Sexual dysfunctions are categorized as either primary or secondary, and situational or global. A primary sexual dysfunction is one that has always existed, whereas a secondary sexual dysfunction is one in which a dysfunction developed after a period of adequate functioning. A situational sexual dysfunction is a dysfunction that occurs during certain sexual activities or with certain partners (for instance, a man who can get an erection with his girlfriend but not his wife; or a woman who can have orgasms during masturba­tion but not during oral sex). A global sexual dysfunction is a dysfunction that occurs in every situation, during every type of sexual activity, and with every sexual partner.

It is important to clarify these differences, for they may affect treatment strategies. For instance, primary problems tend to have more biological or physiological causes, whereas secondary problems tend to have more psychological causes. Sex therapists fur­ther categorize dysfunctions as those of sexual desire, sexual arousal, orgasm, or pain dis­orders (most sex therapists use the DSM-IV-TR to help in their diagnosing). Each of these may be primary or secondary, situational or global. See Table 14.1 for an overview of sexual dysfunctions.

TABLE 14.1 The Sexual Dysfunctions

Sexual Desire Disorders

Symptoms: Sexual Interest

Hypoactive Sexual Desire Disorder

Primary—Lifelong diminished or absent feelings of sexual interest or desire; absent sexual thoughts and/or fantasies

Secondary—Acquired diminished or absent feelings of sexual interest or desire; diminished or absent sex­ual thoughts and/or fantasies

Sexual Aversion Disorder

Primary—Lifelong persistent or recurrent extreme aversion to, and avoidance of, all genital sexual con­tact with a sexual partner

Secondary—Acquired persistent or recurrent extreme aversion to, and avoidance of, all genital sexual contact with a sexual partner

Sexual Arousal Disorders

Symptoms: Physiological Arousal

Female Sexual Arousal Disorder

Primary—Lifelong diminished or absent lubrication response of sexual excitement Secondary—Acquired diminished or absent lubrication response of sexual excitement

Male Erectile Disorder

Primary—Lifelong diminished or absent ability to attain or maintain, until completion of the sexual ac­tivity, an adequate erection

Secondary—Acquired diminished or absent ability to attain or maintain, until completion of the sexual activity, an adequate erection

Orgasm Disorders

Symptoms: Orgasm Difficulties

Female Orgasmic Disorder

Primary—Lifelong delay or absence of orgasm following normal sexual excitement Secondary—Acquired delay or absence of orgasm following normal sexual excitement

Male Orgasmic Disorder

Primary—Lifelong absence of orgasm in men

Secondary—Acquired diminished ability to orgasm or markedly decreased orgasmic intensity from any type of stimulation

Premature Ejaculation

Primary—Lifelong pattern of ejaculating with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it

Secondary—Acquired pattern of ejaculating with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it

Sexual Pain Disorders

Symptoms: Genital Pain

Dyspareunia

Primary—Lifelong recurrent or persistent genital pain associated with sexual intercourse, in either a male or female

Secondary—Acquired recurrent or persistent genital pain associated with sexual intercourse, in either a male or female

Vaginismus

Primary—Lifelong pattern of recurrent or persistent involuntary spasms of the outer third of the vagina that interferes with sexual intercourse

Secondary—Acquired pattern of recurrent or persistent involuntary spasms of the outer third of the vagina that interferes with sexual intercourse

Other Sexual Dysfunctions Due to a General Medical Condition

Presence of Sexual Dysfunction That Is Due to the Physiological Effects of a General Medical Condition

Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright © 2000 by the American Psychiatric Association.

multimodal

using a variety of techniques.

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