Human Sexuality Flashcards
Why is Sexual History Important
Part of the overall health of individuals
if ignored, a provider can miss a medical condition or psychological problem that may significantly impact quality of life
The World Health Organization (WHO) defines sexual health as the presence of “a state of ___, ___, ____ and ____ well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.”
Physical
Emotional
Mental
Social well-being
Sexual health requires that a pt have a ___, ___ approach to sexuality and sexual relationships, as well as the possibility of having sexual experiences that are ___, ___, and free of ____, ____ and/or ___.
positive
respectful
pleasurable
safe
coercion
discrimination
violence
Society “normal” is determined by (7) things
Religion Cultural Legacy Social customs Science Medicine Personal experiences Community (socio-economic status, ethnicity, generation)
genetic, anatomical define ______
Biological Sex
____ is the terms for previously “hermaphrodite”; ambiguous genitalia
Intersex
Psychosocial meaning of maleness and femaleness define _____
Examples: ___, ___, ____, ____
Gender
Female, male, third gender, genderqueer
subjective sense of being male or female define _____
Gender Identity
how an individual chooses to present themselves in public (behaviors, clothing, etc.) define ______
___ lies between male and female expression
Gender Expression
Androgynous
Whether an individual is sexually attracted to men or women define _____
Examples: ____, ____, ___,
Sexual Orientation
Bisexual, asexual, pansexual (attracted to the entire spectrum of biological sexes)
The relationship between a person’s gender identity and their biological sex defines ______
(usually don’t match up)
Transgender/Cisgender
___ is a formally derogatory term that is now being embraced by the LGBTQIA community to describe anyone with fluid sexuality or gender identity/expression
Queer:
what does LGBTQIA stand for
Lesbian Gay Bisexual Transgender Queer/Questioning Intersex Asexual
The range of human sexuality is on a scale from ___-___
with 0 being _____
and 6 bring _____
0-6
0= exclusively heterosexual w/ no homosexual 6 = exclusively homosexual w/ no heterosexual
what are the 4 topics of human sexuality that fall on a scale
Gender identity (woman--> man) Gender Expression (feminine--> masculine) Biological Sex (female --> male) Sexual Orientation (heterosexual --> homosexual)
To set the stage for the sex conversation you should Establish \_\_\_\_\_ Appropriate \_\_\_\_\_ Eye \_\_\_\_ & \_\_\_\_ Tone of \_\_\_ Allow time for \_\_\_\_\_\_ Timing is \_\_\_\_\_ Avoid \_\_\_\_
Rapport Timing Level, eye contact Voice Response Everything Assumptions
When are appropriate times to discuss sex with your pt?
Probably anytime it is concerning but….
With a new patient as part of a complete evaluation
With an established patient with whom you previously have never discussed sexual matters
During discussion of presenting medical problem
**Incorporate the topic with ROS routinely
During the physical exam when should you reconsider the sex talk timing
if your patient is undressed
What aspects should you avoid assumptions about a persons sexual hx
Whether they are or are not sexually active
Sex of one’s partner
Number of partners
If married; that they are monogamous
Certain sexual behaviors are associated with specific lifestyles
All sexual activity is consensual
When beginning the sex conversation you should State your ___ and asking ____ to proceed
Intention
Permission
If a person declines talking about their sexual hx what are some tips?
Ask second more specific f/u questions to continue the conversation
Ask questions that are not directly about sex, but assess the person’s safety
Questions to ask about sexual activity
Are they ‘sexually active’?(if no, go to *)
YES:
- Change in your level of sexual activity
- Have you had sex in the past few months?
NO
- Have you ever had sex with another person before?
- If no, do you have concerns with or about your sexual function?
