Human sexuality Flashcards
What are some of the legal issues associated with female transgenders?
there is a real lack of funding for transgenders - no or lack of funding from CCGs
They can end up in male prisons and this ends up leading to many cases of suicide
What did the government recommend in terms of sexuality?
Recommended for GPs to continually ask patients about their sexuality- this can be very challenging in such a short consultation
Pyschiatrists tend to take sexual histories, and generally ask by starting with a very open question such as “are you in a relationship?”
What is the difference between sex and gender?
Sex: is biologically determined e.g. genetic makeup and productive anatomy and biological function
Gender: is the social interpretation of sex
The two usually correspond but NOT always = transexualism
Define gender role:
behaviours, attitudes, values, beliefs which society expects / considers appropriate to males/females
Define gender stereotypes:
widely held beliefs about psychological diffs between males/females
Define sex typing:
process by which children acquire sex/gender identity and learn gender appropriate behaviours
What are the multidimensional factors involved in sex?
chromosomal sex gonadal sex hormonal sex sex of the internal reproductive structures sex of the external genitals = usually correlate
What is intersexuality?
low correlation of categories of biological sex
- “true hermaphroditism” - most cases consist of genital ambiguity (genitals not consistent with chromosoma/gonadal sex)
- can influence gender identity
What are the different types of intersexuality?
Androgen insensitivity syndrome: male develops female external appearance due to insensitivity to androgens
Androgenital syndrome: female develops male external appearance due to prenatal exposure to high levels of androgens
DHT deficient males: males develop female external appearance due to deficiency in alpha reductase (inborn error in metabolism)
- more common in South America
- as it is more common out there, they are treated differently being more accepted than other places in the world
Chromosomal abnormalities: can lead to abnormal sexual phenotypes and hypogonadism
What are some examples of chromosomal abnormality conditions?
Turners syndrome (XO)
- short stature, swollen hands/feet, webbed neck
- infertility, amenorrhoea, absent/incomplete pubertal development
Klinefelter (XXY) syndrome
- Gynaecomastia, small testes, less hair, infertility
- tall with abnormal body proportions (long legs, short trunk, shoulder equal to hip size)
What was the original theory about people with XYY chromosomal abnormalities ?
Original theory was that people with XYY were overrepresented in prison - have more testosterone, bigger, more aggressive due to increased testosterone - but further experiments have disproven it
What is the biological theory around gender development?
Males and females are “biologically programmed” for different roles - supported by evidence of structural and functional differences in male and female brains
- empathising -systemising theory = women more caring/empathetic while men are more systematic
What is the feminist theory?
emerged from feminist political movements
- in late 20th century, feminists began to argue that gender is socially constructed - women felt “imprisoned” by their role and should be liberated
What is the sociobiological theory?
Gender evolved so we can adapt to our environment
Parental investment theory= investment in a child to increase their chances of survival is at the expense of the parent’s ability to invest in other offspring- historically maternal investment >paternal
What is the social learning theory?
Learn behaviour through being treated differently
Observational leanring and reinforcement
What is Freud’s psychoanalytic theory?
Rooted in phallic stage of psychosexual development
What is the cognitive development theory?
Children’s discovery that they are males / female causes them to identify with and imitate same sex models:
- gender labelling (age 3)
- gender stability (age 4-5)
- gender constancy (age 6-7)
What is gender schematic processing theory?
Gender identity alone can provide a child with sufficient motivation to assume sex-types behaviour
What is cultural relativism?
Gender is socially constructed
Enormous cultural diversity of males and female roles
e.g. more than one gender type in some native American cultures, social dominance of females in woodaabe Africas
What is transsexualism?
Convinced they are gender opposite to their chromosomal sex
Listed as psychiatric disorder - but in the future that is likely to change
More common in those born males
Cross dressing is NOT for sexual arousal
Different brain structures??
In real life you need to check for any other conflicting psychiatric disorders to ensure it is real before referring to surgery
What is transvestism?
Wears clothes of opposite sex but not for sexual excitement nor are transexuals
Enjoy cross dressing to gain temporary membership of opposite sex
Not necessarily related to sexual orientation
What are the determinants for sexual orientation?
Determinants unknown but suggested:
- genes, hormones, neuroanatomy, psychological factors, social learning, likely to be a combination
When was homosexuality decriminalised ?
WHO ICD listed it as a mental disorder in 1977
Only decriminalised in UK in 1967
What is paraphiliac?
Sexual urges directed to non-human objects, suffering/humiliation of oneself or partner, towards others incapable of giving consent
- fetisism
- exhibitionalism
- voyerism
- sadomasochism
- paedophilia
Are paraphilias mental disorders?
- classified as mental disorders in ICD-10
- No longer excluded from the mental health act - amended in 2007 - originally you couldn’t detain someone for their sexual behaviours
When do paraphilias tend to start and why?
Adolescence
- early conditioning
- social learning
- addiction model
- Genes
- structural brain abnormalities
What techniques can be used to manage a person with paraphilias?
- aversive conditioning
- reconditioning techniques
- cognitive techniques
- psychotropic medications e.g. SSRIs
- Hormonal treatments e.g MPA, cytoproterone acetate==
- castration and neurosurgery controversial and unethical
- studies looking at efficacy are flawed
What are the key types of sexual disorders?
Problems of desire
Problems of arousal
Problems of orgasm
- combinations of problems commonly occur
Psychiatrists can listen to patients and try to decipher what exactly the problem is and generally it is relatively easy to put interventions in to help them
What comes under problems with desire?
Lack or loss of desire
- common
- age, hormones, medical/psychiatric disorders, medication
Sexual aversion
- rare
- more common in people who have suffered sexual abuse
Lack of sexual enjoyment
What comes under problems of arousal in women?
lack of subjective excitement as well as adequate physiological response Could be due to: - psychological (anxiety) - pathological (infections) - oestrogen deficiency (post-menopause)
What comes under problems of arousal in men?
Erectile dysfunction Lifelong or acquired general or situation Relatively uncommon increases with age organic and psychological aetiology Viagra has changed treatment
What are the problems with orgasm in women?
Common - 15% premenopausal and 35% postmenopausal
Physical, psychological
What are the problems with orgasm in men?
Inhibited orgasm Ejaculatory pain Premature ejaculation - common - esp in young males - stop-start-squeeze technique
What is non-organic vaginismus?
Involuntary muscle spasms
Sexual abuse, relationship difficulties
Relaxation techniques, gradual vaginal dilatation procedures
What is non-organic dyspareunia?
Pain during sexual activity
What are the general principles of management for a patient with a sexual disorder?
Thorough history and physical examination to establish cause
Focussing on treating sexual problem, simple advice, counselling, education may be all that is required
PLISSITmodel - permission, limited info, specific suggestion, intensive therapy
What happens if the sexual disorder is secondary ?
couple therapy
sex therapy
physical treatment
What does sex therapy entail?
Partners treated together
Helped to communicate better about their sexual relationship
Education about anatomy/physiology of sexual intercourse
“Graded tasks”- increasing intimate exercise concentrating only on “sensate focus” at first
How effective is sex therapy?
Long term follow up is challenging
50-70% of couples report substantial benefits
Depends on condition being treated
What are the key points when asking about sensitive subjects?
- need to know whole history
- be empathetic and non-judgemental
- pre-empt the individuals embarrassment
- measure that sexual dysfunction is common
- Discuss in plain, clear, specific terms
- start with open question
- never assume anything
