced interest in sex, reduced sexual thought or fantasies, reduced initiation of sexual activity, reduced excitement during sexual activity, reduced excitement to sexual cues, and reduced sensation during sexual encounters.<\/td>\r\n<td style=\"width: 181.875px; height: 93px;\">Unknown<\/td>\r\n<\/tr>\r\n<tr style=\"height: 10px;\">\r\n<td style=\"width: 147.431px; height: 10px;\">Erectile disorder (ED)<\/td>\r\n<td style=\"width: 499.653px; height: 10px;\">Difficulty in obtaining or maintaining an erection during sexual activity 75\u2013100% of the time.<\/td>\r\n<td style=\"width: 181.875px; height: 10px;\">Prevalence increases with age; 2% in men younger than 40\u201350 and 40\u201350% of men older than 60\u201370 years old.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 46px;\">\r\n<td style=\"width: 147.431px; height: 46px;\">Delayed ejaculation<\/td>\r\n<td style=\"width: 499.653px; height: 46px;\">Marked delay in ejaculation or infrequency\/absence of ejaculation in 75\u2013100% of partnered sexual activity.<\/td>\r\n<td style=\"width: 181.875px; height: 46px;\">Unknown. 75% of men report always ejaculating during sexual activity and 1% complain of problems with ejaculation in the past six months.<\/td>\r\n<\/tr>\r\n<tr style=\"height: 34px;\">\r\n<td style=\"width: 147.431px; height: 34px;\">Premature ejaculation<\/td>\r\n<td style=\"width: 499.653px; height: 34px;\">Persistent and undesirable premature ejaculation that occurs around one minute or less of vaginal penetration.<\/td>\r\n<td style=\"width: 181.875px; height: 34px;\">Between 1%-3% of men<\/td>\r\n<\/tr>\r\n<tr style=\"height: 69px;\">\r\n<td style=\"width: 147.431px; height: 69px;\">Female Orgasmic Disorder<\/td>\r\n<td style=\"width: 499.653px; height: 69px;\">Delay in, absence of, or markedly reduced intensity of orgasms during 75\u2013100% of sexual activity.<\/td>\r\n<td style=\"width: 181.875px; height: 69px;\">Large variation; between 10 and 42%. 10% of women report never experiencing an orgasm.[footnote]Diagnostic and Statistical Manual of Mental Disorders 5. <em>American Psychiatric Association<\/em>. 2013. p. 431. ISBN 978-0-89042-555-8[\/footnote]<\/td>\r\n<\/tr>\r\n<tr style=\"height: 69px;\">\r\n<td style=\"width: 147.431px; height: 69px;\">Genito-pelvic pain\/penetration disorder (GPPPD)<\/td>\r\n<td style=\"width: 499.653px; height: 69px;\">Formerly called\u00a0dyspareunia and vaginismus, this is characterized by difficulty or pain during vaginal penetration during intercourse. This may also include fear or anxiety about penetration or tensing and tightening of pelvic floor muscles during intercourse.<\/td>\r\n<td style=\"width: 181.875px; height: 69px;\">Unknown, but 15% of women in North American say they have recurrent pain during intercourse.<\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/div>\r\n<h2>Sexual Desire Disorders<\/h2>\r\nSexual desire disorders or decreased libido are characterized by a lack or absence for some period of time of sexual desire or libido for sexual activity. The condition ranges from a general lack of sexual desire to a lack of sexual desire for the current partner. The condition may have started after a period of normal sexual functioning or the person may always have had no or low sexual desire.\u00a0The causes vary considerably, but include a possible decrease in the production of normal estrogen in women or testosterone in both men and women. Other causes may be aging, fatigue, pregnancy, medications (such as SSRIs), or psychiatric conditions, such as depression and anxiety.\r\n<h3 id=\"firstHeading\" class=\"firstHeading\" lang=\"en\">Hypoactive Sexual Desire Disorder<\/h3>\r\n[caption id=\"attachment_4058\" align=\"alignright\" width=\"300\"]<img class=\"wp-image-4058 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/03054306\/breakup-908714_1280-300x199.jpg\" alt=\"Two silhouetted facial side profiles facing away from each other.\" width=\"300\" height=\"199\" \/> <strong>Figure 1<\/strong>. In some cases, HSDD may put a strain on relationships.[\/caption]\r\n\r\n<strong>Hypoactive sexual desire disorder\u00a0(HSDD)\u00a0<\/strong>is considered a\u00a0sexual dysfunction\u00a0and is characterized as a lack or absence of\u00a0sexual fantasies\u00a0and\u00a0desire for sexual activity, as judged by a clinician.\r\n\r\nIn the\u00a0DSM-5,\u00a0hypoactive sexual desire disorder\u00a0(HSDD) was split into\u00a0<b>male hypoactive sexual desire disorder<\/b>\u00a0and\u00a0<b>female sexual interest\/arousal disorder<\/b>. Hypoactive sexual desire disorder\u00a0(HSDD) was first included in the DSM-3 under the name <em>inhibited sexual desire disorder<\/em>,\u00a0but the name was changed in the DSM-3-R. Other terms used to describe the phenomenon include sexual aversion and sexual apathy.\u00a0More informal or colloquial terms are\u00a0<i>frigidity<\/i>\u00a0and\u00a0<i>frigidness<\/i>.\r\n\r\n<span style=\"font-size: 1em;\">There are various subtypes. HSDD can be general (general lack of sexual desire) or situational (still has sexual desire but lacks sexual desire for current partner), and it can be acquired (HSDD started after a period of normal sexual functioning) or lifelong (the person has always had no\/low sexual desire.)\u00a0<\/span>\r\n\r\nFor HSDD to be regarded as a disorder, it must cause marked distress or interpersonal difficulties and not be better accounted for by another mental disorder, a drug (legal or illegal), or some other medical condition. A person with male hypoactive sexual desire disorder\u00a0or\u00a0female sexual interest\/arousal disorder will not start or respond to their partner's desire for sexual activity.\r\n<h4>Male Hypoactive Sexual Desire Disorder (MHSDD)<\/h4>\r\nIn the\u00a0DSM-5,<strong> male hypoactive sexual desire disorder<\/strong> is characterized by \"persistently or recurrently deficient (or absent) sexual\/erotic thoughts or fantasies and desire for sexual activity,\" as judged by a clinician with consideration for the patient's age and cultural context.\r\n<h4>Female Sexual Interest\/Arousal Disorder (FSIAD)<\/h4>\r\n<strong>Female sexual interest\/arousal disorder<\/strong> is defined as a \"lack of, or significantly reduced, sexual interest\/arousal,\" manifesting through at least three of the following symptoms: no or little interest in sexual activity, no or few sexual thoughts, no or few attempts to initiate sexual activity or respond to partner's initiation, no or little sexual pleasure\/excitement in 75\u2013100% of sexual experiences, no or little sexual interest in internal or external erotic stimuli, and no or few genital\/nongenital sensations in 75\u2013100% of sexual experiences.\r\n<h3>Diagnosing HSDD<\/h3>\r\n<span style=\"font-size: 1em;\"><span style=\"font-size: 1em;\">For both diagnoses, symptoms must persist for at least six months, cause clinically significant distress, and not be better explained by another condition. Simply having lower desire than one's partner is not sufficient for a diagnosis. Self-identification of a lifelong lack of sexual desire as asexuality precludes diagnosis.<\/span><\/span>\r\n\r\n<span style=\"font-size: 1em;\">Low sexual desire alone is not equivalent to HSDD because of the requirement in HSDD that the low sexual desire causes marked distress and interpersonal difficulty and because of the requirement that the low desire is not better accounted for by another disorder in the DSM or by a general medical problem. It is therefore difficult to say exactly what causes HSDD. It is easier to describe, instead, some of the causes of low sexual desire.\u00a0<\/span>\r\n<h3>Etiology of HSDD<\/h3>\r\nThe cause of lifelong\/generalized HSDD is unknown. In the case of acquired\/generalized low sexual desire, possible causes include various medical\/health problems, psychiatric problems, low levels of\u00a0testosterone\u00a0or high levels of\u00a0prolactin. One theory suggests that sexual desire is controlled by a balance between inhibitory and excitatory factors.\u00a0This is thought to be expressed via neurotransmitters in selective brain areas. A decrease in sexual desire may therefore be due to an imbalance between neurotransmitters with excitatory activity like dopamine and norepinephrine and neurotransmitters with inhibitory activity, like serotonin.\u00a0Low sexual desire can also be a side effect of various medications. In the case of acquired\/situational HSDD, possible causes include\u00a0intimacy difficulty,\u00a0relationship problems,\u00a0sexual addiction, and chronic illness of the partner. The evidence for these is somewhat in question. Some claimed causes of low sexual desire are based on empirical evidence. However, some are based merely on clinical observation.\u00a0In many cases, the cause of HSDD is simply unknown.