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Diagnosis_Management 1 > Sex dysfunction and paraphilias > Flashcards

Sex dysfunction and paraphilias Flashcards

1
Q

subtypes of sexual dysfunction

A

lifelong
acquired
generalized
situational

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2
Q

definition of delayed ejaculation

A

either marked delay in ejaculation or infrequency/absence for ejaculation

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3
Q

how long do symptoms have to be present for dx of delayed ejaculation

A

6 months

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4
Q

what is common about ejaculation in delayed ejaculation disorder

A

often can achieve with self-stimulation but not during sex

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5
Q

changes in delayed ejaculation disorder with age

A

prevalence increases
may have reduced volume, force, or sensation

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6
Q

what are the predominate contributors to delayed ejaculation disorder

A

depression
relationship dissatisfaction
medications

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7
Q

what types of medications can contribute to delayed ejaculation disorder

A

tamsulosin
antihypertensives
antidepressants
antipsychotics

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8
Q

why does tamsulosin have an effect of ejaculation

A

medication inhibits a-adrenergic innervation of the ejaculatory system

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9
Q

what are the 3 possible manifestations of erectile disorder and how many have to be present for dx

A

1+:
-difficulty achieving erection
-difficulty maintaining erection
-decrease in erectile rigidity

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10
Q

how long do symptoms have to be present for dx of erectile disorder

A

6 months

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11
Q

what is the difference between erectile dysfunction and erectile disorder

A

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

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12
Q

treatment efficacy in lifelong v. acquired erectile disorder

A

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

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13
Q

lab values to assess in the tx of erectile disorder

A

thyroid function
lipids
fasting glucose (DM)
testosterone levels

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14
Q

what is a potential medical cause of erectile disorder

A

vascular disease

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15
Q

what are some characteristics of erectile disorder when the cause is psychological

A

situational
inconsistent
acute onset

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16
Q

onset of erectile disorder when r/t organic cause

A

tends to be gradual and generalized

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17
Q

common comorbidities of erectile disorder

A

dyslipidemia
cardiovascular disease
hypogonadism
MS
DM

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18
Q

possible manifestations of female orgasmic disorder and how many must be present for dx

A

1+
-delay/infrequency/absence of orgasm
-reduced intensity of orgasm

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19
Q

how long must symptoms be present for dx of female orgasmic disorder

A

6 months

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20
Q

what if there is orgasm during clitoral stimulation but not during sex

A

Does not meet criteria for dx

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21
Q

6 possible manifestations of female sexual interest/arousal disorder and how many have to be present for dx

A

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

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22
Q

how long must symptoms be present for dx of female sexual interest/arousal disorder

A

6 months

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23
Q

disorders associated with female sexual interest/arousal disorder

A

depression
thyroid dysfunction
anxiety
incontinence
arthritis
IBS

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24
Q

4 possible manifestations of genito-pelvic pain/penetration disorder and how many must be present for dx

A

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

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25
Q

how long must symptoms be present for dx of genito-pelvic pain/penetration disorder

A

6 months

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26
Q

dyspareunia

A

pain during intercourse

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27
Q

vaginismus

A

involuntary muscle contraction making penetration difficult or impossible

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28
Q
A
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29
Q

additional disorders of pelvic floor/reproductive organs that may be associated with genito-pelvic pain/penetration disorder

A

interstitial cystitis
constipation
vaginal infection
endometriosis
IBS

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30
Q

definition of male hypoactive sexual desire disorder

A

little/no erotic fantasies or sexual desire for at least 6 months
(must meet both criteria)

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31
Q

definition of premature ejaculation

A

persistent/recurrent pattern of ejaculation within 1 minute of penetration that lasts at least 6 months

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32
Q

what are 3 things that may be associated with premature ejaculation

A

prostatitis
thyroid disease
drug withdrawal

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33
Q

6 meds that have the highest rates of sexual dysfunction

A

citalopram
fluoxetine
fluvoxamine
paroxetine
sertraline
venlafaxine

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34
Q

gender dysphoria

A

distress from incongruence between expressed and assigned gender

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35
Q

transgender

A

gender identity is different than assigned gender

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36
Q

cisgender

A

gender identity congruent with birth assigned gender

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37
Q

transexual

A

one who seeks or is undergoing transition from one gender to another

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38
Q

how long must symptoms be present for dx of gender dysphoria

A

6 months

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39
Q

8 possible manifestations of gender dysphoria in children and how many must be present for dx

A

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

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40
Q

6 possible manifestations of gender dysphoria in adolescents/adults and how many must be present for dx

A

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

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41
Q

typical onset of gender dysphoria without a disorder of sexual development

A

between 2-4 years

42
Q

what disorder is more common in those with gender dysphoria than in the general population

A

Autism

43
Q

mild premature ejaculation

A

within 30 seconds to 1 minute

44
Q

moderate premature ejaculation

A

within 15-30 seconds

45
Q

sever premature ejaculation

A

within 15 seconds

46
Q

orgasmic anhedonia

A

ejaculation remains intact but there is no physical sensation of orgasm

47
Q

what is trazadone rarely associated with

A

priapism

48
Q

medications that can enhance sex drive

A

wellbutrin
clomipramine
selegiline

49
Q

what antihistamine medication may reduce SSRI-induced delayed orgasm

A

cyproheptadine

50
Q

what anticholinergic medication may reverse SSRI-induced orgasmic dysfunction

A

amantadine

51
Q

how does sildenafil work and what is it prescribed for

A

nitric oxide enhancer that facilitates the inflow of blood to the penis
Erectile disorder

