Principles of classification sexual dysfunctions in ICD-10
According to ICD-10, sexual dysfunctions include various options for the inability of the subject to engage in sexual activity in accordance with his desire, including: lack of interest; lack of satisfaction; lack of physiological reactions necessary for full sexual contact (for example, erection); inability to control or experience an orgasm. Sexual dysfunctions can be permanent (existing from the beginning of sexual activity of the individual) and acquired (after a period of normal sexual life), generalized (when problems arise during all sexual contacts of a person without exception) and selective or selective (under certain conditions, under some forms stimulation, with a specific sexual partner). According to developmental mechanisms, they are divided into organic (associated with diseases of internal organs, endocrine glands, neurological disorders and pathology of the blood supply to the genitals), psychogenic (due to psychological problems and neurotic symptoms) and mixed (there is a combination of organic and psychogenic factors) sexual dysfunctions.
Currently, four successive phases are usually considered in the cycle of a person’s sexual reactions. In contrast to the model of W. Masters and W. Johnson, the desire phase is additionally highlighted. This is due to the fact that sexual desire is functionally connected with arousal and orgasm, but has its own neurophysiological features. In turn, the phases of excitement and plateau, following each other, are combined into one common – the phase of excitation. Each of the four phases has its own sexual dysfunctions (H. I. Kaplan, B. J. Sadock, 1994).
1. Attraction (desire). The phase differs from the other physiological phases and includes psychological aspects (motivation, motivations, personality traits and attitudes), which are closely related to the sexual desires of the person. It is characterized by sexual fantasies and the thirst for sexual activity. In sexual attraction, a special role belongs to the energy component associated with the deep structures of the brain and the activity of the endocrine glands. This component provides the awakening of sexual desire and largely determines its presence and severity in the future. Sexual dysfunctions associated with the first phase: reduced sexual desire (hypolibidemia), the absence or loss of sexual desire, lack of sexual pleasure, aversion to sexual contact (aversion); increased libido (nymphomania, satiriasis).
2. Excitement. The phase consists of the subjective sensation of sexual pleasure and the accompanying physiological changes in the genitals and the whole body. Sexual dysfunctions associated with the second phase: insufficiency or absence of a genital reaction (sexual arousal disorders in women and erectile dysfunction in men); with some reservations – dyspareunia and vaginismus. Dyspareunia (pain during intercourse) can interfere with the arousal phase and prevent you from enjoying sexual contact. Vaginismus makes it extremely painful or impossible to insert the penis into the vagina, blocking the arousal phase that occurs in women only during extra-intra-sexual sexual activity.
3. Orgasm. The culmination of sexual pleasure. Sexual dysfunction associated with the third phase; orgasmic dysfunction, manifested in men with difficulty ejaculation or its absence (anejaculatory syndrome), in women – anorgasmia; premature ejaculation in men, at which the severity of orgasmic experiences is often reduced; post ejaculatory pain.
4. Resolution. There is a general relaxation, accompanied by a feeling of satisfaction. Sexual dysfunctions associated with this phase are quite rare: post-coital dysphoria (after successful in all other aspects of coitus, some people lose their mood, stress, anxiety, irritability, sometimes aggression, they want to quickly get rid of their partner); postcoital headache (throbbing pain in the occipital or frontal region, which occurs immediately after coitus and may last for several hours).