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Chapter 18 Flashcards

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1
Q

What is the definition of sexual disorders?

A

Problems with sexual response that cause a person mental distress

Did not appear in the DSM prior to 1980 (DSM III)

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2
Q

What are the 2 dimensions of sexual disorders?

A

Lifelong sexual disorder
-present since the person began sexual functioning

Acquired sexual disorder
-develops after a period of normal functioning

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3
Q

What is a generalized sexual disorder?

A

occurs in all situations were sexual functioning may occur

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4
Q

What is situational sexual disorder?

A

Occurs in some sexual situations but not in others

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5
Q

What are predisposing factor for sexual disorders?

A

experiences that people have had in the past that presently affect their sexual response

Eg. Sex negativity experienced as a child

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6
Q

What are maintaining actors of sexual disorders?

A

various on-going circumstances, personal characteristics, and lovemaking patterns that inhibit sexual response

Eg. Ineffective or lack of communication by the couple about sexual issues

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7
Q

What are the cognitive factors/cognitive interference of sexual disorder?

A

Negative thoughts that distract a person from focussing on the erotic experience

Eg. Spectatoring

Term coined by Master’s and Johnson as a factor that can contribute to the experience of a sexual disorder

Acting as an observer or judge of one’s own sexual performance and inhibits performance

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8
Q

What are some common feelings the sexual issues are faced?

A

May avoid sexual opportunities for fear of failure

May lack the communication skills to explore the issues with a partner

May anticipate sex will result in pain or frustration

May feel inadequate or incompetent “

  • Guilt
  • “Shame, frustration, depression, anxiety
  • “Alone in their feelings
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9
Q

What is hypoactive sexual desire disorder?

A

Lack of interest in sexual activity

  • low level of sexual desire (inhibited)
    “response sexual desire considered

-Multiple physical and psychological causes “ Distressing to the individual
Can be temporary

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10
Q

What is discrepancy of sexual desire?

A

Discrepancy of Sexual Desire
“Communication issue that affects a couple
“Not a defined sexual disorder

Someone who wants sex 6 vs 2 timies a week

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11
Q

What is male hypoactive sexual desire disorder?

A

If the man’s low desire is explained by self-identification as an asexual, then a diagnosis of male hypoactive sexual desire disorder is not made.

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12
Q

What is erectile disorder?

A

““inability to have an erection or maintain an erection on almost all or all occasions”

  • Lifelong or acquired
  • Generalized or situational

May be caused by a variety of bio-psycho-social factors

  • Isolated episodes are common
  • Issue may create cycle of anxiety and/or depression
  • Myths and misinformation -Negative attitudes about sexuality
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13
Q

Who is affected with erectile disorder?

A

Affects men under age 40
“10% of men

Affects men men in their 60’s
“30% of men

Most common disorder cited when sex therapy is sought by men

May lead to negative self talk

  • Depressed state
  • May avoid sexual encounters
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14
Q

What are the organic causes of ED?

A 
"CHD
"Diabetes
"MS
"Spinal Cord Injury
"Radical Prostatectomy "Treatment for testicular cancer

Depends on the location of lesion

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15
Q

Does testicular cancer affect libido?

A

Testicular cancer doest affect libido, if only one testicle the testosterone decreases natural anyways but may be lower

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16
Q

What are the prostate cancer treatments?

A

! Surgery
! Cryosurgery
! Radiation
! Brachytherapy

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17
Q

What are testicular cancer treatments?

A

! Surgery
! Radiation
! Chemotherapy

May result in erectile dysfunction due to
“lower testosterone levels
“damage to the pelvic cavity

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18
Q

How can pharmacology assist with ED?

A

Advent of Viagra and Cialis (sildenafil) increased awareness about
erectile dysfunction

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19
Q

What are the difference biomedical therapies and drug treatments for ED?

A

Sildenafil
Drug may be obtained via internet/ underground economy
-Used recreationally and unsupervised

The physiologic mechanism of erection of the penis involves release of nitric oxide (NO) in the corpus cavernosum

  • Relaxes smooth muscle
  • Allows for blood engorgement

New drugs such as Levitra (vardenafil) and Zydena (udenafil) are also PDE5 enzyme inhibitors like sildenafil
-Same mechanism of action -Slightly different formulations

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20
Q

What are the treatments for erectile disorder?

