Psychosexual disorders

Psychosexual disordersDept.of Psychiatry andPsychotherapyPécsKrafft-Ebing(1840-1902)Sigmund FreudPhases• Desire• Excitement• Orgasm• ResolutionSexual dysfunctionsDysfunctionHypoactive sexual desire disorder; sexual aversiondisorder; hypoactive sexual desire disorder due to ageneral medical condition (male or female); substanceinducedsexual dysfunction with impaired desireFemale sexual arousal disorder; male erectile disorder(may also occur in stage 3 and in stage 4); male erectiledisorder due to a general medical condition; dyspareuniadue to a general medical condition (male or female);substance-induced sexual dysfunction with impairedarousalFemale orgasmic disorder; male orgasmic disorder;premature ejaculation; other sexual dysfunction due to ageneral medical condition (male or female); substanceinducedsexual dysfunction with impaired orgasmPostcoital dysphoria; postcoital headacheSexual Dysfunction Not Correlated withPhases of the Sexual Response CycleCategory• Sexual paindisorders• OtherDysfunctionsVaginismus (female) Dyspareunia (femaleand male)Sexual dysfunctions not otherwise specified.Examples:1. No erotic sensation despite normalphysiological response to sexual stimulation(e.g., orgasmic anhedonia)2. Female analogue of prematureejaculation3. Genital pain occurring duringmasturbation1

Diagnostic Criteria for Sexual DysfunctionDue to a General Medical ConditionA. Clinically significant sexual dysfunction thatresults in marked distress or interpersonaldifficulty predominates in the clinical picture.B. There is evidence from the history, physicalexamination, or laboratory findings that thesexual dysfunction is fully explained by the directphysiological effects of a general medicalcondition.C. The disturbance is not better accounted for byanother mental disorder (e.g., major depressivedisorder).Diagnostic Criteria for Sexual DysfunctionDue to a General Medical ConditionSelect code and term based on the predominant sexual dysfunction:• Female hypoactive sexual desire disorder due to a general medicalcondition: if deficient or absent sexual desire is the predominant feature.• Male hypoactive sexual desire disorder due to a general medical condition:if deficient or absent sexual desire is the predominant feature.• Male erectile disorder due to a general medical condition: if male erectiledysfunction is the predominant feature.• Female dyspareunia due to a general medical condition: if pain associatedwith intercourse is the predominant feature.• Male dyspareunia due to a general medical condition: if pain associated withintercourse is the predominant feature.• Other female sexual dysfunction due to a general medical condition: ifsome other feature is predominant (e.g., orgasmic disorder) or no featurepredominates.• Other male sexual dysfunction due to a general medical condition: if someother feature is predominant (e.g., orgasmic disorder) or no featurepredominates.• Coding note: Include the name of the general medical condition on Axis I, e.g.,male erectile disorder due to diabetes mellitus; also code the general medicalcondition on Axis III.ParaphiliasNeurotransmitter Effects on Sex FunctionEjaculation +/- + + +/-• Transvesticand orgasm α 1fetishismDopamine Serotonin Adrenergic Cholinergic• Pedophilia•Coprophilia• Exhibitionism•UrophiliaErection ++ +/- α, β +/-• Voyeurism•Telephon scatologia- +• Frotteurism•Computer scatologia• Sexual masochism •Necrophilia• Sexual sadism• Fetishism• ZoophiliaGender identity disorders I.Gender identity disorders II.• Gender identity disorder– Transsexualism– Adolescent/adult gender identity disorder– Childhood gender identity disorder• Gender identity disorder NC– Intersexual disorders (etc.: androgenresistency, congenital adrenal hyperplasia)and related discomfort– Transient, stress-related cross-dressing2

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