sexual disorders and gender identity

Question 1

2 neurological pathways involved in the sexual response cycle

Answer 1

 Central reward – dopamine and mesolimbic

 Peripheral SNS(somatic nervous sys.) mediation – hypogastric plexus

Question 2

ALL DSM-5 sexual dysfunctions must ….

Answer 2

symptoms cause sig. distress
persist for min of 6 months
and disturb an aspect of the sexual response cycle

not better explained by anything else

Question 3

delayed ejaculation

treatment

Answer 3

delay or absence of ejaculation on most partnered sexual activity
a. Treat: behavioral interventions to minimize performance anxiety or drugs (cyproheptadine)

Question 4

erectile disorder

Answer 4

at least 1 of the 3:

• -hard to obtain an erection
• -hard maintaining erection until completion
• -decrease in erectile rigidity
  a. Risk factors: old age, diabetes, vascular disease, smoking, hypercholesterolemia

Question 5

treatment for erectile disorder

Answer 5

testosterone for hypogonadism

bromocriptine for hyperprolactinemia

psychotherapy

penile prosthetic

intracavernosal injections – papaverine, phenoxybenzamine, PGE1 (alprostadil)

oral therapy – sildenafil (4 hr halflife), vardenafil (4-6 hr), tadalafil (36 hrs)

Question 6

female orgasmic disorder

Answer 6

marked delay, absence or reduced intensity of orgasm

Question 7

Female Sexual Interest/Arousal Disorder

Answer 7

lack of or reduced interest or arousal with atleast 3 of these signs:

i. Absent/reduced interest
ii. Absent/reduced sexual/erotic thoughts
iii. No/reduced initiation of sexual activity; typically unreceptive to attempts
iv. Absent/reduced excitement/pleasure in sexual encounters
v. Absent/reduced arousal in response to sexual cues
vi. Absent or reduced genital/nongenital sensations during sex

Question 8

Male Hypoactive Sexual Desire Disorder

Answer 8

deficient/absent sexual/erotic thoughts and desires

judgement of deficiency is made by the clinician

Question 9

Premature (early) Ejaculation

Answer 9

ejaculation within 1 minute following vaginal penetration and before wished

a. Mild: 30 sec – 1 min after penetration
b. Mod: 15-30 sec
c. Severe: prior to/at start of – 15 sec

Question 10

treatment for early ejaculation

Answer 10

behavioral (start-stop/squeeze) and drugs (SSRIs/clomipramine)

Question 11

Genito-Pelvic Pain/Penetration disorder

Answer 11

Persistent or recurrent difficulties with one or more:

i. Vaginal Penetration During Intercourse
ii. Marked pain during intercourse on penetration
iii. Marked fear or anxiety of pain in anticipation of, during, or as a result of vaginal penetration

Question 12

Substance/Medication Induced Sexual Dysfunction

Answer 12

• a clinically significant sexual dysfunction
  i. Symptoms developed during/soon after substance intoxication, withdrawal, or medication
  ii. The involved substance is capable of producing the symptoms
  b. Not better explained and Does not occur exclusively during delirium

Question 13

Paraphilias

Answer 13

• Paraphilias: recurrent, intense sexual arousal, fantasies, and urges involving anomalous sexual activity
• Paraphilic Disorders: the above, plus acting on urges, resulting in distress or impairment in functioning

Question 14

drug used to decrease obsessive intrusive sexual fantasies?

Answer 14

SSRIs or naltrexone

Question 15

sexual identity
gender identity
gender role

Answer 15

• Sexual identity – ones biological sex or ones’ sexual preference
• Gender identity – ones’ subjective sense of maleness or femaleness
• Gender role- the behaviors an individual engages in that identify as male/female

Question 16

gender dysphoria

Answer 16

A marked incongruence between one’s experienced/expressed of gender and their “assigned” gender for at least six months
o Treatment: Hormone Therapy/Sexual Reassignment Surgery