UNIVERSITY OF NORTH TEXAS - DALLAS Dr. Dean Aslinia Sexual Dysfunctions UNIVERSITY OF NORTH TEXAS - DALLAS Dr. Dean Aslinia

Sex is complex “Sexual response has a requisite biological underpinning, yet is usually experienced in an intrapersonal, interpersonal, and cultural context. Thus, sexual function involves a complex interaction among biological, sociocultural, and psychological factors” DSM-5 pg. 423

Defining Sexual Dysfunction Sexual dysfunction (sexual malfunction)is difficulty experienced by an individual (couple) during any stage of a normal sexual activity (physical pleasure, desire, preference, or sexual response cycle. Sexual dysfunctions can have a profound impact on an individual's perceived quality of sexual life, and therefore their self-esteem, worth, and attractiveness. Sexual Response Cycle (Normal process) Excitement Plateau Orgasm Resolution

Difference between male & female sexual response cycle

DSM-5 – Required Factor Checks According to the DSM-5, sexual dysfunction requires a person to feel extreme distress and interpersonal strain for a minimum of 6 months (excluding substance or medication-induced sexual dysfunction). In addition to the lifelong/acquired and generalized/situational subtypes of sexual dysfunctions, several factors must be considered during the assessment of the sexual dysfunction: 1. Partner factors (their sexual problems, their health status) 2. Relationship factors (poor communication, discrepancies in desire for sexual activity. 3. Individual vulnerability factors (poor body image, history of sexual or emotional abuse) 4. Cultural or religious factors (inhibitions related to prohibitions against sexual activity or pleasure; attitudes towards sexuality) 5. Medical factors relevant to prognosis (Libido, cardiovascular disease, diabetes)

Direct Quotes from DSM-5 Pages (423-424) “If the sexual dysfunction is mostly explainable by another nonsexual mental disorder (e.g. depressive or bipolar disorder, anxiety disorder, posttraumatic stress disorder, psychotic disorder), then only the other mental disorder diagnosis should be made”. “If the problem is thought to be better explained by the use/misuse or discontinuation of a drug or substance, it should be diagnosed accordingly as a substance/medication-induced sexual dysfunction”. “If the sexual dysfunction is attributable to another medical condition (e.g. peripheral neuropathy, the individual would not receive a psychiatric diagnosis” “If severe relationship distress, partner violence, or significant stressors better explain the sexual difficulties, then a sexual dysfunction diagnosis is not made, but rather an appropriate V or Z code for the relationship problem or stressor may be listed.

Sexual Dysfunctions in the DSM-5 ICD-9 ICD-10 Delayed Ejaculation (302.74) (F52.32) Erectile Disorder (302.72) (F52.21) Female Orgasmic Disorder (302.73) (F52.31) Female Sexual Interest/Arousal Disorder (302.72) (F52.22) Genito-Pelvic Pain/Penetration Disorder (302.76) (F52.6) Male Hypoactive Sexual Desire Disorder (302.71) (F52.0) Premature (Early) Ejaculation (302.75) (F52.4) Other Specified Sexual Dysfunction (302.79) (F52.8) Unspecified Sexual Dysfunction (302.70) (F52.9) Substance/Medication-Induced Sexual Dysfuction(____.__) (___.__)

Gender Dysphoria in the DSM-5 ICD-9 ICD-10 Gender Dysphoria in Children (302.6) (F64.2) Gender Dysphoria in Adolescents and Adults (302.85) (F64.1) Others Specified Gender Dysphoria (302.6) (F64.8) Unspecified Gender Dysphoria (302.6) (F64.9)

Paraphilic Disorders in DSM-5 ICD-9 ICD-10 Voyeuristic Disorder (302.82) (F65.3) Exhibitionistic Disorder (302.4) (F65.2) Frotteuristic Disorder (302.89) (F65.81) Sexual Masochism Disorder (302.83) (F65.51) Sexual Sadism Disorder (302.84) (F65.52) Pedophilic Disorder (302.2) (F65.4) Fetishistic Disorder (302.81) (F65.0) Transvestic Disorder (302.3) (F65.1) Other Specified Paraphilic Disorder (302.89) (F65.89) Unspecified Paraphilic Disorder (302.9) (F65.9)

Hypersexual Disorder Hypersexuality disorder has not been added to the list of psychiatric disorders for the Diagnostic and Statistical Manual of Mental Disorders (DSM) V, published in May 2013. A brief contextual analysis makes clear that the creation of this concept follows moral norms and psychosocial values. The construction of hypersexuality disorder in terms of a diagnostic entity rests on the clash of social forces at play in the development process