Psych-Sexual and Gender Identity Disorders

Question 1

Stages of the sexual response cycle

Answer 1

Desire (appetite or craving) -> Excitement (erection) -> Orgasm -> Resolution (different in males and females)

Question 2

What characterizes a sexual dysfunction?

Answer 2

Disturbance of sexual response cycle, symptoms persist of 6+ months and cause significant distress.

Question 3

For the past 6 months a patient has had significant distress due to a marked delay or absence of ejaculation in almost all sexual experiences. His symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What things need to be specified in his diagnosis?

Answer 3

Delayed ejaculation needs to be specified lifelong vs. acquired, generalized vs. situational (more common) and mild, moderate or severe.

Question 4

Treatment for delayed ejaculation

Answer 4

Behavioral interventions: sensate focus (increase stimulation and reduce performance anxiety. Pharmacotherapy: cyproheptadine and yohimbine (1-2 hrs before sex, makes you sleepy).

Question 5

For the past 6 months a patient has had significant distress due to difficulty in obtaining an erection during intercourse and decreased erectile rigidity. His symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What are risk factors for this condition?

Answer 5

Erectile disorder risks include aging, diabetes, vascular disease, smoking and hypercholesterolemia.

Question 6

Treatment for erectile disorder

Answer 6

Assess vascular diseases. Can treat with testosterone (for hypogonadism), bromocriptine (for hyperprolactinemia), psychotherapy, penile prosthesis and medications (PDE5 inhibitors: sildenafil, vardenafil, tadalafil)

Question 7

For the past 6 months a patient has had significant distress due to difficulty in obtaining an orgasm and reduced intensity when it comes.Her symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. How common is this?

Answer 7

Female orgasmic disorder is reported in ~25% of women, but only 25% of them are distressed about it.

Question 8

For the past 6 months a patient has had significant distress due to lack of interest or arousal in sexual activity or fantasies. She denies initiating sexual activity, has reduced pleasure in encounters and reduced sensation. Her symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What is your diagnosis?

Answer 8

Female sexual interest/arousal disorder.

Question 9

For the past 6 months a patient has had significant distress due to absent sexual thoughts or fantasies and decreased desire for sexual activity. His symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What is your diagnosis?

Answer 9

Male Hypoactive Sexual Desire Disorder

Question 10

For the past 6 months a patient has had significant distress due to recurring ejaculation occurring within 1 minute following vaginal penetration and before the individual wishes it to occur. His symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What is your diagnosis?

Answer 10

Premature Ejaculation. Mild = 30s - 1 min. Moderate = 15-30s. Severe = < 15s.

Question 11

Treatment for premature ejaculation

Answer 11

Behavioral: stop, start, squeeze. Pharmacologic: SSRIs and clomipramine.

Question 12

For the past 6 months a patient has had significant distress due to pain on vaginal penetration, pain during intercourse and fear/anxiety about pain in anticipation of intercourse. Her symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What is your diagnosis?

Answer 12

Genito-Pelvic Pain/Penetration Disorder

Question 13

For the past 6 months a patient has had significant distress due to sexual dysfunction. Further exam reveals the symptoms are correlated with medication. It is note better explained by sexual dysfunction that is not substance/medication induced, it does not occur exclusively during delirium and it causes significant distress. What is your diagnosis?

Answer 13

Substance/Medication Induced Sexual Dysfunction

Question 14

Sexual dysfunction due to disease

Answer 14

*

Question 15

Recurrent, intense sexual arousal, fantasies and urges involving anomalous sexual activity. What is it called when you act on these urges and that action causes distress?

Answer 15

Paraphilic disorders.

Question 16

Etiology of paraphilic disorders

Answer 16

Learning theory (early sexual experiences), biologic basis and other psychiatric conditions

Question 17

Treatment of paraphilic disorders

Answer 17

Prison, Behavioral therapy (to help them see consequences and correct cognitive distortions), anti-androgens to reduce testosterone (last resort) and SSRIs (decrease libido and decrease intrusive thoughts) and Naltrexone (reduce addictive behaviors)

Question 18

One’s biological sex, also used to refer to one’s sexual preference

Answer 18

Sexual identity

Question 19

One’s subjective sense of maleness or femaleness

Answer 19

Gender identity

Question 20

Behaviors an individual engages in that identify the individual as male or female

Answer 20

Gender role

Question 21

Strong and persistent cross-gender identification and distress associated with incongruence of one’s personal experience with gender and their assigned gender.

Answer 21

Gender dysphoria

Question 22

Treatment for gender dysphoria

Answer 22

Hormone therapy/sexual reassignment therapy

Question 23

3 major types of sexual disorders

Answer 23

Sexual dysfunctions, paraphilic disorders, gender dysphoria