Davis-Sexual Dysfunction

Question 1

What are the elements of the sexual response cycle?

Answer 1

Desire
Arousal
Orgasm
Revolution

Question 2

What is diagnostic criteria for female sexual interest/arousal disorder?

Answer 2

Reduced interest/arousal in sex. At least 3 of the following…

• reduced interest in sexual activity
• reduced erotic thoughts/labido
• Reduced initiation/receptivity

During physical encounters (75-100% of the time)

• absent pleasure
• absent arousal
• absent genital sensations

Question 3

What is the criteria for male hypoactive sexual desire disorder?

Answer 3

Absent erotic thoughts/desire for sexual activity.

-judgement made by clinician

Question 4

What is the criteria for female orgasmic disorder?

Answer 4

In 75-100% of sexual activity:

• delayed, infrequency, absence of orgasm
• reduced intensity of orgasmic sensations

Question 5

What is the criteria for delayed ejaculation?

Answer 5

In 75-100% of sexual activity:

• delay in ejaculation
• infrequency/absence of ejaculation

*Caused by SSRIs

Question 6

What is the criteria for premature ejaculation?

Answer 6

Ejaculation 1 min following vaginal penetration and before the individual wishes it.

Question 7

What is the criteria for erectile disorder?

Answer 7

In 75-100% of sexual activities:

• difficulty obtaining erection during sexual activity
• difficulty in maintaining erection until completion of sexual activity
• decrease in erectile rigidity

Question 8

What is the criteria for Genito-Pelvic Pain/Penetration disorder?

Answer 8

Difficulties with one or more of the following:

• vaginal penetration during intercourse
• vulvovaginal/pelivc pain
• fear/anxiety about vaginal/pelvic pain in anticipation of or during intercourse
• tensing/tightening of pelvic floor muscles during vaginal penetration

Question 9

What is the criteria for substance/medication-induced sexual dysfunction?

Answer 9

• disturbance in sexual fxn due to substance/medication
• sx develop soon after exposure to medication
• medication is capable of producing sx

Question 10

What drugs could contribute to sexual dysfunction?

Answer 10

Psychotropics:
1. APs
2. ADs
3. Anxiolytics
4. Sedatives
5. Anti-convulsants/ Li
Antihypertensives
Oral estrogen
Street drugs

Question 11

What is the PLISSIT Model of sex therapy?

Answer 11

Specifies 4 levels of treatment
P-permission to have normal sexual feelings
LI-Limited information critical to sexual concern
SS-specific suggestions (exercises/activities to help them reach their goal
IT- intensive therapy provided when emotional/relationship difficulties interfere w/ sexual expression

Question 12

What are drug treatments for sexual response disorders?

Answer 12

Testosterone patch 
Viagra-30 min onset, lasts 4 hrs
-levitra = 30 mins lasts 12 hrs
-cialis = lasts 2 days
Penile injections of alprostadil
Tranurethral alprostadil
Bremelanotide (melanocortin agonist)

Question 13

How can you treat SRI induced sexual problems (reduced sexual desire, latency to orgasm in 50% of pts)?

Answer 13

Reduce dose
Switch agents
Agument with wellbutrin
Cyproheptadine (before sex)- blocks SSRI
SRI weekend holiday

Question 14

When should you defer sex therapy?

Answer 14

Depression, chemical abuse/dependency, spouse abuse, affair, marital distress