psychosexual disorders

Question 1

Sofia LO;
Psychosexual management: recognise common presentations of patients with psychosexual factors affecting sexual function and/or relationships, and know where to refer them

Answer 1

okay

Question 2

characterise sexual dysfunction?

Answer 2

problems with libido, arousal, orgasm, or pain .

Problems are either
primary (normal function never obtained) or secondary
(loss of function).

Question 3

whta is important to exclude in hyper sexuality?

Answer 3

Exclude mania, substance misuse,

and organic brain disorders (e.g. frontal lobe syndrome);

Question 4

list causes of erectile dysfunction ?

Answer 4

Organic
• Diabetes
• Arteriosclerosis
• Neurological (e.g. autonomic neuropathy)
• Pituitary failure
• Medication, e.g.
– antidepressants, antipsychotics
– antihypertensives, beta-blockers, diuretics
• Substance misuse

Psychological
• Depression
• Performance anxiety

Question 5

ivx for erectile dysfunction ?

Answer 5

1. Physical examination including genitals (usually
   normal, but reassures patients).
2. Blood tests:
   • testosterone and sex hormones (low testosterone/
   hyperprolactinaemia)
   • glucose (diabetes), LFTs/γGT (alcohol misuse).

Question 6

management for erectile dysfunction ?

Answer 6

Management
1. Modifiable risk factors:
• Stop smoking, exercise, reduce weight and alcohol.
• Treat underlying conditoins diabetes, hypertension, etc.
• Review medication (e.g. change fluoxetine to
mirtazapine).

2. Physical treatments can overcome physical problems:
   • Phosphodiesterase-5 inhibitors, e.g. sildenafil
   (Viagra).

2b• Intracavernosal prostaglandin self-injections prior
to intercourse. This can be painful!
• Vacuum pumps. A plastic dome and pump placed
over the penis create a vacuum, producing an erection.
This is maintained by slipping a tight ring
around the base of the penis.

3. Psychological approaches (from diagnosis)
   
   • sensate focused therapy

Question 7

rx for hyper sexuality?

Answer 7

CBT based therapy

Question 8

list 3 problems that arise with orgasms and their management?

Answer 8

Anorgasmia
encourage self-exploration, masturbation,
and sensate focus therapy (Box 16.1),

Premature ejaculation
1. SSRIs
1b.Squeezing the glans penis postpones
orgasm (the stop–start technique)

Delayed ejaculation
This term describes a delayed or absent male orgasm.
Causes can be physical (e.g. SSRIs) or psychological (e.g.
fear of conception).
Treatment includes psychotherapy,
advice on varying sexual techniques, and medication
review.

Question 9

list causes of dyspareunia?

rx?

Answer 9

women—infection, episiotomy, endometriosis, tumour,
vaginal dryness

men—urethritis, protastatitis.

rx - psych therapy

Question 10

define vaginismus and name the rx?

Answer 10

This is a painful, involuntary spasm of the vaginal muscles
when penetration is attempted.

Treatment involves
education, relaxation, and self-exploration; insertion of
‘trainers’ (cylindrical plastic objects) of increasing sizes
can accustom the patient to penetration.

Question 11

define paraphilia?

what are the 4 types?

Answer 11

disorders of sexual preference

•Fetishism: sexual arousal and gratification rely on an
object rather than a person, e.g. shoes, rubber, leather.
• Paedophilia: sexual arousal in response to children.
• Sadism: inflicting pain causes arousal.
• Masochism: humiliation or suffering cause arousal.

Question 12

what is the management of paraphilia?

Answer 12

Covert sensitization: this pairs the arousal with aversive images
(e.g. the patient imagines his manager discovering him
in his wife’s underwear).

Patients should avoid activities that reinforce the paraphilia, e.g. fantasizing, looking at
related pornography.

Anti-androgens may be used in
severe or dangerous situations

Question 13

what is thee management of gender dysphoria?

Answer 13

hormone therapy
gender reassignment surgery

following careful joint
assessment by psychiatrists and surgeons