2. Sexual Dysfunctions Flashcards
What sexual disorder (new to DSM-5) was formerly known as Gender Identity Disorder?
Gender Dysphoria
What is Gender non-comformity?
A person’s gender identity, role, or expression differs from the cultural norms prescribed for people of a particular sex
What is Gender dysphoria?
Discomfort/distress that’s caused by a discrepancy b/w a person’s gender identity and the person’s sex assigned at birth
What disorders must you rule out to diagnose a sexual dysfunction?
Rule out schizophrenia + transvestic disorder
Are boys or girls referred to more for evaluation for GD?
Boys > girls referred for evaluation
When is cross-gender behavior observed in children w/ Gender Dysphoria?
Cross-gender often by age 3
What behaviors are observed in children w/ Gender Dysphoria?
- Boys playing w/ dolls, assuming a female role in play, cross-dressing, associating w/ a peer group of girls
- Girls taking a male role in family games, reject female activities like playing w/ dolls
What is most likely for boys + girls with Gender Dysphoria?
- Girls are more likely to remain dysphoric
- Boys are more likely to grow up gay men than have GD
What criteria must be met to be diagnosed w/ Gender Dysphoria?
A marked incongruence b/w one’s experienced/expressed gender + assigned gender, of at least 6mo duration, as manifested by at least 2 of the following:
1A. Incongruence b/w one’s experienced gender + primary/secondary sex characteristics*
- Desire to be rid of one’s primary/secondary sex characteristics
- Desire for primary/second. sex characteristics of other gender
- Desire to be of other gender (diff from assigned gender)
- Desire to be treated as other gender
- Conviction that one has typical feelings + reactions of other gender
What is Gender Dysphoria associated with?
Clinically significant stress/ impairment in social, school/ other important areas of functioning
What causes gender dysphoria?
- Cause is unknown
- No specific biological link (early learning may play a role)
What are transitioning and sex “gender” interventions?
- Gender affirming or conforming surgeries
- Hormonal + surgical interventions ($25-30,000+)
- Double $ for female to male
What are some Desire & Arousal Dysfunctions for men and women?
- Male hypoactive sexual desire disorder
- Female sexual interest/ arousal disorder
Are sexual dysfunctions specific to gender?
(Yes!) Gender specific - Except substance-induced dysfunctions
What are Orgasm dysfunctions?
- Erectile disorder, Premature (early) ejaculation, Delayed ejaculation
- Female orgasmic disorder
What are Pain-Related Dysfunctions?
- Genito-pelvic pain/ penetration disorder
- Substance/ medication induced sexual dysfunctions
When is the onset of sexual dysfunctions?
Early adulthood - some may begin later in life
How common are sexual dysfunctions for men and women?
Most are common
10-52% of men and 25-63% of women
What are the causes of sexual dysfunctions?
- Causes include psychological + biological factors
How long can you have sexual dysfunctions? Are they situational?
- Can be lifelong or acquired
- Generalized/ situational (except genito-pain/penetration Dx)
Wha are the requirements for being diagnosed with sexual dysfunctions?
Requires clinically significant stress almost all or all the time (75% of time or more)
What partner factors play a role in SD?
Sexual problems/ health status
What relationship factors play a role in SD?
Poor communication, discord, differences in desire/ interest in sex
What vulnerability factors play a role in SD?
Hx of sexual abuse/ poor body image
How is performance anxiety related to SD?
Arousal, cognition, negative affect, distraction plays large role
What cultural/religious factors play a role in SD?
Rules, prohibitions against sex
What medical factors are related to prognosis, course + treatment of SD?
Chronic illness
What is Male Hypoactive Sexual Desire disorder?
Persistently deficient (or absent) sexual/erotic thoughts or fantasies + desire for sexual activity. Judgement of deficiency is made by clinician.
How long do the symptoms of Male Hypoactive Sexual Desire disorder last?
Symptoms persist for at least 6 months
What percentage of men meet diagnostic criteria for male hypoactive sexual desire disorder? How many are young and old?
