Sexual orientation

and sexual disorders

dr Cecep Sugeng Kristanto, Sp KJ (K)

Disampaikan pada kuliah S1 FK UGM

2011
Sexual dysfunction

 In the DSM-IV-TR, a sexual dysfunction is

defined as disturbance in the sexual response
cycle or as pain with sexual intercourse.
 It can be symptomatic of biological (biogenic)
problems or intrapsychic/interpersonal
(psychogenic) conflicts or a combination of
these factors.
These syndromes are devided into four groups
based on the sexual physiological responses
 Desire  Orgasm
- Hypoactive sexual - Female orgasmic
desire disorder disorder
- Sexual aversion - Male orgasmic
disorder disorder
 Excitement  Resolution
- Female sexual arousal - Postcoital dysphoria
disorder - Postcoital headache
- Male sexual arousal
disorder
Desire
Desire is distinct from any identified
solely through physiology and reflects the
patient’s motivation, drives and personality.
It is characterized by sexual fantasies and
the desire to have sex.
Sexual desire disorders
 Etiology :
1. Physics
- Hormonal alteration ( decreased of
testosterone and tyroxin,
increased of prolactin)
- Renal disease, cardiac disease etc.
Etiology
2. Psychogenic
- Boring with the partner
- Guilty feeling
- Stress
- Sex trauma
- Inhibition during the phallic psychosexual phase of
development and of unresolved oedipal conflicts
(examplevagina dentata)
- Anxiety
- Depression
- Abstinence from sex for a prolonged period
Etiology
3. Absence on several factor that improve desire :
- Biological drive
- Adequate self esteem
- Accept oneself as a sexual person
- Previous good experiences with sex
- The availability of an appropriate partner
- A good relationship in non sexual areas with a
partner
Sexual desire disorders can be
classified in two groups
 Hypoactive sexual desire disorders :
- Persistently/ recurrenctly deficient (or
absolute) sexual fantasies and desire for
sexual activity.
 Sexual aversion disorders
-Persistent/ recurrent extreme aversion to and
avoidance of, all (or almost all) genital
sexual contact with sexual partner
 Sign & Symptom  Treatment of sexual
 Decrease frequency of desire disorders
sexual activity  Causative
 Complain other sexual  Sex therapy
disorders
 Depressed
 Irritable
 Not have sexual desire
although seeing
attractive partner
Sexual arousal disorder
 Arousal
is subjective sense of sexual pleasure and
accompanying physiological changes
 Sexual arousal disorder
is persistent or recurrent inability to attain or
to maintain until completion of the sexual
activity, an adequate lubrication-swelling
response (female) and erection (male) of
sexual excitement
Sexual arousal disorder
 Etiology :
a. Physics
- Disorders which inhibit vaginal lubrication
(diabetes mellitus, lack of estrogen,
vaginitis)
- Drugs (antihistamin)
- Smoking
B. Psychogenic
- Sexual trauma
Sexual arousal disorder
 Sexual arousal disorder can be devided in to two
category:
- Female sexual arousal disorder
- Male sexual arousal disorder
a. Female sexual arousal disorder
 Etiology :
a. Hormonal
Alteration in testosterone, estrogen,
prolactin and thyroxine levels
B. Medication which can decrease vaginal
lubrication
- Antihistamin
- Anticholinergic
a. Female sexual arousal disorder
 Sign and symptom
 Lack of vaginal lubrication
 Clitoris failure to erect
 Lack of arousal feeling

 Treatment
 Causative
 Sex therapy
 Sexual device to rising sexual reaction
 Vaginal lubricant
b. Male sexual arousal disorder
 Impotence / erectile dysfunction
is inability for reaching/ keeping penis to erect
adequately to have sexual activity

 If a man reports having spontaneous erections at

times when he does not plan to have intercourse,
having morning erections, or having good
erections with masturbation or with partners other
than his usual, the organic cause of impotence
can be considered negligible
Etiology

