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Psych Week 3 > ICL 10.4: Human Sexuality > Flashcards

ICL 10.4: Human Sexuality Flashcards

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1
Q

what is sexual identity?

A

the person’s biological characteristics

the body structures and hormones that identify the person as male or female

the natal gender

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2
Q

what is gender identity and expression?

A

the person’s sense of being male or female

what a person says or does to disclose himself or herself as having the status of man or woman

the lived role or lived gender

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3
Q

what is sexual orientation?

A

the object of the person’s sexual impulses

it can be the opposite sex, same sex or both sexes

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4
Q

what is sexual behavior?

A

physiological responses and behaviors related to expression of sexual feelings in males and females

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5
Q

how does gender develop throughout life?

A

gender identity begins at 18 months and is often fixed by 24 to 30 months

gender labeling and identity: usually achieved by 3 years

gender stability: 4-5 yrs: girl says she will be a mom when she grows up; boy says he will be a dad

gender constancy: 7 yrs: the child is aware that gender remains the same in different types of clothing

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6
Q

which psychological factors can impact sexual health?

A
  1. thoughts

distracted by thoughts or fantasy unrelated to sex during sexual activity, critically monitoring one’s own sexual behavior, feelings or anxiety about possible inadequate “performance”, work or other life stressors, body image issues

  1. behaviors

inadequate or miscommunication with partner regarding sex due to cultural norms, typical gender roles, fear of being shamed, etc.

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7
Q

what is sexual anxiety?

A
  1. person reports persistent or recurrent extreme aversion to, and avoidance of all (or almost all) genital sexual contact with a partner
  2. person fears physical contact
  3. person is disgusted by sexual contact
  4. person recalls terrifying sexual experiences

sexual anxiety is different than typical anxiety!!

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8
Q

what is sexual dysfunction?

A

a disturbance in the processes that characterize the sexual response cycle:

excitement –> plateau –> orgasm –> resolution

or

pain associated with sexual intercourse

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9
Q

what is the sexual response cycle?

A

excitement –> plateau –> orgasm –> resolution

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10
Q

what are the 4 categories of sexual dysfunction?

A
  1. desire disorders = lack of sexual desire or interest in sex
  2. arousal disorders = inability to become physically aroused or excited during sexual activity
  3. orgasm disorders = delay or absence of orgasm (climax)
  4. pain disorders = pain during intercourse
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11
Q

what conditions are commonly comorbid with sexual disorders?

A
  1. substance abuse/dependence
  2. mood disorders (MDD)
  3. anxiety disorders
  4. impulse control disorders; engaging in risky behaviors

kind of like the chicken and the egg, we don’t know if the sexual disorder or other disorder came first

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12
Q

how do we talk to patients about sex?

A
  1. “i’m going to ask you a few questions about your sexual health. since sexual health is very important to overall health, I ask ALL my adult patients these questions. before i begin, do you have any questions or sexual concerns you’d like to discuss?” –> this helps create an open dialogue and lets the know they’re not being singled out
  2. “have you been sexual active in the last year?”
  3. if yes: do you have sex with men, women or both? in the past 12 months, how many sexual partners have you had?

if no: have you ever been sexually active? –> if yes: have you had sex with men, women or both? how many sexual partners have you had? –> if no: continue with medical history

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13
Q

if someone has a sexual concern, what do you do next?

A
  1. ask about onset: lifelong/acquired
  2. ask about context: generalized/situational
  3. medical evaluation; is the issue the patient having a physical problem , psychological or both?
  4. expectations and goals of treatment

what does the person want/expect? make sure they have realistic expectations of what improvements can be made

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14
Q

what is the PLISSIT model?

A

it’s a model for addressing sexual functioning with patients

  1. permission**

giving patients permission to raise sexual issues; enabling them and giving them the opportunity to talk with you! “Is there anything about your sexual health you’d like to discuss?”

