This information was written by the education committee of the mental health program, caritas health group  december /02

Information for Patients and Families
Mental Health Programs
Grey Nuns Community Hospital &
Misericordia Community Hospital
This pamphlet was written by Dr. Lorne Warneke of the Mental Health Program at the Grey Nuns Community Hospital, Caritas Health Group. June 2005 Reorder # 90285
What are the sexual disorders that commonly occur in
pleasurable sensation that is felt in the genital area, females?
particularly in the muscles that surround the vagina, but is also experienced as a warm and tingling Sexual dysfunction can be classified as follows: sensation that spreads throughout the body. • The period of resolution is the time interval before a
female can become aroused to the point of orgasm again. For some females this period is very short and allows multiple orgasms to the single one experienced The Human Sexual Response Cycle
Each of the phases of the sexual response cycle is distinct Before describing the various disorders of sexual with respect to the neurotransmitters (chemical functioning, some information about the human sexual messengers) that are involved as well as the part of the nervous system that is involved. Dysfunction can occur in any of the phases of the sexual response cycle leading • The desire phase which includes interest in sexual
activity, and spontaneous sexual feelings. Also, there are major differences between females and • The arousal phase occurs after there is sexual interest
males when it comes to sexual desire and arousal. Males and involves the reaction of the body. This includes are more easily ‘turned on’ by the thought of sex, or a increased heart rate, increased breathing, sweating, visual cue, and become more immediately aroused and flushing and, in the female, swelling of the genital area usually wish to engage in sex very quickly. Females are including the clitoris as well as the surrounding area. more slowly aroused and are more likely to become This is often referred to as the ‘orgasmic’ plateau. Of desirous of sex and become aroused through interaction interest, females have as much, if not more, erectile with their partner. This difference is often a cause of tissue than males. In the male the erectile tissue is concentrated in the penis, whereas in the female this includes the clitoris as well as the surrounding tissue. Information About the Specific Disorders of Sexual
Because of the increased blood flow to the area, there Functioning
is also secretion or lubrication which occurs in the Overall about 43% of females have some degree of sexual vagina. Other parts of the body may also swell and become aroused, such as the nipples and the breast Disorders of Sexual Desire
The orgasmic phase is the actual orgasm and is
difficult to describe. For females it is an intense This occurs in about 34% of females and is characterized Female Orgasmic Disorder
by a very low or absent interest in sexual activity. It can Inorgasmia is the condition in which an individual is unable to achieve an orgasm or is able to do so only with a great deal of stimulation and after a long period of time. • Depression or other psychiatric illness, such as severe This is in spite of adequate sexual interest and excitement. It occurs in about 24% of females. This can be caused by: • Low levels of testosterone which can occur in females, • Some medications, such as antidepressants 2. Sexual Aversion Disorder- This is present when the opportunity for sexual activity, or the thought of such Sexual Pain Disorder
activity, creates feelings of revulsion or disgust and 1. Dyspareunia can be caused by any local problem avoidance if possible. It is usually a learned response. involving the vagina, such an infection, a cyst of the Bartholin’s glands, Herpes lesions, prolapse of the • Traumatic sexual experiences as a child or as an adult • Strong puritanical views about sex that may have come 2. Vaginismus is a condition in which the muscles surrounding the vagina contract as a reflex whenever sexual penetration is attempted. If intercourse Disorders of Sexual Arousal
continues to be attempted this can result in severe pain. About 19% of females have problems with becoming There can be various degrees of severity of sexually aroused, that is, there is no swelling in the genital area and no lubrication. This problem can be caused by: • Any previous traumatic sexual experience in which physical and or psychological pain was experienced • As a result of this experience the muscles surrounding • Severe anxiety about performing sexually – it can be the vagina contract as a reflex to prevent this from caused by a neurological problem, such as complications of Diabetes or Multiple Sclerosis • It may be due to testosterone deficiency, even in Are There Treatments Available for the Sexual
• It can be a side effect of medications, such as The answer is yes. To begin with, it is important to talk to your family doctor about the problem you are having. He will need to know if the problem occurs every time sexual activity is attempted, or periodically. Is the work if the individual has interest in sexual activity. It problem recent, or has it been life long? What part of the cannot be used if the individual is using nitrates for a sexual response cycle is affected, and does the problem occur with every partner (if there is more than one)? • Cialis (tardanifil) is a drug very similar to Viagra, but Does the problem occur during masturbation? Is there a lasts longer, up to three days and is probably a drug psychiatric or medical illness present and, if so, are medications involved? Depending on the problem, a • Levitra (vardenafil) is a similar drug to the other two referral may be made to a specialist, such as a gynecologist or even a psychiatrist that specializes in this There are other drugs that are being studied, but are not 3. Orgasmic Disorders
Specific Treatment
1. Hypoactive Sexual Desire or Interest
This may be due to a number of factors, but is most This can be a complex problem if it is due to psychological problems and may require talk therapy to antidepressants. It is important to discuss this with your help the person deal with issues to do with their sexuality. Sometimes the use of testosterone in a low dose can be • Changing or lowering the dose of the medication, if 2. Disorders of Sexual Arousal
If this is due to anxiety, then counseling can be useful to • Switching to a medication that does not have this side enhance the person’s self-confidence. There are many other psychological factors that can affect arousal. • For some medications, stopping the drug for a couple Couple’s therapy involving sensual massage (forbidding of days will reverse this side effect long enough to actual sexual activity for a period of time) can be useful, focusing on foreplay. This can advance to more sexual • There are a number of ‘antidotes’ that can be tried, There are some medications that are useful for sexual arousal problems in males. These drugs have not been studied extensively in females, but there are reports of them being helpful and are worth trying. • Viagra (sildenafil) is a drug that helps with the blood flow to the penis and would also increase the blood flow to the genital area in the female. It will only There are a specific set of exercises that a female can Getting Help:
engage in to help with the problem of inorgasmia that include a series of steps involving self massage that The best place to start is to discuss your problem with advances to self stimulation or masturbation, your family doctor. If the family doctor is unable to sometimes with the use of a vibrator. This is provide help he or she will be able to refer you to a important particularly for those females who have not specialist in this area. The type of specialist may depend had an orgasm before. The exercises are repeated with on the nature of your problem and could include a a partner. Pubococcygeal muscle exercises (also gynecologist, urologist, psychiatrist, psychologist or called Kegel exercises) can be useful. These muscles social worker. The most important thing is to realize that surround the vagina and contain nerve endings help is available and to overcome any embarrassment that important in orgasm. The exercises consist of bearing down and contracting these muscles (squeezing the anal sphincter tight) several times a day in a repetitive 4. Sexual Pain Disorder

This needs to be investigated by a physician and the
underlying cause treated. Once treated, the pain with
sexual activity usually goes away.
This is a bit more complex to treat. Psychotherapy or talk
therapy is required to address the fear of intercourse that
has been developed. The reflex spasm of the
pubococcygeal muscles can be overcome by the use of
dilators that come in a range of sizes. The woman uses
these dilators first until comfortable, and then the
exercises are repeated with the regular sexual partner.


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