Paraphiliac Disorders, Sexual Dysfunctions Flashcards
What is the diagnostic criteria for delayed ejaculation?
Marked delay in ejaculation, infrequency or absence of ejaculation for ≥ 6 months
How is delayed ejaculation treated?
sex therapy, CBT
* Off-label: testosterone, buspirone, amantadine, oxytocin, and cabergoline
What are RF for erectile disorder?
- MC 40-70 y/o
- atherosclerosis
- antihypertensives
- sickle cell
- hx pelvic surgery or perineal trauma
- alcohol abuse
- hypogonadism
What labs would you get to work up erectile disorder?
free testosterone, serum prolactin, fasting glucose, lipids, TFTs
What is the diagnostic criteria for erectile disorder?
Recurring inability to achieve & maintain an erection sufficient for satisfactory sexual performance for ≥ 6 months
How is erectile disorder treated?
lifestyle modifications, PDE-5 inhibitors (sildenafil, tadalafil)
What will a patient typically complain of with female orgasmic disorder?
normal libido & sexual excitement w/o the ability to orgasm
What is the diagnostic criteria for female orgasmic disorder?
delayed, infrequent, or absent orgasm w/ ↓ intensity of orgasmic sensations ≥ 6 months
How is female orgasmic disorder treated?
directed masturbation
* If SSRI induced: substitute w/ bupropion, nefazodone, or duloxetine
* If typical antipsychotic-induced: substitute w/ aripiprazole, quetiapine, or olanzapine
What is the diagnostic criteria for female sexual intrest/arousal disorder?
≥3 sxs of lack/reduced sexual interest/arousal that causes distress and last ≥6 months
* Absent/reduced interest in sexual activity, sexual thoughts or fantasies, initiation, excitement/pleasure
* Absent/reduced sexual interest/arousal in response to any internal/external cues (written, verbal, visual), genital or nongenital sensations during sexual activity
How is female sexual intrest/arousal disorder treated?
CBT, couples therapy, topical creams/lubricants
* Off-label: bupropion, testosterone patches, sildenafil/tadalafil
What is the diagnostic criteria for genito-pelvic pain/penetration disorder?
≥1 sxs that causes significant distress for ≥ 6 months
* difficulty having intercourse
* genito-pelvic pain
* fear of pain or vaginal penetration
* tension of pelvic floor muscles
How is genito-pelvic pain/penetration disorder treated?
CBT, pelvic-floor rehab, vaginal creams/lubricants
What is the diagnostic criteria for male hypoactive sexual desire disorder?
persistent or recurring absence/deficiency of sexual/erotic thoughts, fantasies & desire for sexual activity for ≥ 6 months
How is male hypoactive sexual desire disroder treated?
CBT + behavioral sex therapy
What is the diagnostic criteria for premature (early) ejaculation?
Persistent or recurrent ejaculation during partnered sexual activity w/in ~1 minute ofl penetration & before the individual wishes for ≥ 6 month
How is premature (early) ejaculation treated?
SSRIs – Paroxetine (daily dosing) or Clomipramine (PRN 4-6 hrs prior)
* Topical anesthetics (lidocaine, prilocaine), sex therapy
What is the diagnostic criteria for voyeuristic disorder?
arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity for ≥6 months AND ≥18 y/o
* Has acted on these urges w/ a nonconsenting person or the urges/fantasies cause clinically significant distress or impairment
How is voyeuristic disorder treated?
Psychotherapy, pornography, Fluoxetine
What is the diagnostic criteria for exhibitionist disorder?
arousal from the exposure of one’s genitals to an unsuspecting person for ≥6 months
* Has acted on these urges w/ a nonconsenting person or the urges/fantasies cause clinically significant distress or impairment
What are the specifications for exhibitionist disorder?
- Sexually aroused by exposing genitals to prepubertal children
- Sexually aroused by exposing genitals to physically mature individuals
- Sexually aroused by exposing genitals to prepubertal children and physically mature individuals
How is exhibitionist disorder treated?
CBT, SSRIs, antiandrogens
What is the diagnostic criteria for frotteuristic disorder?
sexual gratification attained by touching or rubbing against a nonconsenting individual
What is the treatment for frotteuristic disorder?
psychotherapy (identifying triggers) + behavior therapy (strategies to redirect thoughts & feelings)
