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Sexual DysfunctionsDelayed Ejaculation (F52.32)DSM-5, p. 424Diagnostic Criteria Ethics TreatmentAssessmentsDifferential Diagnosis-marked delay in ejaculation-marked infrequency or absence of ejaculation -above symptoms are experienced on almost all or all occasions (75%-100%) of partnered sexual activity, and have persisted for a minimum duration of approx. 6 months-symptoms above cause distress to the individualSpecify whether: -Lifelong: present since the individual became sexually active-Acquired: began after a period of relatively normal sexual function-Generalized: Not limited to certain types of stimulation, situations, or partnersSituational: Only occurs with certain types of stimulation, situations, or partnersSeverity:Mild: Mild distress over symptomsModerate: Moderate distress over symptomsSevere: Severe/extreme distress over symptomsB.4.b Couples and Family Counseling -Counselor needs to identify who the client is and discuss limitations of confidentiality and must have written agreement to share information B.1. Respecting Client Rights-counselor must respect clients’ culture and differing views towards sexual dysfunctions B.5.c. Release/Receiving of Confidential Information-counselor must have consent to release/receive information from PCP if there was a health screen regarding sexual dysfunction-Psychosexual Therapy-Cognitive Behavior Therapy -Person Centered-Holistic Approach-Self-report-Sexual Tipping Point (STP)-Sexual History Interview-Another medical condition-Substance/medication use-Dysfunction with orgasm Cultural -More common among men in Asia populations-may be inhibitions related to prohibitions against sexual activity-cultural attitudes towards sexualityRisk Factors -temperamental -age-smoking tobacco-lack of physical exercise-diabetes-decreased desire OtherFollowing factors need to be considered at the time of assessment:-partner factors-relationship factors-individual vulnerability factors-cultural/religious factors-medical factorsErectile Disorder DSM-5, p. 426Diagnostic Criteria Ethics TreatmentAssessmentsDifferential Diagnosis-At least one of three of the following symptoms are experienced on almost all or all (75%-100%) occasions of sexual activity, and have persisted for a minimum duration of approx. 6 months and cause significant distress to the individual:-marked difficulty in obtaining an erection during sexual activity-marked difficulty in maintaining an erection until the completion of sexual activity-marked decrease in erectile rigidity Specify whether: -Lifelong: present since the individual became sexually active-Acquired: began after a period of relatively normal sexual function-Generalized: Not limited to certain types of stimulation, situations, or partners-Situational: Only occurs with certain types of stimulation, situations, or partnersSeverity:-Mild: Mild distress over symptoms-Moderate: Moderate distress over symptoms-Severe: Severe/extreme distress over symptomsB.4.b Couples and Family Counseling -Counselor needs to identify who the client is and discuss limitations of confidentiality and must have written agreement to share information B.1. Respecting Client Rights-counselor must respect clients’ culture and differing views towards sexual dysfunctions B.5.c. Release/Receiving of Confidential Information-counselor must have consent to release/receive information from PCP if there was a health screen regarding sexual dysfunction -Psychotherapy -Psychosexual therapy -Couples counseling -Cognitive Behavior Therapy-Relaxation Techniques -Rhythmic breathing -deep breathing -mental relaxation -Self-report-Sexual History Interview- Nonsexual mental disorders-Normal Erectile Dysfunction-Substance/medication useCultural Risk Factors -older age-psychological conditions-medications-relationship problems-alcohol useOtherFollowing factors need to be considered at the time of assessment:-partner factors-relationship factors-individual vulnerability factors-cultural/religious factors-medical factorsFemale Orgasmic DisorderDSM-5, p. 429Diagnostic Criteria EthicsTreatmentAssessmentsDifferential Diagnosis-At least one of three of the following symptoms are experienced on almost all or all (75%-100%) occasions of sexual activity, and have persisted for a minimum duration of approx. 