Gender and Sexuality-Schmidt Flashcards
You should address risk factors to prevent outcomes
high risk _ can lead to high risk _ which leads to undesired _
factors
behaviors
outcomes
what are some examples of high risk factors?
substances use, limited access to care, poor health literacy about STIs, young age, poor communication skills
what are some examples of high risk behaviors
unprotected sex (anal, vaginal, oral)
multiple sex partners, high risk partner, sex trade world, IV drug use
what are some examples of undesired outcomes
STI, unwanted pregnancy, relationship complications, poverty
what are the 4 phases of the sexual response cycle
Desire, Excitement, Orgasm, Resolution
what are the 3 components of “DESIRE” in the sexual response cycle
sexual drive- biological and or genital sensations/thoughts of sex
motivation- psychological and willingness to offer your body for sex
wish fulfillment- social, hoping for sex/expectations for sex which can be culturally influenced
explain the “EXCITEMENT PHASE” in the sexual response cycle
this is “arousal”
that can last several minutes to several hours, where there is an erection/vaginal lubrication, nipples will harden and respiratory/cardio rate will increase (BP will increase as well)
what are the two basic physiological processes that our during the EXCITEMENT stage of the sexual response cycle
- vasodilation/constriction: where there is engorgement of blood vessels of the genitals as a result of dilation of the blood vessels
- Myotonia: muscle contractions not only in the genitals but all throughout the body
describe phase three “ORGASM” in the sexual response cycle
peak of sexual pleasure where there is a release of sexual pleasure and the rhythmic contraction of the perinatal muscles and the pelvic reproductive organs
it typically will last from 3-25 seconds
how long does the “ORGASM PHASE LAST”
3-25 seconds
orgasm:peak of sexual pleasure where there is a release of sexual pleasure and the rhythmic contraction of the perinatal muscles and the pelvic reproductive organs
what is phase 4 “RESOLUTION” of the sexual response cycle
disgorgement of blood from the genitalia and the body will return to its resting state. IF orgasm has occurred the resolution is rapid and accompanies by a general self of well being
if orgasm has occurred resolution is _ and accompanied by a general sense of well-being
rapid
if an orgasm does not occur then resolution may take up to ?
2-6 hours
females have no _ period but usually need time for resolution
refractory
Education for timing and coordination teaches patients about?
the sexual response cycle so they know what is normal for themselves and their partners
what is male hypoactive sexual desire disorder
this is persistent/recurrent absent sexual fantasies and desire for sexual activity
has to be ongoing for about 6 months
what is female sexual interest/arousal disorder
lack of or significantly reduced sexual interest/arousal with as least 3 of the following for 6 MONTHS
-reduced interest in sexual activity
-absent or reduced sexual/erotic thoughts or fantasies
-none or reduced imitation of sexual activity and unreceptive to partners attempts
-absent sexual pleasure
-absent sexual interest/arousal response
-absent genital/non genital sensations
what is erectile dysfunction
at least one of the three following occasions must be experienced on 75-100% of sexual encounters for 6 months
-difficulty obtaining an erection
-difficulty maintaining an erection until completion
-marked decreased in erectile rigidity
Erectile dysfunction risk factors
Hypertension, Diabetes, Smoking, CAD, alcoholism, priapism treatment
what is female orgasmic disorder
persistent or recurrent delay in orgasm or reduced intensity following normal sexual excitement for 6 months
**best way to combat this is when education
what is delayed ejaculation
marked delay in ejaculation or inference of ejaculation for 6 months
what is premature ejaculation
persistent early ejaculation within 1 minute following penetration for 6 months
what is Genito-pelvic pain penetration disorder
difficulties in vaginal penetration, or vulvovaginal pain during penetration
OR
fear and anxiety about pain
OR
tensing/tightening of the pelvic floor muscles
FOR 6 months
what is the vicious cycle of sexual dysfunction
- sexual dysfunction is actually experienced
- fear of failure again
- anxiety that interferes with some phase of the sexual response
describe the general approach to treatment in someone with sexual dysfunction (5 possibilities)
- evaluate and treat the underlying medical condition
- consider medication side effects
- educate
- behavior therapy
- refer to counseling if there are relationship problems
Behavioral therapy: sensate focus
no intercourse for a time period then systematically reintroduce sexual stimulation
behavioral therapy: squeeze technique; Start-Stop method
this is used for premature ejaculation
behavioral therapy: relaxation techniques
this can include systematic desenitization
what increases knowledge and awareness of personal preferences and is a form of behavior therapy
masturbation
what are categories of abnormal sexuality
sexuality that is not about a human sexual partner, sex that excludes stimulation of primary organs, is compulsive or injurious to self or others
What is the definition of Paraphilia
any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners, for at least 6 months
-this is an overarching term that describes several individual disorders
what are the legal (non-victimizing) forms of paraphilias
fetishism
sexual masochism
transvestic fetishism
sexual sadism (mild)
what are the illegal victimizing types of paraphilias ?
