human sexuality Flashcards
1
Q
Encompasses thoughts, feelings and behaviors connected with sexual gratification and reproduction
A
sexuality
2
Q
what is biologic gender
A
anatomic gender, natal gender, sex
biological sexual characteristics
3
Q
individual with genetic, hormonal, and/or physical features
of both male and female at once
A
intersex
4
Q
everyone starts out ___ during early stages of fetal life
A
anatomically female
5
Q
what differentiates male from female?
A
fetal androgens
6
Q
- Innate sense of feeling male, female, some combination of both male and female, or neither/a “third gender”
A
gender identity
7
Q
How one thinks of oneself in terms of whom one is romantically or sexually attracted to
A
sexual identity
8
Q
Describes the object of a person’s sexual impulses and attractions
A
sexual orientation
9
Q
Specific actions and behaviors involving sexual activities
A
sexual behavior
10
Q
how one presents one’s gender to others
A
gender expression
11
Q
discrepancy between assigned (biological) gender and gender identity
A
gender discordance (dysphoria)
12
Q
Gender discordant people who make changes to their perceived gender and/or anatomic sex in order to conform with their gender identity
A
transsexuals
13
Q
a person whose gender identity, gender expression, and biological sex all align
A
cisgender
14
Q
a person who is not cisgender
A
transgender
15
Q
a person whose gender identity is neither masculine nor feminine, is some combination of both, or is fluid
A
nonbinary/genderqueer
16
Q
Attitudes toward sexuality and toward one’s sexual partner are directly involved with, and affect, the physiology of human sexual response
A
sexual response
17
Q
the normal sequence of physiological responses to sexual stimulation
A
- desire
- excitement
- orgasm
- resolution
18
Q
characterized by sexual fantasies and desire to have sexual activity
A
desire (libido) - phase 1
19
Q
brought on by psychological OR physiological stimulation OR combination
subjective sense of pleasure
A
excitement and arousal - phase 2
20
Q
peaking of sexual pleasure; releasing of sexual tension; rhythmic contraction of perineal muscles and pelvic reproductive organs; ↑ BP, pulse, respiratory rate
A
orgasm - phase 3
21
Q
disgorgement of blood from genitalia (detumescence); subjective sense of well-being and relaxation
A
resolution - phase 4
22
Q
if there was no orgasm, what happens to resolution?
A
may take several hours and may be associated with irritability and discomfort
23
Q
what are the 3 excitatory effect hormones
A
- dopamine
- testosterone
- estrogen
24
Q
what are the 2 inhibitory effect hormones
A
- serotonin
- progesterone
25
who has predominantly physical stimuli and who has predominantly psychologic stimuli
males, females
26
describe 5 ways sexual dysfunctions can be
1. may be lifelong or acquired
2. generalized or situational
3. may be due to psych or phys factors, or both
4. may be attributed to medical condition or substance-induced
5. freq associated with other psychiatric syndromes
27
6 factors sexual desire disorders depend on
1. biological drive
2. self-esteem
3. ability to accept oneself as a sexual person
4. previous good experiences with sex
5. availability of an appropriate partner
6. relationship in nonsexual areas with partner
28
2 sexual desire disorders
1. hypoactive sexual desire disorder
2. sexual aversion disorder
29
- Deficiency or absence of sexual fantasies, desire for sexual activity
- Prevalence estimated at 20%
- more common in females
Hypoactive sexual desire disorder
30
Characterized by an aversion to, and avoidance of, genital
sexual contact
Sexual aversion disorder
31
treatment for sexual desire disorders
1. therapy - CBT, sexual therapy, couples therapy
2. pharm - dopamine agonists
- Serotonergic drugs - flibanserin (Addyi)
- Melanocortin agonists - bremelanotide (Vyleesi)
- Testosterone + estrogen
32
- Dysfunction with lubrication-swelling response of sexual excitement until the completion of sexual act
- Many psych factors play a role (anxiety, guilt, fear, etc.)
