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Psychopath 2 > sexual disorders > Flashcards

sexual disorders Flashcards

1
Q

sexual desire disorders

A

female sexual interest disorder
male hypoactive sexual desire disorder
sexual aversion disorder

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2
Q

hypoactive sexual interest d/o

A

1- persistently deficient sexual fantasies/ desires for sexual activity for one’s age and context
2- causes distress or difficulty
3- not better accounted for by another disorder, not d/t substance or general medical condition

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3
Q

tx for female sexual interest disorder

A

couples therapy
bremelanotide (inc libido in 90% pts), subQ method in testing now (intranasal had adverse effects on BP)
flibanserin- a 5HT-1a agonist, 5HT-2a antagonist; *Severe hypotension with EtOH and CYP3A4 inhibitors

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4
Q

male hypoactive sexual desire disorder

A

persistently or recurrently deficient sexual/erotic thoughts or fantasies and desire
min 6 months
causes distress
not explained by another disorder

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5
Q

tx male hypoactive sexual desire disorder

A

psychotherapy, testosterone
? bremelanotide
D2-agonist (cabergoline, pramipexole, ropinirole) - may inc desire but may lead ot hypersexuality condition/ psychosis

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6
Q

sexual aversion disorder (DSM4)

A

1- persistent/recurrent extreme aversion and avoidance of genital contact w sexual partner
2- causes distress or difficulty
3- not explained by another axis 1 disorder (except another sexual dysfunction)

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7
Q

tx sexual aversion disorder

A

graduated exposure
CBT
stress reduction, relaxation
relation therapy (if relation or communication problems)

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8
Q

sexual aversion from PTSD and tx

A

sexual abuse or other traumatic experiences caused disorder

tx: work through these disorders

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9
Q

sexual arousal disorders

A

female/male sexual arousal disorder

male erectile disorder

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10
Q

female sexual arousal disorder

A

1- persistent/recurrent inability to attain or maintain until completion of activity, an adequate lubrication-swelling response of excitement
2- causes distress or difficulty
3- not better accounted for by axis 1 d/o (except sexual dysfunction), and not d/t substance or general medical condition

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11
Q

sexual arousal disorder tx

A

focus on relationship issues, improved communication (verbal and nonverbal), non-sexual intimacy, education about sexuality
topical cream Femprox for females (under development)- contains PGE1

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12
Q

male erectile disorder

A

1- persistent/recurrent inability to attain or maintain adequate erection until completion of activity
2- causes distress or difficulty
3- not better accounted for by axis 1 d/o (except sexual dysfunction), substance, or medical condition

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13
Q

erectile dysfunction tx

A

PDE5-I (sildenafil, vardenafil, tadalafil)
injection therapy: papaverine, phentolamine, PGE1
penile prosthesis or pump

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14
Q

orgasmic disorders

A

female and male orgasmic disorders
premature ejaculation
delayed ejaculation

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15
Q

orgasmic disorder criteria

A

1- persistent/recurrent delay or absence of orgasm following normal sexual excitement phase (although there is always variation in type/intensity of stimulation that triggers orgasm)
2- causes distress or difficulty
3- not accounted for by another d/o, substance, medical condition

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16
Q

tx orgasmic disorders

A

Hitachi magic wand
sialidase (enzyme to regrow damaged nerve)
yohimbine - male impotence
Wellbutrin ?
cabergoline (D2-agonist) - dec prolactin - may help achieve orgasm partially or fully

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17
Q

premature ejaculation

A

1- persistent/recurrent ejaculation with minimal stimulation before, on, soon after penetration and before desired; must account for age, recent frequency of sexual activity, duration of excitement phase, etc.
2- distress
3- not d/t substance (like opioid withdrawal)

18
Q

tx premature ejaculation

A

SSRI
tramadol- atypical oral analgesic; mu agonist and inc NE and 5HT
clomipramine (TCA)- side effect = delayed ejaculatory response
desensitizing creams- apply to penis, may cause contamination and dec sensitivity of partner

19
Q

delayed ejaculation

A

delayed ejaculation during 75%+ partnered sexual activity
minimum of 6 months duration
tx: sex therapy, no known meds yet

20
Q

sexual pain disorders

A

dyspareunia, vaginismus

21
Q

dyspareunia

A

1- recurrent/persistent genital pain a/w sexual intercourse in male or female
2- distress
3- not d/t vaginismus/lack of lubrication exclusively, not d/t axis 1 d/o, substance, or medical condition