  1. limited information

giving patients limited information about sexual side effects of treatments; lets you brainstorm and further explore with a streamline approach instead of overwhelming them with information

  1. specific suggestions

making specific suggestions after doing a full evaluation of presenting problems –> let the patient know that this is just an initial conversation and it may be a while before the perfect treatment that solves their problem is found

  1. intensive therapy

if needed, referral to intensive therapy including psychological interventions, sex therapy, pelvic floor specialist, and/or biomedical approaches

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15
Q

which sexual dysfunctions are listed in the DSM5?

A
  1. delayed ejaculation
  2. erectile disorder
  3. female sexual interest/arousal disorder
  4. genito-pelvic pain/penetration disorder
  5. male hypoactive sexual desire disorder
  6. premature (early) ejaculation
  7. substance/medication-induced sexual dysfunction
  8. other specified or unspecified sexual dysfunction
  9. gender dysphoria
  10. female orgasmic disorder
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16
Q

which sexual dysfunctions are female specific?

A
  1. female orgasmic disorder
  2. female sexual interest/arousal disorder
  3. genito-pelvic pain/penetration disorder
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17
Q

what is the DSM5 criteria for female orgasmic disorder?

A

A. presence of the following symptoms experienced at least 75% of sexual activity:
delayed or infrequent orgasm; reduced intensity of orgasm

B. these symptoms have occurred for at least six months

C. these symptoms cause distress in the person

D. the dysfunction is not better explained by other nonsexual disorder, stressors, or medication

must specify how long it’s been present, if it’s generalized or situational, if orgasm has never been achieved, and current severity.

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18
Q

what is the prevalence of female orgasmic disorder?

A

range from 10-42% depending on various factors

approximately 10% of women never experience orgasm in their lifetime

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19
Q

how do you treat female orgasmic disorder?

A
  1. educate

explore characteristics of good sex with this partners; what’s different now if this is a newer issue? (e.g. alcohol, new baby, job loss, grief)

  1. suggestions based on specific problems
  2. practice self-stimulation to arousal if they’re never experienced orgasm so they can learn what works for them so they can tell their partners

referral likely necessary

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20
Q

what is the DSM5 criteria for female sexual interest/arousal disorder?

A

A. lack of or reduced sexual interest/arousal with at least 3 of the following:

  1. absent/reduced interest in sexual activity
  2. absent/reduced sexual/erotic thoughts or fantasies
  3. no/reduced initiation of sexual activity, and typically unreceptive to partner’s advances
  4. absent/reduced sexual excitement/pleasure in ≥75% of sexual encounters
  5. absent/reduced sexual excitement/pleasure in response to any internal or external sexual/erotic cues
  6. absent/reduced genital or non-genital sensations during sexual activity in ≥75% of sexual encounters

B. these symptoms have occurred for at least six months

C. these symptoms cause distress in the person

D. the dysfunction is not better explained by other nonsexual disorder, stressors, or medication

must specify how long it’s been present, if it’s generalized or situational, if orgasm has never been achieved, and current severity

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21
Q

what is the DSM5 criteria for genito-eplvic pain/penetration disorder?

A

A. persistent difficulties with at least one of the following:

  1. vaginal penetration during intercourse
  2. vulvovaginal or pelvic pain during intercourse or penetration
  3. fear or anxiety related to vulvovaginal or pelvic pain
  4. marked tensing or tightening of the pelvic floor muscles during attempted penetration

B. these symptoms have occurred for at least six months

C. these symptoms cause distress in the person

D. the dysfunction is not better explained by other nonsexual disorder, stressors, or medication

must specify how long it’s been present and current severity.

22
Q

what is genito-pelvic pain/penetration disorder?

A

recurrent or persistent genital pain associated with sexual intercourse without physical findings

recurrent or persistent involuntary spasm of the musculature of the vagina that interferes with sexual intercourse

23
Q

what is the cycle that occurs with genito-pelvic penetration disorder?

A

someone who is anticipating sex will get anxious because of fear of pain and if they engage in sex and experience pain which can cause spasms and they don’t enjoy sex which then leads to further anxiety

anxiety –> pain –> spasm –> no enjoyment –> further anxiety

so it’s important to try and break the cycle when treating this disorder

24
Q

how do you treat genito-pelvic penetration disorder?