\r\n\r\nResearch has not yet examined factors associated with FSIAD and there has been little investigation of the impact of individual factors, notably stress, levels of fatigue, gender identity, health, and other individual attributes and experiences, such as dysfunctional sexual beliefs that may affect sexual desire or response. However, researchers have investigated a number of causes and consequences of low sexual interest in women and low sexual arousal. These elements are broken down into biological factors including medical health, hormones, and medications, and psychological factors including stress, relationships, comorbid mental illness, and history of sexual abuse.[footnote]Female Sexual Interest\/Arousal Disorders Cindy Meston, Ph.D. &amp; Amelia M. Stanton at https:\/\/labs.la.utexas.edu\/mestonlab\/female-sexual-interestarousal-disorders\/[\/footnote]\r\n<h2>Sexual Arousal Disorders<\/h2>\r\nSexual 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 that can be broken down into four categories. These four categories, as described by the DSM are lack of desire, lack of arousal, pain during intercourse, and lack of orgasm.\u00a0For both men and women, these conditions can manifest themselves 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.\u00a0There may be physiological origins 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.\r\n<h3>Erectile Disorder<\/h3>\r\n[caption id=\"attachment_4056\" align=\"alignright\" width=\"303\"]<img class=\"wp-image-4056\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/03053754\/1024px-Erectile_dysfunction-300x169.jpg\" alt=\"A 3D medical animation still showing the inability to develop or maintain an erection of the penis during sexual activity.\" width=\"303\" height=\"171\" \/> <strong>Figure 2.<\/strong>\u00a0Physical damage as a cause of erectile dysfunction is more severe than psychological causes.[\/caption]\r\n\r\nMen with <strong>erectile disorder\u00a0<\/strong>cannot attain or maintain an erection during sexual activity that is sufficient to allow them to initiate or maintain sexual activity.\u00a0<strong>Erectile dysfunction<\/strong> or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. There are various underlying causes, such as damage to the nervi erigentes, which prevents or delays erection, or diabetes as well as cardiovascular disease, which simply decreases blood flow to the tissue in the penis, many of which are medically reversible.\r\n\r\nThe causes of erectile dysfunction may be psychological or physical. Psychological erectile dysfunction can often be helped by almost anything that the patient believes in; there is a very strong placebo effect. Physical damage is much more severe. One leading physical cause of erectile dysfunction is continual or severe damage taken to the nervi erigentes. These nerves course beside the prostate arising from the sacral plexus and can be damaged in prostatic and colorectal surgeries.\u00a0Diseases are also common causes of erectile dysfunction; especially in men. Diseases such as cardiovascular disease, multiple sclerosis, kidney failure, vascular disease, and spinal cord injury are the source of erectile dysfunction.\r\n\r\nDue to its embarrassing nature and the shame felt by sufferers, the subject was taboo for a long time and is the subject of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by the news-worthiness of stories about it and heavy advertising.\r\n\r\nIt is estimated that around 30 million men in the United States and 152 million men worldwide suffer from erectile dysfunction. However, social stigma, low health literacy, and social taboos lead to underreporting,which makes an accurate prevalence rate hard to determine.\r\n<h2>Orgasm Disorders<\/h2>\r\nEjaculatory and orgasmic disorders are common male sexual dysfunctions. The DSM-5 specifically mentions delayed ejaculation and premature ejaculation (PE), although there are others that may include\u00a0anejaculation (inability to orgasm), or retrograde ejaculation (where some of the semen travels back to the bladder), or anorgasmia (persistent inability or struggle to orgasm).\r\n<h3><b>Delayed Ejaculation<\/b><\/h3>\r\n<b>Delayed ejaculation<\/b>\u00a0is a man's inability for or persistent difficulty in achieving\u00a0orgasm, despite typical\u00a0sexual desire\u00a0and\u00a0sexual stimulation. Generally, a man can reach orgasm within a few minutes of active thrusting during\u00a0sexual intercourse, whereas a man with delayed ejaculation either does not have orgasms at all or cannot have an orgasm until after prolonged intercourse which might last for 30\u201345 minutes or more.\u00a0In most cases, delayed ejaculation presents the condition in which the man can climax and ejaculate only during\u00a0masturbation, but not during sexual intercourse. It is the least common of the male sexual dysfunctions, and can result as a side effect of some medications. In one survey, 8% of men reported being unable to achieve orgasm over a two-month period or longer in the previous year.\r\n\r\nDelayed ejaculation can be\u00a0<i>mild<\/i>\u00a0(men who still experience orgasm during intercourse, but only under certain conditions),\u00a0<i>moderate<\/i>\u00a0(cannot ejaculate during intercourse but can during\u00a0fellatio\u00a0or\u00a0manual stimulation),\u00a0<i>severe<\/i>\u00a0(can ejaculate only when alone), or\u00a0<i>most severe<\/i>\u00a0(cannot ejaculate at all).\u00a0All forms may result in a sense of\u00a0sexual frustration.\r\n\r\nMedical conditions that can cause delayed ejaculation include\u00a0hypogonadism,\u00a0thyroid\u00a0disorders,\u00a0pituitary\u00a0disorders such as\u00a0Cushing's disease,\u00a0prostate\u00a0surgery outcome, and drug and alcohol use.\u00a0Difficulty in achieving orgasm can also result from\u00a0pelvic\u00a0surgery\u00a0that involved\u00a0trauma\u00a0to pelvic nerves responsible for orgasm. Some men report a lack of sensation in the nerves of the glans penis, which may or may not be related to external factors, including a history of circumcision.\u00a0Delayed ejaculation is a possible\u00a0side effect\u00a0of certain\u00a0medications, including\u00a0selective serotonin reuptake inhibitors\u00a0(SSRIs); opiates\u00a0such as\u00a0morphine,\u00a0methadone, or\u00a0oxycodone; many\u00a0benzodiazepines\u00a0such as Valium; certain antipsychotics; and\u00a0antihypertensive.\r\n\r\nPsychological and lifestyle factors have been discussed as potential contributors, including insufficient sleep, distraction due to worry, distraction from the environment, anxiety about pleasing their partner, and anxiety about relationship problems.\r\n<h3>Premature Ejaculation<\/h3>\r\n<p style=\"text-align: start; font-size: 16px;\"><strong>Premature ejaculation (PE)<\/strong> is a prevalent\u00a0sexual dysfunction\u00a0in men<span style=\"font-size: 1em;\">\u00a0characterized as a p<\/span><span style=\"font-size: 1em;\">ersistent and undesirable premature ejaculation that occurs around one minute or less of vaginal penetration\u00a0<\/span><span style=\"font-size: 1em;\">and must be experienced in almost all or all (75\u2013100%) occasions during partnered sexual activity.<\/span><span style=\"font-size: 1em; text-align: initial;\"> Premature ejaculation (PE) often\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">occurs when a man experiences\u00a0orgasm\u00a0and\u00a0expels semen\u00a0within a few moments of beginning\u00a0sexual activity\u00a0and with minimal\u00a0penile stimulation. PE<\/span><span style=\"font-size: 1rem; text-align: initial;\">\u00a0has also been called\u00a0<\/span>early ejaculation<span style=\"font-size: 1rem; text-align: initial;\">,\u00a0<\/span>rapid ejaculation<span style=\"font-size: 1rem; text-align: initial;\">,\u00a0<\/span>rapid climax<span style=\"font-size: 1rem; text-align: initial;\">,\u00a0<\/span>premature climax,<span style=\"font-size: 1rem; text-align: initial;\">\u00a0and (historically)\u00a0<\/span>ejaculatio praecox.<span style=\"font-size: 1rem; text-align: initial;\">\u00a0<\/span><\/p>\r\n<p style=\"text-align: start; font-size: 16px;\">There is no correct length of time for intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in around one minute or less from the time of the insertion of the penis. B<span style=\"font-size: 1em;\">ecause of the variability in time required to ejaculate and in partners' desired duration of sex, exact prevalence rates of PE are difficult to determine.\u00a0<\/span>For a diagnosis, the patient must have a chronic history of premature ejaculation (at least six months), poor ejaculatory control, and the problem must cause feelings of dissatisfaction as well as distress for the patient, the partner, or both.<\/p>\r\n<p style=\"text-align: start; font-size: 16px;\">Historically attributed to psychological causes, new theories suggest that premature ejaculation may have an underlying neurobiological cause that may lead to rapid ejaculation.\u00a0The\u00a0nucleus paragigantocellularis\u00a0of the brain has been identified as having involvement in ejaculatory control.\u00a0Scientists have long suspected a\u00a0genetic\u00a0link to certain forms of premature ejaculation. However, studies have been inconclusive in isolating the gene responsible for lifelong PE. Other researchers have noted that men who have premature ejaculation have a faster neurological response in the pelvic muscles.