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For further information, see CMDT Part 25-09: Psychosexual Disorders
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Essentials of Diagnosis
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Large category of vasocongestive and orgasmic disorders
Often involve problems of sexual adaptation, education, and technique
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General Considerations
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Often mentioned only after direct questioning
Patients sometimes use the term "impotence" incorrectly to describe premature ejaculation
Causes can be psychological, physiologic, or both
A history of occasional erections—especially nocturnal tumescence—suggests a psychological origin
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Ejaculation disturbances
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Ejaculation control is an acquired behavior that is minimal in adolescence and increases with experience
Sexual ignorance, anxiety, guilt, depression, and relationship problems may interfere with learning control
Interference with the sympathetic nerve distribution through surgery or radiation can be responsible
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Sexual activity varies from active avoidance of sex to an occasional orgasm
Causes for the dysfunctions include poor sexual techniques, early traumatic sexual experiences, interpersonal disharmony (partner struggles, use of sex as a means of control), and intrapsychic problems (anxiety, fear, guilt)
Organic causes include
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Hyposexual desire disorder
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Although menopause may lead to diminution of sexual desire in some women, the relationship between menopause and libido is complicated and may be influenced by sociocultural factors
Alcohol, sedatives, opioids, marijuana, and some medications may affect sexual drive and performance
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Ejaculation disturbances
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Difficulty in experiencing erotic sensation and lack of vasocongestive response
Should be differentiated from orgasmic dysfunction
In orgasmic dysfunction, varying degrees of difficulty are experienced in achieving orgasm
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Hyposexual desire disorder
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Consists of diminished or absent libido
May be a function of organic or psychological difficulties (eg, anxiety, phobic avoidance)
Hormonal disorders, including hypogonadism or use of antiandrogen compounds such as cyproterone acetate, and chronic kidney disease contribute to deterioration in sexual desire
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Differential Diagnosis
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Depression or anxiety
Underlying medical condition, eg, diabetes mellitus, peripheral vascular disease, hyperprolactinemia, hypogonadism
Dyspareunia or chronic pelvic pain
Drugs or substance use, eg, selective serotonin reuptake inhibitors (SSRIs), tricyclic antidepressants, alcohol
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Diagnostic Procedures
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