Chapter 13 - Sex disorders Flashcards
1
Q
What was the Human Sexual Response Cycle according to Masters and Johnson?
A
1) Sexual excitement - engagement of sexual organs
2) Plateau - level off of the degree of excitement
3) Orgasm - Climax (one for penis, can have multiple for vaginas)
4) Resolution - mainly for the penis, vaginas do not experience this
2
Q
How would you define a sexual disorder?
A
- Disorders that interfere with the sexual functioning and enjoyment of a sexual activity
3
Q
What’s the Human Sexual Response Cycle according to Helen Singer Kaplan?
A
1) Desire (especially for women)
2) Excitement
3) Orgasm
4
Q
What are common requirements that must be met to diagnose a sexual dysfunction?
A
- Must include recurrence of problems over 6 months and clear distress or interpersonal difficulty
- No diagnosis will be made if there’s no distress
- Must not be explainable by other disorders or a medical condition
5
Q
T/F: People with paraphilias who do not experience their sexual activity as distressing and who do not cause harm to others are not diagnosed.
A
- TRUE
6
Q
T/F: A lot of sexual dysfunctions are associated with medical conditions
A
- TRUE
7
Q
Lifelong sexual dysfunction vs. an acquired sexual dysfunction?
A
- Lifelong - They have had it since they can remember
- Acquired - has only developed recently in all situations. Important to uncover why this is
8
Q
Generalized sexual dysfunction vs. situational sexual dysfunction?
A
- Generalized - The problem occurs in all situations
- Situational - The problem only arises in certain situations
9
Q
What are male hypoactive sexual disorders?
A
- Persistent/recurrent deficient or absent sexual/erotic thoughts or fantasies and desire for sexual activity
- i.e., they’re not interested/don’t think about it
- May be difficult for the partner
10
Q
What’s female sexual interest/arousal disorder?
A
- Lack of sexual interest and arousal
- Lack of capacity to become aroused
11
Q
What’s erectile disorder?
A
- Difficulties with obtaining an erection during sexual activity, maintaining an erection until completion of activity, and/or marked decrease in erectile rigidity in 75% and 100% of sexual occasions
12
Q
What are the sexual desire and arousal phase disorders?
A
- Male hypoactive sexual disorders
- Female sexual interest/arousal disorder
- Erectile disorder
13
Q
What are the orgasmic phase disorders?
A
- Delayed ejaculation
- Female orgasmic disorder
- Premature ejaculation
*Must be partnered encounters
14
Q
What’s delayed ejaculation?
A
- Marked delay in ejaculation or marked infrequency or absence of ejaculation present in 75%-100% of sexual occasions with a partner for over six months
15
Q
What’s female orgasmic disorder?
A
- Marked infrequency or delay or absence of orgasm, or marked reduced intensity of orgasmic sensation in 75%-100% of sexual encounters
- Often requires a medical condition prior to diagnosis
16
Q
What’s premature ejaculation?
A
- Persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately one minute following vaginal penetration, before the individual wishes it
- Individual is displeased that they cannot control the ejaculation
17
Q
What’s another term for hypersexuality?
A
- Often referred to as a sex addiction
- Individual has a lack of control/compulsivity in sexual activity
- Not in the DSM-5 but the IDM has it
- Not really a withdrawal from sex
18
Q
What’s genito-pelvic pain/penetration disorder?
A
Persistent or recurrent difficulties with one or more of the following:
- Vaginal penetration during intercourse
- Marked vulvovaginal and pelvic pain during vaginal intercourse and penetration attempts
- Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation, during, or as a result of vaginal penetration
- Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
19
Q
What 2 former disorders does genito-pelvic pain/penetration disorder roll into one disorder?
A
- Dyspareunia and vaginismus
20
Q
T/F: Genital pain in men is rare and is often linked to a disease.
A
- TRUE
21
Q
Which sexual disorders do people sought treatment for the most?
A
- Mostly for erectile disorder, female orgasmic disorder, premature orgasm (in men)
22
Q
T/F: Sexual desire problems have become more frequent.
A
- TRUE
23
Q
T/F: Erectile dysfunction is completely unrelated to vascular dysfunction
A
- FALSE
24
Q
T/F: Tobacco, alcohol, and cannabis can affect arousal and sexual dysfunction
A
- TRUE
- Affects alertness. concentration, etc.
- Hard to treat damage caused by substances
25
How do SSRIs affect sexual function?
- They can cause delayed ejaculation and orgasmic dysfunction
26
How can neurological disorders impact sexual functions in men and women?
- Neurological disorders can cause erectile dysfunction in men (i.e., damage to peripheral nerves)
- Neurological disorders, pelvic disease, hormonal dysfunctions can interfere with vaginal swelling, lubrication
27
What are some of the social factors that contribute to the etiology of sex disorders?
- Major influence of culture and belief systems
- Childhood socialization (attitudes towards sex vary considerably)
- Women born in recent decades report fewer orgasmic problems
- Women with orgasmic disorder are less likely to talk about sex. They hold negative attitudes about masturbation and feel more guilt about sex
28
What are the psychological factors that contribute to the etiology of sex disorders?
