madman
Super Moderator
Primary Sexual Dysfunctions and Sexual Dysfunction Associated with Psychiatric Illness and Treatment
Introduction to the Session Welcome, My name is Joe Ceremelli, and I oversee Grand Rounds for the Department of Psychiatry and Behavioral Sciences. Thank you for joining today’s presentation. Before we begin, here are a few notes: comments or questions can be submitted in the chat or Q&A during the presentation, and I will address them with our presenter, Dr. Clayton, at the end.
Acknowledgements and Introductions The Ripley Fund and the Garvey Institute for Brain Health Solutions are supporting this Grand Rounds. Our dedicated core team includes Samhar Braha on coordination and communications and Mike Walker on technology. A new speaker evaluation will be shared towards the end; your feedback is appreciated to help us plan future sessions.
Introducing Dr. Anita Clayton Today’s speaker is Dr. Anita Clayton, Chair of the Department of Psychiatry and Neurobehavioral Sciences and Professor of Obstetrics and Gynecology at the University of Virginia. After completing medical school and a Psychiatry residency in Virginia, Dr. Clayton worked as a staff psychiatrist at the National Naval Medical Center and then returned to the University of Virginia, where she has been a faculty member since.
Dr. Clayton’s clinical and research expertise is internationally recognized, particularly in mood disorders associated with reproductive life events, major depressive disorder, and sexual dysfunction associated with psychiatric illness and treatment. Notably, she has also served as president of the International Society for the Study of Women's Sexual Health and contributed to the World Health Organization's committee on the ICD-11 chapter on sexual health conditions.
Disclosures Dr. Clayton’s disclosures include grants for research on treatments for depression and sexual dysfunction, advisory roles in developing new treatments, and unrestricted stock holdings.
Biopsychosocial Model of Sexual ResponseSexual response, both typical and dysfunctional, can be understood through a biopsychosocial model encompassing:
- Biological Factors: Neuroendocrine function, genetics, medical conditions, and medications.
- Intrapsychic Factors: Performance anxiety, impaired self-image, depression, trauma.
- Interpersonal Factors: Relationship quality, levels of abstinence, life stressors.
- Psychosocial Factors: Family attitudes towards sexuality, cultural and religious norms, expectations.
- Linear Model (Masters and Johnson): Begins with stimulation, arousal, plateau, orgasm, and resolution.
- Kaplan’s Addition: Introduced spontaneous desire preceding stimulation.
- Circular Model (Rosemary Basson): Emphasizes responsive desire driven by emotional intimacy, with arousal building through stimulation.
- Testosterone and Estrogen: Drivers of desire, with testosterone being more significant in men.
- Oxytocin and Prolactin: Affect attachment, excitement, and inversely relate to dopamine.
- Neurotransmitters: Serotonin, dopamine, norepinephrine—with serotonin inhibiting dopamine and testosterone, affecting sexual response.
- DSM-4: Included phase-specific disorders and pain disorders for men and women.
- DSM-5: Introduced sex-specific labels, combined diagnoses (e.g., female interest and arousal disorder), included substance-induced sexual dysfunction, and removed sexual aversion disorder.
- Critiques: Limited scientific evidence, few field trials, expert panel composition, and exclusion of special populations.
Impact of Antidepressants and Treatments According to studies, SSRIs and other antidepressants cause changes in brain activity that are associated with sexual dysfunction:
- fMRI Studies: Indicated significant reductions in sexual response areas with paroxetine.
- Bupropion: Shown to increase activation in sexual response areas, demonstrating fewer sexual dysfunction side effects.
- Women: 43% reported sexual complaints; 10% had distressing low desire.
- Men: 30% reported climaxing too early; 30% experienced erectile dysfunction.
- Depression: Associated with 50–70% increased risk of sexual dysfunction.
- Sexual Dysfunction: Increased the risk of major depression by 130–210%.
- Identifying and Managing Modifiable Factors: Medical, psychiatric, and lifestyle elements.
- Pharmacotherapy Options: Alternatives and adjuncts like bupropion, buspirone, and mirtazapine.
- Approved Treatments: Include flibanserin (5-HT1A agonist) and bremelanotide (melanocortin agonist).
- Off-label Treatments: Testosterone and DHEA in postmenopausal women, with caution for side effects.
Conclusion Effective treatment of sexual dysfunction requires a comprehensive understanding of its biopsychosocial contributors and a tailored approach addressing both primary and secondary factors. Open communication, patient education, and collaborative treatment plans can significantly improve patient outcomes.
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