<span style=\"color: #800000;\">\u00a0<\/span><\/p>\r\nPremature ejaculation can be diagnosed as either lifelong (primary) or acquired (secondary), with acquired PE developing at some point in life after previous normal experiences. Acquired PE may be due to situational factors such as performance anxiety, relationship problems, or some ailments more comment in older men, such as prostatitis, hyperthyroidism, or diabetes.[footnote]McMahon, C. G., Jannini, E. A., Serefoglu, E. C., &amp; Hellstrom, W. J. (2016). The pathophysiology of acquired premature ejaculation. Translational andrology and urology, 5(4), 434\u2013449. https:\/\/doi.org\/10.21037\/tau.2016.07.06[\/footnote]\r\n<h3 class=\"heading-title\">Female Orgasmic Disorder<\/h3>\r\n<div class=\"t m0 x8 ha y6d ff7 fs4 fc0 sc0 ls0 ws3c\">In medical and scientific journals, the term <strong>female orgasm disorder<\/strong>\u00a0is often referred to as anorgasmia.[footnote]Stuparu, Cristina &amp; Cristian, Delcea. (2020). Female orgasm disorder. Anorgasmia. International Journal of Advanced Studies in Sexology. 2. 10.46388\/ijass.2020.13.25.[\/footnote] It represents\u00a0a type of\u00a0sexual dysfunction\u00a0in which a person cannot achieve\u00a0orgasm\u00a0despite adequate stimulation. Anorgasmia is also found in men, but not as often as in women.<\/div>\r\n<div><\/div>\r\n<div>\r\n<div class=\"t m0 x7 ha y78 ff7 fs4 fc0 sc0 ls0 ws45\"><span style=\"font-size: 1em;\">Anorgasmia is one of the<\/span>\u00a0most common sexual problems\u00a0in women.<span style=\"font-size: 1em;\">\u00a0<\/span><span style=\"font-size: 1em;\">Symptoms associated with the disorder are\u00a0most often the marked infrequency\/<\/span><span style=\"font-size: 1em;\">absence<\/span><span style=\"font-size: 1em;\">\u00a0of experiencing\u00a0orgasm or delayed orgasm, heightened frus<\/span><span style=\"font-size: 1em;\">tration and inhibition of sexual desire, fear of\u00a0<\/span><span style=\"font-size: 1em;\">failure, prejudices, or avoidance of sexual contact\u00a0<\/span><span style=\"font-size: 1em;\">for various reasons.<\/span><span style=\"font-size: 1em;\">[footnote]Stuparu, Cristina &amp; Cristian, Delcea. (2020). Female orgasm disorder. Anorgasmia. International Journal of Advanced Studies in Sexology. 2. 10.46388\/ijass.2020.13.25.[\/footnote]<\/span><\/div>\r\n<div class=\"t m0 x7 ha y7f ff7 fs4 fc0 sc0 ls0 ws47\">\r\n\r\n<span style=\"font-size: 1rem; text-align: initial;\">In a clinical context, orgasm is usually defined strictly by the muscular contractions involved during sexual activity, along with the characteristic patterns of change in heart rate, blood pressure, and often respiration rate and depth.\u00a0This is categorized as the sudden discharge of accumulated sexual tension during the\u00a0sexual response cycle, resulting in rhythmic muscular contractions in the pelvic region.\u00a0However, definitions of orgasm vary and there is a sentiment that consensus on how to consistently classify it is absent. At least twenty-six definitions of orgasm were listed in the journal\u00a0<\/span><i style=\"font-size: 1rem; text-align: initial;\">Clinical Psychology Review<\/i><span style=\"font-size: 1rem; text-align: initial;\">.<\/span>\r\n\r\n<\/div>\r\n<\/div>\r\n<div class=\"t m0 x7 ha y71 ff7 fs4 fc0 sc0 ls0 ws40\">\r\n\r\nThere is some debate whether certain types of sexual sensations should be accurately classified as orgasms, including female orgasms caused by\u00a0G-spot\u00a0stimulation alone, and the demonstration of extended or continuous orgasms lasting several minutes or even an hour.\u00a0The question centers around the clinical definition of orgasm, but this way of viewing orgasm is merely physiological while there are also psychological, endocrinological, and neurological definitions of orgasm.<sup id=\"cite_ref-levine_orgasm_11-1\" class=\"reference\"><\/sup><sup id=\"cite_ref-mah_&amp;_binik_12-1\" class=\"reference\"><\/sup>\u00a0In these and similar cases, the sensations experienced are subjective and do not necessarily involve the involuntary contractions characteristic of orgasm. However, the sensations in both sexes are extremely pleasurable and are often felt throughout the body, causing a mental state that is often described as transcendental, and with\u00a0vasocongestion\u00a0and associated pleasure comparable to that of a full-contractionary orgasm.\r\n\r\n<\/div>\r\n<div class=\"t m0 x7 ha y7f ff7 fs4 fc0 sc0 ls0 ws47\">\r\n\r\n<strong>Primary anorgasmia<\/strong> is a condition where one has never experienced an orgasm. Women with this condition can sometimes achieve a relatively low level of sexual excitement. Frustration, restlessness, and pelvic pain, or a heavy pelvic sensation may occur because of vascular engorgement. On occasion, there may be no obvious reason why orgasm is unobtainable. In such cases, women report that they are unable to orgasm even if they have a caring, skilled partner, adequate time and privacy, and an absence of medical issues that would affect sexual satisfaction.\r\n\r\n<strong>Secondary anorgasmia<\/strong> is the loss of the ability to have orgasms o<span style=\"font-size: 1em;\">r loss of the ability to reach orgasm of past intensity.\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">The cause may be multifactorial (alcoholism, depression, grief, pelvic surgery or injuries, certain medications,\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">illness,\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">menopause<\/span><span style=\"font-size: 1rem; text-align: initial;\">, or rape).<\/span>\r\n\r\nAbout 15% of women report difficulties with orgasm, and as many as 10% of women in the United States have never climaxed. It is estimated that only 29% of women always have orgasms with their partner.\r\n\r\n<\/div>\r\n<h2>Sexual Pain Disorders<\/h2>\r\nSexual pain disorders affect women almost exclusively and are also known as dyspareunia (painful intercourse) or vaginismus (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse).\r\n<h3><strong>Genito-Pelvic Pain\/Penetration Disorder (GPPPD)<\/strong><\/h3>\r\n<p id=\"__p10\" class=\"p p-first\"><strong>Genito-pelvic pain\/penetration disorder (GPPPD)<\/strong>\u00a0is a new diagnosis included in the DSM-5, which merged the revised definitions of both female sexual dysfunctions\u00a0<em>dyspareunia<\/em>\u00a0and\u00a0<em>vaginismus<\/em>.<\/p>\r\nAt least one of the following persistent or recurrent criteria characterizes GPPPD: (1) difficulties with vaginal penetration during intercourse, (2) genito-pelvic pain during vaginal intercourse or penetration attempts, (3) fear or anxiety associated with genito-pelvic pain or vaginal penetration, or (4) tightness of the pelvic floor muscles during attempted vaginal penetration. One or more of these symptoms have to be present for at least six\u2009months and must cause clinically significant distress. GPPPD can be classified as either lifelong or acquired and, depending on the level of distress, as mild, moderate, or severe. The fusion of vaginismus and dyspareunia under a new classification and set of criteria was due to the significant overlap in clinical presentation and exceeding difficulties to distinguish between the two reliably.\r\n<h4>Etiology of Genito-Pelvic Pain\/Penetration Disorder (GPPPD)<\/h4>\r\nDyspareunia 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 breastfeeding. Irritation from contraceptive creams and foams can also cause dryness as can fear and anxiety about sex.\r\n\r\nIt 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.\r\n<p id=\"__p11\">The prevalence of GPPPD has not been ascertained due to the novel criteria set. Reported prevalence rates in the general population vary between three and 25% for dyspareunia and 0.4 and 6.6% for vaginismus. Prevalence estimates are heterogeneous due to varying diagnostic criteria, assessment methods, study design, and sample characteristics.<\/p>\r\n<p id=\"__p12\">The burden of suffering associated with GPPPD and linked conditions such as\u00a0<em>vulvodynia<\/em>\u00a0and provoked\u00a0<em>vestibulodynia<\/em>\u00a0is high as symptoms have a detrimental impact on physiological and psychological health, and relational well-being.\u00a0<b>Vulvodynia<\/b>\u00a0is chronic pain in the vulva, the area on the outside of a woman\u2019s genitals. It is usually described as a sensation of burning, stinging, itching, or rawness.\u00a0<b>Vestibulodynia<\/b>\u00a0is chronic pain and discomfort that occurs in the area around the opening of the vagina, inside the inner lips of the vulva. This area is known as the\u00a0<em>vestibule<\/em>.