Lecture 3: Human Sexuality Flashcards
What is included in sexuality?
Capacity for sexual feeling
Sexual orientation, identity, and preference
Traditionally includes perception of gender status
What defines biologic gender?
External genitalia OR chromosomes.
What do AFAB and AMAB mean?
Assigned female at birth
Assigned male at birth
What is intersex?
An individual with features of both male and female.
EX: A genetic male without any external male genitalia.
What do we all start out as anatomically?
Female
What is the differentiating factor at birth that allows some of us to become male?
Fetal androgens
What is gender identity?
Psychological aspects of behavior.
It is not always congruent with biological gender.
What is sexual identity?
How one thinks of oneself in terms of whom one is romantically or sexually attracted to.
EX: straight, lesbian, queer, bi, etc.
Does not have to align with biological gender, or sexual orientation.
What is sexual orientation?
The object of a person’s sexual impulses or attractions.
AKA
Heterosexual, homosexual, bisexual, etc…
What is sexual behavior?
True psychophysiological experience.
Specific actions and behaviors involving sexual activities.
Not always consistent with identity or orientation.
What is gender expression?
How one present’s one gender to another.
What is gender discordance/dysphoria?
Discrepancy between assigned gender and gender identity.
What is a transsexual?
Gender discordant people who make changes to their perceived gender/anatomic sex to match their identity. (e.g. dressing, grooming, hormones, surgery)
What is a cisgender?
Alignment of gender identity, expression, and biological sex.
What are the significant health risks to keep in mind regarding the LGBTQIA+ community?
Mental health
CV disease and obesity (women)
Poor physical health and loneliness (men)
Harassment (verbal/physical)
What are some common barriers the LGBTQIA+ community faces regarding care?
Lack of disclosure to providers
Lack of income for healthcare
Fear
Denial
What are the 4 phases of sexual response?
Desire/libido
Excitement and arousal
Orgasm
Resolution
What characterizes phase 1 of the sexual response?
Desire/Libido
Sexual fantasies and desire to have sexual activity.
What characterizes phase 2 of the sexual response?
Excitement and arousal
Psychological or physiological stimulation or both.
Subjective sense of pleasure.
What characterizes phase 3 of the sexual response?
Orgasm
Peaking of sexual pleasure, release, contraction of perineal muscles and pelvic organs.
Increased BP, RR, and HR.
What characterizes phase 4 of the sexual response?
Resolution
Disgorgement of blood from genitalia (detumescence), subjective sense of well-being and relaxation.
Lack of orgasm may cause extended resolution and irritability/discomfort.
What period occurs between phase 3 and 4 of the sexual response?
Refractory period.
What hormones are excitatory in the sexual response?
Dopamine
Testosterone (Both)
Estrogen (women)
What hormones are inhibitory in the sexual response?
Serotonin (increased levels = decreased desire)
Progesterone (increased levels = decreased desire)
What primarily drives male and female sexual desire?
Men = physical stimuli
Women = psychologic stimuli
What disorders are in regards to desire?
Hypoactive sexual desire disorder
Sexual aversion disorder
What disorders are in regards to excitement?
Female sexual arousal disorder
Male erectile disorder
What disorders are in regards to orgasm?
Orgasmic disorder
Premature ejaculation
What disorders are in regards to resolution?
Postcoital dysphoria
Postcoital headache
What does sexual desire depend on factor-wise?
Biological drive
Adequate self-esteem
Ability to accept oneself as a good person
Previous good sexual experiences
Availability in partner
Relationship in non-sexual areas with partner
What is hypoactive sexual desire disorder?
Deficiency/absence of sexual fantasies.
LACK of desire of any sexual activity.
More common in females.
What is sexual aversion disorder?
Aversion/avoidance of gential sexual contact.
How are sexual desire disorders treated?
CBT, sexual therapy, couples therapy.
Dopamine agonists (Limited data)
Serotonergic drugs (Addyi)
Melanocortin agonists (Vyleesi)
Testosterone + estrogen
What is female sexual arousal disorder?
Dysfunction with lubrication-swelling response until orgasm.
Essentially, difficulty maintaining sexual excitement or attaining it.
How is female sexual arousal disorder treated?
Therapy referral
Testosterone (transdermal, only 10% of the dose men take)
Wellbutrin (if associated with SSRI)
Viagra (Select groups only)
What is male erectile disorder?
ED/impotence.
10-20% of all men have it and is the primary complaint of men being treated for sexual disorders.
Increases in prevalence due to age.
What helps prevent ED?
Available sex partner
History of consistent sexual activity
Absence of vascular disease
What suggests that ED is more psychological than physiological?
If erections do occur sometimes, it is most likely psychological.
What is female orgasmic disorder?
Inhibited female orgasm/anorgasmia
High prevalence (30-35%)
Recurrent or persistent inhibition of female orgasm as manifested by the recurrent delay, or absence of, orgasm after a normal sexual excitement phase as judged by a clinician.
AKA lack of consistent orgasm in females.
What are some physiological factors that may contribute to female orgasmic disorder?