A

Biological approaches

  • Urethral suppositories
  • Intracavernosal Injections
  • -used for organic causes that don’t respond to drug therapy
Muscle relaxants (e.g., Caverject)
-Relax smooth muscle in the corpus cavernosum
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21
Q

What are vacuum devices?

A

Vacuum and elastic tension to maintain erection

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22
Q

What are surgical implants?

A

Mechanisms to allow for erection simulation eg malleable rods; pumps

ejaculation possible for some

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23
Q

What is intervention with cognitive behavioural therapy?

A

Treat Cognitive Interference

- negative thoughts that distract a person from focussing on the erotic experience

24
Q

What are sensate focused exercises?

A

Pioneered by Masters and Johnson to:

  • Reduce performance anxiety
  • Series of structured exercises

To address myths and information they might have, be comfortable with sexuality, pay attention to what they have overlooked before

25
Q

What is premature ejaculation?

A

“a man persistently has an orgasm and ejaculates sooner than desired during sexual activity with a partner and is significantly distressed about the problem”

26
Q

How do we define early ejaculations?

A

30 seconds?
1 1⁄2 minutes?
10 pelvic thrusts?
Until partner orgasms?

27
Q

What are the definitions from the international society for sexual medicine for premature ejaculation?

A

“Ejaculation that always occurs within one minute of vaginal penetration
-Time component

The inability to delay ejaculation
-Control component

Distress about the problem
-Distress component

28
Q

What are the CBT strategies for delaying ejaculation?

A

Behavioural Therapy technique developed by Masters & Johnson

Develop awareness of imminent ejaculation

Slow down>change positions/ activity

Stop-start technique or Squeeze technique

Partner is a participant in the therapy

Gaining greater control over the Pubococcygeal Muscles

29
Q

What is the pharmacological approach for delaying ejaculation?

A

small doses of antidepressants can assist some men

30
Q

What is delayed ejaculation?

A

Consistently unable to orgasm” for a period of at least 6 months

Unable to orgasm

Orgasm is greatly delayed with partnered sexual activity

Leads to distress

No issues with erection or stimulation

31
Q

How common is delayed ejaculation?

A

Diagnosis is rare

Less than 1% of men meet diagnostic criteria

Situational more common
-Eg Issue with penetrative sex but not solo sex or oral sex

32
Q

What are the different kinds of sexual pain in men?

A

“Ejaculatory pain

“Penile shaft or testicular pain

” Pain in the glans of the penis

  • phimosis
  • paraphimosis
33
Q

What is the difference between phimosis and paraphimosis?

A

Phimosis
“Most common cause of balanitis “ Home therapy may be prescribed “ 30 minute sessions

Paraphimosis
“ May require a surgical procedure

34
Q

What is female sexual interest/arousal disorder?

A

the woman’s sexual interest or arousal is significantly reduced

-Subjective and or physiological
“ Psychological, physical, behavioural causes

35
Q

What is the treatment for female sexual interest/arousal disorder?

A 
Treatment
" Sex education; changing cognitions 
" Bibliotherapy
" Drug therapy
-testosterone, sildenafil trials
-"Eros -similar mechanism to vacuum pump used by men 
-" Gentle suction over clitoris
36
Q

What are factors that contribute to sexual disorders?

A

Communication issues within the interpersonal relationship

Attachment Issues

Negative historical experiences

Lack of knowledge about female sexual arousal and
anatomy/physiology of arousal in women

Societal mixed messages and double standards of female sexuality

37
Q

What is female orgasmic disorder?

A

” Recurrent difficulty having an orgasm or reduced orgasm intensity during almost all sexual activity
-Distress results from the issue

Cases may be situational or generalized
Life-long or acquired

38
Q

What is anorgasmia?

A

the absence of orgasm

39
Q

What is female orgasmic disorder?

A

Historical references by Freud about female orgasm

Consider anatomy, cultural definitions of sexual pleasure, and sexual scripts

Clitoral stimulation often involved in female orgasm

DSM 5 clearly states that the necessity of clitoral stimulation in order to reach orgasm precludes diagnosis of Female Orgasmic Disorder

40
Q

What are cognitive behavioural therapies for self directed masturbation programs use to educate?