6 months and cause significant distress to the individual:-marked delay in, marked infrequency of, or absence of orgasm-markedly reduced intensity of orgasmic sensationsSpecify whether: -Lifelong: present since the individual became sexually active-Acquired: began after a period of relatively normal sexual function-Generalized: Not limited to certain types of stimulation, situations, or partners-Situational: Only occurs with certain types of stimulation, situations, or partnersSeverity:-Mild: Mild distress over symptoms-Moderate: Moderate distress over symptoms-Severe: Severe/extreme distress over symptomsSpecify if never experience an orgasm under any situationB.4.b Couples and Family Counseling -Counselor needs to identify who the client is and discuss limitations of confidentiality and must have written agreement to share information B.1. Respecting Client Rights-counselor must respect clients’ culture and differing views towards sexual dysfunctions B.5.c. Release/Receiving of Confidential Information-counselor must have consent to release/receive information from PCP if there was a health screen regarding sexual dysfunction -Psychotherapy -Cognitive Behavior Therapy-Pharmacotherapy -Self-report-Sexual History Interview- Nonsexual mental disorders-substance/medication-induced sexual dysfunction -another medical condition-interpersonal factors-other sexual dysfunctionsCultural -marked sociocultural and generational differences in women’s orgasmic ability Risk Factors -temperamental -psychological factors -anxiety -concerns about pregnancy-genetic and physiological -medical conditions/medicationsOtherFollowing factors need to be considered at the time of assessment:-partner factors-relationship factors-individual vulnerability factors-cultural/religious factors-medical factorsFemale Sexual Interest/Arousal DisorderDSM-5, p. 433Diagnostic Criteria EthicsTreatmentAssessmentsDifferential Diagnosis-absent/reduce interest in sexual activity-absent/reduced sexual/erotic thoughts or fantasies -no/reduced initiation of sexual activity, unreceptive to a partner’s attempt to initiate -absent/reduced sexual excitement during sexual activity in almost all, or all (75%-100%) sexual encounters-absent/reduced sexual interest/arousal in response to any internal and external sexual/erotic cues-absent/reduced genital or non-genital sensations during sexual activity-at least three of the symptoms above occur and have been persisted for a minimum duration of approx. 6 months and cause significant clinical distressSpecify whether: -Lifelong: present since the individual became sexually active-Acquired: began after a period of relatively normal sexual function-Generalized: Not limited to certain types of stimulation, situations, or partners-Situational: Only occurs with certain types of stimulation, situations, or partnersSeverity:-Mild: Mild distress over symptoms-Moderate: Moderate distress over symptoms-Severe: Severe/extreme distress over symptomsB.4.b Couples and Family Counseling -Counselor needs to identify who the client is and discuss limitations of confidentiality and must have written agreement to share information B.1. Respecting Client Rights-counselor must respect clients’ culture and differing views towards sexual dysfunctions B.5.c. Release/Receiving of Confidential Information-counselor must have consent to release/receive information from PCP if there was a health screen regarding sexual dysfunction -Psychotherapy -Cognitive Behavior Therapy-Pharmacotherapy -Self-report-Sexual History Interview-Brief Sexual Symptom Checklist - Nonsexual mental disorders-substance/medication -another medical condition-interpersonal factors-other sexual dysfunctions-inadequate or absent sexual stimuli Cultural -lower sexual desire are common in East Asian womenRisk Factors -temperamental -negative cognitions and attitudes about sexuality and past history of mental disorders-relationship difficulties-partner sexual functioning -developmental history-medical conditionsOther-relationship difficulties and mood disorders are frequently associated with disorderGenito-Pelvic Pain/Penetration Disorder (F52.6)DSM-5, p.437Diagnostic Criteria Ethics TreatmentAssessmentsDifferential DiagnosisPersistent of recurrent difficulties with one (or more) of the following for a minimum duration of approx. 