female sexual arousal disorder
33
2 sexual arousal/excitement disorder
1. female sexual arousal disorder
2. male erectile disorder
34
2 sexual orgasm disorders
1. orgasmic disorder
2. premature ejaculation
35
2 sexual resolution disorders
1. postcoital dysphoria
2. postcoital headache
36
3 treatments for female sexual arousal disorder
1. Testosterone
2. Bupropion (Wellbutrin) - mainly if associated with SSRI use
- Buspirone (Buspar) may also be used, but not as much evidence for benefit
3. Sildenafil (Viagra) - for certain groups
37
- “erectile dysfunction”, “impotence”
- happening 10-20% of all men
- NOT universal in aging men
male erectile disorder
38
3 factors of continuing potency
1. available sex partner
2. hx of consistent sexual activity
3. absence of vascular disease
39
young or middle-aged men with ED is usually a ____ problem
psych
- Feeling conflicts (affection vs. sexual desire)
- Punitive superego or moral prohibition
- Inability to trust, fear, anxiety, anger
- Feelings of inadequacy or being undesirable
40
if ED is present some times, the cause is most likely ?
psych
41
inhibition of female orgasm as manifested by the recurrent delay in, or absence of, orgasm after a normal sexual excitement phase
female orgasmic disorder - “inhibited female orgasm”, “anorgasmia”
30-35% prevalence
42
6 psych factors of female orgasmic disorder
1. Insufficient preliminary phases
2. Hostility toward men
3. Feelings of guilt about sexual impulses
4. Fear of vulnerability, loss of control, physical harm, impregnation, or rejection by partner
5. Belief that sexual pleasure is not a natural entitlement
6. Increased tension, irritability, and fatigue
43
2 physiologic factors of female orgasmic disorders
1. pelvic complaints
- Endometriosis, pelvic floor dysfunction, pelvic organ prolapse, uterine fibroids
- Childbirth or miscarriage/abortion
- Atrophy of genital tissues
2. insufficient stimulation of clitoris
44
treatment for insufficient stimulation of clitoris
1. Vacuum-pump device for clitoris
2. PDE-5 inhibitors such as sildenafil (Viagra) - off-label use
3. Recommend use of OTC lubricant
4. Counsel about mechanical factors: manual clitoral stimulation, alternate positions, controlling depth and force of penetration
45
Male achieves ejaculation and orgasm during coitus only
after great difficulty, if at all
male orgasmic disorder
5% prevalence
46
lifelong male orgasmic disorder usually indicates ?
severe psychopathology
- Rigid, puritanical background
- Unconscious guilts
- History of abuse
47
2 treatments for male orgasmic disorder
1. therapy
2. dopamine agonists
48
when a man regularly ejaculates before or immediately after entering his partner
premature ejaculation
49
difference between male vs couple definition of premature ejaculation
male: persistent or recurrent orgasm and ejaculation before the male wishes to (no definite time frame to define)
couple: inability to control ejaculation long enough during sexual activity containment to satisfy his partner in most of their episodes of coitus
50
what is the most common CC among men with sexual disorders?
ED
51
what is the second most common CC among men with sexual disorders
premature ejaculation
52
2 treatments for premature ejaculation
1. squeeze technique: The penis is forcefully squeezed at the coronal ridge of the glans = erection is diminished and ejaculation is inhibited
2. SSRI
53
Recurrent or persistent genital pain occurring in either men or women before, during, or after intercourse
often seen with vaginismus
dyspareunia
54
for dyspareunia what must you do?
