Sex dysfunction and paraphilias Flashcards
subtypes of sexual dysfunction
lifelong
acquired
generalized
situational
definition of delayed ejaculation
either marked delay in ejaculation or infrequency/absence for ejaculation
how long do symptoms have to be present for dx of delayed ejaculation
6 months
what is common about ejaculation in delayed ejaculation disorder
often can achieve with self-stimulation but not during sex
changes in delayed ejaculation disorder with age
prevalence increases
may have reduced volume, force, or sensation
what are the predominate contributors to delayed ejaculation disorder
depression
relationship dissatisfaction
medications
what types of medications can contribute to delayed ejaculation disorder
tamsulosin
antihypertensives
antidepressants
antipsychotics
why does tamsulosin have an effect of ejaculation
medication inhibits a-adrenergic innervation of the ejaculatory system
what are the 3 possible manifestations of erectile disorder and how many have to be present for dx
1+:
-difficulty achieving erection
-difficulty maintaining erection
-decrease in erectile rigidity
how long do symptoms have to be present for dx of erectile disorder
6 months
what is the difference between erectile dysfunction and erectile disorder
dysfunction is the descriptive term for difficulty achieving/maintaining erection and disorder is a diagnostic category of which dysfunction has been present for at least 6 months
treatment efficacy in lifelong v. acquired erectile disorder
acquired usually r/t to biologic factors and tends to persist
lifelong tends to be r/t psych factors and is more responsive to tx
lab values to assess in the tx of erectile disorder
thyroid function
lipids
fasting glucose (DM)
testosterone levels
what is a potential medical cause of erectile disorder
vascular disease
what are some characteristics of erectile disorder when the cause is psychological
situational
inconsistent
acute onset
onset of erectile disorder when r/t organic cause
tends to be gradual and generalized
common comorbidities of erectile disorder
dyslipidemia
cardiovascular disease
hypogonadism
MS
DM
possible manifestations of female orgasmic disorder and how many must be present for dx
1+
-delay/infrequency/absence of orgasm
-reduced intensity of orgasm
how long must symptoms be present for dx of female orgasmic disorder
6 months
what if there is orgasm during clitoral stimulation but not during sex
Does not meet criteria for dx
6 possible manifestations of female sexual interest/arousal disorder and how many have to be present for dx
3+
-absent/reduced interest in sex
-absent/reduced sexual thoughts/fantasies
-no/reduced initiation of sex and unresponsive to partner’s initiation
-absent/reduced excitement/pleasure in sexual activities
-absent/reduced arousal in response to sexual cues
-absent/reduced sensations during sexual activity
how long must symptoms be present for dx of female sexual interest/arousal disorder
6 months
disorders associated with female sexual interest/arousal disorder
depression
thyroid dysfunction
anxiety
incontinence
arthritis
IBS
4 possible manifestations of genito-pelvic pain/penetration disorder and how many must be present for dx
persistent/recurrent difficulty w/ 1+:
-vaginal penetration during intercourse
-marked pain during intercourse or penetration attempts
-marked fear/anxiety about pain while anticipating, having, or after intercourse
-marked tensing of pelvic floor muscle during penetration attempts
how long must symptoms be present for dx of genito-pelvic pain/penetration disorder
6 months
dyspareunia
pain during intercourse
vaginismus
involuntary muscle contraction making penetration difficult or impossible
additional disorders of pelvic floor/reproductive organs that may be associated with genito-pelvic pain/penetration disorder
interstitial cystitis
constipation
vaginal infection
endometriosis
IBS
definition of male hypoactive sexual desire disorder
little/no erotic fantasies or sexual desire for at least 6 months
(must meet both criteria)
definition of premature ejaculation
persistent/recurrent pattern of ejaculation within 1 minute of penetration that lasts at least 6 months
what are 3 things that may be associated with premature ejaculation
prostatitis
thyroid disease
drug withdrawal
6 meds that have the highest rates of sexual dysfunction
citalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
venlafaxine
gender dysphoria
distress from incongruence between expressed and assigned gender
transgender
gender identity is different than assigned gender
cisgender
gender identity congruent with birth assigned gender
transexual
one who seeks or is undergoing transition from one gender to another
how long must symptoms be present for dx of gender dysphoria
6 months
8 possible manifestations of gender dysphoria in children and how many must be present for dx
6+
-insistence/desire to be other gender
-preference for cross-dressing
-preference for cross-gender roles in play
-preference for toys/games/activities typically associated with other gender
-preference for playmates of other gender
-rejection of toys associated with assigned gender
-dislike for one’s own sexual anatomy
-desire for sex characteristics that match expressed gender
6 possible manifestations of gender dysphoria in adolescents/adults and how many must be present for dx
2+
-incongruence between expressed gender and secondary sex characteristics
-desire to be rid of sex characteristics
