3.5 Basic Human Needs:
Eating, Sex and Sleep
Week 2
Sex
,DSM-5 Criteria → Delayed Ejaculation
A Either of the following symptoms must be experienced on almost all or all
occasions (approximately 75%–100%) of partnered sexual activity (in identified
situational contexts or, if generalized, in all contexts), and without the individual
desiring delay:
1. Marked delay in ejaculation.
2. Marked infrequency or absence of ejaculation.
B Symptoms have persisted for at least 6 months.
C Symptoms cause clinically significant distress.
D Sexual dysfunction is not better explained by a nonsexual mental disorder or
severe relationship distress or other significant stressors and is not attributable to
the effects of a substance or medication or other medical condition.
Subtype ● Lifelong: Disturbance has been present since the individual has become
sexually active.
● Acquired: Disturbance began after a period of relatively normal sexual
function.
Subtype ● Generalized: Present in all types of stimulation, situations or partners.
● Situational: Only certain stimulation, situations and partners.
Severity ● Mild: Evidence of mild distress over the symptoms in Criterion A.
● Moderate: Evidence of moderate distress over the symptoms in Criterion A.
● Severe: Evidence of severe or extreme distress over the symptoms in
Criterion A.
Diagnostic features
● Difficulty or inability to ejaculate despite presence of stimulation & desire, usually
involves partnered sexual activity
● Most cases is self report
● Definition of delay does not have precise boundaries → there is no consensus what
constitutes a reasonable time to reach orgasm or what is unacceptable
Associated features supporting diagnosis
● May report prolonged thrusting to the point of exhaustion or genital discomfort and
ceasing efforts, or avoidance of sexual activity, feeling less attractive
● Five other factors should be considered besides subtypes
○ Partner factors
○ Relationship factors
○ Individual vulnerability factors, psychiatric comorbidity, stressors
○ Cultural & religious factors
○ Medical factors relevant to prognosis, course, treatment
,Prevalence
● Unclear due to lack of a precise definition of the syndrome
● Least common male sexual complaint
● 75% of men report always ejaculating, only 1% will complain of problems reaching
ejaculation that last more than 6 months
Development and course
● Lifelong → begins with early sexual experiences & continues throughout life
● Acquired → beings after period of normal functioning
● Prevalence appears relatively constant until 50 years → increases
○ Men in their 80s report 2x as much difficulty ejaculating
Risk & prognostic factors
● Genetic & physiological → age related loss of the fast conducting peripheral sensory
nerves and age related decreased sex steroid secretion may be associated with
increase in men older than 50
Culture related diagnostic issues
● Complaints are more common in asian populations (could be cultural or genetic)
Functional consequences
● Can cause difficulties in conception, often associated with psychological distress in one
or both partners
Differential diagnosis
● Another medical condition → being explained fully by another medical illness or injury,
independent of psychological issues (eg nerves, surgery, ANS, neurodegenerative
diseases), should also be differentiated from retrograde ejaculation
● Substance or medication use → antidepressants, antipsychotics, alpha sympathetic
drugs, opioid drugs
● Dysfunction with orgasm → important to distinguish if it is about delayed ejaculation or
sensation of orgasm or both (ejaculation occurs in genitals, orgasm is primarily
subjective, usually occur together but not always)
Comorbidity
● It is more common in severe MDD
DSM-5 Criteria → Erectile Disorder
A At least one of the three following symptoms must be experienced on almost all or
all (approximately 75%–100%) occasions of sexual activity (in identified situational
contexts or, if generalized, in all contexts):
, 1. Marked difficulty in obtaining an erection during sexual activity.
2. Marked difficulty in maintaining an erection until the completion of sexual
activity.
3. Marked decrease in erectile rigidity.
B The symptoms in Criterion A have persisted for a minimum duration of
approximately 6 months.
C The symptoms in Criterion A cause clinically significant distress in the individual.
D Sexual dysfunction is not better explained by a nonsexual mental disorder or as a
consequence of severe relationship distress or other significant stressors and is
not attributable to the effects of a substance/medication or another medical
condition.
Subtype ● Lifelong: Disturbance has been present since the individual has become
sexually active.
● Acquired: Disturbance began after a period of relatively normal sexual
function.
Subtype ● Generalized: Present in all types of stimulation, situations or partners.
● Situational: Only certain stimulation, situations and partners.
Severity ● Mild: Evidence of mild distress over the symptoms in Criterion A.
● Moderate: Evidence of moderate distress over the symptoms in Criterion A.
● Severe: Evidence of severe or extreme distress over the symptoms in
Criterion A.
Diagnostic features
● Careful sexual history is necessary to know how long it has been going on and when it
occurs, symptoms may only occur in specific situations
Associated features supporting diagnosis
● Low self-esteem, low self-confidence, decreased sense of masculinity, depressed affect
● Fear/avoidance of future sexual encounters
● Decreased sexual satisfaction & reduced sexual desire in partner
● Other factors to be considered besides subtypes
○ Partner factors
○ Relationship factors
○ Individual vulnerability factors, psychiatric comorbidity, stressors
○ Cultural/religious factors
○ Medical factors
Prevalence
● Age related increase in incidence (after 50)
● 13-21% of those aged 40-80 report occasional problems
● 2% under 50 report frequent problems
Eating, Sex and Sleep
Week 2
Sex
,DSM-5 Criteria → Delayed Ejaculation
A Either of the following symptoms must be experienced on almost all or all
occasions (approximately 75%–100%) of partnered sexual activity (in identified
situational contexts or, if generalized, in all contexts), and without the individual
desiring delay:
1. Marked delay in ejaculation.
2. Marked infrequency or absence of ejaculation.
B Symptoms have persisted for at least 6 months.
