The video below is the section for Female Sexual Dysfunction from Part 3 of TSM’s lecture series on DSM-5 and the EPPP, followed by a transcript. This lecture series aims to equip those preparing for the EPPP with everything you need to know about the impact DSM-5 will be having on the EPPP. To watch all of Part 3, click HERE. To watch Part 1 and 2, or register for our webinar series on DSM-5 and the EPPP, click HERE.
Transcript of DSM-5 EPPP Lecture Video: Female Sexual Dysfunction
NARRATIVE DEFINITION: Sexual Dysfunctions are disorders in desire, arousal and orgasm. Sexual disorders described in the DSM-5 that are found specifically in women include Female Orgasmic Disorder, Female Sexual Interest/Arousal Disorder, and Genito-Pelvic/Penetration Disorder.
The first two disorders are characterized by persistent disturbances in the normal sexual response cycle. Women with Female Sexual Interest/Arousal Disorder demonstrate an absent or reduced interest in sexual activity, or an ongoing inability to attain or maintain an adequate lubrication-swelling response of sexual excitement (i.e., vasocongestion in the pelvis, vaginal lubrication, swelling of the external genitals). Women with Female Orgasmic Disorder are able to achieve a normal level of sexual excitement, but do not experience orgasm, experience delayed orgasm after the sexual excitement phase, or have orgasms infrequently or of reduced intensity. These disorders are diagnosed when the symptoms cause significant distress or interpersonal disturbances and are not solely due to the effects of a drug or another medical condition.
Genito-Pelvic Pain/Penetration Disorder, in which there are recurrent and persistent involuntary spasms in the outer third of the vagina that interfere with intercourse. These vaginal spasms occur when penetration (e.g., with a tampon, speculum, finger, or penis) is attempted; in some women, anticipation of penetration is enough to induce muscle spasms. The involuntary vaginal contractions may be experienced as a tightening with mild discomfort or as a ripping, burning, or tearing pain that prevents penetration entirely.
Genito-Pelvic Pain/Penetration Disorder is often associated with fearfulness or anxiety regarding intercourse; the condition may be exacerbated by vaginal scarring due to child bearing, surgery, or abuse; irritation from the use of douches, spermicide, or condoms; and infection. Specifiers indicate whether the condition is Lifelong or Acquired, and whether the severity is Mild, Moderate, or Severe.
Genito-pelvic pain/penetration disorder is new in DSM-5 and represents a merging of the DSM-IV categories of vaginismus and dyspareunia, which were highly comorbid and difficult to distinguish. The diagnosis of sexual aversion disorder has been removed due to rare use and lack of supporting research.
Sexual Dysfunctions are usually caused by performance anxiety, unrealistic expectations, misinformation, early conditioning, and/or ignorance of sexual physiology.
Sexual Dysfunctions in both men and women are divided into subtypes on the basis of the onset, context, and etiology. Sexual Dysfunctions that have been present since the onset of sexual functioning are classified as Lifelong Type, while those that appear after a period of normal functioning are classified as Acquired Type. Sexual Dysfunctions that appear in a variety of contexts are classified as Generalized Type, whereas those that are limited to specific forms of stimulation, situations, or partners are classified as Situational Type. Specify if “never experienced an orgasm under any situation.” Specifiers for severity of the condition are mild, moderate, or severe. Sexual dysfunctions in the DSM-5 (except substance-/medication-induced sexual dysfunction) now require a minimum duration of approximately 6 months and more precise severity criteria.
Treatment approaches employ a variety of methods, including relationship counseling, cognitive restructuring, and sensate focus. Women with Female Orgasmic Disorder may receive instruction in, and be encouraged to, engage in masturbation. Vaginismus is often treated with relaxation exercises and the gradual dilation of the vagina by, for example, increasingly larger vibrators (Hersen, 20007). Women with Sexual Dysfunctions may also improve their sexual functioning and enhance sexual pleasure through the use of Kegel exercises, which involve repeated and voluntary tightening of the pelvic floor muscles.
Female Sexual Dysfunctions
Disorders in desire, arousal, and orgasm in the female
They are: Female Sexual Arousal Disorder, Female Orgasmic Disorder, and Vaginismus
a. Female Sexual Arousal Disorder: Involves inability to maintain lubrication/swelling response when sexually excited
b. Female Orgasmic Disorder: Involves lack of orgasm, or delayed infrequent or orgasm of reduced intensity
c. Genito-Pelvic Pain/Penetration Disorder: Involves recurrent, persistent, involuntary spasms in outer third of vagina that interfere with intercourse
Genito-Pelvic Pain/ Penetration Disorder: Can be associated with misinformation, unrealistic expectations, fearfulness, and/or performance anxiety
Lifelong Type (present since onset of sexual functioning) vs. Acquired Type (appears after a period of normal functioning)
Generalized Type (appears in a variety of contexts) vs. Situational Type (limited to specific forms of stimulation, situations)
Specify if: never experienced an orgasm under any situation
Specify severity of condition: mild, moderate, or severe
Treatment involves relationship counseling, cognitive therapy, and sensate focus; for vaginismus, relaxation may be used; Masturbation encouraged; Kegel exercises (repeated and voluntary tightening of the pelvic floor muscles) also useful to enhance sexual functioning and increase pleasure
In Female Sexual Arousal Disorder, compared to Orgasmic Disorder, the primary problem relates to all of the following, except:
RATIONALE: C is correct, as lubrication, swelling of external genitalia, and vasocongestion of the pelvic region are all associated with Arousal Disorder, whereas the orgasm/climax is the primary problem for Orgasmic Disorder.