PREFERRED PRACTICE PATTERN
A 56-year-old woman reports that she was sexually inactive for 10 months following treatment for breast cancer. This treatment was 3 years ago. She has attempted to resume sexual relations with her husband: however, now she is unable to achieve an orgasm. They have tried many different approaches include masturbation without success.
Inability to achieve sexual orgasm during sexual intercourse or other sexual activity despite adequate stimulation and the desire to do so
Normal libido and sexual excitement
Primary anorgasmic (preorgasmic): Not yet able to reach organism
Secondary orgasmic disorder: Was previously able to reach orgasm, but is no longer able
Definitions of Sexual Dysfunction
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TABLE 265-1 Definitions of Sexual Dysfunction
|APA Definitiona ||AUA Definitionb |
|Hypoactive sexual desire disorder ||Sexual desire/interest disorder |
|Persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity. Judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning ||Absent or diminished feelings of sexual interest or desire, absent sexual thoughts or fantasies, and a lack of responsive desire. Motivations for attempting to become sexually aroused are scarce or absent. Lack of interest goes beyond a normal lessening with increasing age and relationship duration |
|Lack of subjective arousal ||Combined arousal disorder |
|No DSM-IV definition addresses the lack of subjective arousal ||Absent or markedly reduced feelings of sexual arousal (sexual excitement and sexual pleasure) from any type of stimulation, and absent or impaired genital sexual arousal (vulvar swelling and lubrication) |
|Lack of subjective arousal ||Subjective arousal disorder |
|No DSM-IV definition addresses the lack of subjective arousal ||Absent or markedly reduced feelings of sexual arousal (sexual excitement and sexual pleasure) from any type of stimulation. Vaginal lubrication and other signs of physical response still occur |
|Female sexual arousal disorder ||Genital arousal disorder |
|Persistent or recurrent inability to attain, or to maintain until completion of sexual activity, adequate lubrication, and swelling response of sexual excitement ||Absent or impaired genital sexual arousal (minimal vulvar swelling or vaginal lubrication from any type of sexual stimulation, and reduced sexual sensations when genitalia are caressed) |
Subjective sexual excitement still occurs from nongenital sexual stimuli (e.g., erotica, breast stimulation, kissing)
|Female orgasmic disorder ||Orgasmic disorder |
|Persistent or recurrent delay or absence of orgasm after a normal sexual excitement phase ||Lack of orgasm, markedly diminished intensity of ...|
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