<\/p>\r\nGPPPD has been shown to have a negative effect on the woman\u2019s overall quality of life, with 60% of women reporting that the disorder compromised their ability to enjoy life. Moreover, it has been linked to depression and anxiety disorder. GPPPD symptoms are often comorbid with a wide range of other sexual dysfunctions and reduced sexual behavior. Many women with GPPPD also experience problems when using tampons or during gynecological examinations. GPPPD has been shown to contribute to declines in self-esteem and feelings of femininity and is associated with a negative body and genital self-image. It can pose a considerable burden on a couple's relationship, especially if they would like to have children.[footnote]Zarski AC, Berking M and Ebert DD (2018) Efficacy of Internet-Based Guided Treatment for Genito-Pelvic Pain\/Penetration Disorder: Rationale, Treatment Protocol, and Design of a Randomized Controlled Trial. Front. Psychiatry 8:260. doi: 10.3389\/fpsyt.2017.00260[\/footnote]\r\n<div class=\"textbox exercises\">\r\n<h3><b>Postorgasmic illness syndrome<\/b>\u00a0(<b>POIS<\/b>)<\/h3>\r\n<strong>Postorgasmic illness syndrome\u00a0(POIS)<\/strong> is a rare\u00a0condition\u00a0in which a person develops flu-like and allergy\u00a0symptoms\u00a0after orgasm, whether with a partner, through masturbation, or spontaneously during sleep. Additionally, the condition postorgasm illness syndrome (POIS) may cause symptoms when aroused, including adrenergic-type presentation; rapid breathing, paraesthesia, palpitations, headaches, aphasia, nausea, itchy eyes, fever, muscle pain, and weakness and fatigue. From the onset of arousal, symptoms can persist for up to a week in patients. The etiology of this condition is unknown, however, it is believed to be a pathology of either the immune system or autonomic nervous systems. It is defined as a rare disease by the NIH but the prevalence is unknown. It is not thought to be psychiatric in nature, but it may present as anxiety relating to coital activities and thus may be incorrectly diagnosed as such. There is no known cure or treatment.\r\n\r\n<\/div>\r\n<div class=\"textbox tryit\">\r\n<h3>Try It<\/h3>\r\nhttps:\/\/assess.lumenlearning.com\/practice\/7213f933-6489-43ec-90c7-63c637e66818\r\n\r\nhttps:\/\/assess.lumenlearning.com\/practice\/c99f3b67-0a3a-40f3-a5c0-d0db2702dae2\r\n\r\n<\/div>\r\n<div class=\"textbox learning-objectives\">\r\n<h3>Glossary<\/h3>\r\n<strong>erectile dysfunction:<\/strong> a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis\r\n\r\n<b>hypoactive sexual desire disorder<\/b>\u00a0<strong>(HSDD):<\/strong> a\u00a0sexual dysfunction characterized as a lack or absence of\u00a0sexual fantasies\u00a0and\u00a0desire for sexual activity, as judged by a clinician\r\n\r\n<strong>primary anorgasmia:\u00a0<\/strong>a condition where one has never experienced an orgasm\r\n\r\n<strong>postorgasmic illness syndrome\u00a0(POIS):<\/strong>\u00a0a rare\u00a0condition\u00a0in which a person develops flu-like and allergy\u00a0symptoms\u00a0after orgasm, whether with a partner, through masturbation, or spontaneously during sleep\r\n\r\n<strong>secondary anorgasmia:<\/strong> the loss of the ability to have orgasms or loss of the ability to reach orgasm of past intensity\r\n\r\n<strong>sexual dysfunction:<\/strong> difficulty experienced by an individual or a couple during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm\r\n\r\n<\/div>","rendered":"<div class=\"textbox learning-objectives\">\n<h3>Learning Objectives<\/h3>\n<ul>\n<li>Describe sexual dysfunction disorders, including sexual desire disorders, arousal disorders, orgasm disorders, and pain disorders<\/li>\n<\/ul>\n<\/div>\n<p><span style=\"font-size: 1rem; text-align: initial;\">We first look into the four proposed categories of<strong> sexual dysfunction disorders<\/strong>: sexual desire disorders, arousal disorders, orgasm disorders and pain disorders as well as some proposed biological and psychological causes of these disorders. Sexual dysfunction among men and women is specifically studied in the fields of andrology and gynecology respectively.<\/span><\/p>\n<p>There are several disorders related to sexual dysfunctions outlined in the DSM-5. These include<\/p>\n<ul>\n<li>delayed ejaculation,<\/li>\n<li>erectile disorder,<\/li>\n<li>female orgasmic disorder,<\/li>\n<li>female sexual interest\/arousal disorder,<\/li>\n<li>genito-pelvic pain\/penetration disorder,<\/li>\n<li>male hypoactive sexual desire disorder,<\/li>\n<li>premature ejaculation,<\/li>\n<li>substance or medication-induced sexual dysfunction, or<\/li>\n<li>other and unspecified sexual dysfunction.<\/li>\n<\/ul>\n<p>We will not go into exhaustive detail about each disorder, but you should be familiar with the basic descriptions of each. They are summarized in the table below.<\/p>\n<div class=\"textbox key-takeaways\">\n<h3>Key Takeaways:\u00a0Sexual Dysfunctions<\/h3>\n<table style=\"width: 865px; height: 432px;\">\n<thead>\n<tr style=\"height: 10px;\">\n<th style=\"width: 851.875px; height: 10px;\" colspan=\"3\">Table 1. Sexual Dysfunctions as Described in the\u00a0DSM-5<\/th>\n<\/tr>\n<tr style=\"height: 10px;\">\n<th style=\"width: 147.431px; height: 10px;\">Disorder<\/th>\n<th style=\"width: 499.653px; height: 10px;\">Description<\/th>\n<th style=\"width: 181.875px; height: 10px;\">Prevalence<\/th>\n<\/tr>\n<\/thead>\n<tbody>\n<tr style=\"height: 57px;\">\n<td style=\"width: 147.431px; height: 57px;\">Male hypoactive sexual desire disorder (MHSDD)<\/td>\n<td style=\"width: 499.653px; height: 57px;\">Persistently or recurrently deficient (or absent) sexual\/erotic thoughts or fantasies and desire for sexual activity, as judged by a clinician with consideration for the patient&#8217;s age and cultural context, and persisting for at least six months.<\/td>\n<td style=\"width: 181.875px; height: 57px;\">Unknown, although 6% of men between ages eight and 24 and 41% of men between 66 and 74 report problems with sexual desire.<\/td>\n<\/tr>\n<tr style=\"height: 93px;\">\n<td style=\"width: 147.431px; height: 93px;\">Female sexual interest\/arousal disorder (FSIAD)<\/td>\n<td style=\"width: 499.653px; height: 93px;\">Lack of interest or significantly reduced interest in sexual activity. At least three of the following symptoms occur for a minimum of six months: reduced interest in sex, reduced sexual thought or fantasies, reduced initiation of sexual activity, reduced excitement during sexual activity, reduced excitement to sexual cues, and reduced sensation during sexual encounters.<\/td>\n<td style=\"width: 181.875px; height: 93px;\">Unknown<\/td>\n<\/tr>\n<tr style=\"height: 10px;\">\n<td style=\"width: 147.431px; height: 10px;\">Erectile disorder (ED)<\/td>\n<td style=\"width: 499.653px; height: 10px;\">Difficulty in obtaining or maintaining an erection during sexual activity 75\u2013100% of the time.<\/td>\n<td style=\"width: 181.875px; height: 10px;\">Prevalence increases with age; 2% in men younger than 40\u201350 and 40\u201350% of men older than 60\u201370 years old.<\/td>\n<\/tr>\n<tr style=\"height: 46px;\">\n<td style=\"width: 147.431px; height: 46px;\">Delayed ejaculation<\/td>\n<td style=\"width: 499.653px; height: 46px;\">Marked delay in ejaculation or infrequency\/absence of ejaculation in 75\u2013100% of partnered sexual activity.<\/td>\n<td style=\"width: 181.875px; height: 46px;\">Unknown. 75% of men report always ejaculating during sexual activity and 1% complain of problems with ejaculation in the past six months.<\/td>\n<\/tr>\n<tr style=\"height: 34px;\">\n<td style=\"width: 147.431px; height: 34px;\">Premature ejaculation<\/td>\n<td style=\"width: 499.653px; height: 34px;\">Persistent and undesirable premature ejaculation that occurs around one minute or less of vaginal penetration.<\/td>\n<td style=\"width: 181.875px; height: 34px;\">Between 1%-3% of men<\/td>\n<\/tr>\n<tr style=\"height: 69px;\">\n<td style=\"width: 147.431px; height: 69px;\">Female Orgasmic Disorder<\/td>\n<td style=\"width: 499.653px; height: 69px;\">Delay in, absence of, or markedly reduced intensity of orgasms during 75\u2013100% of sexual activity.<\/td>\n<td style=\"width: 181.875px; height: 69px;\">Large variation; between 10 and 42%. 10% of women report never experiencing an orgasm.<a class=\"footnote\" title=\"Diagnostic and Statistical Manual of Mental Disorders 5. American Psychiatric Association. 2013. p. 431. ISBN 978-0-89042-555-8\" id=\"return-footnote-817-1\" href=\"#footnote-817-1\" aria-label=\"Footnote 1\"><sup class=\"footnote\">[1]<\/sup><\/a><\/td>\n<\/tr>\n<tr style=\"height: 69px;\">\n<td style=\"width: 147.431px; height: 69px;\">Genito-pelvic pain\/penetration disorder (GPPPD)<\/td>\n<td style=\"width: 499.653px; height: 69px;\">Formerly called\u00a0dyspareunia and vaginismus, this is characterized by difficulty or pain during vaginal penetration during intercourse. This may also include fear or anxiety about penetration or tensing and tightening of pelvic floor muscles during intercourse.<\/td>\n<td style=\"width: 181.875px; height: 69px;\">Unknown, but 15% of women in North American say they have recurrent pain during intercourse.