Class 9 Flashcards
the sexual response cycle
- Desire phase
- Excitement phase: engorgement of penis/ clitoris
- Orgasm phase
- Resolution phase: time before next orgasm
Interest/arousal disorder in women criteria
Diminished, absent or reduced frequency of at least 3 of the following for 6 mo or more:
Interest in sexual activity
Sexual/ erotic thoughts or fantasies
Initiation of sexual activity and responsiveness to partner’s attempts to initiate
Sexual excitement/ pleasure during 75% sexual encounters
Sexual interest/ arousal elicited by any internal ou external erotic cues
Genital or nongential sensations during 75% of sexual encounters
Marked distress/ interpersonal problems
Not a GMC, substance or another psychological disorder
Hypoactive sexual desire disorder
Sexual fantasies or desires are deficient or absent, as judged by clinician.
Marked distress/ interpersonal problems
Not a GMC, substance or another psychological disorder
Male erectile disorder
On at least 75% of sexual occasions:
Inability to attain an erection or
Inability to maintaine an erection for completion of sexual activity or
Marked decrease in erectile rigidity that interferes with penetration/ pleasures
Not a GMC, substance or another psychological disorder
Female orgasmic disorder
absence of orgasm after sexual excitement
2 types of ejaculation disorder
Delayed ejaculation disorder, premature ejaculation disorder
Genitopelvic pain/ penetration disorder
R/o medical causes (ex: infection), lack of lubrication or menopausal problems
Most womena achieve orgasm and arousal
10-30% prevalance
Genitopelvic pain/ penetration disorder criteria
Persistant or recurrrent diff with at least one of the following:
Inability to have vaginal intercourse/ penetration
Marked vulvar, vaginal or perlvic pain during vaginal penetration or intercourse attempts
Marked fear or anxiety about penetration
Marked tensing of the pelvic floor muscles during attempted vaginal penetration
Marked distress/ interpersonal problems
Not a GMC, substance or another psychological disorder
Successful sexual functioning psychological factors
good emo health, attraction towards partner, positive attitude toward partner, positive sexual attitude
Successful sexual functioning physical factors
good physical health, appropriate exercise, good nutrtion
Successful sexual functioning social and sexual history factors
positive sexual experiences in the past, good relationship with partner, sexual knowledge and skills
Poor sexual functioning psychological factors
Dep/ anx, focus on performance, too much routine, poor self-esteem, uncomfortable environment for sex, , rigid narrow attitude towards sex, negative thoughts about sex
Poor sexual functioning physical factors
Smoking, drinking, db, cardiovascular problems, neurological disease, low physiological arousal, SSRI, antihta drugs
Poor sexual functioning social and sexual history factors
Rape or sexual abuse, relationship problems such as anger and poor communication, long periods of abstinence, hist of hurried sex
Trx of sexual dysfunction
Anx reduction, directed masturbation, procedures to change thoughts and attitudes: sensory awareness procedures, rational-emotive therapy, sexual skills and communication training, couples therapy, squeeze technique for early ejaculation, PDE-5 inhibotirs for erectile dysfunction
Paraphilia
Recurrent sexual attraction to unusual objects or sexual activities
For at least 6 mo
Should only be diagnosed when they cause markes distress or are done with nonconsenting persons
Fetishistic disorder prev
+M, object usually necessary for sexual arousal, attraction to obj irresistable and involuntary, often co-occur with other paraphilias
Fetishistic disorder criteria
For at least 6 mo, recurrent and intense sexually arousing fantasies, urges or behaviors involving the use of nonliving obj or nongenital body parts. The sexually arousing obj are not limited to articles used in corss-dressing or to devies designed to provide tactile genital stimulations
Pedophilic dis
Sexually arousing urges, fantasies or behaviors involving sexual contact with prepubertal or pubescent child.
Offender at leat 16 yo and 5 years older than victim
Person has acted on the urges or the urges and fantasies caused markes distress or interpersonal prb
Voyeurisitc dis
Sexually arousing urges, fantasies or behaviors while observing others who are unclothed or engaging in sexual activity.
Almost always M
Excitement comes from knowing the victim is unaware of the voyeur, element of risk is important.
