Sexual Dysfunctions and Disorders

Introduction

Welcome to the QBankMD MCCQE1 preparation guide on Sexual Dysfunctions and Disorders. This comprehensive resource is designed to help Canadian medical students excel in their MCCQE1 exam, focusing on the unique aspects of Canadian healthcare and psychiatry practices.

Classification of Sexual Dysfunctions

Sexual dysfunctions are classified based on the phase of the sexual response cycle in which they occur. The DSM-5 categorizes sexual dysfunctions as follows:

Key Concepts for MCCQE1

1. Epidemiology in Canada

• Sexual dysfunctions are common in the Canadian population
• Prevalence varies by age, gender, and specific disorder
• Approximately 40% of women and 30% of men report at least one sexual problem

2. Diagnostic Criteria

For a sexual dysfunction diagnosis in Canada, the following criteria must be met:

1. Symptoms have persisted for at least 6 months
2. Symptoms cause significant distress
3. The dysfunction is not better explained by a non-sexual mental disorder, severe relationship distress, or other significant stressors
4. It is not attributable to the effects of a substance/medication or another medical condition

3. Canadian Approach to Assessment

4. Treatment Approaches in Canada

Canadian healthcare emphasizes a biopsychosocial approach to treating sexual dysfunctions:

1. Psychotherapy: Cognitive Behavioral Therapy (CBT) and sex therapy
2. Pharmacotherapy: SSRIs, PDE5 inhibitors, hormonal treatments
3. Combination therapy: Integrating psychological and medical interventions
4. Lifestyle modifications: Exercise, stress reduction, smoking cessation

Specific Sexual Dysfunctions

Erectile Dysfunction (ED)

Erectile Dysfunction is a common concern in Canadian men, particularly as they age.

Key Points for MCCQE1:

• Definition: Persistent inability to achieve or maintain an erection sufficient for satisfactory sexual performance
• Prevalence: Affects approximately 40% of men over 40 in Canada
• Risk Factors: Age, diabetes, cardiovascular disease, smoking, obesity
• Canadian Guidelines: The Canadian Urological Association (CUA) recommends a stepwise approach to ED management

Female Sexual Interest/Arousal Disorder

This disorder combines the previously separate categories of Female Hypoactive Sexual Desire Disorder and Female Sexual Arousal Disorder.

Key Points for MCCQE1:

• Definition: Persistent lack of sexual interest and arousal in women
• Prevalence: Affects approximately 10% of Canadian women
• Risk Factors: Relationship issues, hormonal changes, psychological factors
• Canadian Approach: Emphasizes a biopsychosocial model of assessment and treatment

Premature Ejaculation

Premature Ejaculation is a common sexual concern among Canadian men.

Key Points for MCCQE1:

• Definition: Ejaculation that occurs sooner than desired, causing distress
• Prevalence: Affects about 20-30% of Canadian men
• Treatment: Combination of behavioral techniques and pharmacotherapy (e.g., SSRIs, topical anesthetics)

Canadian Guidelines for Sexual Dysfunction Management

The Society of Obstetricians and Gynaecologists of Canada (SOGC) provides guidelines for the management of sexual dysfunctions:

1. Comprehensive biopsychosocial assessment
2. Patient education and counseling
3. Addressing modifiable risk factors
4. Pharmacotherapy when appropriate
5. Referral to specialists (e.g., sex therapists, urologists) as needed

Key Points to Remember for MCCQE1

• Understand the DSM-5 classification of sexual dysfunctions
• Know the Canadian epidemiology of common sexual disorders
• Familiarize yourself with the Canadian approach to assessment and treatment
• Recognize the importance of addressing both psychological and physiological factors
• Be aware of Canadian guidelines for specific disorders (e.g., CUA guidelines for ED)
• Understand the coverage of treatments under the Canadian healthcare system

Sample Question

Question

A 55-year-old man presents to his family physician in Toronto with concerns about his sexual function. He reports difficulty achieving and maintaining erections for the past 8 months, which is causing distress in his marriage. He has a history of type 2 diabetes and hypertension, both well-controlled with medication. Which one of the following is the most appropriate next step in management?

• A. Prescribe sildenafil (Viagra) 50mg as needed
• B. Refer to a urologist for penile implant consultation
• C. Conduct a comprehensive cardiovascular risk assessment
• D. Recommend psychotherapy for possible performance anxiety
• E. Order serum testosterone levels

Explanation

The correct answer is:

• C. Conduct a comprehensive cardiovascular risk assessment

Explanation: In the Canadian healthcare context, particularly following the Canadian Urological Association (CUA) guidelines, the most appropriate next step for this patient is to conduct a comprehensive cardiovascular risk assessment. Here's why:

1. Erectile Dysfunction (ED) is often an early marker of cardiovascular disease, especially in men with risk factors like diabetes and hypertension.
2. The patient's age (55) and medical history (diabetes and hypertension) put him at increased risk for cardiovascular disease.
3. Canadian guidelines emphasize the importance of assessing and managing cardiovascular risk factors in men presenting with ED.
4. While other options like prescribing sildenafil or ordering testosterone levels may be considered later, addressing potential underlying cardiovascular issues is the priority.
5. This approach aligns with the Canadian healthcare system's focus on preventive care and comprehensive assessment.

Remember, for the MCCQE1 exam, it's crucial to consider the Canadian healthcare context and guidelines when approaching clinical scenarios.

References

1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

2. Brock, G., et al. (2015). Canadian Urological Association guideline on erectile dysfunction. Canadian Urological Association Journal, 9(1-2), 23-29.

3. Goldstein, I., et al. (2017). Hypoactive Sexual Desire Disorder: International Society for the Study of Women's Sexual Health (ISSWSH) Expert Consensus Panel Review. Mayo Clinic Proceedings, 92(1), 114-128.

4. Lewis, R. W., et al. (2010). Definitions/epidemiology/risk factors for sexual dysfunction. The Journal of Sexual Medicine, 7(4 Pt 2), 1598-1607.

5. Society of Obstetricians and Gynaecologists of Canada. (2012). Female Sexual Health Consensus Clinical Guidelines. Journal of Obstetrics and Gynaecology Canada, 34(8), 769-775.