Other sex related questions that are important
of partners
Type of Sexual activity
Pregnancy/Contraception/STI protection or exposure
To be defined as Sexual Dysfunction D/o they duration must be at least _____ (time), cause ___, (for dx of primary sexual dysfxn) not be due to ___ or _____ d/o
6 months
Distress
Medical
Non-sexual mental
Types of male sexual dysfunction d/o
Male Hypoactive Sexual d/o
Male Erectile Disorder: (difficulty getting an erection or keeping one)
Premature Ejaculation: (reach climax or come before you want to)
Delayed ejaculation
Substance/Medication-Induced Sexual Dysfunction
Types of Female sexual dysfunction d/o
Female Hypoactive Sexual d/o
Female Sexual Interest/Arousal D/o: (trouble getting sufficiently lubricated for sexual intercourse)
Female Orgasmic D/o: (Able to reach orgasm)
Genito-Pelvic Pain/Penetration D/o: (pain during intercourse? Do you ever have trouble w/ tightening/tensing of your pelvic floor muscles making sex difficult or not possible? (vaginismus) (vulvar vestibulitis)
Substance/Medication-Induced Sexual Dysfunction
DSM 5 version of Gender Identity disorder
Gender Dysphoria
DSM 5 version of Male orgasmic d/o
Delayed Ejactulation
DSM 5 version of premature ejaculation (trick question )
Premature (early) ejaculation
DSM 5 version of male erectile d/o
Erectile d/o
DSM 5 version of Female sexual arousal d/o
Female Sexual Interest/Arousal d/o
DSM 5 version of Hypoactive sexual desire d/o
Male hypoactive sexual desire d/o
Female sexual interest/arousal d/o
S/S of sexual abuse
depression self-mutilation anxiety PTSD fear of intimacy sexual acting out sexual dysfunction
Types of sexual dysfunction d/o/
Lifelong type
Acquired Type
Generalized Type
Situational Type
Dysfunction is present during all sexual situations describes _____
Generalized Type
Pts who struggle w/ sexual dysfunction their whole lives describes _____
Lifelong type
Pts in which nml sexual functioning preceded the d/o describes ____
Acquired Type
Dysfunction is tied to particular situations describes ____
Situational Type
5 Contextual Factors of sexual dysfunction
Partner factors Relationship factors Indiviual vulnerability factors Cultural/Religious factors Medical Factors
Partner Factors include …..
Sexual problems?
Health status?
Relationship Factors include….
Poor communication
Discrepancies in sexual desire
Individual Vulnerability Factors include…. (5)
Poor body image History of sexual or emotional abuse Psychiatric comorbidity or stressors (Depression, anxiety) External stressors such as job loss Bereavement
Cultural/Religious Factors include….
Religious prohibitions
Attitudes and beliefs toward sexuality
Medical Factors include….
Chronic dz
Injury
____ is D/o in which people experience pain/dysfunction in one or more phases of sexual response cycle (excitation, plateau, orgasm, resolution)
Sexual dysfunctions
Sexual dysfunction Affects up to ___ of men and ___ of women at some point in their lives
30% men
50% women
Sexual dysfunction is very distressing, and often lead to ___, ___, ___, and _____
Often these dysfunctions are interrelated; many pts w/ one dysfunction experience _____ as well
sexual frustration, guilt, loss of self-esteem, and interpersonal problems
Another
3 causes of sexual dsyfunction
Biological
Psychological
Sociocultural
Biological causes of sexual dysfunction include: (5)
Hormone interactions/deficiencies Chronic illness Meds/Drugs Vascular problems Genetic predisposition
Psychological causes of sexual dysfunction include: (7)
Anxiety depression anger Other psychological d/o Cultural beliefs attitudes memories
Sociocultural causes of sexual dysfunction include: (3)
Situational pressures: Divorce, death, job stress, infertility, and/or relationship difficulties
Cultural standards can impact the development of these d/o
Trauma of sexual molestation/assault is very likely to produce sexual dysfunction
A person’s sex drive is determined by a combo of ___, ___, ____ factors→ any of these may ↓ sexual desire
biological
psych
sociocultural
Most cases of low sexual desire or sexual aversion are caused primarily by ___ and ___ factors
sociocultural and psychological
Male Hypoactive Sexual Desire D/O is characterized by:
You should be r/o other ___ 1st
Lack of interest in sex and little sexual activity;
DDx
**Physical responses may be normal when sex does occur
Male Hypoactive Sexual Desire D/O is prevalent in ___ % of men
16%
Male Hypoactive Sexual Desire D/O must be present for ____ (time) and must cause ______
6 months
significant distress
Types of Male Hypoactive Sexual Desire D/O include…
Lifelong vs Acquired
Generalized vs Situational
Severity (mild/moderate/severe)
Male Hypoactive Sexual Desire D/O is Often associated w/ ____ concerns
ED/ejaculatory
Female Sexual Interest/Arousal Disorder is Characterized by (5)
Lack of/significantly ↓ sexual interest and thoughts
Absent or ↓ initiation of sexual activity
Absent or ↓ response to erotic cues
Absent or ↓ pleasure in 75% of encounters
Lack of or ↓ vasocongestion and lubrication