Seldom results in physical contact
Exhibistionistic dis
Intense desire to obtainsexual gratification by exposing one’s genitals to unwilling strangers
Seldom results in physical contact
Usually involves desire to shock or alarm victim
Exhibistionistic dis criteria
For at least 6 mo, recurrent and intense sexually arousing fantasies, urges or behavior involving showing one’s genitals to an unsuspecting individual
Person has acted on these urges on an unsuspecting individual or the urges cause distress/ interpersonal prb
Frotteuristic dis
Sexually oriented touching of another person .
The person rubs his gentials against a woman’s body or fondles her breasts or genitals
Usually in public space
Sexual masochism dis
Intense and recurrent desire to obtain or increase sexual gratification through receiving pain or humiliation.
Must cause distress or impairment in functioning
Sexual sadism dis
Intense and recurrent desire to obtain or increase sexual gratification by inflicting pain or psychological suffering on another person
Must cause distress or be on a non-consenting individual
Etiologies of paraphilias
Neurobiological factors: male hormones or androgens , almost all individuals who have paraphilias are men
Operant conditioning: poor social skills or reinforcement of unconventionality
History of childhood physical or sexual abuse
ROH and negative affect are common triggers
Cognitive distortions: because the child doesn’t run away, she must like it
Trx of paraphilias
Enhance motivation: denial and minimization of the prb are present, some blame the victim, lack of motivation for trx, drop out of trx
CBT: aversion trx, covert sensitisation, counter distorted thinking, social skills and empathy training
Bio: SSRIs, Depo-provera to reduce to androgens
Delay in orgasm in both gendersRx
SSRI
Causes low libido
Depression, antidepressant, antihta, stress, unhealthy habits (smoking, drinking), GMC (db, artherosclerosis), partner related issues (interpersonal conflict)
What to do when SSRI causes decrease in libido
Treat depression. Switch to another Rx. Switch reduction, relaxation. Add bupropion. Couples therapy. Reduce antidepressant. Less sexual s/e: bupropion, mirtazapine. Less sex s/e, not covered by RAMQ: trintellix. Worse SSRI: paxil, escitalopram
When do sexual s/e appear with SSRIs
. Most s/e get better in the first 2 weeks except for sexual s/e and weight gain. Sexual s/e onset during 2nd week, persist, stop after you stop the rx.
True or false, viagra increases libido
False
Risperidone and sexual function
increase PRL: infertility, irregular periods, change in menstrual flow, pause in menstrual cycle, loss of libido, lactation (galactorrhea), pain in breasts, vaginal dryness, gynecomastia.
PRL normal: 40-70
Switch to abilify or add abilify
Effects of schizophrenia on sexuality in men and women
Men and women with schizophrenia are more than twice as likely to develop sexual dysfunction than individuals without the illness. In men, the most commonly-reported problem is erectile dysfunction; in women, it is diminished sex drive. Still, in both sexes social and interpersonal impairments limit the development of stable sexual relationships
Impotencecause
Neuropathy, performance anxiety, anxiety, antihta rx (beta blockers ++), depression?, aging process, how does he feel about his rln with women, what happened with the divorce, mid-life crisis,
Only supplement that helps with erectile dysfunction
Yohimbine: boosts testosterone stimulation (natural supplement) = increase in desire
Stay away from noname brands. Choose rather: Jameson, Swiss, Quest
Viagra s/e
flushing, headache, dyspepsia, visual disturbance, epistaxis
Viagra contre-indications
Monitor blood pressure and pulse when used concurrently with medications that lower blood pressure; monitor for pulmonary edema
Not safe in cardiac conditions
Viagra mechanism of action
Phosphodiesterase-5 Enzyme Inhibitor. 15$/ pill
when sexual stimulation causes local release of NO, inhibition of PDE-5 by sildenafil causes increased levels of cGMP in the corpus cavernosum, resulting in smooth muscle relaxation and inflow of blood to the corpus cavernosum
when Viagra doesn’t work anymore
Refer to urology when Viagra doesn’t work anymore: prostaglandin intercavernosol injections. S/e: bruise, scarring of the corpus cavernosa tissue
Mechanical tax for impotence
Mechanical: pump with a cock ring, draws blood into the penis and then put a cock ring
Priapism, cause rx
go to ER, within 2-4h: no permanent damage
Trx: sympathothememic drug into the corpus cavernosa + evacuation of blood
trazodone
