The video below is the section for Male Sexual Disfunctions 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: Male Sexual Disfunctions
NARRATIVE DEFINITION: Delayed Ejaculation, Erectile Disorder, Male Hypoactive Sexual Desire Disorder, and Premature (Early) Ejaculation are sexual disorders specific to men. They 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.
Delayed Ejaculation is distinguished by a marked delay or inability to achieve ejaculation. The “delay” is not specified as a time period in the DSM-5, but rather relates to the subjective determination that the amount of time to ejaculation is unacceptably long. Symptoms must have persisted for a minimum of 6 months.
In Erectile Disorder, there is recurrent impairment in the ability to obtain an erection or to maintain an adequate erection until the end of a sexual encounter. Erectile Disorder is one of the most common sexual dysfunctions, as more than half of the men who seek treatment for sexual problems complain of this disorder. Although Erectile Disorder may occur at any age, its prevalence tends to increase as men grow older; most men diagnosed with Erectile Disorder are between 40 and 64 years old. Erectile Disorder has both psychological and physiological causes; a purely physiological etiology can be ruled out if the individual experiences nocturnal erections. Psychological factors associated with Erectile Disorder include sexual anxiety, fear of failure, worries about sexual performance, and a decreased sense of sexual pleasure. Physiological factors associated with the disorder include diabetes, hypertension, high cholesterol, atherosclerosis, multiple sclerosis, Parkinson’s disease, liver disease, kidney disease, and the use of some antidepressant or antipsychotic drugs. Methods for treating Erectile Disorder include sensate focus, lifestyle changes (e.g., limiting the use of alcohol, tobacco, and other drugs), and medications – e.g., sildenafil citrate (i.e., Viagra), Levitra, or Cialis. Medications provide a therapeutic effect by increasing blood flow to the penis.
Male Hypoactive Sexual Desire Disorder is characterized by a lack of desire for sex and deficient/absent erotic thoughts or fantasies over a 6 month duration. The clinician must be careful to distinguish between a “desire discrepancy” between partners and this disorder. A man who has lower sexual desire for his partner would not qualify for this diagnosis if he has other erotic fantasies.
In Premature (Early) Ejaculation, orgasm and ejaculation occurring during partnered sexual activity within a very short period of time or before he wishes for it to happen. (In vaginal penetration within approximately 1 min, specific duration criteria not measured for nonvaginal sexual activities). Premature Ejaculation is most frequently found in younger men and may be more common in sexual encounters with new, as opposed to long-term, partners. Typically, men with this disorder have a greater ability in delaying orgasm while masturbating, but not during sexual activity with a partner. Psychological factors associated with Premature Ejaculation include sexual anxiety, depression, a sense of guilt related to sex, and a history of feeling the need to rush through sexual activity in order to avoid being caught. Premature Ejaculation is one of the most treatable sexual dysfunctions; Masters and Johnson reported a 98 percent success rate in their treatment of Premature Ejaculation. The most common treatment is the squeeze technique, also referred to as stop-and-start. In this technique, the man is aroused until ejaculation is imminent. Before ejaculation occurs, the man’s partner squeezes the head of his penis, thus preventing ejaculation. This process is repeated and, over time, the man learns to control the timing of his orgasm. Premature Ejaculation may also be treated with SSRIs, the side effects of which include inhibited orgasm.
Sexual dysfunctions in both men and women are divided into subtypes on the basis of onset, context, and etiology. Sexual dysfunctions that have been present since the onset of sexual functioning are classified as Lifelong Type, whereas 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. Severity of the disorder is also specified as Mild, Moderate, or Severe.
Sexual Disorders specific to men: Delayed Ejaculation, Erectile Disorder, Male Hypoactive Sexual Desire Disorder, and Premature Ejaculation
1. Delayed Ejaculation: marked delay or inability to achieve ejaculation
2. Erectile Disorder: impairment to obtain erection or maintain adequate erection
A. Most common dysfunction (half of men seeking treatment)
B. Diagnosed typically between 40 and 64 years old
C. Psychological and Physiological causes
D. Treatments: Sensate focus, lifestyle changes, medication (e.g., Viagra)
3, Male Hypoactive Sexual Desire: lack of desire for sex, absence of erotic thoughts
4. Premature Ejaculation: orgasm/ejaculation occur with minimal stimulation
A. Found frequently in younger men
B. Psychological factors: sexual anxiety, depression, guilt related to sex
C. Most treatable dysfunction: Masters and Johnson: 98% success rate using squeeze technique (stop-and-start)
D. Medications: SSRIs
- Lifetime (present since onset of sexual activity) vs. Acquired (after a period of normal functioning)
- Generalized (appear in a variety of contexts) vs. Situational (limited to specific forms of stimulation, situations, partners)
- Severity: Mild, Moderate, or Severe
Diabetes, kidney disease, and multiple sclerosis are conditions associated with:
B. Premature Ejaculation.
C. Male Erectile Disorder.
D. Male Orgasmic Disorder.
RATIONALE: C is correct, as Male Erectile Disorder (but not other Male Sexual Disorders) is associated with a number of disease conditions.