52
Q

how long does sildenafil take to work and how long does it last

A

effect in 1 hour
may last up to 4 hours

53
Q

common side effects of sildenafil

A

HA
flushing
dyspepsia

54
Q

sildenafil in women

A

increases lubrication but not necessarily desire

55
Q

alprostadil delivery

A

PO, transurethral and injectable

56
Q

effect time of alprostadil

A

effect in 2-3 minutes
lasts up to 1 hour

57
Q

how can SSRIs treat sexual dysfunction

A

can prolong sexual response in those with premature ejaculation

58
Q

dopaminergic meds and sexual dysfunction

A

may increase libido and improve sexual performance

59
Q

dopaminergic drugs that can be used to treat sexual dysfunction

A

L-dopa (dopamine precursor)
bromocriptine (dopamine agonist)

60
Q

effects of hormone therapy on sexual function

A

-androgens increase sex drive
-estrogen may decrease libido

61
Q

what medications may treat compulsive sexual behaviors

A

antiandrogens (estrogen and progesterone)

61
Q

psychotherapies used to treat sexual dysfunction

A

dual-sex therapy
behavioral therapy
mindfulness
group therapy
hypnotherapy
analytically oriented therapy

62
Q

how are paraphilic behaviors divergent

A

they involve aggression, victimization, and extreme one-sidedness

63
Q

exhibitionism

A

recurrent urge to expose genitals to strangers
there is sexual excitement prior to exposure and orgasm r/t masturbation during or after exposure

64
Q

sexual focus of fetishism

A

objects that are intimately associated with the body or nongenital body parts

65
Q

frotteurism

A

rubbing penis against fully clothed women to achieve orgasm that usually occurs in crowded places

66
Q

how old do children have to be for sexual desire to be considered pedophilia

A

under 14
patient must be over 16 and at least 5 years older than victim

67
Q

sexual masochism

A

sexual urges/fantasies involving being humiliated, beaten, bound, or otherwise made to suffer

68
Q

subtypes of sexual masochism

A

asphyxiophilia
erotic asphixiation

69
Q

sexual sadism

A

sexual arousal d/t the suffering of others
must have either acted on fantasies or they cause significant distress

70
Q

what is another name for voyeurism

A

scopophilia

71
Q

voyeurism

A

preoccupation/fantasies of observing people while naked or engaged in grooming or sexual activity
usually accompanied by maturbation

72
Q

transvestism

A

fantasies/urges to dress as opposite gender for arousal and as an adjunct to masturbation/coitus

73
Q

coprophilia

A

sexual pleasure associated with defacationur

74
Q

urophilia

A

sexual desire associated with urination

75
Q

klismaphilia

A

use of enemas for sexual stimulation

76
Q

what are the 5 types of psych interventions for treatment of paraphilias

A

external control
reduction of sex drive
tx of comorbidities
CBT
dynamic psychotherapy

77
Q

external control as treatment for paraphilias

A

physically eliminating opportunities for individual to act on urges

78
Q

4 psychosexual factors that sexuality depends on

A

sexual identity
sexual orientation
gender identity
sexual behavior

79
Q

what is the role of the cortex in sexual behavior

A

involved in controlling sexual impulses and controlling sexual stimuli

80
Q

areas of the cortex that are particularly active during sexual stimulation

A

orbitofrontal cortex
L anterior cingulate cortex
right caudate nucleus

81
Q

role of brain stem in sexual behavior

A

exerts inhibitory/excitatory control over spinal cord and sexual reflexes

82
Q

dopamine effect on libido

A

increased dopamine increases libido

83
Q

serotonin effect on sexual function

A

exerts inhibitory effect

84
Q

phosphodiesterase-5 inhibitors for sexual dysfunction

A

sildenafil
vardenafil
tadalafill

85
Q

brand name of sildenafil

A

viagra

86
Q

brand name of vardenafil

A

levitra

87
Q

brand name of tadalafil

A

cialis

88
Q

high fat meals with phosphodiesterase-5 inhibitors

A

absorption delayed up to 60 minutes and peak concentration not as strong

89
Q

half life of sildenafil and vardenafil

A

3-4 hoursalf li

90
Q

half life of tadalafil

A

18 hours

91
Q

what enzyme metabolizes phosphodiesterase-5 inhibitors

A

3A4

92
Q

medication used to treat priapism

A

phenylephrine

93
Q

intracavernosal injection for priapism

A

phenylephrine

94
Q

what are some of the more potent 3A4 inhibitors

A

ketoconazole
itraconazole
mibefradil

95
Q

typical dosage and range of sildenafil

A

50mg PO 1h prior to sexual activity
range is 25-100mg

96
Q

starting dose of sildenafil for patients >65 and w/ cirrhosis or renal impairment

A

25mg

97
Q

how often can you use sildenafil

A

no more than daily

98
Q

typical dosage and range for vardenafil

A

10mg PO 1h prior to sex
range 5-20mg

99
Q

typical dose and range for tadalafil

A

10mg PO prior to sex
range 5-20mg

100
Q

what else is used to treat erectile dysfunction but does not work as well as phosphodiesterase-5 inhibitors

A

yohimbine

Diagnosis_Management 1 (16 decks)

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