Paraphilic Disorders, Sexual Dysfunction Flashcards
what are the sexual dysfunction disorders
-delayed ejaculation
-erectile d.o
-female orgasmic d.o
-female sexual interest/arousal d.o
-genito-pelvic pain/penetration d.o
-male hypoactive sexual desire d.o
-premature ejaculation
-substance/medication-induced sexual dysfunction
dsm-5 criteria for sexual dysfxn disorders
-dysfunction is not better explained by a nonsexual mental d.o
-dysfxn is not better explained by relationship stress
-not attributable to substances/meds or a medical condition
in order for delayed ejaculation dx, when must symptoms occur
-on almost all occassions
-apx 75-100% of partnered sexual activity
for 6 months
2 types of delayed ejaculation
-delay in ejaculation
-infrequency/absence of ejaculation
t/f: there are FDA approved drugs for delayed ejaculation
f!
they are all used off label
what drugs are used off label for delayed ejaculation
testosterone
buspirone
amantadine
oxytocin
cabergoline
non pharm tx for delayed ejaculation (2)
CBT
masturbatory retraining
dsm 5 for erectile d.o
at least one of the 3 following sx on almost all occassions of sexual activity (75-100%) x 6 months:
-difficulty obtaining an erection during sex
-difficulty maintaining an erection until completion of sex
-decrease in erectile rigidity
pharm for erectile d.o (2)
-phosphodiesterase inhibitors -> sildenafil, tadalafil etc
-intraurethral/intracavernosal prostaglandins
non pharm for erectile d.o (2)
-vacuum erection devices
-surgical implants
dsm 5 for female orgasmic d.o
presence of either of the following sx on almost all or all (75-100%) of occasions of sex:
-delay/infrequency/absence of orgasm
-reduced intensity of orgasmic sensations
first line tx for female orgasmic d.o
directed masturbation
basically a voice that provides instructions while the pt masturbates
what do you think when you see a pt who is completely disinterested in sex and is not receptive to partner’s attempts to initiate foreplay - she also never achieves orgasm when they have sex and it is affecting her relationship
female sexual interest/arousal d.o
dsm 5 for female sexual interest/arousal d.o
lack of, or significantly reduced, sexual interest/arousal based on at least 3 of the following sx for a minimum of 6 months:
-absent/reduced interest in sex
-absent/reduced sexual/erotic thoughts or fantasies
-no/reduced initiation of sexual activity/unreceptive to partner’s attempts to initiate
-absent/reduced sexual excitement/pleasure during sex
-absent/reduced sexual interest/arousal in response to any sexual/erotic cues
-absent/reduced genital or nongenital sensations during sex
tx for female sexual arousal interest/arousal d.o
education about sexual anatomy and fxn:
-nonphysical/physical nongenital/non penetrative genital stimulation
-CBT
-hormones (testosterone)
dsm 5 for genito-pelvic pain/penetration d.o
persistent/recurrent difficulties w. one more more of the following for at least 6 months:
-vaginal penetration during intercourse
-vulvovaginal or pelvic pain, or penetration attempts
-fear/anxiety about vulvovaginal or pelvic pain in anticipation of or as a result of vaginal penetration
-tensing or tightening of pelvic floor muscles during attempted penetration
tx for genito-pelvic pain/penetration d.o (5)
-treat the cause: ex topical estrogen for atrophic vaginitis
-education about chronic pain related to sex
-CBT
-pelvic floor PT
-progressive desensitization
what do you think when you see a man w. a lack of desire for sex w. his wife which causes distress x 1 year - his wife is hurt and it is affecting their marriage - he used to be into sex and they would have it more often - he is active and competes in triathlons, no significant PMH
male hypoactive sexual desire d.o
persistently or recurrently deficient (or absent) sex/erotic thoughts/fantasies and desire for sex for at least 6 months
male hypoactive sexual desire d.o