C Symptoms cause clinically significant distress.
D Sexual dysfunction is not better explained by a nonsexual mental disorder or
severe relationship distress or other significant stressors and is not attributable to
the effects of a substance or medication or other medical condition.
Subtype ● Lifelong: Disturbance has been present since the individual has become
sexually active.
● Acquired: Disturbance began after a period of relatively normal sexual
function.
Subtype ● Generalized: Present in all types of stimulation, situations or partners.
● Situational: Only certain stimulation, situations and partners.
Severity ● Mild: Evidence of mild distress over the symptoms in Criterion A.
● Moderate: Evidence of moderate distress over the symptoms in Criterion A.
● Severe: Evidence of severe or extreme distress over the symptoms in
Criterion A.
Diagnostic features
● Difficulty or inability to ejaculate despite presence of stimulation & desire, usually
involves partnered sexual activity
● Most cases is self report
● Definition of delay does not have precise boundaries → there is no consensus what
constitutes a reasonable time to reach orgasm or what is unacceptable
Associated features supporting diagnosis
● May report prolonged thrusting to the point of exhaustion or genital discomfort and
ceasing efforts, or avoidance of sexual activity, feeling less attractive
● Five other factors should be considered besides subtypes
○ Partner factors
○ Relationship factors
○ Individual vulnerability factors, psychiatric comorbidity, stressors
○ Cultural & religious factors
○ Medical factors relevant to prognosis, course, treatment
,Prevalence
● Unclear due to lack of a precise definition of the syndrome
● Least common male sexual complaint
● 75% of men report always ejaculating, only 1% will complain of problems reaching
ejaculation that last more than 6 months
Development and course
● Lifelong → begins with early sexual experiences & continues throughout life
● Acquired → beings after period of normal functioning
● Prevalence appears relatively constant until 50 years → increases
○ Men in their 80s report 2x as much difficulty ejaculating
Risk & prognostic factors
● Genetic & physiological → age related loss of the fast conducting peripheral sensory
nerves and age related decreased sex steroid secretion may be associated with
increase in men older than 50
Culture related diagnostic issues
● Complaints are more common in asian populations (could be cultural or genetic)
Functional consequences
● Can cause difficulties in conception, often associated with psychological distress in one
or both partners
Differential diagnosis
● Another medical condition → being explained fully by another medical illness or injury,
independent of psychological issues (eg nerves, surgery, ANS, neurodegenerative
diseases), should also be differentiated from retrograde ejaculation
● Substance or medication use → antidepressants, antipsychotics, alpha sympathetic
drugs, opioid drugs
● Dysfunction with orgasm → important to distinguish if it is about delayed ejaculation or
sensation of orgasm or both (ejaculation occurs in genitals, orgasm is primarily
subjective, usually occur together but not always)
Comorbidity
● It is more common in severe MDD
DSM-5 Criteria → Erectile Disorder
A At least one of the three following symptoms must be experienced on almost all or
all (approximately 75%–100%) occasions of sexual activity (in identified situational
contexts or, if generalized, in all contexts):
, 1. Marked difficulty in obtaining an erection during sexual activity.
2. Marked difficulty in maintaining an erection until the completion of sexual
activity.
3. Marked decrease in erectile rigidity.
B The symptoms in Criterion A have persisted for a minimum duration of
approximately 6 months.
C The symptoms in Criterion A cause clinically significant distress in the individual.
D Sexual dysfunction is not better explained by a nonsexual mental disorder or as a
consequence of severe relationship distress or other significant stressors and is
not attributable to the effects of a substance/medication or another medical
condition.
Subtype ● Lifelong: Disturbance has been present since the individual has become
sexually active.
● Acquired: Disturbance began after a period of relatively normal sexual
function.
Subtype ● Generalized: Present in all types of stimulation, situations or partners.
● Situational: Only certain stimulation, situations and partners.
Severity ● Mild: Evidence of mild distress over the symptoms in Criterion A.
● Moderate: Evidence of moderate distress over the symptoms in Criterion A.
● Severe: Evidence of severe or extreme distress over the symptoms in
Criterion A.
Diagnostic features
● Careful sexual history is necessary to know how long it has been going on and when it
occurs, symptoms may only occur in specific situations
Associated features supporting diagnosis
● Low self-esteem, low self-confidence, decreased sense of masculinity, depressed affect
● Fear/avoidance of future sexual encounters
● Decreased sexual satisfaction & reduced sexual desire in partner
● Other factors to be considered besides subtypes
○ Partner factors
○ Relationship factors
○ Individual vulnerability factors, psychiatric comorbidity, stressors
○ Cultural/religious factors
○ Medical factors
Prevalence
● Age related increase in incidence (after 50)
● 13-21% of those aged 40-80 report occasional problems
● 2% under 50 report frequent problems
