Sexual Disorders Flashcards
What are the stages of the normal sexual response? (5)
- Desire: Interest in sexual activity
- Excitement: Begins with either fantasy or physical contact
- Plateau: Facial flushing and increases in pulse, blood pressure, and respiration occur in both men and women
- Orgasm: Ejaculations in men and contractions of the uterus in women
- Resolution: Muscles relax and cardiovascular state returns to baseline
What are the differences in the platuea phase between men and women?
- Men: Characterized by increased size of testicles, tightening of the scrotal sac, and secretion of a few drops of seminal fluid
- Women: Contractions of the outer third of the vagina and enlargement of the upper one third of the vagina
What sexual changes occur in men with aging?
- Desire does not usually change
- Men usually require more direct stimulation of genitals and more time to achieve orgasm
- Intensity of ejaculation usually decreases
- Length of refractory period increases
What sexual changes occur in women with aging?
After menopause, women experience vaginal drynes and thinning due to decreased levels of estrogen
What are six potential causes of sexual dysfunction?
- General medical conditions (ex: atherosclerosis; pelvic adhesions)
- Abnormal levels of gonadal hormones
- Medication side effects: Antihypertensives, anticholinergics, SSRIs and antipsychotics
- Substance abuse
- Presence of sexual disorder
- Depression
What are the roles of gonadal hormones in sexual functioning?
- Estrogen:
- Testosterone:
- Progesterone:
- Estrogen: Decreased levels after menopause cause vaginal dryness and thinning in women (without affecting desire)
- Testosterone: Promotes libido (desire) in both men and women
- Progesterone: Inhibits libido in both men and women by blocking androgen receptors; found in oral contraceptives, hormone replacement therapy, and treatments for prostate cancer
How do the following substances affect sexual functioning?
- Alcohol/marijuana:
- Cocaine/amphetamines:
- Narcotics:
- Alcohol/marijuana: Enhance sexual desire by suppressing inhibitons
- Cocaine/amphetamines: Enhance libido by stimulating dopamine receptors
- Narcotics: Inhibit libido
What DSM-IV criteria do all sexual disorders share?
- Causes marked distress or interpersonal difficulty
- Dysfunction is not caused by substance use or a general medical condition
What are some psychological causes of sexual disorders?
- Interpersonal problems with sexual partner
- Guilt about sexual activity
- Fears (pregnancy, rejection, loss of control)
What are the most common sexual disorders in women? men?
Women: sexual desire disorder and orgasmic disorder
Men: secondary erectile disorder and premature ejaculation
What are the disorders of desire? (2)
- Hypoactive sexual desire disorder: absence or deficiency of sexual desire or fantasies
- Sexual aversion disorder: Avoidance of genital contact with a sexual partner
What are the disorders of arousal? (2)
- Male erectile disorder: inability to attain an erection
- Female sexual arousal disorder: Inability to maintain lubrication until completion of sex act
What is the difference between primary and secondary erectile disorder?
- Primary: Never have had an erection
- Secondary: Acquired after previous ability to maintain erections
What are the orgasm disorders? (3)
- Female orgasmic disorder: Inability to have an orgasm after a normal excitement phase; estimated prevalence in women is 30%
- Male orgasmic disorder: Achieves orgasm with great difficulty, if at all; much lower incidence than impotence or premature ejaculation
- Premature ejaculation: Ejaculation earlier than desired time (before or immediately upon entering the vagina)
What are the sexual pain disorders? (2)
- Dyspareunia: Genital pain before, during, or after sexual intercourse; much higher incidence in women than men; often associated with vaginismus
- Vaginismus: Involuntary muscle contraction of the outer third of the vagina during insertion of penis or object; increased incidence in higher socioeconomic groups
What is dual sex therapy?
- Utilizes the concept of the marital unit rather than the individual
- Couples meet with a male and female therapist together in four-way sessions to identify and discuss their sexual problems
- Therapists suggest sexual exercises for the couple to attempt at home
- Activities focus on heightening sensory awareness and progressively incorporate increased levels of sexual contact
How is behavioral therapy used to treat sexual disorders?
- Approaches sexual dysfunction as a learned maladaptive behavior
- Utilizes traditional therapies such as systematic desensitization
- patients are progressively exposed to increasing levels of stimuli that provoke their anxiety
- Muscle relaxation techniques
- Assertiveness training
- Prescribed sexual exercises to try at home
What types of therapy can be used to treat sexual disorders aside from behavioral therapy and dual sex therapy?
- Hypnosis - used adjunctively
- Group therapy
- Analytically oriented psychotherapy: long term individual therapy
What are some specific techniques for treating premature ejaculation?
- The squeeze technique: Used to increase the threshold of excitability; when the man has been excited to near ejaculation, he or his sexual partner is instructed to squeeze the glans of his penis in order to prevent ejaculation
- The stop-start technique: Involves cessation of all penile stimulation when the man is near ejaculation
- Pharmacotherapy: Side effects of drugs including SSRIs and TCAs may prolong sexual response
What are paraphilias?
Sexual disorders characterized by engagement in unusual sexual activities for at least 6 months that cause impairment with daily functioning
What are the three most common paraphilias?
Pedophilia, voyeurism, and exhibitionism
Describe the following paraphilias…
- Pedophilia:
- Voyeurism:
- Exhibitionism:
- Fetishism:
- Pedophilia: Sexual gratification from fantasies or behaviors involving sexual acts with children
- Voyeurism: Watching unsuspecting nude intercourse
- Exhibitionism: Exposure of one’s genitals to strangers
- Fetishism: Sexual preference for inanimate objects
Describe the following paraphilias…
- Transvestic fetishism:
- Frotteurism:
- Masochism:
- Telephone scatologia:
- Transvestic fetishism: Sexual gratification in men (usually heterosexual) from wearing women’s clothing (especially underwear)
- Frotteurism: Sexual pleasure in men from rubbing their genitals against unsuspecting women; usually occurs in a crowded area (such as a subway)
- Masochism: Sexual excitement from being humiliated or beaten
- Telephone scatologia: Sexual excitement from calling unsuspecting women and engaging in sexual conversations with them
What are poor prognostic factors for paraphilias?
What are good prognostic factors?
Poor: Early age of onset, comorbid substance abuse, high frequency of behavior, and referral by law enforcement agencies
Good: Self-referral for treatment, sense of guilt associated with the behavior, history of otherwise normal sexual activity in addition to the paraphilia
What are treatment options for paraphilias?
- Insight oriented psychotherapy: Most common method
- Behavior therapy: Aversive conditioning
- Pharmacologic therapy: Antiandrogens
What is gender identity disorder?
Transexuality
People have the subjective feeling that they were born the wrong sex; they may dress as the opposite sex, take sex hormones, or undergo sex change operations
What is homosexuality?
When is it considered a dysfunction?
Homosexuality is a sexual or romantic desire for people of the same sex; It is a normal variant of sexual orientation
Distress about one’s sexual orienation is considered a dysfunction that should be treated with individual psychotherapy and/or group therapy
