Women s Sexual Interest/Desire Disorder : Implications of New Definition

Transcription

1 Women s Sexual Interest/Desire Disorder : Implications of New Definition Rosemary Basson MD FRCP(UK) Vancouver General Hospital University of British Columbia Vancouver, Canada 1 New Model of Sex Response : New Definitions of Dysfunction Why move from the model desire - arousal (erection/lubrication) - orgasm - resolution? What is the new model and the new definition of low desire/interest? What are two major changes? Where are sex hormones involved? How do we assess and manage desire/ arousal problems? 2 1

2 Why propose any new model of response or revise definitions of dysfunction? Intensity ORGASM PLATEAU Linear model of relatively discreet phases AROUSAL Lubrication swelling RESOLUTION DESIRE time 3 Need for New Model Women in established relationships only rarely begin sex with their partners for reasons of desire.(initially) Desire has a broad normative range across sexually content women 4 2

3 Need for New Model Women in established relationships only rarely begin sex with their partners for reasons of desire..(initially) Desire has a broad normative range across sexually content women Women do not focus on genital congestion when they assess their sexual arousal 5 Psychophysiological studies :- Women watch an erotic (made for women), video 6 3

4 Vaginal photoplethysmograph Light-emitting diode Phototransistor Objective increase in congestion is measured along with subjective sexual arousal 7 Studies over the past 25 years Psychophysiological studies repeatedly confirm women may genitally congest in a healthy manner but experience no subjective sexual arousal For women with chronic low arousal measured increase in vasocongestion matches that of sexually healthy women 8 4

5 Need for New Model Women in established relationships only rarely begin sex with their partners for reasons of desire..(initially) Women do not focus on genital congestion when they assess their sexual arousal Phases are not discreet, dysfunctions coexist 9 Non sexual rewards - emotional intimacy well being,lack of negative effects from sexual avoidance Multiple motivations. Awareness of positive rewards/ spinoffs from satisfying sex Willingness to find / be receptive Arousal & responsive desire Sexual satisfaction (+/- orgasms) Subjective Arousal Sexual stimuli with appropriate context Processed psychological biological 10 5

6 Spontaneous/Initial Desire?? Common early on in relationships May endure for decades in the same relationship Frequently extremely rare Is the focus of existing definitions of desire disorder 11 Non sexual rewards - emotional intimacy well being,lack of negative effects from sexual avoidance Sexual satisfaction Multiple motivations. Awareness of positive rewards/ spinoffs from satisfying sex Spontaneous innate desire motivates Willingness to find / be receptive Sexual stimuli with appropriate context Arousal & responsive desire Subjective Arousal psychological Processed biological 12 6

7 American Foundation of Urological Disease International Consensus Committee on Definitions of Women s Sexual Dysfunctions Basson R, Leiblum S, Brotto L, Derogatis L, Fourcroy J, Fugl Meyer K, Graziottin A, Heiman J, Laan E, Meston C, Schover L, Wejmar Schultz W, van Lankveld J J Psychosom Obstet Gynecol 2003;24: Sexual Interest/Desire Disorder Absent or diminished feelings of sexual interest or desire, absent sexual thoughts or fantasies, and a lack of responsive desire. The lack of interest is considered to be beyond a normative lessening with life cycle & relationship duration. 14 7

8 Two Major Points It is the inability to be subjectively aroused and access desire during the experience, that designates disorder Lack of initial desire per se, does not designate disorder. (Its sudden loss may accompany loss of subjective arousability and lack of responsive desire) 15 Sex Hormones Testosterone via AR &/or ER involved in arousabilty - response - pleasure, excitement, orgasm -and in any initial spontaneous desire -? in the active neurovascular genital smooth muscle response of swelling & increased lubrication -? in genital sexual sensitivity 16 8

9 Sex Hormones Estrogen is involved directly in vulval, vaginal congestive response and indirectly via effects on mood, sleep, it is linked to sexual motivation and arousability 17 How Do We Assess Lack of Subjective Arousal Lack of Interest /Desire? 18 9

10 Jenny and Michael Sex was fine for first 5 years Infertility testing. desire and arousal faded Alisha is now 5 years old No improvement in Jenny s sexual experiences. 19 Little in the way of non sexual rewards - emotional intimacy, well being not increased Little emotional intimacy-each suffered alone, Sex is lonely,? resentment No Sexual satisfaction PE NO Spontaneous innate desire motivates Little willingness to find / be receptive Stopped arranging sexual stimuli with appropriate context No responsive desire No Arousal psychological Processed biological 20 10

11 Anna and Sharon Sex was fine for their 10 years together until Anna s BSO & hysterectomy for ovarian mass 21 Neither emotional nor physical satisfaction Minimal arousal No responsive desire Minimal arousal Minimal Sexual motivation Minimal Spontaneous Desire Arousability impaired Little willingness to find / be receptive Sexual stimuli avoided - proven ineffective Processing affected by low androgen 22 11

12 Conclusions Women s sexual desire is largely responsive triggerable The concept of arousability is key Many psychological, interpersonal and contextual factors influence arousability Biological factors also influence - eg fatigue, depression, medications, androgen loss 23 12