Human Sexuality: Function and Dysfunction Flashcards
1
Q
Phases of Sexual Response Cycle
A
- Desire (Phase I): circumstance-dependent
- Excitement (Phase II): first amount of measurable physiologic responses
- Plateau Phase (Phase III): Physiology remains unchanged for some time
- Orgasm Phase (Phase IV): Involuntary contractions, EEG changes
- Resolution Phase (Phase V): Obligatory or non-obligatory physiologic changes to baseline
2
Q
Components of desire phase
A
- Desire for intercourse is a primary desire like that for food, water, or air.
- Some degree of sexual desire is always present.
- Like all appetites, sexual desire can be whetted or inhibited by circumstances.
- Sexual desire is not lust
3
Q
Physiologic components of excitement phase
A
- Vasocongestion of the pelvis
- ↑ heart rate and respiration.
- Skin “mottling” + warmth from increased blood flow to the skin
- Nipple erection occurs in both sexes.
- male: penile erection
- female: vaginal lubrication and expansion
4
Q
Major mechanism of penile erection (excitment phase)
A
- caused by distension of the corpus callosum with blood
- parasympathetic nervous system
- Scrotal shortening occurs late in the excitement phase
5
Q
Major mechanism of vaginal lubrication/increase in clitoral size (excitement phase)
A
- vaginal lubrication and expansion both result from increased blood flow to the pelvis.
- Clitoral vasocongestion leads to increase in clitoral size.
- Vaginal lubrication results from direct transudation across the vaginal wall and not from secretion of any glands
6
Q
Physiologic components of plateau phase
A
- more advanced stage of arousal.
- Physiology remains unchanged for some time with no further increase in heart rate and respiration, and no blood flow shifts.
7
Q
Physiologic components of orgasm phase
A
- Accompanied by a series of rhythmic contractions of the perineal muscles occurring every 0.8 seconds.
- In the male it is accompanied by 3 to 7 ejaculatory spurts of seminal fluid.
- In the female it is accompanied by elevation of the “orgasmic platform.”
- In both sexes there are involuntary contractions of skeletal muscles and EEG changes.
8
Q
Physiologic components of resolution phase
A
- males: orgasm is followed by an obligatory resolution phase
- physiologic changes return to baseline & further stimulation cannot produce excitement
- length of the resolution phase varies with age
- In females, resolution is not always obligatory—women may have repeated orgasm without resolution to a basal state, but some women do have an obligatory resolution phase.
9
Q
Approach to tx of sexual dysfxn
A
- Accept the patient’s problem as real
- Assure patient that others have the problem
- Assure patient that there is therapy available
- Address anxiety
- Address anger
10
Q
Tx paradigms for sexual dysfxn
A
- Most sexual dysfunctions are due to performance anxiety
- Anxiety, pain, and anger interfere with sexual function
- The same underlying issue may exhibit at different points in the sexual response cycle and may manifest as different disorders
11
Q
Types of treatments for sexual dysfxn
A
- sensate focus exercises
- marital therapy
- bibliotherapy
- pharmacotherapy
- vaginismus
12
Q
Characteristics of sensate focus excerises
A
- A series of defined behaviors and exercises; whole goal is to break the script
- Focus on sensations and emotions
- engage w/senses and associated emtiones
- Training methods
- Typically 12 - 16 visits
- Involves behavioral modification
- Involves marital therapy
13
Q
Characteristics of marital therapy and bibliotherapy
A
- Marital therapy - usually a part of sex therapy
- Bibliotherapy - give patient something to read
- Most successful in female orgasmic dysfunction
14
Q
Pharmacotherapy tx for sexual dysfxn
A
- PDE5 inhibitors = males for ED dysfxn
- ↑ cGMP; add sexual stimulation and local release of NO
- Estrogen
- High association of sexual dysfunction and ↓ E2 levels in women
- Testoterone
- Transdermal testosterone has small effect on ↑ sexual desire
- Not FDA approved
15
Q
Antidepressants and sexual dysfxn
A
- SSRIs ==> treatment emergent dysfunction
- Bupropion can improve hypoactive sexual desire associated with SSRI
- Generally helps women, can improve desire and orgasm, but which women is unclear
- Also not sure if just treating depression is what is fixing the problem