•Problems in sexuality are classified into three groups:
1) Sexual dysfunction
2) Disorders of sexual preference ,known as paraphilias
3) gender identity disorder
Sexual dysfunction:
•In men sexual dysfunction refers to repeated impairment of normal sexual interest and /or performance.
•In women it refers to a repeated unsatisfactory quality to the experience of normal sexual intercourse.
Classification of psychosexual disorder:
•Sexual dysfunction not caused by organic disorder: majority of the problems lasted <6months.
1) Lack or loss of sexual desire
2) Sexual aversion and lack of sexual enjoyment
3) Failure of genital response
4) Orgasmic dysfunction
5) Premature ejaculation
6)Non-organic dyspareunia and non-organic vaginismus
7) Excessive sexual drive
Causes of sexual dysfunction:
•Poor relationship with partner
•Low sexual drive
•Ignorance about sexual technique
•Anxiety about sexual performance.
•Othersà physical illness, depressive and anxiety disorders, medication, drug abuse, alcohol.
Medical causes of sexual dysfunction:
•Diabetes, hyperthyroidism, myxoedema
•Addison’s disease, hyperprolactinaemia
•Gynecological à Vaginitis, endometriosis, pelvic infection
•Respiratory Asthma, Obstructive airways disease.
•Arthritis, Renal failure, spinal cord lesion, stroke.
Management of sexual dysfunction:
•Education and advice about the sexual problem
•Couple therapy
Surgical causes of sexual dysfunction:
•Mastectomy
•Colostomy
•Oophorectomy
•Operations of prolapse
•Amputation
Some drugs may impair sexual function:
•Antihypertensiveà Diuretics, Beta-blokers
•Antidepressantà Tricylic, SSRIs
•Mood stabilizersà Lithium
•Anxiolytics and hypnoticsà Benzodiazepines
•Antipsychoticsà typicals
•Hormonal agentsà Anabolic steroid, oestrogen.
•Education and advice about sexual problem
•Couple therapy
•Oral medication sildenafil, vardenafil. They enhance the effects of sexual stimulation.
•Microsugery to treat erectile disorder results from proven vascular abnormality.
Abnormalities in sexual preference:
•Transvestic fetishism The preferred or only means of achieving sexual excitement from inanimate objects i,e. clothing of opposite sex. This behavior takes precedence over the usual pattern of sexual intercourse.
•Paedophilia repeated sexual activity with prepubertal children. Most of the female child aged between 6 to 12 years are the victims.
•Exhibitionism repeated exposing of genital organ to strangers for the purpose of achieving sexual excitement.
•Sexual sadism extreme cruelty to women for sexual purposes.
•Masochism Achieving sexual gratification through the experience of suffering or humiliation.
•Voyeurism Getting sexual gratification by observing others engaged in sexual intercourse.
Treatment:
•Coucelling the patient to identify the problem and give up the behavior.
•Councelling to reduce the practices.
•Hormonal treatment: Testosterone antagonist is used in Europe.
•Behavioral treatment.
