Human Sexuality – Function and Dysfunction Flashcards
How common is sexual dysfunction?
Roughly 40% of women and 30% of men report some kind of sexual dysfunction.
Most of sexual behavior is __________.
learned
What are Masters’ four phases of sex?
Excitement
Plateau
Orgasm
Resolution
(Helen Kaplan added the desire phase prior to excitement.)
There are no measurable physiologic changes during the ___________ phase.
desire
Disorders of the desire phase are most often due to ___________.
performance anxiety or aversion
What physiologic changes occur during sex in women?
Clitoral engorgement
Vaginal expansion
Uterine elevation
Nipple erection
What causes erection?
Relaxation of the penile arteries and the smooth muscle of the corpus cavernosa (mediated by NO release on endothelium which raises cGMP)
During orgasm, there are rhythmic contractions of the _____________.
perineal muscles
During orgasm, there are about _________ contractions of ejaculatory fluids.
3 to 7
What percent of Americans aged 40 to 80 report that physicians had asked them about sexual concerns?
14%
What questions are important to consider asking in a sexual history?
- Are you in a sexual relationship and how often do you have sexual intercourse?
- For women:
- Do you have pain with intercourse?
- How often do you have an orgasm with intercourse?
• For men:
- Do you have trouble getting or maintaining an erection?
- Do you ever ejaculate earlier or later than you want?
In developing a differential diagnosis for sexual dysfunction, how should you proceed?
- First, try to determine where in the phases of sexual intercourse the problem is occurring.
- Second, look for associated conditions/problems.
Describe the general presentation of sexual aversion disorders.
A person wants to have sex –as evidenced by stated desire or pursuit of sexual things –but when they get into a situation in which they might have sex they shut down.
What things need to be present for an official diagnosis of erectile dysfunction?
- Difficulty maintaining or getting an erection or insufficient rigidity
- Cause distress
- Present for at least six months
- Not explained by another disorder
What is dyspareunia?
Pain with intercourse
Vaginismus is the ______________.
spasming of vaginal muscles with intercourse; it is associated with religiosity or negative attitudes about sex
What four categories of sex therapy are there?
- Sensate focus exercises
- Bibliotherapy
- Marital therapy
- Pharmacotherapy
What is sensate focus?
It is a process of doing defined behaviors to get couples unstuck from the repetitive, stylized behaviors that are problematic.
Bibliotherapy is most successful in ____________.
women having trouble with orgasm
In women with arousal disorder, there is usually ___________________.
a mismatch between what the woman reports and what objective measurements record; for instance, one study showed that many women who watched an erotic video had increased blood flow to their vaginas but reported no arousal
Describe the role of testosterone in sexual dysfunction.
Testosterone supplementation has been shown to cause small improvements in female sexual dysfunction, but the risks do not outweigh the benefits.
One cause of vaginal dryness is _____________.
excessive use of anticongestants
Sexual physiology is not a _______________.
learned behavior
The length of the ____________ phase in men tends to get prolonged with age.
resolution
Low libido is often associated with ______________.
chronic diseases
What four things need to be present for a diagnosis of delayed ejaculation?
- Delayed or absent ejaculation
- Cause distress
- Present for at least six months
- Not explained by another dis
What three categories does the DSM-V recommend in evaluating a sexual disorder?
• Is the problem lifelong or acquired?
•Is the problem generalized or situational?
* Is the patient’s distress mild, moderate, or severe?
Premature ejaculation is usually defined as _____________.
ejaculation within one minute
All of the arousal/interest disorders in females are now lumped into the diagnosis ____________.
female sexual arousal/interest disorder
Which category of drugs has been implicated in female sexual dysfunction?
Anti-epileptics (lamotrigine, gabapentin, and topiramate, to be specific)
Antidepressants (SSRIs, duloxetine and paroxetine especially as well as sertraline and fluoxetine)
Marijuana decreases orgasm and causes painful sex
What recreational substance has been shown to increase the incidence of anorgasmia in women?
Alcohol
Use of PDE5 inhibitors in women has been __________________.
shown to have no improvement on arousal or orgasm
What drug was recently approved for sexual dysfunction in women?
Flibanserin (serotonin receptor agonist)
What is a huge caveat on flibanserin use?
Using flibanserin with even a little alcohol has been shown to cause serious hypotension.
What is the PLISSIT model?
Permission giving ("It's ok to have sex.")
LImited Information (tell them only what they need to know)
Specific Suggestions
Intensive Therapy (e.g., sensate focus)What causes mullerIan regression?
Fetal testis serotoli cells producing mullerian inhibiting substance/anti mullerian hormone
What causes male external genitalia differentiation?
Testosterone is converted to dihydrotestosterone by 5a reductase and DHT causes the differentiation
What is the dual control model?
Inhibition: glutamate, endocannabinoids, and serotonin
Excitation: dopamine, norepi, and melanocortin
The brain is constantly negotiating a balance of factors which inhibit sexual desires and factors that lead to excitation.
Types of sexual dysfunction (3)
Desire disorders
Sexual pain disorders
Orgasm disorders
Desire disorders
Hypoactive sexual desire disorder (HSDD)
Female genital arousal disorder
Sexual pain disorders
Dermatoses (lichen sclerosis, lichen simplex chronicles, erosive lichen plants, infectious vaginitis, vulvar manifestations of systemic disease)
Vestibulodynia
Pelvic floor dysfunction
Orgasm disorders
Persistent genital arousal disorder (PGAD)
Female orgasm disorder
Female orgasmic illness syndrome
What is female genital arousal disorder?
The inability to develop or maintain adequate genital response for (lubrication, genital engorgement, or sensitivity to sexual activity) for greater than 6 months
What is Hypoactive sexual desire disorder
Lack of sexual motivation manifest by:
Decreased spontaneous desire (thought or feelings)
Decreased response to erotic cues and stimulation
Loss of desire to initiate or participate in sexual activity, including avoiding situations that could lead to sexual arousal combined with distress, frustration etc
What is persistent genital arousal disorder?
Persistent or recurrent unwanted and intrusive distressing feelings of genital arousal or being on the verge of orgasm not associated with concomitant sexual interests, thoughts, or fantasies for greater than 6 months.
How to diagnose persistent genital arousal disorder, and what is the treatment?
Diagnosis lumbar spine mri
Treatment: pudendal nerve block, surgical decompression or the spinal nerve root
What is female orgasm disorder?
Persistent or recurrent distressing compromise of orgasm frequency, intensity, timing, and/or pleasure associated with sexual activity for greater than 6 months.
What is female orgasmic illness syndrome
Peripheral or central aversive symptoms that occur before during or after orgasm (migraines, pain, nausea)
