15. Sexual disorders and paraphilias Flashcards
The sexual response cycle has 4 phases including desire, excitement, orgasm and ?
Resolution
Phase 1 is desire- includes sexual drive, motivation, wish fulfillment, phase 2 excitement includes erection/vaginal lubrication, nipples harden, inc respiration and BP,the physiologic processes that occur during phase 2 excitment include vasodilation/constriction (genitals) and?
Myotonia- muscle contractions
Phase 3 is organ includes peak of sexual pleasure, releasing sexual tension, lasting 3-25 seconds. Phase 4 is resolution including disgorgement of blood from genital, resting state rapid and sense of well being if orgasmed, if orgasm did not occur resolution takes?
2-6 hours
Males can average 3-10mins for resolution, 24 hours or even several days for a refractory period, females have no refractory period but usually need time for?
Resolution
Educating for what and coordination is important- teach patients about the sexual response cycle so they known what is normal in themselves and their partner?
Timing*
What male disoder is persistently deficient or absent sexual fantasies and desire for sexual activity, considering age and context (recent death/bad pain) of the person’s life- for 6months?
Male Hypoactive Sexual Desire Disorder
What disorder is characterized by significantly reduced sexual interest/arousal with 3 of the following for the past 6 months…..?
- reduced interest in sexual acitivity
- reduced sexual/erotic thoughts
- none/reduced initiation of sex activity-unreceptive to partners initiation
- absent/reduced sexual pleasure
- absent/reduced sexual interest/arousal in response to stimulation
- reduced genital/nongenital sensations
Female Sexual Interest/Arousal Disorder
What disorder in men is at least one of the 3 following symptoms on almost all occasions of sexual acitivity for 6 months (75-100% encounters)…?
- difficulty obtaining an erection
- difficulty maintaining erection until completion of sex
- decrease in erectile rigidity
Erectile Disorder (ED)
What female disorder is persistent delay in, or absence of, orgasm following normal sexual excitement phase for *6months? (male practice to hit the clit)
Female Orgasmic Disorder
What is either of the following symptoms experienced on all occassion for 6 months…?
- delay in ejaculation
- infrequency or absence of ejaculation
Delayed Ejaculation
What is persistent ejaculation with partnered sexual activity within approx. 1 minute, following penetration and before the patient prefers it- for 6 months on all occassions?
Premature Ejaculation
What disorder is persistent difficulties/pain with 1 or more of the following for 6 months…?
- vaginal penetration
- vulvovaginal or pelvic pain during
- fear or anxiety about pain during vaginal penetration
- tensing or tightening of the pelvic floor muscles
Genito-Pelvic Penetration Disorder
Performance pressure leads to fear of failure causing anxiety that intereferes with some phase of sexual response, causing?
sexual dysfunction
**expectations to fail - tx with reducing focus on performance
Approach to tx includes evaluating and treating underlying conditions, med SE (ssri), education, behavior therapy, and referring to counseling if there are relationship?
problems
Behavioral therapies include sensate focus where no sex is allowed for a period of time, then systematically reintroduced sexual stimulation (for focus on failure pts), squeeze technique/start-stop method (premature ejac), relaxation techniques (anxiety-system desensitization), and even?
Masturbation to increase knowledge and awareness of personal preferences
What is any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners for 6 months? (overall term)
Paraphilia - occurs via classical conditioning
Legal/non-victimizing paraphilias include fetishism, sexual masochism (injury to self), tranvestic fetishism, sexual sadism (mild). Illegal/victimizing paraphilias include voyeurism, exhibitionism, pedophilia, and sexual?
sadism
Paraphilic disorders are rare in the US and have early onset and mainly male, 50% are married, nonvictimizing paraphilias usually have no comorbid psychopathologies, not likely to present for tx, sometimes described as alternative sexual ?
Lifestyle
Victimizing paraphilia disorders are unlikely to seek treatment- more time present as being arrested, and have high comorbidity rates with antisocial?
personality disorder (criminal behavior)
What disorder derives sexual pleasure from suffering (humiliation/beaten/bound)- real acts~ not stimulation?
Sexual Masochism Disorder
What is also known as asphyxiophilia, which involves sexual arousal by oxygen deprivation, known to increase the intensity of an orgasm, has lead to death in 250-1000 men per year?
Hypoxyphilia
What disorder is characterized by sexual arousal from the physical or psychological suffering of another person- partner may or may not have consented?
Sexual Sadism Disorder (not self-the other person suffers)
What disorder is exposure of genitals (males) to unsuspecting strangers in public- with the intent of evoking their shock or fear, victim is usually nonconsenting?
Exhibitionism (Flasher)
What disorder is sexual arousal from non-living objects or specific focus on non-gential body parts such as womens shoes or panties, feets or ears?
Fetishistic Disorder
What disorder is touching or rubbing genitals against non-consenting people such as on the subway, most commonly men between 15-25 years of age?
Frotteruristic Disorder
What disorder (does she think will go away) is sexually excited/arousing fantasies, urges, or behaviors about cross dressing- not related to gender identity?
Transvestic Disorder
What is sexual arousal by watching an unsuspecting person who is naked, disrobing, or engaging in sexual activity- must be 18+ years old? (aka peeping tom)
Voyeuristic Disorder
What disorder is sexual fantasies, urges or activity with prepubescent children (usually under 13), perpetrator must be 16+ and at least 5 years older than the child, exclusive= sexual interest only in children, nonexclusive = usually heterosexual/married?
Pedophilic Disorder
Risk factors: male victims, stanger victims, prior sex offenses
Behavioral therapy is used with low success, aversive therapy to reduce pleasure, desensitization to neutralize anxiety, social skills training to form better interpersonal relationships, and orgasmic recondition to teach more appropriate mental imagery for sexual?
Fantasies
Rx have low success rate