Voyeruism
Exhibitionistm
Pedophilia
Sexual Sadism
what are the stats regarding paraphilias?
they are rare in the US
there is an early onset usually before the age of 18
Males are 20 times more likely to have them
and 50% of people are married
Victimizing paraphilia have a high comorbidity with what disorder
antisocial personality disorder
usually victimizing paraphilia people use _ as a defense mechanism
rationalization
what is sexual masochism disorder?
when a person derives sexual pleasure from suffering/humiliation
-real acts of violence not just stimulation being afflicted upon them gets them off
What is Hypoxyphilia ?
sexual arousal from oxygen deprivation - by way of chest compression, noose, ligature, plastic bag, mask, or any chemical
the most common motivation for hypoxyphilia is?
fantasy of bondage and pain
cerebral hypoxia makes a person dizzy and light headed and may increase the intensity of _
orgasm
what is sexual sadism disorder
sexual arousal from physical and psychological suffering of another person
-the partner may or may not have consented (illegal if did not obtain consent)
what is exhibitionism ?
exposure of genital to unsuspecting stranger in public
the shock/fear that is evoked is what leads to orgasm
this is illegal the victim is usually non consenting
what is fetishistic disorder
this is sexual arousal from non-living objects or specific focus on non genital body parts like shows, socks, panties, feet
what is frotteruisitc disorder?
touching or rubbing against a non consenting person
“image shows a man rubbing on a female with his crotch on the subway”
what is transvestic disorder?
sexually arousing fantasies, urges or behaviors about cross dressing
(not related to gender identity)
what is voyeuristic disorder?
sexual arosual by watching an unsuspecting person who is naked, in the shower, having sex, disrobing etc.
-must be 18+ years old
wha tis pedophilic disorder?
sexual fantasies, burgers, or activity with a prepubescent child usually under the age of 13
pedophile must be 16+ and at least 5 years older than the child
Exclusive pedophilia
sexual interest in children only
non-exclusive pedophilia
usually heterosexual male and married
pedophilia disorder has nearly a 100% recidivism rate
- what are the risk factors for recidivism
male victims, stranger victims, prior sex offenses, lack of cohabitation history with adult partner
what are some behavioral therapies for pedophilic disorders
aversive therapy
desensitization
social skill training
orgasmic reconditioning
- all have low success rates
pedophilia therapies:
aversive therapy reduces _
desensitization neutralizes _
social skills training forms better _
orgasmic reconditioning teaches more appropriate mental imagery for sexual fantasies
pleasure
anxiety
interpersonal relationships
patient centered care affirms _
gender
what are three thing we can do that is gender affirming and patient centered care
respect for patient preferences, emotional support and alleviation of fear and anxiety, access to care
initial steps in affirming gender
ASK about gender identity
USE patients pronouns
LEARN the standard of care
is it true that there is scientific evidence for surgical regret with gene affirming surgery ?
-1% which is less than total knee arthroplasty at 17.1% and tattoo removal at 12%
what are some aspects of gender affirming care that might not be controversial and that all physicians despite your religious background and morals can implement
non-maleficence- ask about safety (intimate partner violence
justice in giving them the initial steps for gender affirming care
provide autonomy- support social transition by encouraging a safe friendship group, use declared pronouns
