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5. Psychiatry > 3- Sexuality & Sexual D/O > Flashcards

3- Sexuality & Sexual D/O Flashcards

1
Q

What are the 4 phases of the sexual response?

A
  1. Desire
  2. Arousal/Excitement
  3. Orgasm
  4. Resolution
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2
Q

Pts that present w/ generalized and gradual onset of sexual dysfunction is suggestive of what etiology?

A

Organic/biologic

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3
Q

Pts that present w/ situational and more rapid onset of sexual dysfunction is suggestive of what etiology?

A

Psychogenic

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4
Q

What is the DSM5 criteria for male hypoactive sexual desire d/o? (3)

A
  1. Absence/deficiency of sexual thoughts/desires/fantasies > 6 mos
  2. Causes distress/impairment
  3. No result of disease/drug
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5
Q

What is the tx for male hypoactive sexual desire d/o? (2)

A
  1. Psychosocial therapy

2. Bupropion & Testosterone

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6
Q

What is the DSM5 criteria for female sexual interest/arousal d/o? (3)

A
  1. Absence/deficiency of sexual thoughts/desires/fantasies, excitement/pleasure, arousal, and/or genital/non-genital sensation during sex > 6 mos
  2. Causes distress/impairment
  3. No result of disease/drug
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7
Q

What is the tx if F pt w/ sexual interest but lack of vaginal lubrication to permit sex? (2)

A

Artificial lubricants

Local estrogen

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8
Q

What is the tx for female sexual interest/arousal d/o? (2)

A

Flibanserin

Psychosocial therapy

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9
Q

What is the DSM5 criteria for erectile d/o? (3)

A
  1. Marked difficulty obtaining/maintain an erection/decreased erectile rigidity > 6 mos
  2. Causes distress/impairment
  3. No result of disease/drug
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10
Q

What are organic causes of erectile d/o?

A

Meds, DM, hormonal imbalance, hx prostatectomy

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11
Q

What are psychological causes of erectile d/o?

A

Performance anxiety, relationship issues

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12
Q

What is the tx for erectile d/o? (2)

A

Psychosocial therapy

PDE-5 inhibitors

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13
Q

What is the DSM5 criteria for premature ejaculation? (3)

A
  1. Recurrent pattern of ejaculation during sex w/in 1 minute & before individual wishes > 6 mos
  2. Causes distress/impairment
  3. No result of disease/drug
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14
Q

What is the tx for premature ejaculation? (2)

A

Self tx: distraction, squeezing, stopping…

Low dose SSRIs

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15
Q

What is the DSM5 criteria for female orgasmic d/o? (3)

A
  1. Marked delay, infrequency, absence, reduced intensity of orgasm despite normal period of sexual arousal > 6 mos
  2. Causes distress/impairment
  3. No result of disease/drug
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16
Q

What is important to distinguish in female orgasmic d/o?

A

Is it situational or generalized

  • W/ masturbation but not w/ partner?
  • Is there both psychological & tactile stimuli?
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17
Q

What is the tx for female orgasmic d/o? (3)

A

Pt edu
Psychosocial interventions
Sildenafil

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18
Q

What is the DSM5 criteria for genito-pelvic pain/penetration d/o? (1)

A
  1. Persistent/recurrent difficulties in 1+ of the following > 6 mos:
    - vaginal penetration during intercourse
    - marked vulvovaginal/pelvic pain w/ penetration or intercourse
    - marked anticipatory fear/anxiety about pain
    - marked tensing/tightening of pelvic floor muscles during attempted penetration
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19
Q

Genito-pelvic pain/penetration d/o has both an anxiety and sexual component is often related to what?

A

Past abuse, strong negative conditioning

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20
Q

What is the tx for genito-pelvic pain/penetration d/o?

A

Trauma therapy (EMDR)

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21
Q

What are psychosocial therapies?

A

Sex therapy

CBT

22
Q

Does sex therapy tx each individual or the couple?

A

The couple

23
Q

Sex therapy is usually short term and includes what?

A

Sexual exercises for at home (increase sensory awareness/level of sexual contact)

24
Q

How does CBT view a sexual d/o?

A

As a learned maladaptive behavior

25
Q

How is CBT used to tx sexual d/o? (5)

A 
Cognitive restructuring
Partner communication training
Systematic desensitization
Muscle relaxation
Assertiveness training
26
Q

Which sexual paraphilias have the potential for victimization?

A 
Exhibitionism
Voyeurism
Frotteruism
Masochism
Sadism
Pedophilia
27
Q

What are paraphilias?

A

Deviations from what is considered normal sexual interest/behavior

28
Q

What is the DSM5 criteria for paraphilias? (2)

A
  1. Recurrent, intense, sexually arousing fantasies, urges or behavior involving 1+ of the following ≥ 6 mos
    • nonhuman objects
    • suffering/humiliation of self/partner
    • children/non-consenting persons
  2. Causes impairment
29
Q

How does Freud’s psychoanalytical theory define paraphilias?