Must rule out medical or physiologic causes
May be significant underlying psychological factors - Common to see history of rape or childhood sexual abuse
55
Involuntary muscle constriction of the outer 1/3 of vagina that interferes with penile insertion and intercourse
vaginismus
56
vaginismus is most commonly seen in ?
highly educated women
high socioeconomic groups
57
treatment for vaginismus
dilation - dilating vaginal opening with patient’s fingers or with graduated dilators (PT with pelvic subspecialty may help)
58
20-50% of men with ED also have ?
medical cause - cardiovascular disease; diabetes; neurologic disease; surgical procedures
59
3 diagnostics for ED
1. lab studies (glucose and A1c, hormone assays, liver,
thyroid, lipids)
2. nocturnal penile tumescence
3. assessing blood flow to the pudendal artery (Doppler US)
60
medical conditions contributing to dyspareunia
1. Irritated or infected hymenal remnants
2. Episiotomy scars
3. Inflammation/infection of vagina, cervix, Bartholin’s glands
4. Endometriosis
5. Leiomyomas (fibroids)
6. Thinning of vaginal mucosa and/or reduced lubrication
7. Interstitial cystitis
61
2 psych medications contributing to sexual dysfunction
1. antipsychotics - decreases dopamine
2. antidepressants - increases serotonin
- anti-anxiety agents
62
general medication that contributes to sexual dysfunction
anticholinergic - dries mucous membranes and impotence
- antihistamines - has anticholinergic properties
63
2 hormonal medications that contribute to sexual dysfunction
1. Contraceptives → abnormal levels of estrogen, progesterone, LH
2. Anti-androgen therapy → lower androgens such as testosterone
- Spironolactone, oral contraceptives
64
to diagnose ANY sexual disorder, the patient must: (4)
1. Experience the disorder 75-100% of the time
2. Have experienced the disorder for at least 6 months
3. Have significant distress due to the disorder
4. Not have another factor that could better explain symptoms (e.g. nonsexual mental disorders, relationship distress, etc.)
65
what two dysfunctions merged into a single syndrome (Sexual interest/arousal disorder) in the DSM-V-TR
Female hypoactive desire dysfunction and Female arousal dysfunction
66
what is not included in the DSM-V
Sexual aversion disorder
67
what two dysfunctions merged into a single syndrome (Genitopelvic pain/penetration disorder) in the DSM-V-TR
Dyspareunia and vaginismus
68
Sexual arousal not associated with psychological desire
Spontaneous, persistent, difficult to control
can last hrs to wks
persistent genital arousal disorder
69
persistent genital arousal disorder is believed to be defect in ?
sensory nerves
70
4 treatment for persistent genital arousal disorder
1. SSRIs
2. psychotherapy
3. topical
4. injected anesthetic agents
71
4 types of therapy options for sexual disorders
1. Dual-Sex Therapy
2. Behavior Therapy
3. Group Therapy
4. Analytically Oriented Sex Therapy
72
Deviations from conventionally normal human sexual interests and behaviors
paraphilias
73
what is the time frame that is considered paraphilia
Present for 6 months or longer
74
achievement of arousal by exposing genitalia to strangers
exhibitionism
75
consists of recurrent cross-dressing in a heterosexual man
transvestism
76
attaining arousal watching an unsuspecting person or people
voyeurism
77
use of a child to achieve sexual arousal and often gratification
pedophilia
78
sexual relationship with a person, usually a child, in the immediate family
incest
79
inflicting pain upon the sexual object as a means of arousal
sexual sadism
80
erotic pleasure being achieved by being humiliated, enslaved, or physically bound or restrained
sexual masochism
81
erotic fantasies and sexual urges or behavior involving non-living objects
fetishism
82
sexual arousal derived from touching or rubbing against a nonconsenting person
frotteurism
83
3 challenges when treating paraphilias
1. Patients tend to hide these traits and to avoid treatment
2. Often comorbid with other psych disease
3. Ethical considerations often get in the way of RCCTs and other studies
84
treatment for paraphilia should always include
1. pharmacotherapy
2. psychotherapy
- Behavioral therapy
- SSRIs
- Gonadotropin antagonists, progesterone therapy