A
  1. educate

explain physiological interference in simple terms; explore interference caused by anxiety

  1. specific suggestions

use vaginal lubricants; use vaginal dilators, implement relaxation techniques

overtime these will expand the vaginal canal and getting used to the feeling of being penetrated

25
Q

which sexual dysfunctions are male specific?

A
  1. delayed ejaculation
  2. erectile disorder
  3. male hypoactive sexual desire disorder
  4. premature (early) ejaculation
26
Q

what is the DSM5 criteria for delayed ejaculation?

A

A. either symptom experienced at least 75% of sexual activity without the person desiring delay of ejaculation:

  1. marked delay in ejaculation; it’s taking them longer or they’re unable to at all
  2. marked infrequency or absence of ejaculation

B. hese symptoms have occurred for at least six months

C. these symptoms cause distress in the person

D. the dysfunction is not better explained by other nonsexual disorder, stressors, or medication

Must specify how long it’s been present, if it’s generalized or situational, and current severity.

27
Q

how prevalent is delayed ejaculation disorder?

A

unclear; however, is the least common male sexual complaint;75% of men report that they always ejaculate during sexual activity.

less than 1% report this issue lasting more than six months

so this isn’t one that you’re going to see frequently

28
Q

what is the DSM5 criteria for erectile disorder?

A

A. at least one of the following symptoms experienced at least 75% of sexual activity:

  1. marked difficulty in obtaining an erection during sexual activity
  2. marked difficulty in maintaining an erection until completion of sexual activity
  3. marked decrease in erectile rigidity

B. these symptoms have occurred for at least six months

C. these symptoms cause distress in the person

D. the dysfunction is not better explained by other nonsexual disorder, stressors, or medication

must specify how long it’s been present, if it’s generalized or situational, and current severity

29
Q

how prevalent is erectile disorder?

A

strong age-related correlation, especially after age 50

men ages 40-80 years: ~13-21% report occasional erectile problems

<40 years: ~2%

60-70 years: ~40-50%

about ~8% of men experienced erectile dysfunction their first sexual penetration.

30
Q

how do you treat erectile disorder?

A
  1. evaluate for medical cause
  2. educate

explain physiology of arousal and interference caused by psychological factors, particularly anxiety

  1. drug treatment = viagra (sildenafil)
  2. reduce distractions, decrease anxiety, monitor alcohol use
31
Q

what is the DSM5 criteria for male hypoactive sexual desire disorder?

A

A. persistent deficient or absent sexual/erotic thoughts, fantasy, and/or desire as determined by clinical judgment

B. these symptoms have occurred for at least six months

C. these symptoms cause distress in the person

D. the dysfunction is not better explained by other nonsexual disorder, stressors, or medication

must specify how long it’s been present, if it’s generalized or situational, and current severity.

32
Q

how prevalent is male hypoactive sexual desire disorder?

A

men ages 18-24 years: ~6% report problems with desire

men ages 66-74: 41% report problems with desire

less than 2% (1.8) of men ages 16-44 report issue lasting > 6 months

33
Q

what is the DSM5 criteria for early ejaculation disorder?

A

A. persistent or reoccurring pattern of ejaculation before the individual wishes it (e.g. one minute following vaginal penetration)

B. these symptoms have occurred for at least six months and experienced during at least 75% of all sexual activities

C. these symptoms cause distress in the person

D. the dysfunction is not better explained by other nonsexual disorder, stressors, or medication

must specify how long it’s been present, if it’s generalized or situational, and current severity

34
Q

how prevalent is early ejaculation disorder?

A

20-30% of men ages 18-70 report concern about early ejaculation

with the “one-minute” rule, only 1-3% of men will likely fit this disorder’s definition

prevalence likely increases with age

35
Q

how do you treat early ejaculation disorder?

A
  1. education

explain conditioned response to fear of disclosure, effect of anxiety

  1. SSRIs because one of their side effects id a day in ejaculation
  2. practice control of arousal; learn to tolerate higher levels of arousal without ejaculating
36
Q

what is gender dysphoria?