<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/div>\n<h2>Sexual Desire Disorders<\/h2>\n<p>Sexual desire disorders or decreased libido are characterized by a lack or absence for some period of time of sexual desire or libido for sexual activity. The condition ranges from a general lack of sexual desire to a lack of sexual desire for the current partner. The condition may have started after a period of normal sexual functioning or the person may always have had no or low sexual desire.\u00a0The causes vary considerably, but include a possible decrease in the production of normal estrogen in women or testosterone in both men and women. Other causes may be aging, fatigue, pregnancy, medications (such as SSRIs), or psychiatric conditions, such as depression and anxiety.<\/p>\n<h3 id=\"firstHeading\" class=\"firstHeading\" lang=\"en\">Hypoactive Sexual Desire Disorder<\/h3>\n<div id=\"attachment_4058\" style=\"width: 310px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4058\" class=\"wp-image-4058 size-medium\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/03054306\/breakup-908714_1280-300x199.jpg\" alt=\"Two silhouetted facial side profiles facing away from each other.\" width=\"300\" height=\"199\" \/><\/p>\n<p id=\"caption-attachment-4058\" class=\"wp-caption-text\"><strong>Figure 1<\/strong>. In some cases, HSDD may put a strain on relationships.<\/p>\n<\/div>\n<p><strong>Hypoactive sexual desire disorder\u00a0(HSDD)\u00a0<\/strong>is considered a\u00a0sexual dysfunction\u00a0and is characterized as a lack or absence of\u00a0sexual fantasies\u00a0and\u00a0desire for sexual activity, as judged by a clinician.<\/p>\n<p>In the\u00a0DSM-5,\u00a0hypoactive sexual desire disorder\u00a0(HSDD) was split into\u00a0<b>male hypoactive sexual desire disorder<\/b>\u00a0and\u00a0<b>female sexual interest\/arousal disorder<\/b>. Hypoactive sexual desire disorder\u00a0(HSDD) was first included in the DSM-3 under the name <em>inhibited sexual desire disorder<\/em>,\u00a0but the name was changed in the DSM-3-R. Other terms used to describe the phenomenon include sexual aversion and sexual apathy.\u00a0More informal or colloquial terms are\u00a0<i>frigidity<\/i>\u00a0and\u00a0<i>frigidness<\/i>.<\/p>\n<p><span style=\"font-size: 1em;\">There are various subtypes. HSDD can be general (general lack of sexual desire) or situational (still has sexual desire but lacks sexual desire for current partner), and it can be acquired (HSDD started after a period of normal sexual functioning) or lifelong (the person has always had no\/low sexual desire.)\u00a0<\/span><\/p>\n<p>For HSDD to be regarded as a disorder, it must cause marked distress or interpersonal difficulties and not be better accounted for by another mental disorder, a drug (legal or illegal), or some other medical condition. A person with male hypoactive sexual desire disorder\u00a0or\u00a0female sexual interest\/arousal disorder will not start or respond to their partner&#8217;s desire for sexual activity.<\/p>\n<h4>Male Hypoactive Sexual Desire Disorder (MHSDD)<\/h4>\n<p>In the\u00a0DSM-5,<strong> male hypoactive sexual desire disorder<\/strong> is characterized by &#8220;persistently or recurrently deficient (or absent) sexual\/erotic thoughts or fantasies and desire for sexual activity,&#8221; as judged by a clinician with consideration for the patient&#8217;s age and cultural context.<\/p>\n<h4>Female Sexual Interest\/Arousal Disorder (FSIAD)<\/h4>\n<p><strong>Female sexual interest\/arousal disorder<\/strong> is defined as a &#8220;lack of, or significantly reduced, sexual interest\/arousal,&#8221; manifesting through at least three of the following symptoms: no or little interest in sexual activity, no or few sexual thoughts, no or few attempts to initiate sexual activity or respond to partner&#8217;s initiation, no or little sexual pleasure\/excitement in 75\u2013100% of sexual experiences, no or little sexual interest in internal or external erotic stimuli, and no or few genital\/nongenital sensations in 75\u2013100% of sexual experiences.<\/p>\n<h3>Diagnosing HSDD<\/h3>\n<p><span style=\"font-size: 1em;\"><span style=\"font-size: 1em;\">For both diagnoses, symptoms must persist for at least six months, cause clinically significant distress, and not be better explained by another condition. Simply having lower desire than one&#8217;s partner is not sufficient for a diagnosis. Self-identification of a lifelong lack of sexual desire as asexuality precludes diagnosis.<\/span><\/span><\/p>\n<p><span style=\"font-size: 1em;\">Low sexual desire alone is not equivalent to HSDD because of the requirement in HSDD that the low sexual desire causes marked distress and interpersonal difficulty and because of the requirement that the low desire is not better accounted for by another disorder in the DSM or by a general medical problem. It is therefore difficult to say exactly what causes HSDD. It is easier to describe, instead, some of the causes of low sexual desire.\u00a0<\/span><\/p>\n<h3>Etiology of HSDD<\/h3>\n<p>The cause of lifelong\/generalized HSDD is unknown. In the case of acquired\/generalized low sexual desire, possible causes include various medical\/health problems, psychiatric problems, low levels of\u00a0testosterone\u00a0or high levels of\u00a0prolactin. One theory suggests that sexual desire is controlled by a balance between inhibitory and excitatory factors.\u00a0This is thought to be expressed via neurotransmitters in selective brain areas. A decrease in sexual desire may therefore be due to an imbalance between neurotransmitters with excitatory activity like dopamine and norepinephrine and neurotransmitters with inhibitory activity, like serotonin.\u00a0Low sexual desire can also be a side effect of various medications. In the case of acquired\/situational HSDD, possible causes include\u00a0intimacy difficulty,\u00a0relationship problems,\u00a0sexual addiction, and chronic illness of the partner. The evidence for these is somewhat in question. Some claimed causes of low sexual desire are based on empirical evidence. However, some are based merely on clinical observation.\u00a0In many cases, the cause of HSDD is simply unknown.<\/p>\n<p>Research has not yet examined factors associated with FSIAD and there has been little investigation of the impact of individual factors, notably stress, levels of fatigue, gender identity, health, and other individual attributes and experiences, such as dysfunctional sexual beliefs that may affect sexual desire or response. However, researchers have investigated a number of causes and consequences of low sexual interest in women and low sexual arousal. These elements are broken down into biological factors including medical health, hormones, and medications, and psychological factors including stress, relationships, comorbid mental illness, and history of sexual abuse.<a class=\"footnote\" title=\"Female Sexual Interest\/Arousal Disorders Cindy Meston, Ph.D. &amp; Amelia M. Stanton at https:\/\/labs.la.utexas.edu\/mestonlab\/female-sexual-interestarousal-disorders\/\" id=\"return-footnote-817-2\" href=\"#footnote-817-2\" aria-label=\"Footnote 2\"><sup class=\"footnote\">[2]<\/sup><\/a><\/p>\n<h2>Sexual Arousal Disorders<\/h2>\n<p>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 that can be broken down into four categories. These four categories, as described by the DSM are lack of desire, lack of arousal, pain during intercourse, and lack of orgasm.\u00a0For both men and women, these conditions can manifest themselves 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.\u00a0There may be physiological origins 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.<\/p>\n<h3>Erectile Disorder<\/h3>\n<div id=\"attachment_4056\" style=\"width: 313px\" class=\"wp-caption alignright\"><img loading=\"lazy\" decoding=\"async\" aria-describedby=\"caption-attachment-4056\" class=\"wp-image-4056\" src=\"https:\/\/s3-us-west-2.amazonaws.com\/courses-images\/wp-content\/uploads\/sites\/5351\/2020\/08\/03053754\/1024px-Erectile_dysfunction-300x169.jpg\" alt=\"A 3D medical animation still showing the inability to develop or maintain an erection of the penis during sexual activity.\" width=\"303\" height=\"171\" \/><\/p>\n<p id=\"caption-attachment-4056\" class=\"wp-caption-text\"><strong>Figure 2.<\/strong>\u00a0Physical damage as a cause of erectile dysfunction is more severe than psychological causes.<\/p>\n<\/div>\n<p>Men with <strong>erectile disorder\u00a0<\/strong>cannot attain or maintain an erection during sexual activity that is sufficient to allow them to initiate or maintain sexual activity.\u00a0<strong>Erectile dysfunction<\/strong> or impotence is a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis. There are various underlying causes, such as damage to the nervi erigentes, which prevents or delays erection, or diabetes as well as cardiovascular disease, which simply decreases blood flow to the tissue in the penis, many of which are medically reversible.