6 months and cause significant distress:-vaginal penetration during intercourse-marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts-fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration-tensing or tightening of the pelvic floor muscles during attempted vaginal penetrationSpecify:Lifelong: disturbance since becoming sexually activeAcquired: disturbance began after normal sexual functionSeverity:-Mild: Mild distress over symptoms-Moderate: Moderate distress over symptoms-Severe: Severe/extreme distress over symptomsB.4.b Couples and Family Counseling -Counselor needs to identify who the client is and discuss limitations of confidentiality and must have written agreement to share information B.1. Respecting Client Rights-counselor must respect clients’ culture and differing views towards sexual dysfunctions B.5.c. Release/Receiving of Confidential Information-counselor must have consent to release/receive information from PCP if there was a health screen regarding sexual dysfunction-lubricants and estrogen-containing creams or medications as prescribed-group Cognitive Behavior Therapy if low sexual desire is present -Physical Therapy -Psychotherapy-Sex Therapy-Self-report-Sexual History Interview-Gynecological exam -another medical condition-somatic symptom and related disorder-inadequate sexual stimuli Cultural -inadequate sexual education Risk Factors -sexual or physical abuse-vaginal infectionsOtherFollowing factors need to be considered at the time of assessment:-partner factors-relationship factors-individual vulnerability factors-cultural/religious factors-medical factorsMale Hypoactive Sexual Desire Disorder (F.52.0)DSM-5, p. 440Diagnostic Criteria EthicsTreatmentAssessmentsDifferential Diagnosis-deficient or absent sexual/erotic thoughts or fantasies and desire for sexual activity-persistent for 6 months-cause clinical stressSpecify:Lifelong: disturbance since becoming sexually activeAcquired: disturbance began after normal sexual functionGeneralized: not limited to certain types of stimulation, situations, or partnersSituational: Only occurs when certain types of stimulation, situations, or partnersSeverity:-Mild: Mild distress over symptoms-Moderate: Moderate distress over symptoms-Severe: Severe/extreme distress over symptomsB.4.b Couples and Family Counseling -Counselor needs to identify who the client is and discuss limitations of confidentiality and must have written agreement to share information B.1. Respecting Client Rights-counselor must respect clients’ culture and differing views towards sexual dysfunctions B.5.c. Release/Receiving of Confidential Information-counselor must have consent to release/receive information from PCP if there was a health screen regarding sexual dysfunction-Cognitive Behavior Therapy-Couples Counseling -Psychotherapy-Sex Therapy-Self-report-Sexual History Interview -nonsexual mental disorders-another medical condition-interpersonal factors-other sexual dysfunctions Cultural -higher rates of low desire among East Asian subgroups of women and men Risk Factors -mood and anxiety symptoms-alcohol use-endocrine disorders-relationship status OtherFollowing factors need to be considered at the time of assessment:-partner factors-relationship factors-individual vulnerability factors-cultural/religious factors-medical factorsPremature (Early) Ejaculation (F52.4)DSM-5, p. 443Diagnostic Criteria EthicsTreatmentAssessmentsDifferential Diagnosis-persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approx. 1 minute following vaginal penetration and before the individual wishes-must be present for at least 6 months -experienced on almost all or all (75%-100%) occasions of sexual activity-causes significant distress to the individualSpecify:Lifelong: disturbance since becoming sexually activeAcquired: disturbance began after normal sexual functionGeneralized: not limited to certain types of stimulation, situations, or partnersSituational: Only occurs when certain types of stimulation, situations, or partnersSeverity:-Mild: ejaculation occurring within approx. 30 seconds to 1 minute of vaginal penetration-Moderate: Ejaculation occurring within approx. 15-30 seconds of vaginal penetration -Severe: Ejaculation occurring prior to sexual activity, at the start of sexual activity, or within approximately 15 seconds of vaginal penetrationB.4.b Couples and Family Counseling -Counselor needs to identify who the client is and discuss limitations of confidentiality and must have written agreement to share information B.1. Respecting Client Rights-counselor must respect clients’ culture and differing views towards sexual dysfunctions B.5.c. Release/Receiving of Confidential Information-counselor must have consent to release/receive information from PCP if there was a health screen regarding sexual dysfunction-Cognitive Behavior Therapy-Couples Counseling -Relaxation Techniques -Stopping/cutting down on alcohol, tobacco use-Anti-depressant medication - Anafranil - Paxil *side effect is inhibited orgasm helping delay ejaculation-Self-report-Sexual History Interview-Physical Exam -substance/medication induced sexual dysfunction-ejaculatory concerns that do not meet diagnostic criteria Risk Factors -more common in men with anxiety disorders, especially social anxiety-moderate genetic contribution OtherFollowing factors need to be considered at the time of