 Psychogenic
a. Predisposition factors b. Precipitating factors
- Negative sight for
sex - Physical disorder
- Sexual trauma - Degenerative process
- Lack of family - Poor honesty to the
relationship partner
- Poor life style - Lack of communication
- Personality factor - Excessive fear
- Lack of sexual
education
Etiology – organic factor
 Hormonal  Drugs
- Prolactin  Psychotropical agent
(ex.antidepressant)
- Tyroxin
 Antihypertension
 Neurological  Hormonal treatment
- Parasympathetic  Anticholinergic
disorders  Recreational drugs (alcohol,
- Brain disorders marijuana, amphetamine,
nicotine)
 Blood vessel
 Surgery
- Scleroting artery
 Brain or vertebra surgery,
- Venous rupture penilectomy
Erectile dysfunction
 It is classified in to two groups :
1. Primary  can not erect from
beginning
2. Secondary succesfully erect before
Examination
 International Index of Erectile Function (IIEF)
 There are 15 questions asking erectile function, orgasm
function, sexual desire etc
 Score :
- 5-10 : severe
- 11-15 : moderate
- 16-20 : mild
- 21-25 : normal
Examination
 Physical examination
 Audiovisual test
 Nocturnal Penile Tumescence & Rigidity (NPTR)
with additional device (erectiometer, snap gauge,
rigiscan, doppler stetoschope)
 Laboratorium Test (CBC, blood glucose,
cholesterol, lipid, liver function test, hormon, renal
function test)
Treatment for erectile dysfunction
 First line :
 Sex therapy
 Oral erectogenic agents (yohimbine, apomorphine,
trazodone, l-arginin, sildenafil sulfate)
 Second line :
 Injecting vasoactive substance to the corpus cavernosum
(papaverine, pentholamine, prostalglandine E1, VIP/
vasoactive intestinal polypeptide, nitropruside)
 Third line :
 Prostethic device implanted in the corpus cavernosum
(semirigid and inflantable)
1. Female orgasmic disorder/ inhibited
female orgasm/anorgasmia

is recurrent/ persistent inhibition of

female orgasm, as manifested by the
recurrent delay in, or absence of, orgasm
after a normal sexual excitement phase
that clinician judges to be adequate in
focus, intensity, and duration-in short, a
woman’s inability to achieve orgasm by
masturbation/ coitus.
Etiology
 Fear of pregnancy
 Rejection by a sex partner
 Damage to the vagina
 Hostility toward men
 Guilty feeling about sexual impulses
 Cultural expectations and social restriction
on women
Sign and symptom
 Persistent/ recurrent delay in/ absence of orgasm
following a normal excitement phase
 Pelvic complains :
- Lower abdominal pain, itching, vaginal
discharge
 Blood pressure increase
 Irritability
 Fatigue
2. Male orgasmic disorders/ inhibited
orgasm/ retarded ejaculation
Definition :
a man achieves ejaculation during coitus with great difficulty
Etiology :
* perceive sex as sinful and genital is dirty (from rigid/ puritanical
background)
* Concious/ unconcious incest wishes and guilt
* Difficulty with closeness in areas beyond those of sexual relations
* Loss of sexual attraction to the partner
* Unexpressed hostility toward a woman
* Attention deficit disorders
* Obsessive compulsive disorders
* Physical factors like genital disorder, impaired sympathetic
ganglion, guanetidine ( sympathetic inhibitor)
Treatment  sex therapy
3. Premature Ejaculation
 Definition :
Men persistently/ recurrently ejaculation
with minimal sexual stimulation before, on,
or shortly after penetration and before the
person wishes it.
Premature Ejaculation
 Etiology
 Anxiety regarding the sexual activity
 Unconcious fears about the vagina
 Negative cultural conditioning
 Men whose early sexual/ contacts occurred largely with
prostitutes
 Youngs, inexperienced men
 Stressful marriage
 Treatment
 Sex therapy
 Drugs which can control ejaculation
 Dyspareunia
Definition :
Recurrent/ persistent genital pain occuring in either men/
women before, during/ after intercourse
Etiology :
* History of rape/ childhood sexual
abuse
* Tension and anxiety about the sexual activity
* Genital inflammation
* IUD
* Condom
* Lack of vaginal lubrication (lack of arousal, antihistamin
drugs, DM, lack of estrogen)
Treatment : sexual counseling and pharmacotherapy
 Vaginismus
Definition :
Sexual dysfunction which manifest as abnormal spasme of the
vaginal smooth muscle
Etiology :
 Physical
 Hymen disorders, infection around vagina/labia