Endometriosis, pelvic floor dysfunction, pelvic organ prolapse, uterine fibroids
Childbirth or miscarriage/abortion
Atrophy of genital tissues
Insufficient stimulation of the clitoris
What are some treatment options for female orgasmic disorder?
Vacuum-pump device for clitoris
OFF-LABEL USE: viagra
OTC lubricants
Changing up sex: manual stimulation, alternate positions, controlling depth/force of penetration
What is male orgasmic disorder?
Inhibited orgasm/delayed ejaculation
5% prevalence
Takes a long time to ejaculate and orgasm.
What does lifelong male orgasmic disorder suggest?
Severe psychopathology:
Rigid, puritanical background
Unconscious guilts
History of abuse
How is male orgasmic disorder treated?
Therapy, dopamine agonists (experimental)
What is premature ejaculation defined as?
Male: Before he wishes to
Couples: Before the other person is satisfied enough
When is premature ejaculation usually diagnosed?
Consistent ejaculation before or immediately after entering partner.
What is the second most common CC in men with sexual disorders?
Premature ejaculation.
What technique may help with premature ejaculation?
Squeezing the coronal ridge of the glans.
What pharmacotherapy may help with premature ejaculation?
SSRI
What is dyspareunia?
Persistent/recurrent genital pain before/during/after intercourse.
What gender is dyspareunia more common in?
Females
What commonly occurs with dyspareunia?
Vaginismus
What is vaginismus?
Involuntary muscle constriction of the outer 1/3 of the vagina
Who is vaginismus most common in?
Highly educated women
High socioeconomic groupas
What is dilation?
Opening the vaginal opening with pt’s fingers or with dilators or going to physical therapy.
Helps with vaginismus
What are the common medical causes of ED?
CVD
DM
Neurologic disease
Surgical procedures
How is ED diagnosed?
Lab studies: BG, A1c, hormone assays, liver, thyroid, lipids
Noctural penile tumescence
Doppler of pudendal artery
What disease causes dyspareunia in men?
Peyronie’s disease
Abnormal fibrous penile tissue
What psych medication classes are known for affecting sexual function?
Antipsychotics (decrease dopamine)
Antidepressants (increase serotonin)
Antianxiety (can improve if inhibited by anxiety, but also increases serotonin)
What general medications are known for affecting sexual function?
Anticholinergics (Dry mucous membranes and impotence)
Antihistamines
What hormonal medications are known for affecting sexual function?
Contraceptives (Abnormal levels of estrogen, progesterone, and LH)
Anti-androgen therapy (lower testosterone)
AKA spironolactone, or OCPs.
According to the DSM-V-TR, what is the criteria to be diagnosed with a sexual disorder?
Disorder must be experienced at least 75% of the time.
6 month duration
Significant distress due to disorder
No other factor that better explains symptoms
What falls under sexual interest/arousal disorder?
Female hypoactive desire dysfunction
Female arousal dysfunction
What disorder is not included in the DSM-V?
Sexual aversion disorder
What falls under genitopelvic pain/penetration disorder?
Dyspareunia and vaginismus
What is persistent genital arousal disorder?
A defect in sensory nerves
How is persistent genital arousal disorder treated?
SSRIs, psychotherapy, topical or injected anesthetic agents
What are the therapy options for sexual disorders?
Dual-sex therapy
Behavior therapy
Group therapy
Analytically oriented sex therapy
What are paraphilias?
Way too much love.
Recurrent, intense, sexually arousing fantasies, urges, or behaviors involving one or more of the following:
Nonhuman objects
Suffering/humiliation of oneself/partner
Children/nonconsenting parties
6 months+
What is exhibitionism (Paraphilia)?
Achievement of arousal by exposing genitalia to strangers, usually a childhood behavior carried into adult life.
Masturbation replaces actual sexual activity.
What is tranvestism (Paraphilia)?
Recurrent cross-dressing in a HETEROSEXUAL MALE.
Not a part of homosexuality or transsexuality.
What is voyeurism (Paraphilia)?
Attaining arousal watching an unsuspecting person or people.
Usually the person is doing something sexual or naked.
Masturbation replaces actual sexual activity.
What is pedophilia (Paraphilia)?
Use of a child to achieve sexual arousal and often gratification.
Contact is frequently oral, but includes any sexual contact.
More common with men.
What is incest (Paraphilia)?
Sexual relationship with a person, usually a child, in IMMEDIATE family.
Usually prevented by cultural norms.
What is sexual sadism (Paraphilia)?
Inflicting pain upon the sexual object as a means of arousal.
What is sexual masochism (Paraphilia)?
Erotic pleasure being achieved by being humiliated, enslaved, or physically bound/restrained.
What is fetishism (Paraphilia)?
Erotic fantasies and sexual urges or behavior involving non-living objects (ex: female undergarments)
What is frotteurism (Paraphilia)?
Sexual arousal derived from touching or rubbing against a non-consenting person.
Commonly in crowded public areas.
How are paraphilias treated?
Pharmacotherapy and psychotherapy.
Behavioral therapy
SSRIs
Gonadotropin ANTAgonists, progesterone therapy.
