Psychosexual Disorders

Question 1

What is the management for low libido?

Answer 1

• Establish there are no physical health problems
• Treatment is mainly psychological
• Communication is encouraged

Sensate Focus Therapy

• Intercourse is banned
• Non-genital caressing (focus on pleasure and relaxation)
• Genital touching to achieve arousal and subsequent orgasm
• In time, intercourse occurs naturally

Timetabling Sex

• Helps partners with different libidos reach a compromise

Question 2

What is the management of hypersexuality?

Answer 2

• CBT-based treatments
• Can also use SSRI’s, GnRH therapies and anti-androgens

Question 3

What are modifiable RFs for erectile dysfunction?

Answer 3

• Stop smoking, exercise, reduce weight and alcohol, stress management
• Treat diabetes, hypertension etc.
• Review medication (e.g. mirtazapine is associated with placebo-level sexual dysfunction whereas SSRIs have a much higher rate)

Question 4

What is the management of erectile dysfunction?

Answer 4

Psychological Approaches

Physical Treatments

• 1st line: Phosphodiesterase-5 inhibitors (e.g. sildenafil (Viagra))
• Intracavernosal prostaglandin self-injections before intercourse
• Vacuum pumps - Plastic dome and pump placed over the penis creating a vacuum to produce an erection. This is maintained by slipping a tight ring around the base of the penis
• Topical Therapies - alprostadil
• Surgery – penile prosthesis

Question 5

What is the management of disorders of gender identity?

Answer 5

• Hormone therapy
• Gender reassignment surgery

Note: patient must demonstrate the ability to live successfully in their desired gender before surgery can be considered