Gender Dysphoria, Sexual Dysfunctions, & Paraphilic Disorders Flashcards
What is the diagnostic criteria for gender dysphoria (GD)?
1) Marked incongruence between one’s assigned (natal) gender and one’s experienced gender
2) Incongruence results in clinically significant distress or functional impairment
3) Symptoms endure at least SIX MONTHS
Describe the onset and course of GD
evident at an early age (2-4y.o)
persist, regardless of social pressure
What is the etiology of GD?
More what happened in utero then the environment.
may have been an absent or atypical hormone (androgen) during critical development period.
Is there any evidence of atypical hormone exposure in utero for GD patients?
yes bed nucleus of the stria terminalis (BNST) in GD
BNST is larger in males than females due to androgen exposure in utero
In male-to - female GD (trans female) describe the BNST
BNST is more similar in size to non transgender females (suggesting lack of androgen exposure)
How does one manage GD cases?
Hormone treatment
transgender living
surgical sex reassignment
What is the diagnosis criteria for sexual dysfunctions?
Problems related to the normal sexual response cycle
Problems persist for at least 6 months
A possible diagnose for sexual dysfunction in females is female sexual interest/arousal disorder, what is the problem in these females?
problems with libido and/or physiological arousal
Another possible diagnose for sexual dysfunction in females is female orgasmic disorder, what is the problem with these females?
a delay in, the inability, or having low intensity orgasms.
The last possible diagnose for sexual dysfunction in females is genito-pelvic pain/penetration disorder, what is the problem with these females?
Difficulties with vaginal penetration or vulvovaginal/pelvic pain during vaginal intercourse or penetration attempts.
What are the male sexual dysfunction diagnosis’s?
1) Male hypoactive sexual desire disorder -> (low libido)
2) Erectile Disorder –> (problems maintaining or attaining an erection)
3) Premature Ejaculation –> (ejaculation occurring during partnered activities within 1 min)
4) Delayed Ejaculation –> (marked delay in, or absence of, ejaculation)
What are the two specifiers for sexual dysfunctions?
generalized or situational
life long or acquired
What are some various causes of sexual dysfunction?
psychological factors are primary
medical condition may co exist but insufficiently explains the symptom
What are ways to assess sexual dysfunction in the patient?
1) Taking a sexual history –> ROUTINELY ask questions
2) Consider whether sexual dysfunction is related to a medication side effect –> SSRIs cause this
3) Consider whether sexual dysfunction is related to recreational drug use –> alcohol…………hmm…
4) Consider whether sexual dysfunction is related to a medical/physical problem –> diabetes, surgery, thyroid, etc.
5) Consider whether the sexual problem is normal for ones age. With age expect –> slower erection, decreased intensity of orgasm, longer refractory period
6) Be familiar with tests to differentiate a psychiatric vs organic basis for a sexual problem
What is the snap gauge test?
determines whether erections occur during REM. If REM erection occur, then the problem is not organic
Does libido wane with age?
not necessarily ( just a decline in certain aspects of sex)
One of the treatment options for sexual dysfunctions is behavioral therapy and specifically dual sex therapy, what does this therapy do?
1) If dysfunction, then both partners are treated
2) Therapy is short term with behavioral focus
* Sex Education
* Communication skills training
* Anxiety reduction through sensate focus exercises
Another treatment options for behavioral sexual dysfunction is treating specific problems. Each card will go through one. 1 –>
- Premature Ejaculation –>
* squeeze technique (partner squeeze the glans penis to cause discomfort)
* Start and stop technique –> partner ceases stimulation of the partner to reduce pleasure
2nd sexual dysfunction specific problem treatment
- Genito-Pelvic Pain/Penetration Disorder
* Use of dilators to expand vaginal opening in conjunction with relaxation techniques
3rd sexual dysfunction specific problem treatment
- Female Orgasmic Disorder
* Strengthen the pubococcygeal muscle to increase orgasm potential.
