Sexual Disorders

Question 1

What are the stages of the normal sexual response? (5)

Answer 1

• 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

Question 2

What are the differences in the platuea phase between men and women?

Answer 2

• 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

Question 3

What sexual changes occur in men with aging?

Answer 3

• 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

Question 4

What sexual changes occur in women with aging?

Answer 4

After menopause, women experience vaginal drynes and thinning due to decreased levels of estrogen

Question 5

What are six potential causes of sexual dysfunction?

Answer 5

• 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

Question 6

What are the roles of gonadal hormones in sexual functioning?

• Estrogen:
• Testosterone:
• Progesterone:

Answer 6

• 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

Question 7

How do the following substances affect sexual functioning?

• Alcohol/marijuana:
• Cocaine/amphetamines:
• Narcotics:

Answer 7

• Alcohol/marijuana: Enhance sexual desire by suppressing inhibitons
• Cocaine/amphetamines: Enhance libido by stimulating dopamine receptors
• Narcotics: Inhibit libido

Question 8

What DSM-IV criteria do all sexual disorders share?

Answer 8

• Causes marked distress or interpersonal difficulty
• Dysfunction is not caused by substance use or a general medical condition

Question 9

What are some psychological causes of sexual disorders?

Answer 9

• Interpersonal problems with sexual partner
• Guilt about sexual activity
• Fears (pregnancy, rejection, loss of control)

Question 10

What are the most common sexual disorders in women? men?

Answer 10

Women: sexual desire disorder and orgasmic disorder

Men: secondary erectile disorder and premature ejaculation

Question 11

What are the disorders of desire? (2)

Answer 11

• Hypoactive sexual desire disorder: absence or deficiency of sexual desire or fantasies
• Sexual aversion disorder: Avoidance of genital contact with a sexual partner

Question 12

What are the disorders of arousal? (2)

Answer 12

• Male erectile disorder: inability to attain an erection
• Female sexual arousal disorder: Inability to maintain lubrication until completion of sex act

Question 13

What is the difference between primary and secondary erectile disorder?

Answer 13

• Primary: Never have had an erection
• Secondary: Acquired after previous ability to maintain erections

Question 14

What are the orgasm disorders? (3)

Answer 14

• 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)

Question 15

What are the sexual pain disorders? (2)

Answer 15

• 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

Question 16

What is dual sex therapy?

Answer 16

• 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

Question 17

How is behavioral therapy used to treat sexual disorders?

Answer 17

• 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

Question 18

What types of therapy can be used to treat sexual disorders aside from behavioral therapy and dual sex therapy?

Answer 18

• Hypnosis - used adjunctively
• Group therapy
• Analytically oriented psychotherapy: long term individual therapy

Question 19

What are some specific techniques for treating premature ejaculation?

Answer 19

• 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

Question 20

What are paraphilias?

Answer 20

Sexual disorders characterized by engagement in unusual sexual activities for at least 6 months that cause impairment with daily functioning

Question 21

What are the three most common paraphilias?

Answer 21

Pedophilia, voyeurism, and exhibitionism

Question 22

Describe the following paraphilias…

• Pedophilia:
• Voyeurism:
• Exhibitionism:
• Fetishism:

Answer 22

• 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

Question 23

Describe the following paraphilias…

• Transvestic fetishism:
• Frotteurism:
• Masochism:
• Telephone scatologia:

Answer 23

• 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

Question 24

What are poor prognostic factors for paraphilias?

What are good prognostic factors?

Answer 24

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

Question 25

What are treatment options for paraphilias?

Answer 25

• Insight oriented psychotherapy: Most common method
• Behavior therapy: Aversive conditioning
• Pharmacologic therapy: Antiandrogens

Question 26

What is gender identity disorder?

Answer 26

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

Question 27

What is homosexuality?

When is it considered a dysfunction?

Answer 27

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