22
Q

causes of dyspareunia

A

congenital: endometriosis, vaginal septa, thickened undilatable hymen, introitus hypoplasia, ovarian cysts
acquired: infection, vulvar vestibulitis, tumor (e.g. fibroid), xerosis (dryness, esp post-menopause), interstitial cystitis, uterine prolapse, surgical complications
acq or cong: retroverted uterus, vaginismus

23
Q

gender differences in dyspareunia

A

significantly more common in women (20%)

causes in men: infection, interstitial cystitis, Peyronie’s disease, tight foreskin, frenulum brevis

24
Q

tx dyspareunia

A

sexual lubricant, positions that limit depth of penetration, estrogen tx (vaginal dryness in post-menopausal women), surgery (some cases)

25
Q

vaginismus

A

1- recurrent/persistent involuntary spasm of outer 1/3 vaginal musculature that interferes w sexual intercourse
2- distress
3- not better accounted for by axis 1 d/o (somatization), general medical condition

26
Q

vaginismus tx

A

vaginal dilators- teach women how to override involuntary contractions w graduated vaginal insertion exercises

27
Q

exhibitionism

A

1- over 6 months, recurrent and intense arousing fantasies, urges, or behaviors involving exposing genitals to unsuspecting stranger
2- acted on these urges or urges cause distress or difficulty

28
Q

fetishism

A

1- over 6 months, recurrent intense fantasies, urges, or behaviors involving use of nonliving objects
2- cause distress or impairment of functioning
3- fetish objects not limited to female clothing for cross-dressing or devices for tactile stimulation

29
Q

frotteurism

A

1- over 6 months, recurrent sexually arousing fantasies, urges, behaviors involving touching and rubbing against a non-consenting person
2- acted on these urges or urges cause distress or difficulty

30
Q

sexual sadism

A

1- over 6 months, recurrent intense fantasies, urges, or behaviors involving real (not simulated) acts in which psychological or physical suffering of victim is exciting to person
2- cause distress or functional impairment

31
Q

sexual masochism

A

1- over 6 months, recurrent intense fantasies, urges, or behaviors involving real (not simulated) acts of being humiliated, beaten, bound, or otherwise made to suffer
2- cause distress or functional impairment

32
Q

transvestic fetishism

A

1- over 6 months, a heterosexual male has recurrent intense fantasies, urges, or behaviors involving cross-dressing
2- cause distress or functional impairment

33
Q

voyeurism

A

1- over 6 months, recurrent intense fantasies, urges, or behaviors involving observation of unsuspecting person who is naked, disrobing, or engaging in sexual activity
2- acted on urges or urges/fantasies cause distress

34
Q

pedophilia

A

1- over 6 months, recurrent intense fantasies, urges, or behaviors involving sexual activity with a prepubescent child or children (13 and younger)
2- acted on urges or urges/fantasies cause distress
3- person is at least 16 and at least 5 years older than child/children in criterion A (does not include late adolescent in sexual relationship w 12-13 year old)

35
Q

hebephilia

A

sexual attraction to adolescents that are post-pubertal, but not yet at age of legal consent
aka Lolita syndrome

36
Q

breakdown of pedophile sex offenders

A

29% are relatives
60% are acquaintances
11% are strangers

37
Q

other paraphilias NOS mentioned in DSM

A 
telephone scatologia (obscene phone calls)
necrophilia (corpses)
partialism (exclusive focus on one part of body)
zoophilia (animals
coprophilia (feces)
klismaphilia (enemas)
urophilia (urine)
emetophilia (vomit)
38
Q

tx paraphilias

A

CBT, psychodynamic therapy, group therapy/ support groups

meds: antidepressants, anti-androgens (MPA, cyproterone acetate, leuprolide acetate), GnRH analogs
* to reduce libido

39
Q

gender dysphoria disorder

A

1- strong and persistent cross-gender identification; 4+ of: repeatedly states desire or insistence of being other sex, insist on wearing opposite gender’s clothing, preference for cross-sex role in make-believe play, desire to partake in stereotypical activities of other sex, strong preference for playmates of other sex
2- persistent discomfort w sex or sense of inappropriateness in gender role of that sex
3- not concurrent with physical intersex condition

40
Q

gender identity disorder tx

A

hormone therapy - may help w breast development (M to F) or body and facial hair development, muscle tone, and lower voice (F to M)
sexual reassignment surgery - genital and non-genital reconstruction

41
Q

sex addiction

A

recurrent compulsive sexual activity that interferes w functioning and/or exposes sufferer to unacceptable levels of risk

  • NOT currently accepted as a diagnosis in DSM
    tx: self help group, SSRI, anti-androgens, CBT

Psychopath 2 (8 decks)

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