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1)Discussion 5: Sexual Disorders (half a page single spaced , 3 citations with references, APA)

Select one disorder of interest from the DSM-5 covered this week. In your initial posting, discuss the diagnostic criteria, treatment options, and prognosis of the disorder. Use at least two current references other than the DSM-5. After you have posted your initial posting by the third day of the module, respond substantively to at least two peers by the end of the module.

2)REPONSE TO ERNESTINA. ¼ A PAGE, SINGLE SPACED AT LEAST ONE CITATION PLUS REFERENCE.

3)Delayed ejaculation (DE), usually known as retarded ejaculation, is noted under Orgasmic disorders for men, which is a persistent delay of orgasm that an individual experiences during normal sexual excitement phase (Butcher, Welliver, Sadowski, Botchway, & Kohler, 2015). The DE causes are identified as organic and psychogenic. The examples of organic DE is due to spinal cord injuries, genital trauma, medications, disease, aging, and alcohol. However, psychogenic, some of the causes are performance anxiety, resentment, fear of losing control, and arousal dysfunction (Blair, 2018). Hence, one must be sifted through patients with DE to identify the cause using critical thinking as future PMHNP.

4)Diagnostic Criteria

5)For an individual to be diagnosed, he must exhibit 75 to 100 percent of the symptoms without desiring delay in ejaculation or absence of ejaculation. Also, there must be a persistent delay in ejaculation or marked infrequency of ejaculation for about six months (American Psychiatric Association, 2013). The symptoms such as marked delay in the ejaculation of absence ejaculation cause significant distress to an individual. Individual sexual dysfunction is not as a result of severe relationship distress or related to substance use or medical problems (American Psychiatric Association, 2013).

6)Treatment

7)The recommended researched therapy for delayed ejaculation is psychosexual therapists (Blair, 2018). Other researchers also considered psychological interventions and pharmacological interventions. Psychological interventions are regarded as a client-centered and holistic approach.For example, psychological solutions consist of cognitive behavioral therapy and sex education (Abdel-Hamid & Ali, 2018) The process of educating and training masturbation retraining is a type of psychological intervention. Researchers are using psychotherapy to focus on areas of conflict and sensate focus exercise. Also, interacting an individual’s orientation from self to the partner and reducing sexual anxiety by teaching individuals to employ breathing techniques and relaxation (Abdel-Hamid & Ali, 2018). Pharmacologic therapies that are used to treat DE are uses as of labels since there has no been a concrete medication designated for it. The pharmacotherapies’ method includes testosterone, amantadine, bupropion, and midodrine (Abdel-Hamid & Ali, 2018).

8)Prognosis

9)Delayed ejaculation is due to genetic and physiological factors. Losing fast conducting peripheral sensory nerves and age-related decreased sex steroids are the known risk factors that lead to delayed ejaculation. The delayed ejaculation increases among men older than fifty years (American Psychiatric Association, 2013). Hence as future PMHNP, we should address our clients with DE with the risk factors and educate them on the recommended treatments such as psychotherapy to prevent them from slipping into depression.

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12) References

13) Abdel-Hamid, I. A. & Ali, O. I. (2018). Delayed ejaculation: Pathophysiology, diagnosis, and treatment. The World Journal of Men’s Health, 36 (1), 22–40. doi:10.5534/wjmh.17051

14) American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. (5th, Ed.) Washington, DC.

15) Blair, L. (2018). How difficult is it to treat delayed ejaculation within a short-term psychosexual model? A case study comparison. Sexual & Relationship Therapy, 33 (3), 298–308. doi:https://doi.org/10.1080/14681994.2017.1365121

16) Butcher, M., Welliver, R., Sadowski, D., Botchway, A., & Kohler, T. S. (2015). How is delayed ejaculation defined and treated in North America? Andrology, 3, 626–631. doi: 10.1111/andr.12041

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3) RESPONSE TO MATACHI ¼ A PAGE, SINGLED SPACED, 0NE CITATION PLUS REFERENCE.

Erectile disorder or dysfunction (ED) is the persistent inability to achieve or maintain an erection firm enough to have sex. Occasional ED isn’t uncommon. Many men experience it during times of stress. Frequent ED, however, can be a sign of health problems that need treatment. It can also be a sign of emotional or relationship difficulties. Organic causes are usually the result of an underlying medical condition affecting the blood vessels or nerves supplying the penis. Many prescription drugs, recreational drugs, alcohol, and smoking, can cause ED (MacGill, 2017).

Diagnostic Criteria

Diagnostic criteria for ED according to DSM-5 include:

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. The 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.

Specify whether:

Lifelong: The disturbance has been present since the individual became sexually active.

Acquired: The disturbance began after a period of relatively normal sexual function.

Specify whether:

Generalized: Not limited to certain types of stimulation, situations, or partners.

Situational: Only occurs with certain types of stimulation, situations, or partners.

Specify current 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 (APA, 2013).

Treatment Options

Treatment for ED will depend on the underlying cause. You may need to use a combination of treatments, including medication or talk therapy. Treatment options include,

Medications: Men can take a group of drugs called PDE-5 (phosphodiesterase-5) inhibitors. They stimulate blood flow to the penis to help treat ED. Example are, avanafil (Stendra), sildenafil (Viagra), tadalafil (Cialis), and vardenafil (Levitra, Staxyn). Alprostadil (Caverject, Edex, MUSE) is another medication that can be used to treat ED. It can be administered in two ways: as a penile suppository or as a self-injection at the base or side of the penis.

Testosterone therapy (TRT) may also be recommended if you have low levels of testosterone.

Psychosocial therapy: This includes,

1.Talk therapy: This helps to address major stress or anxiety factors, feelings around sex, and subconscious conflicts.

2.Relationship counseling: This can help patient and partner reconnect emotionally, which may also help ED.

Exercise: The best way to treat erectile dysfunction without medication is by strengthening the pelvic floor muscles with Kegel exercises.

Vaccum pumps: This treatment uses the creation of a vacuum to stimulate an erection (Seladi-Schulman, 2019).

Surgical treatments: There are several surgical treatment options:

1.Penile implants: These are a final option reserved for men who have not had any success with drug treatments and other non-invasive options.

2.Vascular surgery: This attempts to correct some blood vessel causes of ED.

Surgery is a last resort and will only be used in the most extreme cases. Recovery time varies, but success rates are high (MacGill, 2017).

Prognosis

Most cases of ED occur in men who were previously able to sustain an erection. The condition is usually reversible, but the chances of completely curing ED depend on the underlying cause. Secondary ED can be reversed and is often temporary. Primary ED may require more intensive and medical-based treatments. ED is usually treatable with medication or surgery. However, a person may be able to treat the underlying cause and reverse symptoms with no medication (Villines, 2018).

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, (5th ed.). Washington, DC: American Psychiatric Association Publishing.

MacGill, M. (2017). What’s to know about erectile dysfunction? Retrieved from https://www.medicalnewstoday.com/articles/5702

Seladi-Schulman, J. (2019). Everything You Need to Know About Erectile Dysfunction (ED). Retrieved from https://www.healthline.com/health/erectile-dysfunction

Villines, Z. (2018). Can erectile dysfunction be reversed? Retrieved from https://www.medicalnewstoday.com/articles/322086

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