- Performance anxiety (especially for men, keep evaluating themselves and become spectators of their performance)
- Relationship factors (poor communication)
- Assertiveness problems, lack of social skills, discomfort about sex (especially for women)
- Previous harmful experience (i.e., sexual assualt/trauma)
29
What's the PLISSIT model?
A model of treatment for sexual disorders (most common):
- Permission (consent)
- Limited information (what access do they currently have?)
- Specific suggestions (what info do they need?)
- Intensive therapy (for those who need serious help)
30
What are some of the best ways to prevent sexual disorders?
- For both genders, prevention of sexual disorders, involves healthy communication between partners, staying sexually active, smoking cessation, reducing alcohol intake to within healthier limits, and regular exercise
31
What's the sensate focus?
- A type of treatment for sexual disorders
- A technique used to reduce anxiety concerning sex where a slow habituation process is used to make the person more comfortable with sex
32
What are some treatments used for premature ejaculation?
- Stop-start technique
- Squeeze technique
33
What are some other general treatments for sexual disorders?
- Scheduling time for sexual activity
- Cognitive restructuring and education
- Communications training
34
What are some treatments used for genito-pelvic pain/penetration disorder?
- Relaxation training
- Changes to sexual approaches
- Interventions targeting body image
- Therapy for relational problems (partner may be too physically aggressive)
35
What are some of the biomedical treatments for GPPPD?
Focus is on ways to reduce pain upon intercourse:
- vaginal moisturizers and lubricants
- Topical estrogen
- Vaginal dilators
- Pelvic floor muscle relaxation
- Topical lidocaine to reduce pain
36
What are some of the biomedical treatments for erectile dysfunction?
- PDE 5 inhibitors (Viagra, Cialis, Levitra; do not cause psychological arousal)
- Injections of neurotransmitters
- Surgery (rarely, not super effective, open up blood vessels near prostate)
- Mechanical devices (usually last resort, not easy to do)
37
What's the definition of paraphilia?
- Intense, persistent sexual interest other than sexual interest in genital stimulation, or preparatory fondling with phenotypically normal, physically mature, consenting human partners
38
What are the typical symptoms of paraphilias?
- Sexual fantasies are strong, long-standing, unusual, very persistent
- Fantasies usually do not involve reciprocal loving with an adult partner
- Themes of aggression, revenge, and hostility dominate many paraphilic fantasies, particularly those leading to criminal offences
- Compulsion, lack of flexibility
39
What are some types of people with paraphilias?
- Many people with sexual paraphilias, particularly those who do not constitute criminal offences, are generally well-adjusted
- Others are often timid, submissive, socially inept
- Some are aggressive, domineering, rigid, self-indulgent
- A few could be described as confused, disorganized, sometimes mentally ill or intellectually deficient
40
What's the difference between transvestism and transvestic fetishism?
- Transvestism - Most often men, where they dress as opposite gender for fun
- Transvestic fetishism - get sexual reward/stimulation from dressing as the opposite gender, may be an indicator of a gender identity disorder
*Only diagnosed if it causes harm to the individual
41
What's hypoxyphilia?
- Deriving sexual pleasure from being choked
42
What's the difference between sexual sadism and masochism?
- Sexual sadism - like inflicting pain upon others
- Masochism - like receiving pain
43
What are some of the major paraphilias?
(usually constitute criminal offences)
- Exhibitionistic disorder - chooses to show themself undressed in public (includes streaking)
- Voyeuristic disorder - Person makes effort to see people naked or having sex
- Pedophilic disorder - Usually men who are attracted to underage people/early teenagers
44
What's the difference between primary pedophiles and secondary pedophiles?
- Primary - Children are primary objects of sexual attraction
- Secondary - May have older, more mature relationships but are still attracted to kids
45
What's the difference between child molesters and pedophiles?
- Pedophiles - the experience of recurrent intense sexually arousing fantasies and urges involving sexual activities with a prepubescent child (around 13 years or younger)
- Child molesters - adult heterosexual males who usually have one or more adult relationships and also interact sexually with children and/or teenagers
*For both, most victims are girls, the most common contact is genital fondling
46
What are the types of relationships found between child victims and their perpetrators?
- Most of the time, the child victims know the perpetrator. Most incidents occur in the child's home or the perpetrator's home
- Incestuous relationships take place between blood relatives or"step-relatives"
- About half the men who sexually abuse their children are also abusing children outside the family
47
T/F: Most men who sexually abuse children are victims of sexual abuse themselves.
- TRUE
- It's a toxic cycle where victims keep turning into perpetrators
48
What are the different character types found among pedophiles?
- Many are passive, sensitive, and relatively non-threatening (relatively normal)
- A few are domineering, controlling, and aggressive (dangerous, may isolate children, seen in cult leaders)
- Others are disorganized, socially incompetent, or suffer from other mental disorders
- Don't know why they're attracted to children, can cause a lot of distress
49
What are some of the statistics regarding sexual assault?
