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