A

Education
Self-exploration
Self-massage
Giving oneself permission (assessing values)
Use of fantasy
Allowing, not forcing, orgasm Use of a vibrator Involvement of the partner

41
Q

What is bibliotherapy?

A

Information

Learn anatomy of the female body

Read narratives of other women that have experienced similar challenges

One source can lead to other sources of practical information

Can demystify sexual issues

May encourage next steps in the therapeutic process

42
Q

What is Genito-pelvic paint/penetration disorder?

A

This new DSM 5 category replaces two previously recognized disorders discussed in the DSM IV

Dyspareunia
Vaginismus
Rationale was that the two conditions typically occurred together

43
Q

What is vaginismus?

A

Skilled client intake

Understanding biopsychosocial factors on an individual basis

Assess knowledge, myths and misinformation about the female anatomy and sexual pleasure
- Can be a maintaining cause

May require bibliotherapy

Treatment may involve vaginal dilators
-As used in transgender MtF confirmation surgeries

44
Q

What are the 4 symptoms of of Genito-pelvic pain/penetration disorder?

A

“Difficulty with penetration/ intercourse

“Significant genital and/or pelvic pain

“Pain with penetrative sex

“Fear of pain associated with vaginal penetration with tension and muscle tightening

45
Q

Can genito-pelvic pain/penetraiton disorder be generalized or situational?

A 
May be generalized or situational
-Most typically experienced over a variety of situations
" Vaginal sex
" Gynecological exams
" Tampon use
46
Q

What is a more appropriate classification for genito-pelvic pain/penetraiton disorder?

A

Critique as a sexual disorder since it occurs in non-sexual situations

“Pain disorder thought to be more appropriate

47
Q

How can pain during penetrative sex can occur?

A

Can be due to the physical changes of menopause

Lower estrogen, progesterone and testosterone levels
“ Shrinking of the labia
“ Constriction of the vaginal canal
“ Decreased lubrication
“ Itchiness, dryness of the mucous membranes

48
Q

what other kinds of disorders can females have?

A

” Disorders of the vaginal entrance

” Pelvic and uterine issues

” Spasms of the pelvic floor muscles

49
Q

What are the physiological factors of sexual disorders?

A 
" Fatigue
" Infections
"Chronic illnesses
"Side Effects of prescribed medications, recreational drugs
"General poor health
50
Q

What are the cultural origins of sexual disorders?

A

Cultural factors

“Sex negativity

  • Negative childhood learning
  • Double standards for sex
  • Limited definitions of sexuality
51
Q

What are the relationship factor origins of sexual disorders?

A

“Lack of emotional intimacy

“Inadequate communication and/or ineffective sexual techniques

52
Q

What are the individual origins of sexual disorders?

A

“Emotional well-being
“Irrational beliefs or performance anxiety
“ Experiences

53
Q

How can work life balance and stress affect intimacy?

A

“Couples may schedule in love- making as they would with other activities

“Work-life balance especially challenging for women
-Carry more of the housework and
childrearing responsibilities even if
working outside the home

54
Q

What are sexual disorders effect on long term relationships?

A

Maintaining a long-term relationship is challenging

Communication is the key

Therapy can assist with communication issues

Sex therapy is different that couples counselling

55
Q

What do non distressed couples have?

A
  1. Good listening and communication skills
  2. Effective problem solving skills
  3. Many positive interactions and few negative interactions
  4. More realistic expectations about what relationships should be like
  5. Interpretations of partner’s behavior that are positive
  6. Common views on the sharing of roles and responsibilities in the relationship
56
Q

What re the general treatment strategies?

A

Primary care practitioner to assess physical causes

Self-awareness

Gathering appropriate information

Address communication and relationship issues

Cognitive-Behavioral techniques

57
Q

What is sex therapy?

A

Many helping professionals not adequately trained in sexual issues

Lack of regulation for use of term “sex therapist”

Should have a governing body for complaints/concerns

Some certified by Board of Examiners in Sex Therapy and Counselling in Ontario (BESTCO)

Sex Psych (27 decks)

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