15. Sexual Disorders and Paraphilias Flashcards
What is considered abnormal sexuality?
- Does not involve a human-being
- Does not involve stimulation of primary sex organs
- Is compulsive and injurious yourself or others
High-risk factors that lead to high-risk behavior
- Substance use
- Limited access to care
- Poor health literacy about STIs, STI sx, prevention
- Unassertive
- Poor communication skills
High risk behaviors
- Unprotected intercouse, oral sex and anal sex
- Many sex partners
- High-risk partners
- Sex trade work
- Self/partner use of IV grades
High-risk behavior can lead to what?
- STI
- Unwanted pregnancies
- Relationship complications
4 phases of the sexual response cycle
- Desire
- Excitement
- Orgasm
- Resolution
What are the components of Desire?
- Sexual drive (biological): genital sensations and thoughts about sex
- Motivation (psychological): willingness to offer your body for sex
- Wish fullfilment (social): hoping for sex, expectations for sex
Which component of desire can be culturally influenced?
Wish fulfillment
What is the excitement phase of the sexual response cylce?
- How long does it last?
- What changes occur?
Arousal:
- Last several minutes - hours
- Changes: vasodilation/constriction (BV in genitals engorge due to dilation) and myotonia (muscle contraction t/o body)
- Erection/vaginal lubrication
- Nipples get hard
- Increase respiration, tachycardia up to 180 bpm, increase in BP
What is the orgasm phase of the sexual response cylce?
- How long does it last?
- What changes occur?
- 3 - 25 seconds
- Peak of sexual pleasure: release of sexual tension and perinatal muscles/reproductive organs contract.
What is the resolution phase of the sexual response cylce?
- How long does it last?
- What changes occur?
- If orgasm occurs = resolution is rapid and followed by a sense of well-being; if it did not occur, can take up to 2 - 6 huors
- What happens?
- 1. Genitals disgorge with blood
- 2. Body returns to resting state
How is resolution different in M and W?
- M = Refractory period = 3- 10 minutes, 24 hours or even seceral days
- W = NO refractory period, but need time for resolution
In educating patients about sex, what is important?
Teaching them timing: teach them about sexual response cycle so they know what is important and what is not.
Male who has lack of or significantly reduced sexual fantasies and desire for sexual activity that lasts for 6 months. The judgment of deficiency or absence is made by the clinician, taking into account factors that affect sexual functioning, such as age and the context of the person’s life.
Male Hypoactive Sexual Desire Disorder
What is Female Sexual Interest / Arousal Disorder?
Lack of or significantly reduced sexual interest/arousal with at least 3 of the following, for 6 months:
- Absent or reduced interest in sexual activity
- Absent or reduced sexual thoughts or fantasies
- None or reduced initiation of sexual activity, unreceptive to partner’s attempts to initiate
- Absent or reduced sexual pleasure in approx. 75%-100% of sexual encounters
- Absent or reduced sexual interest/arousal in response to any internal or external sexual/erotic cues
- Absent or reduced genital or non-genital sensations during sexual activity in approx. 75%-100% of sexual encounters
What is Erectile Disorder?
At least 1/3 symptoms must be experienced in 75-100% of sexual encounters, for 6 months
- Difficulty obtaining an erection
- Difficulty maintaining an erection until completion of sexual activity
- Marked decrease in erectile rigidity
Persistent or recurrent delay in, or absence of, orgasm or reduced intensity (75%-100%) for 6 months, after a normal sexual excitement phase.
Female Orgasmic Disorder
Delayed Ejaculation
Dx Criteria
1/2 sx must be experienced on almost all or all occasions, for 6 months
- Marked delay in ejaculation
- Marked infrequency or absence of ejaculation
Persistent or recurrent ejaculation with partnered sexual activity within approximately 1 minute following penetration and before the patient prefers it, for 6 months, for almost all or all occasions of sexual activity
Premature Ejaculation
Genito-Pelvic Pain Penetration Disorder
- Persistant or recurrent diffulties in 1 or more of the following for 6 months:
- 1. Vaginal penetration during intercourse
- 2.Marked vulvovaginal or pelvic pain during penetration on intercourse.
- 3.Marked fear or anxiety about pain preceding, during or as a result of vaginal penetration.
- Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
Psychologically, what is the reason for the vicious cycle of sexual dysfunction?
- Performance pressure => fear of failure
- => anxiety that inferferes with phase of sexual response
- => sexual dysfunction actually experienced
What is the general approach to treating sexual disorders?
- Eval and treat underlying medical conditions
- Consider medications and SE
- Education, if needed
- Behavior therapy, if needed
- Refer to counseling, if relationship problems
Examples of behavioral therapies for sexual disorders
- Sensate focus: no intercourse for a while; then systematically re-introduce sexual stimulation
- Squeeze Technique; start-stop method for premature ejaculation
- Relaxation techniques
- Masturation: increase knowledge and awareness of personal preference.
What is paraphilia?
An overall term describing several individual disorders: any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human, for at least 6 months
How does paraphilia develop?
- Early inappropriate sexual association or experience (inadeq develop of consensual adult arousal patterns or social skills for relating to adults) =>
- Inappriate fantasies repeatedly associated with masturbation activities and strongly reinforced =>
- Repeated attempts to inhibit undesired arousal behavior => increase in thoughts, fantasies and behaviors
Types of legal (non-victimizing) paraphilias?
- Fetishism
- Sexual masochism
- Tranvestic Fetishism
- Sexual sadism (mild)
Types of illegal (victimizing) paraphilias?
- Voyeurism
- Exhibitionism
- Pedophilia
- Sexual sadism
Who are paraphilic disorders MC in?
- Early onset (before 18 YO)
- M
- 50% are married
Those with non-victimizing paraphilias..
*
- No severe co-morbid pathologies
- Not likely to present for treatment
How likely are those with victimizing paraphilias to seek treatment?
Comorbidities?
- Unlikely, because use “rationalizing” as a defense mechanism.
- Antisocial Personality Disorder
Gets sexual pleasure from suffering (humiliation, beaten, bound) –real acts, not simulation
Sexual Masochism Disorder
Sexual arousal by oxygen deprivation obtained by means of chest compression, noose, ligature, plastic bag, mask, or chemical (amyl nitrite).
Hypoxyphilia (autoerotic asphyxiation)
What is the motivation for Asphyxiophilia/ Hypoxyphilia?
- Motivation: fantasy of pain/bondage; risk of sudden death increases sexual pleasure by feeling in “mortal danger”
People with Asphyxiophilia or Hypoxyphilia believe that cerebral hypoxia (=> dizziness/light headedness) may do what?
Increase intensity of orgasm
Who is most likely to engage in Asphyxiophilia or Hypoxyphilia?
- Middle-class, White male ( < 30 YO), with no hx of mental illness
Sexual arousal from the physical or psychological suffering of another person; “Partner” may or may not have consented
Sexual Sadism Disorder
Exposure of genitals to unsuspecting strangers in public with the intent of evoking shock/fear in others; victims are usually nonconsenting
Exhibitionism
Sexual arousal from non-living objects or specific focus on non-genital body parts.
Give an example
Fetishistic Disorder: womans shoes, panties, feet
Touching or rubbing against a non-consenting person
MC in?
Frotteuristic Disorder
M (15-25 YO)
Sexually arousing fantasies, urges, or behaviors about cross-dressing; NOT related to gender identity
Tranvestic Disorder
Sexual arousal by watching an unsuspecting person who is naked, disrobing, or engaging in sexual activity
Voyeuristic Disorder: must be 18+
Sexual fantasies, urges, or activity with prepubescent child (usu. < 13 years old);
How old must the perp be?
Pedophilic Disorder
Perp must be 16+ and at least 5 years older than child
Outcomes of treatment of Pedophilic Disorder?
VERY difficult to treat: recidivism (likely to reoffend) is 100%
RF for recidivism in Pedophilic Disorder
- M victims
- Stranger victims
- Prior sex offenses
- Lack of cohabitation history with adult partners
Behavior therapies for paraphilic disorders
- do they work?
- what are some and goals?
- low success rate
- Aversive therapy => reduce pleasure
- Densensitization => neutralization anxiety
- Social skills training => form better interpersonal relationships
- Orgasmic reconditioning => teach more app mental images for sexual fantasies