tx for male hypoactive sexual desire d.o
-testosterone
-sex therapy
dsm 5 for premature ejaculation d.o
-ejaculation w.in 1 minute following vaginal penetration and before pt wishes it to happen
-must occur almost all or all the time (75-100%) x at least 6 months
tx for premature ejaculation d.o
-SSRIs
-topical anesthetics
-sex therapy
-TCAs
condition in both men and women in which patients have difficulties w. sexual desire, arousal, and/or orgasm due to a s.e of certain meds (legal or illicit)
substance/medication induced sexual dysfxn
what are the paraphilic disorders
-voyeuristic d.o
-exhibitionistic d.o
-frotteuristic d.o
-sexual masochism d.o
-sexual sadism d.o
-fetihistic d.o
-pedophilic d.o
-transvestic d.o
what do you think when you see: 20 yo male college student who was spying thru the windows of his female dormmates
voyeuristic d.o
recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disorbing, or engaging in sex
voyeuristic d.o
dsm 5 for voyeuristic d.o
-recurrent/intense sexual arousal from observing an unsuspecting person who is naked, disrobing, or engaging in sexual activity
-for at least 6 months
-pt has acted on urges w. a nonconsenting person OR urges/fantasies cause distress
tx for voyeuristic d.o
- -psychotherapy
-SSRIs - antiandrogen drugs - if refractory
what do you think when you see a pt who exposes his genitals to people in the park and then runs away
exhibitionistic d.o
how long must exhibitionist d.o occur for diagnosis
at least 6 months
tx for exhibitionist d.o
- SSRIs and CBT
- antiandrogen drugs if refractory
what do you think when you see a patient who likes to rub his genitals against other people when they are not looking
frotteuristic d.o
tx for frotteuristic d.o
CBT
what do you think when you see a pt who requires partners to strangle him and humiliate him in order to achieve erection
sexual masochism d.o
subtype of sexual masochism d.o
asphyxiophilia
how long must sexual masochism d.o occur for dx
6 months or more
and sx must cause distress
tx for sexual masochism d.o
-CBT
-antidepressants - reduce sex drive
what do you think when you see a pt who tells you he and his gf have been cutting and drawing/drinking blood from one another during sex - drinking his partners blood is the only way he can orgasm is drinking his partner’s blood - he has deep cuts/scars in various stages of healing
sexual sadism d.o
sexual gratification in response to inflicting humiliation, bondage, or suffering
sexual sadism d.o
difference btw sexual masochism and sexual sadism d.o
masochism: pt undergoes humiliation/bondage/suffering
sadism: patient inflicts humiliation/bondage/suffering
tx for sexual sadism d.o
-CBT
-SSRIs
-antiandrogens
-GnRH analogs
t/f: sexual sadism d.o only requires tx if pt is causing significant impairmentor distress to self or another
t!
what do you think when you see a pt who insists on being able to see his partner’s feet during sex
fetihistic d.o
sexual arousal is obtained by specific objects for at least 6 months
fetihistic d.o
t/f: fetihistic d.o can involve living OR nonliving objects
t!
usually focuses on nongenital body parts
tx for fetihistic d.o
- CBT
- +/- SSRIs (limited success)
repeated and intense sexual urges or fantasies about watching/touching/engaging in sexual acts w. children
pedophilic d.0
victims of pedophilic d.o are generally _ yo or youger
13
how long must sx of pedophilic d.o last for dx
at least 6 mo
tx for pedophilic d.o
1st line: IM medroxyprogesterone acetate
2. leuprolide (GnRH agonist) - reduces testosterone
persistent, recurrent, and intense sexual arousal from wearing clothes associated w. the opposite gender as evidenced by fantasies, urges, or behaviors
transvestic d.o
transvestic d.o doesn’t usually need to be treated, but if it is causing significant distress/affecting pt’s life, what are options
- support groups
- CBT
- +/- SSRIs if obsessive component