-desire for sex characteristics of other gender
-desire to be other gender
-desire to be treated as other gender
-conviction that they have thoughts/feelings/rxns of other gender
typical onset of gender dysphoria without a disorder of sexual development
between 2-4 years
what disorder is more common in those with gender dysphoria than in the general population
Autism
mild premature ejaculation
within 30 seconds to 1 minute
moderate premature ejaculation
within 15-30 seconds
sever premature ejaculation
within 15 seconds
orgasmic anhedonia
ejaculation remains intact but there is no physical sensation of orgasm
what is trazadone rarely associated with
priapism
medications that can enhance sex drive
wellbutrin
clomipramine
selegiline
what antihistamine medication may reduce SSRI-induced delayed orgasm
cyproheptadine
what anticholinergic medication may reverse SSRI-induced orgasmic dysfunction
amantadine
how does sildenafil work and what is it prescribed for
nitric oxide enhancer that facilitates the inflow of blood to the penis
Erectile disorder
how long does sildenafil take to work and how long does it last
effect in 1 hour
may last up to 4 hours
common side effects of sildenafil
HA
flushing
dyspepsia
sildenafil in women
increases lubrication but not necessarily desire
alprostadil delivery
PO, transurethral and injectable
effect time of alprostadil
effect in 2-3 minutes
lasts up to 1 hour
how can SSRIs treat sexual dysfunction
can prolong sexual response in those with premature ejaculation
dopaminergic meds and sexual dysfunction
may increase libido and improve sexual performance
dopaminergic drugs that can be used to treat sexual dysfunction
L-dopa (dopamine precursor)
bromocriptine (dopamine agonist)
effects of hormone therapy on sexual function
-androgens increase sex drive
-estrogen may decrease libido
what medications may treat compulsive sexual behaviors
antiandrogens (estrogen and progesterone)
psychotherapies used to treat sexual dysfunction
dual-sex therapy
behavioral therapy
mindfulness
group therapy
hypnotherapy
analytically oriented therapy
how are paraphilic behaviors divergent
they involve aggression, victimization, and extreme one-sidedness
exhibitionism
recurrent urge to expose genitals to strangers
there is sexual excitement prior to exposure and orgasm r/t masturbation during or after exposure
sexual focus of fetishism
objects that are intimately associated with the body or nongenital body parts
frotteurism
rubbing penis against fully clothed women to achieve orgasm that usually occurs in crowded places
how old do children have to be for sexual desire to be considered pedophilia
under 14
patient must be over 16 and at least 5 years older than victim
sexual masochism
sexual urges/fantasies involving being humiliated, beaten, bound, or otherwise made to suffer
subtypes of sexual masochism
asphyxiophilia
erotic asphixiation
sexual sadism
sexual arousal d/t the suffering of others
must have either acted on fantasies or they cause significant distress
what is another name for voyeurism
scopophilia
voyeurism
preoccupation/fantasies of observing people while naked or engaged in grooming or sexual activity
usually accompanied by maturbation
transvestism
fantasies/urges to dress as opposite gender for arousal and as an adjunct to masturbation/coitus
coprophilia
sexual pleasure associated with defacationur
urophilia
sexual desire associated with urination
klismaphilia
use of enemas for sexual stimulation
what are the 5 types of psych interventions for treatment of paraphilias
external control
reduction of sex drive
tx of comorbidities
CBT
dynamic psychotherapy
external control as treatment for paraphilias
physically eliminating opportunities for individual to act on urges
4 psychosexual factors that sexuality depends on
sexual identity
sexual orientation
gender identity
sexual behavior
what is the role of the cortex in sexual behavior
involved in controlling sexual impulses and controlling sexual stimuli
areas of the cortex that are particularly active during sexual stimulation
orbitofrontal cortex
L anterior cingulate cortex
right caudate nucleus
role of brain stem in sexual behavior
exerts inhibitory/excitatory control over spinal cord and sexual reflexes
dopamine effect on libido
increased dopamine increases libido
serotonin effect on sexual function
exerts inhibitory effect
phosphodiesterase-5 inhibitors for sexual dysfunction
sildenafil
vardenafil
tadalafill
brand name of sildenafil
viagra
brand name of vardenafil
levitra
brand name of tadalafil
cialis
high fat meals with phosphodiesterase-5 inhibitors
absorption delayed up to 60 minutes and peak concentration not as strong
half life of sildenafil and vardenafil
3-4 hoursalf li
half life of tadalafil
18 hours
what enzyme metabolizes phosphodiesterase-5 inhibitors
3A4
medication used to treat priapism
phenylephrine
intracavernosal injection for priapism
phenylephrine
what are some of the more potent 3A4 inhibitors
ketoconazole
itraconazole
mibefradil
typical dosage and range of sildenafil
50mg PO 1h prior to sexual activity
range is 25-100mg
starting dose of sildenafil for patients >65 and w/ cirrhosis or renal impairment
25mg
how often can you use sildenafil
no more than daily
typical dosage and range for vardenafil
10mg PO 1h prior to sex
range 5-20mg
typical dose and range for tadalafil
10mg PO prior to sex
range 5-20mg
what else is used to treat erectile dysfunction but does not work as well as phosphodiesterase-5 inhibitors
yohimbine
