First Aid CH16 Sex Dysfunctions/Disorders

Question 1

sexual response cycle

Answer 1

desire > excitement/arousal > orgasm > resolution

- women have no refractory period during resolution, men do though (minutes to hours w/ no orgasm)

Question 2

female sexual changes with aging

Answer 2

menopause, causes vaginal dryness and thinning d/t dec lvls of estrogen and lubrication, reduced nipple/clitoral/vulvar sensitivity
- tx: estrogen, vaginal creams

Question 3

ddx for sexual dysfunction

Answer 3

vascular dx (inc lipids, DM), meds (anti-HTN, anti-ACh, anti-depressants/SSRIs), depression, substance use, dec E/T

Question 4

what substances enhance sexual desire?

Answer 4

ETOH and weed suppress inhibitions, cocaine and stimulants stim dopamine Rs
- narcotics inh libido

Question 5

dopamine and serotonin on sexual function

Answer 5

dopamine increases

serotonin decreases

Question 6

psychological causes of sexual dysfunction

Answer 6

depression, anxiety, stress, relationship difficulties or conflict, poor self-esteem, fears of sex

Question 7

what are the sexual dysfunctions?

Answer 7

ED, premature or delayed ejaculation, female orgasmic disorder, male and female hypoactive sexual disorders

Question 8

how many women have low sexual desire? orgasmic disorder? pain during intercourse?

Answer 8

roughly 35%
as much as 42%
15% (predisposition is abuse or religious conflicts)

Question 9

tx for sexual disorders

Answer 9

sex therapy (couples therapy, short-term)
CBT
pharm (ED = sildenafil, PE = SSRIs, testosterone and estrogen)
vacuum-assisted erection device
directed masturbation (female orgasmic disorder)
squeeze tech (PE, squeeze the glans penis) and stop tech (stop sex when near ejaculation, restart soon after)
genito-pelvic pain/penetration disorder (relaxation exercises > erotic massage > intercourse)

Question 10

define gender dysphoria

Answer 10

aka gender identity disorder/transgender/transexuality, individuals are distressed by incompatibility between expressed and assigned genders.

Question 11

when do cross-gender behaviors begin?

Answer 11

around age 3 when gender identity is established

Question 12

comorbidities with gender dysphora

Answer 12

MDD, anxiety disorders, suicide

Question 13

tx for gender dysphoria

Answer 13

surgical sex reassignment after living 1 year in the desired gender role and 1 year after continuous hormone therapy

Question 14

define paraphilias

Answer 14

disorders where pt engages in unusual sexual activities or fantasies for at least 6 months, acted on a non-consenting being

• not considered a disorder if they don’t interfere with daily life
• occasional fantasies are considered normal components of sexuality (even if weird)

Question 15

what are the paraphilic disorders?

Answer 15

pedophilic disorder (13yo or younger)
frotteuristic disorder (touching or rubbing nonconsenting person)
voyeuristic disorder (observing unsuspecting nude individual, often with binoculars)
exhibitionistic (exposing genitals to an unsuspecting person)
masochism (arousal from suffering or humiliation)
sadism (arousal from suffering of another)
fetishistic (arousal from non-living objects or nongenital body parts)
transvestic disorder (arousal from cross-dressing)

Question 16

tx options for paraphilias

Answer 16

difficult to tx

• CBT
• Social skills training
• 12-step programs
• group therapy

Question 17

do pts often have more than one paraphilia?

Answer 17

yes

Question 18

most rape offenders are?

Answer 18

relatives of the victim