Paraphilic Disorders; Sexual Dysfunctions

Question 1

Exhibitionistic disorder

Answer 1

• 2-4% male, onset before 18y, directed at females
• sxs: exposure of genitals to unsuspecting person or manifestation of urges to do so +/- masturbation or shock value, hope observer will become aroused or join, period of at least 6mo
• prognosis: 25% receive tx

Question 2

Paraphilic disorder

Answer 2

• sexual urges and behaviors that are intense, enduring, arousing that involve (nonhuman objects, suffering or humiliation, children, or nonconsenting persons)
• tx: CBT

Question 3

Fetishistic disorder

Answer 3

• does not include items for cross dressing or vibrators, M>F
• MC foci: feet, footwear, socks, and female undergarments
• sxs: involves use of nonliving objects (women’s underpants, bras, stockings, shoes, boots) or focus on nongenital body parts, +/- masturbation while holding, rubbing, or smelling item, trouble becoming aroused without item, must have significant distress or psychosocial role impairement for dx
• prognosis: 2% receive tx

Question 4

pedophilic disorder

Answer 4

• 3-5% M
• RF: child porn?
• sxs: intense recurrent sexually . arousing fantasies and urges or behaviors involving a prepubescent child or children (<13yo) for at least 6mo
  
  • dx if acted on or marked distress, must be at least 16yo and at least 5y older than child
• prognosis: 45% receive tx but dont initiate it

Question 5

sexual masochism disorder

Answer 5

• 2% M > 1% F, done with a consenting partner
• sxs: intense sexualyl arousing fantasies, urges, or behaviors involving act of being humiliated, beaten, bound, or made to suffer (restraint, blindfolding, paddling, spanking, whipping, beating, electrical shocks, cutting, piercing, and being urinated or defecated on)
  
  • typically consenting, nondistressing, and nonpathological
  • specifier: +/- asphyxiophilia 6+mo
• prognosis: 3% receive tx

Question 6

Voyeruistic disorder

Answer 6

• M (12%) > F (4%), onset in adolescence, dx at age 18
• sxs: fantasy or actual viewing of unsuspecting and nonconsenting people who are naked, disrobing, or engaging in sexual activity
  
  • period of at least 6mo
• prognosis: 12% receive tx

Question 7

Female sexual interest/arousal disorder

Answer 7

• arousal: vaginal lubrication (not clitoral engorgement)
  
  • female failure to lubricate
• sxs: lack of sexual interest/arousal: no interest, erotic thoughts or fantasies, initiation, or responsiveness, reduced interest/arousal in response to external cues (written, verbal, visual), absent genital/nongenital sensations, at least 6mo, significant distress
• tx: sex tx, CBT (effective as sildenafil, avoid performance anxiety), lubrication, PDE inhibitors, venous ligation, position change, EROS clitoral tx device

Question 8

Male hypoactive sexual desire disorder

Answer 8

• age related: after age 50
• sxs: no sexual/erotic thoughts or fantasies/desire for sexual activity for at least 6mo, significant clinical distress
• tx: early tx (psychotx, behavioral or exposure tx), late (precoital benzodiazepine), tx underlying depression or hypogonadism (testosterone)