<\/p>\n<p>The causes of erectile dysfunction may be psychological or physical. Psychological erectile dysfunction can often be helped by almost anything that the patient believes in; there is a very strong placebo effect. Physical damage is much more severe. One leading physical cause of erectile dysfunction is continual or severe damage taken to the nervi erigentes. These nerves course beside the prostate arising from the sacral plexus and can be damaged in prostatic and colorectal surgeries.\u00a0Diseases are also common causes of erectile dysfunction; especially in men. Diseases such as cardiovascular disease, multiple sclerosis, kidney failure, vascular disease, and spinal cord injury are the source of erectile dysfunction.<\/p>\n<p>Due to its embarrassing nature and the shame felt by sufferers, the subject was taboo for a long time and is the subject of many urban legends. Folk remedies have long been advocated, with some being advertised widely since the 1930s. The introduction of perhaps the first pharmacologically effective remedy for impotence, sildenafil (trade name Viagra), in the 1990s caused a wave of public attention, propelled in part by the news-worthiness of stories about it and heavy advertising.<\/p>\n<p>It is estimated that around 30 million men in the United States and 152 million men worldwide suffer from erectile dysfunction. However, social stigma, low health literacy, and social taboos lead to underreporting,which makes an accurate prevalence rate hard to determine.<\/p>\n<h2>Orgasm Disorders<\/h2>\n<p>Ejaculatory and orgasmic disorders are common male sexual dysfunctions. The DSM-5 specifically mentions delayed ejaculation and premature ejaculation (PE), although there are others that may include\u00a0anejaculation (inability to orgasm), or retrograde ejaculation (where some of the semen travels back to the bladder), or anorgasmia (persistent inability or struggle to orgasm).<\/p>\n<h3><b>Delayed Ejaculation<\/b><\/h3>\n<p><b>Delayed ejaculation<\/b>\u00a0is a man&#8217;s inability for or persistent difficulty in achieving\u00a0orgasm, despite typical\u00a0sexual desire\u00a0and\u00a0sexual stimulation. Generally, a man can reach orgasm within a few minutes of active thrusting during\u00a0sexual intercourse, whereas a man with delayed ejaculation either does not have orgasms at all or cannot have an orgasm until after prolonged intercourse which might last for 30\u201345 minutes or more.\u00a0In most cases, delayed ejaculation presents the condition in which the man can climax and ejaculate only during\u00a0masturbation, but not during sexual intercourse. It is the least common of the male sexual dysfunctions, and can result as a side effect of some medications. In one survey, 8% of men reported being unable to achieve orgasm over a two-month period or longer in the previous year.<\/p>\n<p>Delayed ejaculation can be\u00a0<i>mild<\/i>\u00a0(men who still experience orgasm during intercourse, but only under certain conditions),\u00a0<i>moderate<\/i>\u00a0(cannot ejaculate during intercourse but can during\u00a0fellatio\u00a0or\u00a0manual stimulation),\u00a0<i>severe<\/i>\u00a0(can ejaculate only when alone), or\u00a0<i>most severe<\/i>\u00a0(cannot ejaculate at all).\u00a0All forms may result in a sense of\u00a0sexual frustration.<\/p>\n<p>Medical conditions that can cause delayed ejaculation include\u00a0hypogonadism,\u00a0thyroid\u00a0disorders,\u00a0pituitary\u00a0disorders such as\u00a0Cushing&#8217;s disease,\u00a0prostate\u00a0surgery outcome, and drug and alcohol use.\u00a0Difficulty in achieving orgasm can also result from\u00a0pelvic\u00a0surgery\u00a0that involved\u00a0trauma\u00a0to pelvic nerves responsible for orgasm. Some men report a lack of sensation in the nerves of the glans penis, which may or may not be related to external factors, including a history of circumcision.\u00a0Delayed ejaculation is a possible\u00a0side effect\u00a0of certain\u00a0medications, including\u00a0selective serotonin reuptake inhibitors\u00a0(SSRIs); opiates\u00a0such as\u00a0morphine,\u00a0methadone, or\u00a0oxycodone; many\u00a0benzodiazepines\u00a0such as Valium; certain antipsychotics; and\u00a0antihypertensive.<\/p>\n<p>Psychological and lifestyle factors have been discussed as potential contributors, including insufficient sleep, distraction due to worry, distraction from the environment, anxiety about pleasing their partner, and anxiety about relationship problems.<\/p>\n<h3>Premature Ejaculation<\/h3>\n<p style=\"text-align: start; font-size: 16px;\"><strong>Premature ejaculation (PE)<\/strong> is a prevalent\u00a0sexual dysfunction\u00a0in men<span style=\"font-size: 1em;\">\u00a0characterized as a p<\/span><span style=\"font-size: 1em;\">ersistent and undesirable premature ejaculation that occurs around one minute or less of vaginal penetration\u00a0<\/span><span style=\"font-size: 1em;\">and must be experienced in almost all or all (75\u2013100%) occasions during partnered sexual activity.<\/span><span style=\"font-size: 1em; text-align: initial;\"> Premature ejaculation (PE) often\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">occurs when a man experiences\u00a0orgasm\u00a0and\u00a0expels semen\u00a0within a few moments of beginning\u00a0sexual activity\u00a0and with minimal\u00a0penile stimulation. PE<\/span><span style=\"font-size: 1rem; text-align: initial;\">\u00a0has also been called\u00a0<\/span>early ejaculation<span style=\"font-size: 1rem; text-align: initial;\">,\u00a0<\/span>rapid ejaculation<span style=\"font-size: 1rem; text-align: initial;\">,\u00a0<\/span>rapid climax<span style=\"font-size: 1rem; text-align: initial;\">,\u00a0<\/span>premature climax,<span style=\"font-size: 1rem; text-align: initial;\">\u00a0and (historically)\u00a0<\/span>ejaculatio praecox.<span style=\"font-size: 1rem; text-align: initial;\">\u00a0<\/span><\/p>\n<p style=\"text-align: start; font-size: 16px;\">There is no correct length of time for intercourse to last, but generally, premature ejaculation is thought to occur when ejaculation occurs in around one minute or less from the time of the insertion of the penis. B<span style=\"font-size: 1em;\">ecause of the variability in time required to ejaculate and in partners&#8217; desired duration of sex, exact prevalence rates of PE are difficult to determine.\u00a0<\/span>For a diagnosis, the patient must have a chronic history of premature ejaculation (at least six months), poor ejaculatory control, and the problem must cause feelings of dissatisfaction as well as distress for the patient, the partner, or both.<\/p>\n<p style=\"text-align: start; font-size: 16px;\">Historically attributed to psychological causes, new theories suggest that premature ejaculation may have an underlying neurobiological cause that may lead to rapid ejaculation.\u00a0The\u00a0nucleus paragigantocellularis\u00a0of the brain has been identified as having involvement in ejaculatory control.\u00a0Scientists have long suspected a\u00a0genetic\u00a0link to certain forms of premature ejaculation. However, studies have been inconclusive in isolating the gene responsible for lifelong PE. Other researchers have noted that men who have premature ejaculation have a faster neurological response in the pelvic muscles.<span style=\"color: #800000;\">\u00a0<\/span><\/p>\n<p>Premature ejaculation can be diagnosed as either lifelong (primary) or acquired (secondary), with acquired PE developing at some point in life after previous normal experiences. Acquired PE may be due to situational factors such as performance anxiety, relationship problems, or some ailments more comment in older men, such as prostatitis, hyperthyroidism, or diabetes.<a class=\"footnote\" title=\"McMahon, C. G., Jannini, E. A., Serefoglu, E. C., &amp; Hellstrom, W. J. (2016). The pathophysiology of acquired premature ejaculation. Translational andrology and urology, 5(4), 434\u2013449. https:\/\/doi.org\/10.21037\/tau.2016.07.06\" id=\"return-footnote-817-3\" href=\"#footnote-817-3\" aria-label=\"Footnote 3\"><sup class=\"footnote\">[3]<\/sup><\/a><\/p>\n<h3 class=\"heading-title\">Female Orgasmic Disorder<\/h3>\n<div class=\"t m0 x8 ha y6d ff7 fs4 fc0 sc0 ls0 ws3c\">In medical and scientific journals, the term <strong>female orgasm disorder<\/strong>\u00a0is often referred to as anorgasmia.<a class=\"footnote\" title=\"Stuparu, Cristina &amp; Cristian, Delcea. (2020). Female orgasm disorder. Anorgasmia. International Journal of Advanced Studies in Sexology. 2. 10.46388\/ijass.2020.13.25.\" id=\"return-footnote-817-4\" href=\"#footnote-817-4\" aria-label=\"Footnote 4\"><sup class=\"footnote\">[4]<\/sup><\/a> It represents\u00a0a type of\u00a0sexual dysfunction\u00a0in which a person cannot achieve\u00a0orgasm\u00a0despite adequate stimulation. Anorgasmia is also found in men, but not as often as in women.<\/div>\n<div><\/div>\n<div>\n<div class=\"t m0 x7 ha y78 ff7 fs4 fc0 sc0 ls0 ws45\"><span style=\"font-size: 1em;\">Anorgasmia is one of the<\/span>\u00a0most common sexual problems\u00a0in women.