assessment:-partner factors-relationship factors-individual vulnerability factors-cultural/religious factors-medical factorsGender DysphoriaGender Dysphoria in Children (F64.2)DSM-5, p. 452Diagnostic Criteria EthicsTreatmentAssessmentsDifferential Diagnosis-incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, and manifested by 6 of the following:-desire to be of the other gender-in boys (assigned gender), a preference for cross dressing or simulating female attire-in girls (assigned gender) preference in wearing masculine clothing and resistance to wearing typical female clothing-preference for cross-gender roles in make-believe play or fantasy play-preference in toys, games, etc. stereotypically used by the other gender-preference for playmates of the other gender-in boys, rejection of typical masculine toys, games, etc. -in girls, rejection towards female games, toys, etc. -strong dislike of one’s sexual anatomy -strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender-condition is associated with clinically significant distress or impairmentA.2.a. Informed Consent-Counselor must gain consent from parent/guardian if client is under 14 years of ageB.1 Respecting Client Rights-counselor must respect privacy of the client, confidentiality, and limits of confidentiality Counselor must make appropriate referrals -Supportive Counseling-Real life experiences -fully adopting the preferred gender in real-life settings-Gender reassignment or physical interventions (surgery or hormonal therapy)*possible referral -Beck’s Depression Inventory-Self-report-nonconformity to gender roles-transvestic disorder-body dysmorphic disorder-schizophrenia or other psychotic disorders Risk Factors *increased risk for suicidal ideation Other--onset of cross-genders may onset between the ages of 2-4-boys may shave their legs-boys may bind genitals -girls may bind breastsGender Dysphoria in Adolescents and Adults (F64.1)DSM-5, p. 452Diagnostic Criteria EthicsTreatmentAssessmentsDifferential Diagnosis-incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months duration, and manifested by 2 of the following:-marked incongruence between one’s experience/expressed gender and primary and/or secondary sex characteristics-desire to be rid of one’s primary and/or secondary sex characteristics because of marked incongruence with one’s experienced/expressed gender-desire for the primary and/or secondary sex characteristics of the other gender-desire to be of the other gender-desire to be treated as the other gender-strong conviction that one has typical feelings and reactions of the other gender-condition is associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning A.2.a. Informed Consent-Counselor must gain consent from parent/guardian if client is under 14 years of age-counselor must make appropriate referrals -Supportive Counseling-Real life experiences -fully adopting the preferred gender in real-life settings-Gender reassignment or physical interventions (surgery or hormonal therapy)-suppression and subsequent cross-sex hormones when they reach the age of 16 years*possible referral -Beck’s Depression Inventory -Self-report - nonconformity to gender roles-transvestic disorder-body dysmorphic disorder-schizophrenia or other psychotic disorders Risk Factors *increased risk for suicidal ideation Other-onset of cross-genders may onset between the ages of 2-4-boys may shave their legs-boys may bind genitals -girls may bind breastsAmerican Counseling Association. (2014). ACA code of ethics. Alexandria, VA: Author American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5thed.). Arlington, VA: Author. Amerman, D. (n.d.). Psychological Exercises for ED (Erectile Dysfunction). Retrieved from , A. L., & Cohen-Kettenis, P. T. (2012). Clinical management of gender dysphoria in children and adolescents: the Dutchapproach. Retrieved from , S. S., & Rullo, J. E. (2015, August 15). Sexual Dysfunction in Women: A Practical Approach. Retrieved from Orgasmic Disorder?Treatment & Management. (2017, June 21). Retrieved from, J. E., Mistretta, P., & Will, J. (2008, March 01). Diagnosis and Treatment of Female Sexual Dysfunction. Retrieved2017, from Pain or Penetration Disorder (Sexual Pain Disorder). Psychology today. (2017, April 18). Retrieved from, V. E., & Paylo, M. J. (2014). Treating those with mental disorders: A strength-based,comprehensive approach to case conceptualization and treatment. Upper Saddle River: Pearson Perelman, M. A. (2016, August). Psychosexual therapy for delayed ejaculation based on the Sexual Tipping Point model. Retrievedfrom Ejaculation - Topic Overview. (n.d.). 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