Atiwut Kamudhamas, MD, DHS, Ph.D., RTCOG, ACS

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and Gynecology 1998 - Maternal and fetal medicine, Washington University in St Louis s Louis, Missouri, USA 2004 - Diplomate Thai Board of Family Medicine 2011 - Doctor of Human Sexuality, Institute

in Human Sexuality, Institute for Advanced Study of Human Sexuality, San Francisco, California, USA Dr Kamudhamas is the only one Thai doctor who received Certified American Board of Sexologist, and

1 Atiwut Kamudhamas, MD, DHS, Ph.D., RTCOG, ACS Biography Doctor of Medicine (First Class Honor) Post-graduate certificate in clinical medical science Diplomate Thai Board of Obstetrics and Gynecology Maternal and fetal medicine, Washington University in St Louis s Louis, Missouri, USA Diplomate Thai Board of Family Medicine Doctor of Human Sexuality, Institute for Advanced Study of Human Sexuality, San Francisco, California, USA Ph.D. in Human Sexuality, Institute for Advanced Study of Human Sexuality, San Francisco, California, USA Dr Kamudhamas is the only one Thai doctor who received Certified American Board of Sexologist, and now works as clinical sexologist and sexual physician in Thammasat University Hospital. As a clinical sexologist and sexual physician, he provides sex counseling and sex therapy at Sexual Health Clinic in Thammasat University Hospital. As a lecturer, he provides comprehensive sexuality education to all levels of student including; internships, medical students, students of other faculties in the universities, and also high school students. He is also a gynecologist, so he practices operative treatment for female sexual pain disorder and vaginismus. He is also skillful in cross-sex hormone administration for transgender people. He is now the head of the department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University.

2 Diagnosis of Sexual Disorders What & Why Anti-aging Physicians Need to Know Division of Clinical Sexology and Sexual Medicine Department of Obstetrics and Gynecology Faculty of Medicine, Thammasat University

3 Consist of Sexual disorders & Sexual dysfunctions Male Female Sexual problems & Sexual concerns Male Female

4 Comorbidity of Anxiety and Depression with Sexual Disorders & Sexual Problems

6 Prevalence of ED in Thai Men Aged Between 40 and 70 Years Old. (TEDES 1998) Severe (4.7%) Moderate (13.7%) Mild (19.1%) Tantiwong A. Epidemiology of erectile dysfunction 2001:17-26

7 Prevalence of Sexual Problems in Women

8 Barriers to seeking treatment for sexual problems in primary care: a qualitative study with older people Merryn Gott Sharron Hinchliff Family Practice, Volume 20, Issue 6, 1 December 2003, Pages Results. The GP was seen as the main source of professional help if sexual problems were experienced. However, several barriers were identified as inhibiting help being sought. These included the demographic characteristics of the GP, GP attitudes towards later life sexuality, the attribution of sexual problems to normal ageing, shame/embarrassment and fear, perceiving sexual problems as not serious and lack of knowledge about appropriate services. Conclusion. These findings indicate that many older people have sexual problems that they would like to discuss with their GP, but they feel unable to do so. GPs may need to be more proactive in raising sexual health issues in consultations if these needs are to be met.

9 In Thailand and Global Prevalence of sexual disorders & sexual problems 30-40% (average both males and females) Only 4% had a prior entry in their medical record relating to sexual problems Reasons 1. Anxiety about physician s perceived inability to treat sexual problems 2. Unwillingness to spend the time required to accurately assess sexual concerns 3. Personal discomfort when discussing sexual matters with patients such as; Not asking about sexual function 4. Female fewer than male seeking sexual consultation; Cultural reason 5. Not known where to go and what doctors to treat So we can help to promote sexual health intervention to those affected people by correction of truth and myth of these reasons. And know a little bit more about the diagnosis of sexual disorders today.

10 ICD-10 Version: World Health Organization F01-F99 Mental, Behavioral and Neurodevelopmental disorders F50-F59 Behavioral syndromes associated with physiological disturbances and physical factors F52 Sexual dysfunction not due to a substance or known physiological condition

11 Codes F52 Sexual dysfunction not due to a substance or known physiological condition F52.0 Hypoactive sexual desire disorder F52.1 Sexual aversion disorder F52.2 Sexual arousal disorders F52.21 Male erectile disorder F52.22 Female sexual arousal disorder F52.3 Orgasmic disorder F52.31 Female orgasmic disorder F52.32 Male orgasmic disorder F52.4 Premature ejaculation F52.5 Vaginismus not due to a substance or known physiological condition F52.6 Dyspareunia not due to a substance or known physiological condition F52.8 Other sexual dysfunction not due to a substance or known physiological condition F52.9 Unspecified sexual dysfunction not due to a substance or known physiological condition

12 Diagnostic Information Disturbances in sexual desire and the psychophysiologic changes that characterize the sexual response cycle and cause marked distress and interpersonal difficulty. In order to be considered a sexual dysfunction, the dysfunction must: 1) occur frequently, although it may be absent on some occasions; 2) have been present for at least 6 months; and 3) be associated with clinically significant distress.