A

it involves a conflict between a person’s physical or assigned gender and the gender with which he/she/they identify

in adolescents and adults gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning

these individuals often experience extreme distress related to their gender –> this is not the same as being gender nonconforming, and is not the same as being gay or lesbian

the DSM5 provides for one overarching diagnosis of gender dysphoria with separate specific criteria for children and for adolescents and adults

37
Q

what is the DSM5 criteria for gender dysphoria in adults and adolescents?

A

in adolescents and adults gender dysphoria diagnosis involves a difference between one’s experienced/expressed gender and assigned gender, and significant distress or problems functioning

it lasts at least six months and is shown by at least 2 of the following:

  1. a marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics
  2. a strong desire to be rid of one’s primary and/or secondary sex characteristics
  3. a strong desire for the primary and/or secondary sex characteristics of the other gender
  4. a strong desire to be of the other gender
  5. a strong desire to be treated as the other gender
  6. a strong conviction that one has the typical feelings and reactions of the other gender
38
Q

what is the DSM5 criteria for gender dysphoria in children?

A

in children, gender dysphoria diagnosis involves at least 6 of the following and an associated significant distress or impairment in function, lasting at least six months.

  1. a strong desire to be of the other gender or an insistence that one is the other gender
  2. a strong preference for wearing clothes typical of the opposite gender
  3. a strong preference for cross-gender roles in make-believe play or fantasy play
  4. a strong preference for the toys, games or activities stereotypically used or engaged in by the other gender
  5. a strong preference for playmates of the other gender
  6. a strong rejection of toys, games and activities typical of one’s assigned gender
  7. a strong dislike of one’s sexual anatomy
  8. a strong desire for the physical sex characteristics that match one’s experienced gender
39
Q

how do you treat gender dysphoria?

A
  1. counseling
  2. hormonal therapy
  3. puberty suppression
  4. gender reaffirming/gender confirmation surgery; formerly called “gender reassignment”
  5. among children, treatment typically involves a multidisciplinary approach.

therapy may focus on psychological support, coping with distress, and providing a safe place to talk about feelings

40
Q

what is the genderbread person?

A
  1. identity = brain
    womanless/menness
  2. attraction = heart
  3. sex = genitalia
    female/male
  4. expression = behavior
41
Q

what is transgender?

A

when someone identity differs from their natal sex

42
Q

what is transitioning?

A

altering one’s birth sex

43
Q

what is gender nonconforming?

A

person does not conform to usual appearance and behavior of natal sex

44
Q

what is gender queer?

A

gender identities that are no exclusively masculine or feminine

‌identities whichareoutside the genderbinary

45
Q

what happens when there’s a mismatch of natal gender and lived gender in children?

A
  1. desire to be the other gender
  2. takes other sex roles in play
  3. prefers same sex playmates
  4. dislike of own or adult anatomy
46
Q

what happens when there’s a mismatch of natal gender and lived gender in adolescents and adults?

A
  1. cross-dressing (not for arousal)
  2. conviction of being the other sex
  3. desire to be treated as the other sex, seeks name change and dresses like the other sex
  4. may wish to become the other sex (requests for surgery, hormones)
47
Q

how can a mismatch of natal gender and lived gender effect stress?

A

there’s a higher risk for distress: confusion, social stigma, isolation, peer pressure, deviation from social norms, family conflict, religious conflict

in distress LGBT persons cope adaptively by resilience, support from others

maladaptive coping includes ambivalence and self destructive behaviors, eating disorders and suicide attempts or tragically completed suicide

48
Q

what is the mental health os sexual minority vs. heterosexual medical students?

A

study of 4000 students; 5% sexual minority

sexual minority students reported more social stressors and isolation.

sexual minority students had greater risk of depressive, anxious symptoms and low self-rated health

49
Q

what is the treatment for dysphoria?

A
  1. medication management
  2. psychotherapy
  3. support groups
50
Q

what is the treatment for a transgender person?

A
  1. appropriate and accurate diagnosis by a mental health provider. Requires team approach, with psychiatrist, psychologist, plastic surgeons, endocrinologists.
  2. physical transition and social transitioning
  3. speech therapy usually required to help male to female persons raise their pitch and modulate their tone

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