- About 6% of women report having been raped
- 21% report having been sexually assaulted
*Most likely underreported
- Rape occurs to men often in prison
50
T/F: In sexual assault, the victims usually don't know the perpetrators.
- FALSE, they often do
- Rape by a stranger is rare, except during war
51
What's the recidivism rate among rapists?
- About 25% of rapists will commit another sexual assault after spending 5 to 10 years in the community
52
What's the common intent for rape?
- Rape is motivated at least partly (in some cases) primarily by aggression
- In other cases, sexual arousal and pleasure are linked to the suffering of the victim. Many people who commit sexual assaults do so to hurt, humiliating, and degrade their victims
53
T/F: People who exhibit one form of paraphilia often exhibit others.
- TRUE
54
What are some of the biological factors that contribute to the etiology of paraphilias?
- Biological etiology is poorly understood
- Some evidence of hormonal (testosterone) dysfunction and temporal lobe dysfunction
55
How does Freud's courtship theory contribute to the psychosocial etiology of paraphilias?
- Believed that paraphilias are the result of courtship behaviours gone awry. Similar to animals, there's a visual appraisal, physical touching, and then sexual touching that should progress normally
- Hard to test, not applied very often
56
What's the feminist theory for why sexual assault occurs?
- The idea that we live in a predominately paternalistic society where men have most of the power, making it easier to assault women
- Some evidence for this, since countries where men have more power/control are correlated to higher levels of sexual assault
57
What are some other psychosocial factors pertaining to the etiology of paraphilias and sexual assault?
- Integrative theories: Sexual abuse, inappropriate modelling of sex behaviour and values, low self-esteem, poor social competence, poor knowledge of sexuality
- Failure to achieve intimacy combined to poor social skills
- Reinforcement provided by sexual pleasure, empowerment, high risk-taking (hard to get data on this)
58
What are some common treatments for paraphilias?
- Aversion therapy - have people imagine performing paraphilic scenarios while on unpleasant medication (not super effective)
- CBT
- Hormone therapy (not super common, may include chemical castration)
- Integrated programs - combine a bunch of interventions, used for sexual assault (success is difficult to estimate)
59
What's gender identity disorder?
- Characterized by a firm conviction that one is a member of the opposite sex.
- Not everyone who has this problem is "dysphoric" or otherwise dysfunctional
- Feelings of belonging to the other gender often arise early in childhood
60
What are some criticisms/concerns regarding GID?
- Many have questioned whether GID should be a mental disorder.
- Many see the diagnosis as a pathologization of gender diversity (gender diversity is a fact of life)
- Often culturally dependent; a large number of distinct cultures allow for multiple gender/sexes
61
What is some of the known etiology concerning gender dysphoria?
- Very poorly understood (has not been researched long)
- Gender identity appears minimally influenced by environmental experiences
- Some researchers have theorized that discordance between gender/sex assigned at birth and perception of one's own gender is related to variations in parental hormone exposure (evidence is lacking)
- Oedipal complications are lacking in evidence
62
What are the different dimensions of gender?
- Chromosomal gender
- Gonadal gender
- Prenatal hormonal gender
- Internal organs
- External genital appearance
- Gender identity
63
What's androgen insensitivity syndrome?
- When the body does not register androgen well. Recognized as male at birth, but does not appear male
- Relatively rare
64
T/F: GID is a very common disorder.
- FALSE
- rare, just gets a lot of attention in the media
- More common in children than adults
65
What are some common treatments for GID?
- Psychotherapy is important to explore gender identity issues and psychological distress, not to encourage gender-appropriate behaviour nor to discourage a strong desire for sex reassignment
- Therapy usually involves a period (about one year) where the individual lives in a gender role congruent with their gender identity
- Hormonal treatment and sex reassignment surgery
66
What are the standards of care from the World Professional Association for Transgender Health?
1) Persistent and well-documented gender dysphoria
2) Capacity to make fully informed decisions and consent to treatment
3) Age of majority in a given country
4) Any significant medical and/or mental health concerns must be well controlled.
5) 12 continuous months of hormone therapy, and for some genital surgeries the individual must live 12 consecutive months in living in a gender role that is consistent with their gender identity
67
What are the most common sexual dysfunctions among men and women?
- Men - Premature ejaculation and erectile disorders
- Women - desire and arousal issues
68
Who was the first to systematically collect data on orgasm in women?
- Alfred Kinsey
- Discovered women were more likely to experience an orgasm through masturbation rather than through penetration
69
What's provoked vestibulodynia?
- Most common form of dyspareunia
- A severe, sharp/burning pain at the entrance of vagina in response to any kind of pressure
70
How can anxiety interfere with sexual performance?
- May interfere with the activation of the parasympathetic branch that is aroused during sexual activity
71
What's an intracavernous treatment and a vestibulectomy?
- Intracavernous treatment - needle injection to treat erectile dysfunction
- Vestibulectomy - a surgical treatment for women who have a particular form of GPPPD
72
What's apotemnophilia?
- A fetish for amputation and genital mutilation
73
What's a penile plethysmography?
- A method to measure arousal in those with penises