 Impaired hymen caused of delivering baby

 Psychogenic
 Rigid background

 Sexual trauma

 Coital pain

 Fear to pregnant

 Fear to sexual transmitted disease

 Women feel emotionally abused by their partners

Treatment :
 Deep counseling to ensure that vaginismus is really true
 Dilator of vaginal muscle
Homosexuality
 The term homosexuality often describes a
person’s overt behaviour, sexual orientation
and sense of personal or social identity.
These include lesbians and gay men.
 Recent research reports rates of
homosexuality in 2-4 percent of the
population.
 According to psychodynamic theory, early
life situations that can result in male
homosexual behaviour include a strong
fixation on the mother; lack of effective
fathering; inhibition of masculin
development by their parents; fixation at or
regression to the narcistic stage of
development; and looses when competing
with brothers and sisters.
 The same-sex erotic fantasies in gay men
center on the father or the father surrogate.
 Gay men reportedly exhibit lower levels of
circulatory androgens than do heterosexual
men.
 Women with hyperadrenocorticalism are
lesbian and bisexual in greater proportion
than women in the general population.
 Gay men and lesbians engage in the same
sexual practices as heterosexual, with the
obvious differences imposed by anatomy.
Abnormal Sexual Behaviour
 Paraphilia
 Exhibitionism
 Fetihism
 Frotteurism
 Pedophilia
 Sexual masochism
 Sexual sadism
 Voyeurism
 Trasnvestic fetihism
 Paraphilia Not Otherwise Specified
Exhibitionism
 Exhibitionism is the recurrent urge to
expose the genitals to a stranger or to an
unsuspecting person.
 Sexual excitement occurs in anticipation of
the exposure, and orgasm is brought about
by masturbation during or after the event.
 The dynamic of men with exhibitionism is to
assert their masculinity by showing their
penises and by watching the
victims’reactions-fright, surprise, and
disgust.
Fetihism
 In fetihism, the sexual objects (e.g shoes,
gloves, pantyhose, and stockings) that are
intimately associated with the human body.
 The disorders is almost exclusively found in
men.
Frotteurism
 Frotteurism is usually characterized by a
man’s rubbing his penis againts the
buttocks or other body parts of a fully
clothed woman to achieve orgasm. At other
times, he may use his hands to rub an
unsuspecting victim.
 The acts usually occur in crowded places,
particularly in subways and buses.
Pedophilia
 Pedophilia involves recurrent intense
sexual urge toward or arousal by childern
13 years of age or younger, over a period
of at least 6 month. Persons with pedophilia
are at least 16 years of age and at least 5
years older than the victim.
Sexual masochism
 A person with sexual masochism have a
recurrent preoccupation with sexual urges
and fantasies involving the act of being
humilated, beaten, bound, or otherwise
made to suffer.
Sexual sadism
 A person who has a reccurent, intense
sexually arousing fantasies, sexual urges,
or behaviors involving acts (real, not
simulated) in which the psychoogical or
physical suffering (including hummiliation)
of the victim is exciting to the person.
Voyeurism/ scopophilia
 Is the recurrent preoccupation with
fantasies and acts that involve observing
persons who are naked or enganged in
grooming or sexual activity.
ANY QUESTIONS?
REFERENCES
 Sadock BJ, Sadock VA, eds.Kaplan & Sadock’s
Comprehensive Textbook of Psychiatry, 8th
ed.Vol.1. Baltimore : Lippincot William & Wilkins ;
2005
 Sadock BJ, Sadock VA, eds.Kaplan & Sadock’s
Synopsis of Psychiatry, 10th ed. Baltimore :
Lippincot William & Wilkins ; 2007
 Pangkahila, W. 2001. Bahagia Tanpa Gangguan
Fungsi Seksual. Jakarta: Kompas.