PS9.1 | Common Psychosexual Disorders — Summary & Reflection

KEY TAKEAWAYS

Common Psychosexual Disorders — Key Points:

• Psychosexual disorders are classified by phase of the sexual response cycle: desire (HSDD), arousal (ED, female arousal disorder), orgasm (PE, orgasmic disorder), and sexual pain (vaginismus, dyspareunia) — per ICD-11.
• ED: differentiate organic (gradual onset, absent NPT, vascular/metabolic risk) from psychogenic (situational, preserved morning erections, performance anxiety cycle). PDE5 inhibitors are first-line pharmacotherapy.
• PE: lifelong vs acquired; IELT <1 minute; dapoxetine (on-demand SSRI) is first-line pharmacotherapy; behavioural techniques (start-stop, squeeze) are core to sex therapy.
• HSDD: commonest dysfunction in women; mixed organic (hormonal, iatrogenic) + psychogenic; address the treatable cause first.
• Vaginismus: involuntary perivaginal muscle contraction; primary vs secondary; graded dilator therapy + relaxation training are the behavioural backbone.
• PLISSIT model: Permission → Limited Information → Specific Suggestions → Intensive Therapy — a graduated, accessible intervention framework for every clinical level.
• Assessment must include a sensitive, structured sexual history, targeted MSE, and focused investigations; always use ICD-11 criteria and document distress.
• Partner involvement and treatment of comorbid depression/anxiety are essential for durable outcomes.

REFLECT

Think about a clinical scenario from your training in which a patient's sexual concern was either not asked about or was dismissed. What was the impact — on the patient's disclosure, on the diagnosis, on the therapeutic relationship? How would you apply the PLISSIT framework at the 'Permission' level the next time you have a consultation with a patient who might be experiencing a sexual difficulty? Reflect on what personal or cultural assumptions you bring to this clinical domain, and how you might recognise and bracket them to provide equitable care.