Psychosexual disorders

Question 1

What are problems with sexual drive/desire?

Answer 1

• Hypoactive Sexual Desire Dysfunction (aka Low Libido)

- Compulsive Sexual Behaviour Disorder (aka Hypersexuality)

Question 2

Explain organic causes of HSDD

Answer 2

Physical illness
Medication, substance use 
Relationship problems
Childbirth, menopause in F 
Low testosterone M
high prolactin 
Psych illness (depression, anxiety)

Question 3

What is treatment for HSDD?

Answer 3

Psychological Therapy
Sensate Focus Therapy
Timetabling Sex

Question 4

What is CSBD?

Answer 4

Uncontrolled intense, repetitive sexual urges resulting in repetitive sexual behaviour for >6months causing distress and functional impairment

Question 5

What is important to exclude for CSBD?

Answer 5

Mania
Substance misuse
Organic brain disorders (frontal lobe syndrome / testosterone use / dopaminergic meds for Parkinson’s)

Question 6

How do you treat Compulsive Sexual Behaviour Disorder?

Answer 6

CBT

Question 7

What is erectile dysfunction?

Answer 7

Erections insufficiently hard to allow penetration

Question 8

What are organic causes of erectile dysfunction?

Answer 8

• diabetes, atherosclerosis
• Neurological (MS, autonomic neuropathy, traumatic nerve injury)
• Pituitary failure, testicular underdevelopment (Kleinfelter’s, Mumps)
• Medications (antidepressants, antipsychotics, antihypertensives, beta blockers, diuretics)
• Substance misuse (alcohol)

Question 9

What are psychological factors for ED?

Answer 9

Depression 
Performance anxiety 
Relationship problems 
Cultural factors
Lack of knowledge/experience

Question 10

What is typical presentation of psych ED?

Answer 10

young pt
sudden onset
still gets some erections (morning / masturbation)
PMH: depression, anxiety

Question 11

What is typical presentation of organic ED?

Answer 11

old pt
gradual onset
no erections
PMG: smoking, obesity, HTN, alcohol consumption

Question 12

What investigations can you do for ED?

Answer 12

Physical exam incl genital exam 
Blood tests 
- Testosterone, sex hormones
- Glucose, HbA1c+
- LFT, GGT

Question 13

What is management of ED?

Answer 13

Stop modifiable RF:

• stop smoking, alcohol, reduce weight, increase exercise
• treat diabetes, HTN
• review medications (mirtazapine vs SSRI)

Psychological approaches (sensate focus therapy, CBT)

Medications

• Phosphodiesterase 5 inhibitor e.g. viagra (sildenafil)
• Intracavernosal prostaglandins self injections

Physical
- vacuum pump

Question 14

What are organic RF for anorgasmia?

Answer 14

medications, alcohol

neurodegenerative conditions

Question 15

What are psych RF for anorgasmia?

Answer 15

depression
relationship/cultural F
previous abuse
lack of connection with partner

Question 16

What is tx for anorgasmia?

Answer 16

self-exploration
masturbation
sensate focus therapy

Question 17

How can you help premature ejaculation?

Answer 17

stop-start technique (squeeze glans)

SSRI

Question 18

What are possible causes for delayed ejaculation?

Answer 18

physical (SSRI)

psychological (anxiety)

Question 19

What are causes for dyspareunia in women?

Answer 19

infection 
episiotomy
endometriosis 
tumour 
vaginal dryness

Question 20

What are causes for dyspareunia in men?

Answer 20

urethritis

prostatits

Question 21

What is vaginismus?

Answer 21

Painful, involuntary spasm of vaginal muscles when penetration is attempted

Question 22

What is treatment for vaginismus?

Answer 22

education
relaxation
self-exploration (insertion of trainers that increase in size)

Question 23

What is required for diagnosis of transgender?

Answer 23

min 2 of the following symptoms for min 2 years:

• strong DISLIKE for their sex characteristics DUE to incongruity with perceived gender
• strong desire to LOSE sex characteristics
• strong desire to GAIN sex characteristics of perceived gender