<span style=\"font-size: 1em;\">\u00a0<\/span><span style=\"font-size: 1em;\">Symptoms associated with the disorder are\u00a0most often the marked infrequency\/<\/span><span style=\"font-size: 1em;\">absence<\/span><span style=\"font-size: 1em;\">\u00a0of experiencing\u00a0orgasm or delayed orgasm, heightened frus<\/span><span style=\"font-size: 1em;\">tration and inhibition of sexual desire, fear of\u00a0<\/span><span style=\"font-size: 1em;\">failure, prejudices, or avoidance of sexual contact\u00a0<\/span><span style=\"font-size: 1em;\">for various reasons.<\/span><span style=\"font-size: 1em;\"><a class=\"footnote\" title=\"Stuparu, Cristina &amp; Cristian, Delcea. (2020). Female orgasm disorder. Anorgasmia. International Journal of Advanced Studies in Sexology. 2. 10.46388\/ijass.2020.13.25.\" id=\"return-footnote-817-5\" href=\"#footnote-817-5\" aria-label=\"Footnote 5\"><sup class=\"footnote\">[5]<\/sup><\/a><\/span><\/div>\n<div class=\"t m0 x7 ha y7f ff7 fs4 fc0 sc0 ls0 ws47\">\n<p><span style=\"font-size: 1rem; text-align: initial;\">In a clinical context, orgasm is usually defined strictly by the muscular contractions involved during sexual activity, along with the characteristic patterns of change in heart rate, blood pressure, and often respiration rate and depth.\u00a0This is categorized as the sudden discharge of accumulated sexual tension during the\u00a0sexual response cycle, resulting in rhythmic muscular contractions in the pelvic region.\u00a0However, definitions of orgasm vary and there is a sentiment that consensus on how to consistently classify it is absent. At least twenty-six definitions of orgasm were listed in the journal\u00a0<\/span><i style=\"font-size: 1rem; text-align: initial;\">Clinical Psychology Review<\/i><span style=\"font-size: 1rem; text-align: initial;\">.<\/span><\/p>\n<\/div>\n<\/div>\n<div class=\"t m0 x7 ha y71 ff7 fs4 fc0 sc0 ls0 ws40\">\n<p>There is some debate whether certain types of sexual sensations should be accurately classified as orgasms, including female orgasms caused by\u00a0G-spot\u00a0stimulation alone, and the demonstration of extended or continuous orgasms lasting several minutes or even an hour.\u00a0The question centers around the clinical definition of orgasm, but this way of viewing orgasm is merely physiological while there are also psychological, endocrinological, and neurological definitions of orgasm.<sup id=\"cite_ref-levine_orgasm_11-1\" class=\"reference\"><\/sup><sup id=\"cite_ref-mah_&amp;_binik_12-1\" class=\"reference\"><\/sup>\u00a0In these and similar cases, the sensations experienced are subjective and do not necessarily involve the involuntary contractions characteristic of orgasm. However, the sensations in both sexes are extremely pleasurable and are often felt throughout the body, causing a mental state that is often described as transcendental, and with\u00a0vasocongestion\u00a0and associated pleasure comparable to that of a full-contractionary orgasm.<\/p>\n<\/div>\n<div class=\"t m0 x7 ha y7f ff7 fs4 fc0 sc0 ls0 ws47\">\n<p><strong>Primary anorgasmia<\/strong> is a condition where one has never experienced an orgasm. Women with this condition can sometimes achieve a relatively low level of sexual excitement. Frustration, restlessness, and pelvic pain, or a heavy pelvic sensation may occur because of vascular engorgement. On occasion, there may be no obvious reason why orgasm is unobtainable. In such cases, women report that they are unable to orgasm even if they have a caring, skilled partner, adequate time and privacy, and an absence of medical issues that would affect sexual satisfaction.<\/p>\n<p><strong>Secondary anorgasmia<\/strong> is the loss of the ability to have orgasms o<span style=\"font-size: 1em;\">r loss of the ability to reach orgasm of past intensity.\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">The cause may be multifactorial (alcoholism, depression, grief, pelvic surgery or injuries, certain medications,\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">illness,\u00a0<\/span><span style=\"font-size: 1rem; text-align: initial;\">menopause<\/span><span style=\"font-size: 1rem; text-align: initial;\">, or rape).<\/span><\/p>\n<p>About 15% of women report difficulties with orgasm, and as many as 10% of women in the United States have never climaxed. It is estimated that only 29% of women always have orgasms with their partner.<\/p>\n<\/div>\n<h2>Sexual Pain Disorders<\/h2>\n<p>Sexual pain disorders affect women almost exclusively and are also known as dyspareunia (painful intercourse) or vaginismus (an involuntary spasm of the muscles of the vaginal wall that interferes with intercourse).<\/p>\n<h3><strong>Genito-Pelvic Pain\/Penetration Disorder (GPPPD)<\/strong><\/h3>\n<p id=\"__p10\" class=\"p p-first\"><strong>Genito-pelvic pain\/penetration disorder (GPPPD)<\/strong>\u00a0is a new diagnosis included in the DSM-5, which merged the revised definitions of both female sexual dysfunctions\u00a0<em>dyspareunia<\/em>\u00a0and\u00a0<em>vaginismus<\/em>.<\/p>\n<p>At least one of the following persistent or recurrent criteria characterizes GPPPD: (1) difficulties with vaginal penetration during intercourse, (2) genito-pelvic pain during vaginal intercourse or penetration attempts, (3) fear or anxiety associated with genito-pelvic pain or vaginal penetration, or (4) tightness of the pelvic floor muscles during attempted vaginal penetration. One or more of these symptoms have to be present for at least six\u2009months and must cause clinically significant distress. GPPPD can be classified as either lifelong or acquired and, depending on the level of distress, as mild, moderate, or severe. The fusion of vaginismus and dyspareunia under a new classification and set of criteria was due to the significant overlap in clinical presentation and exceeding difficulties to distinguish between the two reliably.<\/p>\n<h4>Etiology of Genito-Pelvic Pain\/Penetration Disorder (GPPPD)<\/h4>\n<p>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 breastfeeding. Irritation from contraceptive creams and foams can also cause dryness as can fear and anxiety about sex.<\/p>\n<p>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.<\/p>\n<p id=\"__p11\">The prevalence of GPPPD has not been ascertained due to the novel criteria set. Reported prevalence rates in the general population vary between three and 25% for dyspareunia and 0.4 and 6.6% for vaginismus. Prevalence estimates are heterogeneous due to varying diagnostic criteria, assessment methods, study design, and sample characteristics.<\/p>\n<p id=\"__p12\">The burden of suffering associated with GPPPD and linked conditions such as\u00a0<em>vulvodynia<\/em>\u00a0and provoked\u00a0<em>vestibulodynia<\/em>\u00a0is high as symptoms have a detrimental impact on physiological and psychological health, and relational well-being.\u00a0<b>Vulvodynia<\/b>\u00a0is chronic pain in the vulva, the area on the outside of a woman\u2019s genitals. It is usually described as a sensation of burning, stinging, itching, or rawness.\u00a0<b>Vestibulodynia<\/b>\u00a0is chronic pain and discomfort that occurs in the area around the opening of the vagina, inside the inner lips of the vulva. This area is known as the\u00a0<em>vestibule<\/em>.<\/p>\n<p>GPPPD has been shown to have a negative effect on the woman\u2019s overall quality of life, with 60% of women reporting that the disorder compromised their ability to enjoy life. Moreover, it has been linked to depression and anxiety disorder. GPPPD symptoms are often comorbid with a wide range of other sexual dysfunctions and reduced sexual behavior. Many women with GPPPD also experience problems when using tampons or during gynecological examinations. GPPPD has been shown to contribute to declines in self-esteem and feelings of femininity and is associated with a negative body and genital self-image. It can pose a considerable burden on a couple&#8217;s relationship, especially if they would like to have children.<a class=\"footnote\" title=\"Zarski AC, Berking M and Ebert DD (2018) Efficacy of Internet-Based Guided Treatment for Genito-Pelvic Pain\/Penetration Disorder: Rationale, Treatment Protocol, and Design of a Randomized Controlled Trial. Front. Psychiatry 8:260. doi: 10.3389\/fpsyt.2017.00260\" id=\"return-footnote-817-6\" href=\"#footnote-817-6\" aria-label=\"Footnote 6\"><sup class=\"footnote\">[6]<\/sup><\/a><\/p>\n<div class=\"textbox exercises\">\n<h3><b>Postorgasmic illness syndrome<\/b>\u00a0(<b>POIS<\/b>)<\/h3>\n<p><strong>Postorgasmic illness syndrome\u00a0(POIS)<\/strong> is a rare\u00a0condition\u00a0in which a person develops flu-like and allergy\u00a0symptoms\u00a0after orgasm, whether with a partner, through masturbation, or spontaneously during sleep. Additionally, the condition postorgasm illness syndrome (POIS) may cause symptoms when aroused, including adrenergic-type presentation; rapid breathing, paraesthesia, palpitations, headaches, aphasia, nausea, itchy eyes, fever, muscle pain, and weakness and fatigue. From the onset of arousal, symptoms can persist for up to a week in patients. The etiology of this condition is unknown, however, it is believed to be a pathology of either the immune system or autonomic nervous systems. It is defined as a rare disease by the NIH but the prevalence is unknown. It is not thought to be psychiatric in nature, but it may present as anxiety relating to coital activities and thus may be incorrectly diagnosed as such. There is no known cure or treatment.