1.8% of men (ages 16-44)
6% younger men vs 41% older men
What do men with Male Hypoactive Sexual Desire disorder report history of having?
History of inappropriate touch before puberty, to have had homosexual activity at some pt in their lives, + use ETOH daily
What is the criteria for Female Sexual Interest/Arousal Disorder?
Lack of, or significantly reduced sexual interest/arousal as manifested by at least 3 of the following:
- Absent/reduced interest in sexual activity
- Absent/reduced sexual/erotic thoughts or fantasies
- No/reduced initiation of sexual activity + typically unreceptive to a partner’s attempts to initiate
- Abs/red sexual excitement/pleasure during sexual activity in most encounters
- Abs/red sexual interest/arousal in response to any internal or external erotic cues
- Abs/red genital/non-genital sensations during sexual activity
What is Erectile Disorder?
Difficulty obtaining + maintaining an erection
(most common male sexual disorder)
What emotions contribute to Erectile Disorder?
Fear, anxiety, anger, guilt & distrust of sexual partner
How is Erectile Disorder diagnosed?
It’s NOT diagnosed if biological factors are primary cause (50%)
If psych factors contribute, a diagnosis can be made
What is Female Sexual Interest/Arousal Disorder?
Fusion of: hypoactive sexual desire + female sexual arousal disorders
What is the #1 complaint from women with Female Sexual Interest/Arousal Disorder seeking treatment?
Lack of interest
(Greater in postmenopausal women)
What do women with Female Sexual Interest/Arousal Disorder have a history of?
Hx of painful intercourse, guilt, or sexual trauma
For what criteria do you NOT diagnose Female Sexual Interest/Arousal Disorder?
- If occurs in context of another MI, such as MDD
- If no interest in sex + yet can get excited sexually
- If self-identified as “a sexual”
What is premature (early) ejaculation?
The man climaxes before he wants to and it yields disappointment + sense of failure for both partners
What may exacerbate Premature (early) ejaculation?
Relationship stress → promotes greater loss of control
In what men is premature ejaculation most common?
Nearly half the men treated for sexual disorders (frequent among men w/ more education)
What is Delayed Ejaculation?
Problem reaching orgasm - anxiety about this can contribute to ED
What personalities do men w/ lifelong Delayed Ejaculation tend to have?
Personalities tend to be rigid + puritanical → sex w/in sin
What do men w/ acquired Delayed Ejaculation tend to exhibit?
Interpersonal difficulties, fear of pregnancy, or lack of sexual attraction to partner
Is Delayed Ejaculation common?
No, it’s uncommon
What medical causes is DE linked to?
Hyperglycemia, proctectomy, abdominal aortic surgery, Parkinson’s disease
What is Female Orgasmic Disorder?
orgasms are too slow, too rare, or too weak
What may contribute to Female Orgasmic Disorder? (they must be ruled out to diagnose)
Medical conditions - hypothyroidism, diabetes, structural damage to vagina
Medications - antihypertensives, CNS stimulants, tricyclic antidepressants, MAOIs
What are psychological contributors to Female Orgasmic Disorder?
Fear of pregnancy, hostility toward partner, guilt abt sex, hx of past sexual experiences
What is Female Orgasmic Disorder often co-morbid with?
Female sexual interest/arousal disorder
What is Genito-Pelvic Pain/Penetration Disorder?
Marked pain when attempting intercourse (limited exclusively to females*)
What percent of women w/ Genito-Pelvic Pain/Penetration disorder experience pain w/ intercourse?
33% women w/ Hx of gynecological surgery experience pain w/ intercourse
How do you NOT diagnose Genito-Pelvic Pain/Penetration Disorder?
Don’t diagnose if pain is symptom of another medical condition/substance misuse
How do you assess sexual functioning?
- Psychosocial assessment
- Exposed to audiovisual erotic material
- Penile strain gauge
- Vaginal plethysmograph
How do you treat sexual dysfunctions?
- Medications - vasodilators/anti-anxiety
- Psychoeducation about sex
- Reduce performance anxiety
- Work to rebuild intimacy