13 The Diagnostic and Statistical Manual of Mental Disorders (DSM) American Psychiatric Association (APA)

14 Discussion: DSM 5 (2013) vs DSM IV-TR (2000) The classification of sexual dysfunctions was simplified. There are now only three female dysfunctions and four male dysfunctions, as opposed to five and six, respectively, in the DSM-IV. Addition of duration criteria for all sexual disorders >> 6 months Addition of severity criteria for all sexual disorders >> Absent/reduced pleasure during sexual activity in almost all or all (approximately 75%-100%)

15 Female hypoactive desire disorder and female sexual arousal disorder were merged into a single syndrome called Sexual interest/arousal disorder. The formerly separate dyspareunia and vaginismus are now called Genitopelvic pain/penetration disorder. Female orgasmic disorder remains in place.

16 As for males, Male hypoactive sexual desire disorder now has a separate entry. The male adjective was dropped from Erectile disorder Male orgasmic disorder was changed to Delayed ejaculation, Premature ejaculation remains unchanged and additional so-called Early ejaculation. Male dyspareunia or male sexual pain does not appear in the sexual dysfunctions chapter of the DSM-5.

17 Sexual aversion disorder and sexual dysfunction due to a general medical condition are absent (eliminated) The Not Otherwise Specified (NOS) category was scrapped from the sexual dysfunctions chapter as well as elsewhere in the DSM-5. Substance- or medication-induced sexual dysfunction remains unchanged.

18 Conclusion: Diagnosis of Sexual Disorders

19 How about Sexual Problems and Sexual Concerns? Sexual problems not currently classified Post-coital dysphoria Hyperactive sexual desire disorder or Hypersexuality (Nymphomania, Satyriasis) Sexual compulsivity or addiction Sexual aversion disorder Penis captivus Persistent genital arousal disorder Sexual concerns not a diagnosable disorder Sexual disastisfaction Desire discrepancy (Incongruence of sexual desire between sexual partners) Sex therapists & physicians should also manage these sexual problems even not currently classified

20 Diagnostic Guideline History taking Physical examination Genital examination FSFI / IIEF Comprehensive assessment Permission giving (PLISSIT model approach) Severity of problem (Disorder/ Problem/ Concern) Bio-psycho-social assessment (Holistic approach) Intersystem assessment (Intrapsychic components + Interreactional components)

21 Anti-Aging Benefits of Sex: Sex = the Ultimate Health Supplement Looking younger Feeling healthier Help balance hormones Lessen the risk of heart attacks Lessen breast cancer Lessen prostrate cancer Help alleviate migraines, headaches and pain Improve mood, relieve depression and anxiety Help lose weight, gain more energy

23 Physician Atiwut Kamudhamas Nurse case manager Kasama Martsri Counselors Winit Longlalearng Karnjana Sombatsirinun Integrative practitioner (ATTM) Suthisa Sritat Thammasat Sexual Health Clinic Team work

treatment Surgical treatment CBT Vaginal physical therapy

24 Modalities of treatment providing; Sex Educating Sex Coaching Sex Counseling Sex Therapy MFT (Marriage and Family Therapy) Medical treatment Surgical treatment CBT Vaginal physical therapy Psychotherapy Sexological hypnotherapy Transgender healthcare Anal pap smear screening

25 Contact information Atiwut Kamudhamas ปร กษาป ญหาหย อนสมรรถภาพทางเพศโดยแพทย เวชศาสตร ทางเพศ เก ดเป นชาย ไปให ส ด atiwut

26 Thank you

Chapter 13. Sexual Variants, Abuse, and Dysfunctions. Sexual Abuse. Sexual and Gender Variants

Chapter 13. Sexual Variants, Abuse, and Dysfunctions. Sexual Abuse. Sexual and Gender Variants Chapter 13 Sexual Variants, Abuse, and Dysfunctions This multimedia product and its contents are protected under copyright law. The following are prohibited by law: any public performance or display, including