Gender Dysphoria, Sexual Dysfunctions & Paraphilic Disorders

Question 1

describe diagnostic criteria for gender dysphoria (GD)

Answer 1

• a marked incongruence between one’s assigned (natal) gender and one’s experienced gender
• the incongruence results in clinically significant distress or functional impairment
• symptoms endure at least 6 months

Question 2

describe indicators of GD

Answer 2

• belief that one is the opposite gender
• desire to act as, and be treated as, the opposite gender
• desire to be rid of one’s sex characteristics and to possess those of the opposite gender
• conviction that one has the typical feelings/reactions of the opposite gender

Question 3

explain the etiology of GD

Answer 3

• a transgender identity is thought to result from altered androgen exposure during critical periods of in-utero development as follows:
  
  • if XY and brain NOT androgenized at typical time, then a female gender identity develops
  • if XX and brain IS androgenized, then a male gender identity develops

Question 4

describe sexual dysfunctions

Answer 4

• problems related to the normal sexual response cycle (sexual desire, sexual arousal, orgasm)
• problems persist for at least 6 months

Question 5

describe female sexual interest/arousal disorder

Answer 5

problems with libido and/or physiological arousal

Question 6

describe female orgasmic disorder

Answer 6

a delay in, the inability to, or having low-intensity orgasms

Question 7

describe genito-pelvic pain/penetration disorder

Answer 7

difficulties with vaginal penetration or vulvovaginal/pelvic pain during intercourse/penetration attempts

Question 8

what are some causes of sexual dysfunction?

Answer 8

• medication (SSRIs)
• alcohol/drug use (sedatives)
• medical/physical problem (circulatory problems leading to erectile dysfunction)
• normal aging (slower erections, decreased orgasm intensity, increased refractory period)

Question 9

describe the snap gauge test

Answer 9

• determines whether erections occur during REM
• if REM erections occur, then the problem is not organic

Question 10

describe treatment to increase libido and responsiveness

Answer 10

• dual sex therapy: involves sensate focus exercise (proscribed non-sex activities progressing to coitus)

Question 11

describe treatment to slow ejaculation in premature ejaculation

Answer 11

• “squeeze” technique: partner squeezes the glans penis to cause discomfort
• “start and stop” technique: partner ceases stimulation of the partner to reduce pleasure
• SSRIs

Question 12

explain PLISSIT (overall treatment strategy)

Answer 12

• permission (P): give approval to discuss, fix and enjoy sex
• limited information (LI): provide basic sex education and correct misconceptions
• specific suggestions (SS): provide specific suggestions (sensate focus exercise, etc.)
• intensitve therapy (IT): refer on if the above steps fail to resolve the issue

Question 13

describe paraphilia

Answer 13

• an intense and persistent (≥6 months) deviant sexual interest (as manifested by fantasies, urges or behaviors)
• deviant: sexual interest OTHER THAN for genital stimulation or preparatory fondling with phenotypically normal, physically mature consenting human partners

Question 14

describe diagnostic criteria for paraphillic disorder

Answer 14

• a paraphilia is a disorder if any of the following 3 conditions occurs:
• if an individual:
  
  • acts on the urge with a non-consenting person
  • acts on the urge with a consenting person (or acts on an urge unrelated to people) and the actions cause significant distress/functional impairment
  • does NOT act on the urge but the urge causes significant distress/functional impairment

Question 15

describe exhibitionism

Answer 15

• sexual arousal from exposing genitals to an unsuspecting stranger

Question 16

describe voyeurism

Answer 16

• sexual arousal from observing unsuspecting person either naked, in the process of disrobing or engaging in sexual activity
• person must be at least 18 years old

Question 17

describe fetishism

Answer 17

• sexual arousal from nonliving objects or a highly-specific sexual focus on a non-genital body part
• note: devices specifically designed for tactile genital stimulation don’t count as a fetish

Question 18

describe transvestism

Answer 18

• sexual arousal by cross-dressing (wearing the opposite sex’s clothing)

Question 19

describe frotteurism

Answer 19

• sexual arousal from touching or rubbing against a non-consenting person

Question 20

describe sexual sadism vs. sexual masochism

Answer 20

• sexual sadism: sexual arousal from causing psychological/physical suffering of another person
• sexual masochism: sexual arousal from receiving psychological/physical suffering

Question 21

describe pedophilia

Answer 21

• sexual arousal by a prepubescent child (usually 13 yrs or younger)
• perpetrator must be at least 16 years old AND at least 5 years older than the child

Question 22

describe the etiology of paraphilias

Answer 22

• the cause of sexual deviancy is multi-factorial and largely unknown
  
  • suggested influences:
    
    • ​testosterone levels affecting sex drive (no differences have been established)
    • frontal lobe dysfunction & serotonin dysregulation affecting impulse control
    • classical conditioning

Question 23

describe aversion therapy to treat paraphilia

Answer 23

• aversion therapy:
  
  • while engaging in (or thinking about) one’s paraphilia, an ACTUAL noxious stimulus is applied to the patient
  • or
  • while fantasizing about one’s paraphilia, a patient IMAGINES averise consequence (covert sensitization)

Question 24

describe medication to treat paraphilic disorders

Answer 24

• antidepressants: SSRIs are used to reduce libido, control impulses and reduce obsessions
• anti-androgen (chemical castration): medroxyprogesterone acetate (aka Depo-Provera) is used to decrease testosterone levels
  
  • helps reduce sex drive and thus minimize deviance
  • used especially when sexual behavior is illegal, uncontrolled or dangerous
  • non-compliance is a problem

Question 25

describe registration and notification of sex offenders

Answer 25

• registration: states require that people convicted of certain sex crimes register as a sex offender
• notification: personal info. about some registered sex offenders is made publically available (Megan’s law)