<\/p>\n<\/div>\n<div class=\"textbox tryit\">\n<h3>Try It<\/h3>\n<p>\t<iframe id=\"assessment_practice_7213f933-6489-43ec-90c7-63c637e66818\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/7213f933-6489-43ec-90c7-63c637e66818?iframe_resize_id=assessment_practice_id_7213f933-6489-43ec-90c7-63c637e66818\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<p>\t<iframe id=\"assessment_practice_c99f3b67-0a3a-40f3-a5c0-d0db2702dae2\" class=\"resizable\" src=\"https:\/\/assess.lumenlearning.com\/practice\/c99f3b67-0a3a-40f3-a5c0-d0db2702dae2?iframe_resize_id=assessment_practice_id_c99f3b67-0a3a-40f3-a5c0-d0db2702dae2\" frameborder=\"0\" style=\"border:none;width:100%;height:100%;min-height:300px;\"><br \/>\n\t<\/iframe><\/p>\n<\/div>\n<div class=\"textbox learning-objectives\">\n<h3>Glossary<\/h3>\n<p><strong>erectile dysfunction:<\/strong> a sexual dysfunction characterized by the inability to develop or maintain an erection of the penis<\/p>\n<p><b>hypoactive sexual desire disorder<\/b>\u00a0<strong>(HSDD):<\/strong> a\u00a0sexual dysfunction characterized as a lack or absence of\u00a0sexual fantasies\u00a0and\u00a0desire for sexual activity, as judged by a clinician<\/p>\n<p><strong>primary anorgasmia:\u00a0<\/strong>a condition where one has never experienced an orgasm<\/p>\n<p><strong>postorgasmic illness syndrome\u00a0(POIS):<\/strong>\u00a0a rare\u00a0condition\u00a0in which a person develops flu-like and allergy\u00a0symptoms\u00a0after orgasm, whether with a partner, through masturbation, or spontaneously during sleep<\/p>\n<p><strong>secondary anorgasmia:<\/strong> the loss of the ability to have orgasms or loss of the ability to reach orgasm of past intensity<\/p>\n<p><strong>sexual dysfunction:<\/strong> difficulty experienced by an individual or a couple during any stage of normal sexual activity, including physical pleasure, desire, preference, arousal, or orgasm<\/p>\n<\/div>\n\n\t\t\t <section class=\"citations-section\" role=\"contentinfo\">\n\t\t\t <h3>Candela Citations<\/h3>\n\t\t\t\t\t <div>\n\t\t\t\t\t\t <div id=\"citation-list-817\">\n\t\t\t\t\t\t\t <div class=\"licensing\"><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Original<\/div><ul class=\"citation-list\"><li>Modification, adaptation, and original content. <strong>Authored by<\/strong>: Sonja Ann Miller for Lumen Learning. <strong>Provided by<\/strong>: Lumen Learning. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">CC licensed content, Shared previously<\/div><ul class=\"citation-list\"><li>Sexual Dysfunction. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Sexual_dysfunction\">https:\/\/en.wikipedia.org\/wiki\/Sexual_dysfunction<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><li>Hypoactive sexual desire disorder. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Hypoactive_sexual_desire_disorder\">https:\/\/en.wikipedia.org\/wiki\/Hypoactive_sexual_desire_disorder<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Female sexual arousal disorder. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Female_sexual_arousal_disorder#DSM-5\">https:\/\/en.wikipedia.org\/wiki\/Female_sexual_arousal_disorder#DSM-5<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Delayed ejaculation. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Delayed_ejaculation\">https:\/\/en.wikipedia.org\/wiki\/Delayed_ejaculation<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Premature ejaculation. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Premature_ejaculation\">https:\/\/en.wikipedia.org\/wiki\/Premature_ejaculation<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Orgasm. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Orgasm#Females\">https:\/\/en.wikipedia.org\/wiki\/Orgasm#Females<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Anorgasmia. <strong>Provided by<\/strong>: Wikipedia. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/en.wikipedia.org\/wiki\/Anorgasmia#Cause\">https:\/\/en.wikipedia.org\/wiki\/Anorgasmia#Cause<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><li>Efficacy of Internet-Based Guided Treatment for Genito-Pelvic Pain\/Penetration Disorder: Rationale, Treatment Protocol, and Design of a Randomized Controlled Trial. <strong>Authored by<\/strong>: Anna-Carlotta Zarski, Matthias Berking, David Daniel Ebert. <strong>Provided by<\/strong>: Frontiers in Psychology. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2017.00260\/full\">https:\/\/www.frontiersin.org\/articles\/10.3389\/fpsyt.2017.00260\/full<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by\/4.0\/\">CC BY: Attribution<\/a><\/em><\/li><li>Two heads. <strong>Authored by<\/strong>: Tumisu. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/pixabay.com\/photos\/breakup-divorce-separation-908714\/\">https:\/\/pixabay.com\/photos\/breakup-divorce-separation-908714\/<\/a>. <strong>License<\/strong>: <em>Other<\/em>. <strong>License Terms<\/strong>: Pixabay License<\/li><li>Erectile dysfunction animation. <strong>Authored by<\/strong>: www.scientificanimations.com. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/commons.wikimedia.org\/wiki\/File:Erectile_dysfunction.jpg\">https:\/\/commons.wikimedia.org\/wiki\/File:Erectile_dysfunction.jpg<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/licenses\/by-sa\/4.0\/\">CC BY-SA: Attribution-ShareAlike<\/a><\/em><\/li><\/ul><div class=\"license-attribution-dropdown-subheading\">Public domain content<\/div><ul class=\"citation-list\"><li>Postorgasmic illness syndrome. <strong>Provided by<\/strong>: NIH. <strong>Located at<\/strong>: <a target=\"_blank\" href=\"https:\/\/rarediseases.info.nih.gov\/diseases\/10809\/postorgasmic-illness-syndrome\">https:\/\/rarediseases.info.nih.gov\/diseases\/10809\/postorgasmic-illness-syndrome<\/a>. <strong>License<\/strong>: <em><a target=\"_blank\" rel=\"license\" href=\"https:\/\/creativecommons.org\/about\/pdm\">Public Domain: No Known Copyright<\/a><\/em><\/li><\/ul><\/div>\n\t\t\t\t\t\t <\/div>\n\t\t\t\t\t <\/div>\n\t\t\t <\/section><hr class=\"before-footnotes clear\" \/><div class=\"footnotes\"><ol><li id=\"footnote-817-1\">Diagnostic and Statistical Manual of Mental Disorders 5. <em>American Psychiatric Association<\/em>. 2013. p. 431. ISBN 978-0-89042-555-8 <a href=\"#return-footnote-817-1\" class=\"return-footnote\" aria-label=\"Return to footnote 1\">&crarr;<\/a><\/li><li id=\"footnote-817-2\">Female Sexual Interest\/Arousal Disorders Cindy Meston, Ph.D. &amp; Amelia M. Stanton at https:\/\/labs.la.utexas.edu\/mestonlab\/female-sexual-interestarousal-disorders\/ <a href=\"#return-footnote-817-2\" class=\"return-footnote\" aria-label=\"Return to footnote 2\">&crarr;<\/a><\/li><li id=\"footnote-817-3\">McMahon, C. G., Jannini, E. A., Serefoglu, E. C., &amp; Hellstrom, W. J. (2016). The pathophysiology of acquired premature ejaculation. Translational andrology and urology, 5(4), 434\u2013449. https:\/\/doi.org\/10.21037\/tau.2016.07.06 <a href=\"#return-footnote-817-3\" class=\"return-footnote\" aria-label=\"Return to footnote 3\">&crarr;<\/a><\/li><li id=\"footnote-817-4\">Stuparu, Cristina &amp; Cristian, Delcea. (2020). Female orgasm disorder. Anorgasmia. International Journal of Advanced Studies in Sexology. 2. 10.46388\/ijass.2020.13.25. <a href=\"#return-footnote-817-4\" class=\"return-footnote\" aria-label=\"Return to footnote 4\">&crarr;<\/a><\/li><li id=\"footnote-817-5\">Stuparu, Cristina &amp; Cristian, Delcea. (2020). Female orgasm disorder. Anorgasmia. International Journal of Advanced Studies in Sexology. 2. 10.46388\/ijass.2020.13.25. <a href=\"#return-footnote-817-5\" class=\"return-footnote\" aria-label=\"Return to footnote 5\">&crarr;<\/a><\/li><li id=\"footnote-817-6\">Zarski AC, Berking M and Ebert DD (2018) Efficacy of Internet-Based Guided Treatment for Genito-Pelvic Pain\/Penetration Disorder: Rationale, Treatment Protocol, and Design of a Randomized Controlled Trial. Front. Psychiatry 8:260. doi: 10.3389\/fpsyt.2017.00260 <a href=\"#return-footnote-817-6\" class=\"return-footnote\" aria-label=\"Return to footnote 6\">&crarr;<\/a><\/li><\/ol><\/div>","protected":false},"author":29,"menu_order":8,"template":"","meta":{"_candela_citation":"[{\"type\":\"cc\",\"description\":\"Sexual Dysfunction\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Sexual_dysfunction\",\"project\":\"\",\"license\":\"pd\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Hypoactive sexual desire disorder\",\"author\":\"\",\"organization\":\"Wikipedia\",\"url\":\"https:\/\/en.wikipedia.org\/wiki\/Hypoactive_sexual_desire_disorder\",\"project\":\"\",\"license\":\"cc-by-sa\",\"license_terms\":\"\"},{\"type\":\"cc\",\"description\":\"Female sexual arousal 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