Overview Sexual dysfunction of some form is very common login to view 8 more bullets Subtypes (DSM-V): lifelong vs. acquired, generalized vs. situational login to view 12 more bullets Snapshot A 55-year-old main comes to his physician for an annual physical. A physical exam was within normal limits. At the conclusion of the encounter, the patient hesitates and asks for help for "an embarrassing problem" which he describes as an inability to maintain an erection during sexual intercourse with his wife. Impotence Introduction login to view 2 more bullets Presentation login to view 2 more bullets Evaluation login to view 7 more bullets Treatment login to view 8 more bullets Snapshot A 33-year-old man presents to his primary care physician with a complaint that he is very anxious about "certain things." When you probe these feelings, he reluctantly describes a problem with "sexual performance," in that he ejaculates immediately when intercourse begins. Premature Ejaculation Introduction login to view 3 more bullets Presentation login to view 2 more bullets Treatment login to view 6 more bullets Genito-Pelvic Pain/Penetration Disorder (Dyspareunia and Vaginismus - DSM IV) This DSM V diagnosis contains the previous DSM IV diagnosis of dysparuenia and vaginismus (below) Sexual aversion disorder has been removed from the DSM V - it was a rare and often unused diagnosis Snapshot A 29-year-old woman presents to her OBGYN for her annual Pap smear. When asked if she was experiencing any other gynecological issues, she mentioned that recently she has become sexually active with a new partner and has been experiencing pain with intercourse. A Pap smear and STD workup is negative. Dyspareunia Introduction login to view 2 more bullets Presentation login to view 2 more bullets Evaluation login to view 2 more bullets Treatment login to view 2 more bullets Snapshot A 23-year-old woman presents to her gynecologist after becoming sexually active for the first time. She was distressed because despite several attempts, she described the act as impossible because of vaginal "contractions." The patient's only medical history was rape that occurred when she was a senior in high school. Vaginismus Introduction login to view 3 more bullets Presentation login to view 2 more bullets Treatment login to view 4 more bullets Snapshot A 38-year-old gentleman presents with a request for sildenafil to help with sex. The patient states that he is able to achieve and maintain an erection, however he is no longer able to have an orgasm. The patient's past medical history is unremarkable with the exception of beginning treatment for depression with a psychiatrist that began a week ago. Medication Induced Sexual Dysfunction Introduction login to view 1 more bullet Presentation login to view 1 more bullet Treatment login to view 3 more bullets Snapshot A 35-year-old woman presents with a chief complaint of trouble during intercourse. She states that she is unable to attain or maintain sexual arousal that is affecting her current relationship with her boyfriend. Female Sexual Interest/Arousal Disorder Introduction login to view 2 more bullets Evaluation (requires ABSENCE/REDUCED of 3 of the following for 6 MONTHS that causes DISTRESS) login to view 7 more bullets Treatment login to view 4 more bullets Others Abnormal sexual behavior in a pediatric patient login to view 2 more bullets Sexual assault login to view 1 more bullet