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EOR: Behavioral Health > Paraphilic Disorders, Sexual Dysfunction > Flashcards

Paraphilic Disorders, Sexual Dysfunction Flashcards

1
Q

what are the sexual dysfunction disorders

A

-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

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2
Q

dsm-5 criteria for sexual dysfxn disorders

A

-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

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3
Q

in order for delayed ejaculation dx, when must symptoms occur

A

-on almost all occassions
-apx 75-100% of partnered sexual activity
for 6 months

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4
Q

2 types of delayed ejaculation

A

-delay in ejaculation
-infrequency/absence of ejaculation

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5
Q

t/f: there are FDA approved drugs for delayed ejaculation

A

f!

they are all used off label

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6
Q

what drugs are used off label for delayed ejaculation

A

testosterone
buspirone
amantadine
oxytocin
cabergoline

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7
Q

non pharm tx for delayed ejaculation (2)

A

CBT
masturbatory retraining

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8
Q

dsm 5 for erectile d.o

A

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

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9
Q

pharm for erectile d.o (2)

A

-phosphodiesterase inhibitors -> sildenafil, tadalafil etc
-intraurethral/intracavernosal prostaglandins

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10
Q

non pharm for erectile d.o (2)

A

-vacuum erection devices
-surgical implants

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11
Q

dsm 5 for female orgasmic d.o

A

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

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12
Q

first line tx for female orgasmic d.o

A

directed masturbation

basically a voice that provides instructions while the pt masturbates

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13
Q

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

A

female sexual interest/arousal d.o

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14
Q

dsm 5 for female sexual interest/arousal d.o

A

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

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15
Q

tx for female sexual arousal interest/arousal d.o

A

education about sexual anatomy and fxn:

-nonphysical/physical nongenital/non penetrative genital stimulation
-CBT
-hormones (testosterone)

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16
Q

dsm 5 for genito-pelvic pain/penetration d.o

A

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

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17
Q

tx for genito-pelvic pain/penetration d.o (5)

A

-treat the cause: ex topical estrogen for atrophic vaginitis
-education about chronic pain related to sex
-CBT
-pelvic floor PT
-progressive desensitization

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18
Q

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

A

male hypoactive sexual desire d.o

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19
Q

persistently or recurrently deficient (or absent) sex/erotic thoughts/fantasies and desire for sex for at least 6 months

A

male hypoactive sexual desire d.o

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20
Q

tx for male hypoactive sexual desire d.o

A

-testosterone
-sex therapy

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21
Q

dsm 5 for premature ejaculation d.o

A

-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

22
Q

tx for premature ejaculation d.o

A

-SSRIs
-topical anesthetics
-sex therapy
-TCAs

23
Q

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)

A

substance/medication induced sexual dysfxn

24
Q

what are the paraphilic disorders

A

-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

25
Q

what do you think when you see: 20 yo male college student who was spying thru the windows of his female dormmates

A

voyeuristic d.o

26
Q

recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disorbing, or engaging in sex

A

voyeuristic d.o

27
Q

dsm 5 for voyeuristic d.o

A

-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

28
Q

tx for voyeuristic d.o

A
  1. -psychotherapy
    -SSRIs
  2. antiandrogen drugs - if refractory
29
Q

what do you think when you see a pt who exposes his genitals to people in the park and then runs away

A

exhibitionistic d.o

30
Q

how long must exhibitionist d.o occur for diagnosis

A

at least 6 months

31
Q

tx for exhibitionist d.o

A
  1. SSRIs and CBT
  2. antiandrogen drugs if refractory
32
Q

what do you think when you see a patient who likes to rub his genitals against other people when they are not looking

A

frotteuristic d.o

33
Q

tx for frotteuristic d.o

A

CBT

34
Q

what do you think when you see a pt who requires partners to strangle him and humiliate him in order to achieve erection

A

sexual masochism d.o

35
Q

subtype of sexual masochism d.o

A

asphyxiophilia

36
Q

how long must sexual masochism d.o occur for dx

A

6 months or more

and sx must cause distress

37
Q

tx for sexual masochism d.o

A

-CBT
-antidepressants - reduce sex drive

38
Q

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

A

sexual sadism d.o

39
Q

sexual gratification in response to inflicting humiliation, bondage, or suffering

A

sexual sadism d.o

40
Q

difference btw sexual masochism and sexual sadism d.o

A

masochism: pt undergoes humiliation/bondage/suffering

sadism: patient inflicts humiliation/bondage/suffering

41
Q

tx for sexual sadism d.o

A

-CBT
-SSRIs
-antiandrogens
-GnRH analogs

42
Q

t/f: sexual sadism d.o only requires tx if pt is causing significant impairmentor distress to self or another

A

t!

43
Q

what do you think when you see a pt who insists on being able to see his partner’s feet during sex

A

fetihistic d.o

44
Q

sexual arousal is obtained by specific objects for at least 6 months

A

fetihistic d.o

45
Q

t/f: fetihistic d.o can involve living OR nonliving objects

A

t!

usually focuses on nongenital body parts

46
Q

tx for fetihistic d.o

A
  1. CBT
  2. +/- SSRIs (limited success)
47
Q

repeated and intense sexual urges or fantasies about watching/touching/engaging in sexual acts w. children

A

pedophilic d.0

48
Q

victims of pedophilic d.o are generally _ yo or youger

A

13

49
Q

how long must sx of pedophilic d.o last for dx

A

at least 6 mo

50
Q

tx for pedophilic d.o

A

1st line: IM medroxyprogesterone acetate
2. leuprolide (GnRH agonist) - reduces testosterone

51
Q

persistent, recurrent, and intense sexual arousal from wearing clothes associated w. the opposite gender as evidenced by fantasies, urges, or behaviors

A

transvestic d.o

52
Q

transvestic d.o doesn’t usually need to be treated, but if it is causing significant distress/affecting pt’s life, what are options

A
  1. support groups
  2. CBT
  3. +/- SSRIs if obsessive component

EOR: Behavioral Health (13 decks)

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