A
  • Result from unsuccessful negotiating in normal developmental phase of courtship
  • Urges are repressed and then re-expresses in paraphilias
30
Q

How does classical conditioning attempt to define paraphilias?

A

Classical conditioning of sexual arousal to objects w/ subsequent negative reinforcement due to unpleasant, normal sexual activity

  • Women don’t condition to these stimuli
31
Q

What is exhibitionism?

A

Indecent exposure/flashing (usually M to F)

Derive pleasure from reaction of victim
Excitement increases w/ risk fo being discovered

32
Q

What is the DSM5 criteria for exhibitionism? (2)

A
  1. Recurrent sexual urges that involving exposing their genital to unsuspecting strangers
  2. Causes impairment
33
Q

What is the DSM5 criteria for voyeurism? (2)

A
  1. Recurrent sexual urges to observe an unsuspecting person who is naked/disrobing/engaging in sexual activity
  2. Causes impairment

*Usually unmarried males in 20-30s, derives sexual gratification from seeing sex organ/sex acts & will masturbate during activity

34
Q

What is the DSM5 criteria for frotteurism? (2)

A
  1. Recurrent sexual urge to rub (usually genitals) against and touch a non-consenting person
  2. Causes impairment

*often in crowded places, milder form = “copping a feel”

35
Q

What is the DSM5 criteria for fetishism? (3)

A
  1. Recurrent sexual urges involving nonliving objects or non-genital body part
  2. Causes impairment
  3. Pts don’t limit fetish objects to articles of female clothing used in cross dressing or to devices designate for purpose of tactile genital stimulation

*object is invariably used for masturbation

36
Q

What is the DSM5 criteria for transvestic fetishism? (2)

A
  1. Recurrent sexual urges involving cross dressing
  2. Causes impairment
  • Majority are heterosexual, married males who derive sexual pleasure from dressing in women’s clothes
  • Different from female impersonators/drag
  • Need to differentiate fro gender dysphoria
37
Q

What is the DSM5 criteria for masochism?

A
  1. Recurrent sexual urges involving act of being humiliated, beaten, bound, or made to suffer
  2. Causes impairment

*Usually starts in early adulthood

38
Q

What is sadomasochism?

A

An individual that derives pleasure from receiving & inflicting pain

39
Q

What is the DSM5 criteria for sadism? (3)

A
  1. Recurrent sexual urges involving acts in which psychological/physical suffering of the victim is sexually exciting to the person
  2. Person has acting on these urges w/ a non-concenting person or sexual urges cause distress/interpersonal difficulty
  3. Causes impairment
  • Fantasy may start in childhood, activity usually begin early adulthood
  • May be a/w ASPD
  • Mild, mod, or severe (rape, torture, murder)
40
Q

What is the DSM5 criteria for pedophilia? (3)

A
  1. Recurrent sexual urges involving sexual activity w/ a prepubescent child/children (≤13 yo)
  2. Pt must be ≥ 16 yo & at least 5 yrs older than the child/children involved
  3. Causes impairment
  • Includes undressing/exposing themselves, masturbation, sexual acts, rape
  • M > F d/o
  • 2/3 of victims are girls 8-11 yo
  • May rationalize behavior as education value or child is sexually provocative
41
Q

What is the victim to perpetrator cycle?

A

Victims of pedophilia become perpetrator/pedophile to replace defeat w/ triumph or establish relationship w. child

42
Q

What are poor prognostic factors of all paraphilias? (5)

A
  1. Multiple paraphilias
  2. Early age of onset
  3. Comorbid substance abuse
  4. High frequency of behavior
  5. Referral by law enforcement for tx
43
Q

What are good prognostic factors for all paraphilias? (4)

A
  1. Only 1 paraphilia
  2. Self-referral for tx
  3. Sense of guilt over behavior
  4. Hx of otherwise normal sexual behavior
44
Q

What is the tx for paraphilias?

A

Psychotherapy + Meds (SSRIs, anti-androgens, mood stabilizers/antipsychotics)

45
Q

What is the goal of CBT in treating paraphilias?

A

Address rationalization and distorted thinking

46
Q

What is the goal of social skills training in treating paraphilias?

A

Intimacy development, communication, sex ed

47
Q

What is the goal of the 12-step program in treating paraphilias?

A

Cognitive restructuring, social support, relinquish control

48
Q

What is the goal of group/individual therapy in treating paraphilias?

A

Address denial, healthy remorse, relapse prevention

49
Q

When are SSRIs used to tx paraphilias?

A

Milder cases

50
Q

When are anti-androgens used to tx paraphilias?

A

Victim-based paraphilias

51
Q

When are mood stabilizers (Valproic acid) and antipsychotics used to tx paraphilias?

A

Aggressive behaviors

5. Psychiatry (19 decks)

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