Female Sexual Interest/Arousal Disorder Criteria:
Present at least 6 mo, causes significant distress, not better explained by another non-sexual factor (stressors, major depression, drugs, partner violence, DM, thyroid disorder)
Types of Female Sexual Interest/Arousal Disorder
Lifelong vs Acquired
Generalized vs Situational
Severity (mild/moderate/severe)
Female Sexual Interest/Arousal Disorder is frequently associated w/: (3)
lack of orgasm
pain during sex/relationship difficulties
mood disorders
Premature Ejaculation is characterised by ____
Persistent reaching of orgasm and ejaculation w/ little sexual stimulation
___% of men experience rapid (premature) ejaculation at some time
~30%
Premature ejaculation seems to be typical of ___, ___ men or may be related to ___, ____, ____
young, sexually inexperienced men
Anxiety
Hurried masturbation experiences
Poor recognition of arousal
Premature ejaculation Criteria
present for 6 mo
causes significant distress
occurs > 75% of occasions
Not better explained by other dx or reason
Premature ejaculation is graded as:
Mild (____), moderate (____) or severe (____)
** answers are times
30 sec-1 minute
15-30 sec
prior to sexual activity or w/in 15 sec
Premature ejactualtion is Often associated w/ ___
erectile disorder
Delayed Ejaculation is Characterized by:
repeated inability to reach orgasm or by a very delayed orgasm after normal sexual excitement
Delayed Ejaculation Criteria
Duration of 6 months
causes significant distress
not better explained by another dx (MS, DM, CNS & CVD, drugs)
Prevalence of Delayed Ejaculation
uncertain, but <1% of the population has sx >6 mo
Delayed Ejaculation May cause ____and contribute to ____
psychological distress
delayed conception
Female Orgasmic D/O is characterized by
Marked delay or absence of orgasm or significantly ↓ intensity of orgasmic sensations
Female Orgasmic D/O Occurs in __% of encounters
_% of women never experience orgasm in their lifetime
75%
~10%
Female Orgasmic D/O criteria
Present 6 mo
Causes significant distress
Female Orgasmic D/O Prevalence varies from __-___%, depending on ___, ___, ___, and ____
10-42
Age, culture, duration and severity of sx
In the presence of Female Orgasmic D/O you should R/o ___, ___, other factor such as (___)
Do not dx if significant ____/____ factors are present
drugs/substances
non-sexual d/o
partner violence
relationship/context
Genito-Pelvic Pain/Penetration D/O has been described by Previously used terms still seen frequently which include
Vaginismus
Dyspareunia
Vaginismus is:
Involuntary contractions of the muscles of the outer ⅓ of vagina;
Dyspareunia is:
Generic severe pain in genitalia during sexual activity (*superficial vs. deep, immediate or delayed)
Genito-Pelvic Pain/Penetration D/O is only given to (Men/Women)
WOMEN
Genito-Pelvic Pain/Penetration D/O is characterized by ____
Also, ask about type/quality of pain, can it be reproduced during ____
Persistent or recurrent difficulties w/ vaginal penetration
marked pain during attempts/intercourse
marked fear/anxiety about penetration
marked tensing or tightening of pelvic floor muscles
gynecologic exam
Genito-Pelvic Pain/Penetration D/O guidelines:
Present for 6 mo
cause significant distress
not due to a nonsexual mental d/t relationship issues (partner violence) or other stressors, drugs, or medical condition
Evaluate for underlying medical condition such as (6)
Lichen sclerosis PID VVS vulvovaginal atrophy Vaginal infections Cystitis
Genito-Pelvic Pain/Penetration D/O Frequently occurs w/ other ___ (especially lack of desire/interest) and/ or ___
sexual dysfunctions
relationship distress
Vulvar Vestibulitis Syndrome (VVS) Most likely caused by a ___
“neuro-inflammatory” condition
Vulvar Vestibulitis Syndrome (VVS) is characterized by
In more severe cases the pain is present during ___ and ____
“Burning” pain at the opening (vestibule) of the vagina
normal daily activities, as well as during sex
Careful exam for Vulvar Vestibulitis Syndrome (VVS) may reveal ____ and ___ of the tissue at the opening of the vagina
erythema
unusual sensitivity
Vulvar Vestibulitis Syndrome (VVS) Can be tx w/:
estrogen cream, lidocaine application, vestibuloplasty
Significant disturbance in sexual fxn (noted during H&P/labs) develops during intoxication, w/drawal, or after exposure to a med/drug
Substance/Medication Induced Sexual Dysfunction
Substance/Medication Induced Sexual Dysfunction Criteria
Substance or drug can produce these sx
Not better explained by another sexual dysfunction that is not drug-induced or persists >1 mo after cessation
Causes significant distress
Major etiologies of Substance/Medication Induced Sexual Dysfunction (6)
EtOH Opioid Sedative Hypnotic or Anxiolytic Amphetamine Cocaine
Specific classes implicated to cause Substance/Medication Induced Sexual Dysfunction
Antidepressants antipsychotics antihypertensives hormones CV drugs cytotoxic GI
Most cases of Substance/Medication Induced Sexual Dysfunction resolve after ____
discontinuing use