Besides behavioral sexual dysfunction treatment, pharmacotherapy can be used. Which drugs should be used?
Adjunct to behavioral therapy
1) Stimulants –> increase libido
2) SSRIs –> slow ejaculation
3) Phosphodiesterase-5 (PDE5) inhibitors –> for erections
What does PLISSIT stand for in regards to sexual dysfunction treatment?
Overall Treatment Strategy:
P–> permission (give approval to enjoy sex)
LI –> limited information (provide basic sex education)
SS –> Specific Suggestions
IT –> refer on to specialists (intensive therapy)
The next group of disorders in regard to sex are the paraphilic disorders. The first disorder is paraphilia, describe the diagnostic criteria
an intense and persistent >6 months deviant sexual interest
If an individual:
a) acts on an urge with a non consenting person
b) acts on an urge with a consenting person and the actions cause significant distress/functional impairment
c) does not act on the urge but the urge causes significant distress/functional impairment
what is the definition of deviant?
sexual interest other than for genital stimulation or preparatory fondling with phenotypically normal physically mature consenting human partners.
There are multiple various diagnosis or types for paraphillia, each card will go through the diagnosis’s/types. 1 –>
1) Exhibitionism –> sexual arousal from exposing genitals to an unsuspecting stranger.
The next type of paraphilia is…
2) Voyeurism –> sexual arousal from observing unsuspecting person either naked, in the process of disrobing, or engaging in sexual activity
PERSON HAS TO BE AT LEAST 18 Y.O
The next type of paraphilia is…
3) Fetishism –> sexual arousal from nonliving objects or a highly specific sexual focus on a non-genital body part
The fourth type of paraphilia is…
4) Transvestism –> sexual arousal by cross-dressing
The fifth type of paraphilia is…
5) Frotteurism –> sexual arousal from touching or rubbing against a non-consenting person
The sixth type of paraphilia is….
6) Sexual Sadism –> sexual arousal from causing psychological/physical suffering of another person.
The seventh type of paraphilia is…
7) Sexual Masochism –> sexual arousal from receiving psychological/physical suffering
The eighth type of paraphilia is….
8) Pedophilia –> sexual arousal by a prepubescent child
In pedophilia what is the age criteria for the perpetrator?
Perpetrator –> 16 y.o and 5 yrs older than the child
Describe the epidemiology of people with paraphiliac disorders?
rare
almost exclusively males
frequent offenders
For individuals with paraphiliac disorders what is the onset and course?
urges –> start in childhood/teens with action becoming better defined with age
What are the suggested causes of paraphilia disorders (because it is unknown)
1) Biological Influences –> testosterone levels or frontal lobe dysfunction and serotonin dysregulation
2) Psychosocial/Environmental Influences –> classical conditioning (object/situation was previously paired with sexual excitement and now triggers the same sexual excitement) and imitation (person repeating behavior that was personally experienced in the past)
What is an example of classical conditioning in regards to psychosocial/environmental influences and paraphilia disorders?
Child masterbating to underwear magazine and now child associates pleasure and sex to underwear
Possible treatment for paraphilia are behavioral therapy, what are the two different behavioral therapies?
- Aversion therapy –> punishing deviant ways with actual noxious stimulus or patient imagines aversive consequences (covert sensitization).
- Masturbating Reconditioning –> directed masturbation phase (appropriate fantasy while masturbating to orgasm) and satiation phase (during post orgasmic refractory period patient masturbates to deviant fantasy without ability to orgasm)
The next possible treatment for paraphilic disorders is pharmacotherapy, what are the two main drugs used?
1) Antidepressants -> SSRIs –>reduce libido, control impulses and reduce obsessions
2) Anti-Androgens —> Medroxyprogesterone acetate(depo-provera) –> decrease testosterone levels
Are antidepressants or anti-androgen drugs better for paraphilic disorders?
Anti-Androgens (again completely kills sex drive)
Legally a sex offender has to do what when living in a county?
1) Registration and 2) Notification
