Paraphilias and Sexual Disorders

Question 1

exposure of one’s genitals to an unsuspecting stranger. Onset <18yo

NO DIFFERENCE IN IQ, VOCATION, EDUCATION LEVELS.

Etiology? Problems with assertiveness, relationship difficulties/rejection, power, hostility towards women

Answer 1

exhibitionistic

Question 2

the act of observing an unsuspecting person bake, disrobing or engaging in sex. Fantasize about the person but do not seek sex. Onset <15yo

Answer 2

voyeuristic

Question 3

touching and rubbing against a nonconsenting person and fantasizes that he is in a relationship with them. Age 15-25yo

Answer 3

frotteuristic

Question 4

psychological and physical suffering of the victim is sexually exciting. Onset of fantasies in early age and progress to acts by adulthood

Answer 4

sexual sadism

Question 5

the use of non living objects. The objects were often somehow significant in childhood or adolescence.

Answer 5

fetishistic disorder

Question 6

cross-dressing heterosexual male, arousal is from the act of cross-dressing, not the actual clothing items. Different from gender identity disorder

Answer 6

transcestic fetishistic

Question 7

co-morbid symptoms of sex offender population

Answer 7

intimacy deficits, hyper-sexuality, emotional ID with children, deviant arousal, psychopathy, antisocial personality

Question 8

recurrent intesne sexually arousing fantasies/urges/behaivour involving sexual activity with prepubescent child/children.

Must be at least age 16 yo and at least 5 yrs older than the child

Specifically excludes an individual in late teens involved in an ongoing sexual relaitonhsip with a 12 or 13 yo

Answer 8

pedophilia

Question 9

subtypes of pedophilia

Answer 9

limited to incest, sexually attracted to males, females or both, or non-exclusive or exclusive pedophilia

Question 10

etiologies of pedophilia

Answer 10

Maladaptive extreme attraction to youthfulness

Masturbatory conditioning: initial sexual experiecnes as a child is reinforced by using these memory during orgasm

Learned behaviours

Biological and genetic predispositions

Neurodevelopmental abnormalities (low IQ, childhood head injuries, higher left handedness)

Attachment problems (particularly sexually abused boys who also had neglect, lacked parental supervision and witnessed serious intra-familial violence

Pathogen exposure while in-utero?

Question 11

T/F all child molesters are pedophiles

Answer 11

false.

Molestation can be due to any of: hypersexuality, inaccessible preferred partners, social incompetence, intimacy deficits, having more emotional affinity for children than adults, general antisocial tendencies, temporary disinhibition due to substances, psychopathy.

Child molesters more likely to have pedophilia when they are:

• Male victims
• Unrelated victims
• More than one child victim
• Victim is aged 11 or younger

Question 12

T/F paraphilic arousal is the same as paraphilia

Answer 12

false.

Paraphilic arousal → paraphilia (intense persistent) → paraphilic disorder (paraphilia lasting at least 6 months and causes distress to person or harm to others)

*paraphilic arousal IS NOT a paraphilia!

Paraphilic sexual arousal is not unsual! More common in men, those who have been sexually unfaithful, pornography users, those who masturbate at least once weekly, those who subjectively rate themselves as low general health

• 62% of men in community reported some arousal to at least one paraphilic stimulus/

Question 13

Sexual Dysfunction
Definition: sexual dysfunction for at leas__months in ___% of occasions and causes clinically significant distress

Answer 13

Sexual Dysfunction
Definition: sexual dysfunction for at least 6 months in 75% of occasions and causes clinically significant distress

Question 14

4 phases of the sex arousal cycle

Answer 14

1. desire
2. arousal
3. orgasm
4. resolution

Question 15

normal physiology of arousal for males and females

Answer 15

Normal physiology

Females: breast engorgemnet, sex flush, clitoris pull back, vascular changes to vagina

Male: erection, scrotal sack tights and lifts, sex flush begins

Female sexual interest/arousal disorder

Question 16

management of erectile disorder

Answer 16

PDE-5 inhibitors, androgens, vacuum erectile devices, constriction rings

Question 17

definition of premature ejactulation

Answer 17

ejaculating within 1 minute

Question 18

Symptoms: persistent or recurrent difficulties with at least one of:

• Vaginal penetration during intercourse
• Marked pain with intercourse of penetration
• Marked fear/anxiety about pain in anticipation of, during or as a result of penetration
• Marked tensing or tightening of pelvic floor during attempted penetration

Answer 18

Genito-Pelvic Pain/Penetration Disorder

Question 19

Management of genito-pelvic pain disorder

Answer 19

Relevant factors: difficulties in partner (healthy issues, mental health), relationship issues (communication, sexual preference), individual issues (body issues, abuse Hx), psych comorbidity/stressors, culture/religious issues, medical issues

Rule out other mental disorders leading to sexual dysfunction, substance/medication use leading to sexual dysfunction

• Antihypertensives, antipsychotics, antidepressants, hormones, drugs of abuse
• Sexual dysfunction due to relationship distress, partner violence, life stressor
  *

Question 20

Human Sexuality

Adolescence: males tend to respond to ____ stimuli, while females respond to ___ ___. Same sex experimentation is common

First coitus: average age is ___, 40% of individuals who had sex prior to 13-14 yo was involuntary/unwanted

• Males: anxiety about __
• Females: anxiety about __ ___

Answer 20

Human Sexuality

Adolescence: males tend to respond to visual stimuli, while females respond to romantic stories. Same sex experimentation is common

First coitus: average age is 16, 40% of individuals who had sex prior to 13-14 yo was involuntary/unwanted

Males: anxiety about performance

Females: anxiety about losing virginity

Question 21

how does human sexuality generally change in late middle age for men and women

Answer 21

Male: longer period to reach orgasm, longer refractory period, more stimulation for erection, sexual confidence?

Female: menopausal hormone changes, sexual confidence