Sexual Disorders

Question 1

Discuss how the stages of sexual function change with age

Answer 1

Desiure
- reduced
Excitement
- less full erection
- less estrogen effects
Plateau
- prolonged pre-ejaculation state
Orgasm
- shorter, less vigorous,
Resolution
- Prolonged refractory period in males
- More rapid resolution in females

Question 2

List the different DSM5 classifications of sexual disorders

Answer 2

Sexual Dysfunction
- desire: male hypoactive sexual desire disorder, or female sexual interest/arousal disorder
- arousal: erectile disorder, female sexual interest/arousal disorder
- orgasmis: female orgasmic disorder, delayed or premature ejaculation
- sexual pain: genito-pelvic pain penetration disorder
- substance/medication induced sexual dysfunction
Gender Dysphoria
Paraphilic Disorder

Question 3

Discuss the management principles for sexual disorders

Answer 3

Consult Urology/Gynecology to rule out medical disorder
Treat medical or psychiatry comorbidities
Medication for symptoms
- decreased desire than buproprion
- anticipatory anxiety then benzodiazepine or beta-blocker
- erectile dysfunction than PDE-5 inhibitors
- premature ejaculation SSRI
- pain than TCA
- if SSRI induced then anti-serotenergic Cyproheptadine 4-8mg daily for women or 2h prior for men
Psychological
- CBT
Social
- Couple therapy

Question 4

List the criteria for female sexual interest/arousal disorder

Answer 4

Decreased or lack of sexual interest by >=3
- absent or reduced interest
- absent sexual or erotic thoughts
- no initiation of sexual activity and unreceptive to partner
- absent or reduced sexual excitement/pleasure during sexual activity
-reduced sexual interest in response to internal or external stimuli
- absent/reduced genital or non-genital sensation during activities
Symptoms >=6 months
Cause distress
No other cause

Question 5

List the criteria for genito-pelvic pain disorder

Answer 5

Persistent or recurrent difficulties with >=1
- vaginal penetration during intercourse
- marked vulvovaginal pain during intercouse or penetration attempts
- marked fear or anxiety about anxiety/pain in anticipation to penetration
- marked tensing or tightening or pelvic floor during penetration
>=6 months
Cause distress
No other cause

Question 6

List the criteria for gender dysphoria in children

Answer 6

Marked incongruence between assigned gender and experienced for >=6 months with >=6
- strong desire to be other gender
- cross dressing
- strong preference for cross gender role
- strong preference for cross gender activities
- strong preference for playmates of other gender
- rejection of assigned gender play
- strong dislike of ones sexual anatomy
- strong desire for primary or secondary characteristics of other gender
Cause distress and impairement

Question 7

List the criteria for gender dysphoria in adolescents

Answer 7

Marked incongruence between assigned and experienced gender for >=6 months with >=2
- difference in experienced gender and primary/secondary characteristics
- strong desire to be rid of primary/secondary characteristics
- strong desire for primary/secondary characteristics of other gender
- strong desire to be other gender
- strong desire to be treated as other gender
- strong conviction that one has typical feelings and reactions of other gender
Cause distress and impairement

Question 8

List the treatment for gender dysphoria

Answer 8

Before Puberty
- hormone therapy to stop secondary sexual characteristics
After Puberty
- Transition to other gender using pharmacotherapy, surgery

Question 9

List the paraphilias

Answer 9

Paraphilia: recurrent and intense sexual arousing fantasies, urges or behaviours which generally involve non-human objects, suffering, or humiliation or self or partner or non-consenting person
Voyeuristic: spying on unsuspecting others in private activities
Exhibitionistic: exposing genitals to an unsuspecting person
Frotteuristic: touching or rubbing genitals against non-consenting individual
Sexual masochism: undergoing humiliation, bondage, suffering
Sexual sadism: inflicting humiliation, bondage, suffering
Fetishistic: sexual arousal from use of non-living objects or having highly specific focus on non-genital body parts
Transvestic: sexual arousal from cross-dressing

Question 10

Discuss the management of pedophilic disorder

Answer 10

External Management
- incarceration
- recidivism: repeat criminal behaviour in order to return to prison
- conditions upon release
Pharmacotherapy
- SSRI to reduce drive
- testosterone antagonist Cyproterone 100-500mg PO daily
- progestin medroxyprogesterone 100-600mg PO daily
- ablation of testosterone with Lupron or peripheral inhibition with finasteride
Psychotherapy