Sexual Disorders and Paraphilias Flashcards
High-risk factors include: (5)
Substance abuse
Limited access to care
Poor health literacy
Unassertiveness
Poor communication skills
High-risk behvaior includes: (5)
Unprotected intercourse, oral, anal
Multiple partners
High-risk partner
IVD use by self or partner
What are the 4 phases of the sexual response cycle?
- Desire
- Excitement
- Orgasm
- Resolution
What are the components of phase 1 (desire)? (3)
- Sexual drive
- biological
- genital sensations and thoughts about sex - Motivation
- psychological
- willingness to offer body for sex - Wish fulfillment
- social
- hope/expectations for sex
- may have cultural influence
What is phase 2 (excitement)?
What are the 2 basic phsyiological processes that occur?
Arousal, which lasts minutes to hours
- erection and vaginal lubrication
- nipples harden
- increased respiration, HR and BP
- Vasodilation/vasoconstriction - engorgement of BVs in the genitals.
- Myotonia - muscle contractions throughout the body.
How long does a typical orgasm (phase 3) last?
3-25 sec.
What occurs during phase 4 (resolution)?
What happens if an orgasm occurred vs. did not occur?
Disgorgement of blood from genitals and body returns to resting state.
If orgasm occurred: resolution is rapid and accompanied by general sense of well-being.
If no orgasm: resolution may take 2-6 hrs.
What are the gender differences in resolution in men vs. women?
Men can average 3-10 min, 24 hrs. or even several days for a refractory period.
Women have no refractory period, but usually take some time for resolution.
What is the focus for educating patients on their sex life?
Teach patients about the sexual response cycle so they know what is normal for themselves and their partner.
*timing and coordination
What dysfunctions occur in males and females if there is an impaired response in phase 1 (desire)?
Male - Male hypoactive sexual desire disorder
Female - Female sexual interest/arousal disorder
What dysfunctions occur in males and females if there is an impaired response in phase 2 (excitement/arousal)?
Male - Erectile disorder
Female - Female sexual interest/arousal disorder
What dysfunctions occur in males and females if there is an impaired response in phase 3 (orgasm)?
Male - Delayed ejaculation and Premature ejaculation
Female - Female orgasmic disorder
What is Male Hypoactive Sexual Desire Disorder?
Persistent or recurring deficient/absent sexual fantasies and desire taking into consideration the patient’s age and their context for life for 6 mo.
How is Female Sexual Interest/Arousal Disorder diagnosed?
Lack or reduced sexual interest/arousal with at least 3 symptoms for 6 mo.
How is ED diagnosed?
At least 1 of the following 3 symptoms on almost all (75-100%) occasions of sexual activity for 6 mo:
- Difficulty obtaining an erection
- Difficulty maintaining an erection until completion
- Marked decrease in rigidity
What is Female Orgasmic Disorder?
Persistent or recurrent delay in, or absence of, orgasm or reduced intensity (75%-100%) following a normal sexual excitement phase, for 6 month
What is Delayed Ejaculation?
Either of the following symptoms must be experienced on almost all or all occasions, for 6 months:
- Marked delay in ejaculation
- Marked infrequency or absence of ejaculation
What is Premature Ejaculation?
Persistent or recurrent ejaculation with partnered sexual activity within approximately 1 minute following penetration and before the patient prefers it, for 6 months, for almost all or all occasions of sexual activity
What is Genito-Pelvic Pain Penetration Disorder?
Persistent or recurrent difficulties with 1or more of following, for 6 months:
- Vaginal penetration during intercourse
- Marked vulvovaginal or pelvic pain during penetration on intercourse.
- Marked fear or anxiety about pain preceding, during or as a result of vaginal penetration.
- Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.
What is Sensate Focus?
No intercourse allowed for a time period, then systemically re-introduce sexual stimulation.
How is Paraphilia defined?
Any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners, for at least 6 months.
An overall term describing several individual disorders.
At what age do paraphilias onset?
Which sex is more common to have one?
Are the married, single, etc.?
Early onset (< 18 y/o)
Male > Female
50% are married
How are non-victimizing paraphilias viewed?
Usually as an “alternative sexual lifestyle”.
There is no severe comorbid psychopathologies and they are unlikely to present for treatment.
What do people with victimizing paraphilias tend to use as a defense mechanism?
What disorder has a high comorbidity?
“Rationalizing”
Antisocial Personality Disorder
What is Sexual Masochism Disorder?
Person derives sexual pleasure from suffering (humiliation, beaten, bound) – real acts, not simulation.
What is Sexual Sadism Disorder?
Sexual arousal from the physical or psychological suffering of another person.
“Partner” may or may not have consented
What us Exhibitonism?
What us the intent usually?
Which sex is more common?
Exposure of genitals to unsuspecting strangers in public.
Evoke their shock or fear - victim usually non-consenting.
Males
What is Fetishistic Disorder?
Sexual arousal from non-living objects or specific focus on non-genital body parts (shoes, panties, etc.).
What is Frotteuristic Disorder?
What sex and age is most common?
Touching or rubbing against a non-consenting person.
Male, usually 15-25 years old.
What is Transvestic Disorder?
Sexually arousing fantasies, urges, or behaviors about cross-dressing.
*Not related to gender identity.
What is Voyeuristic Disorder?
What type of patient must it be in order to meet the criteria?
Sexual arousal by watching an unsuspecting person who is naked, disrobing, or engaging in sexual activity.
Must be 18+ years old.
What is Pedophilic Disorder?
What ages must the perp and victim be to meet the criteria?
What is the exclusive vs. non-exclusive types?
Sexual fantasies, urges or activity with prepubescent child (< 13 y/o).
Must be 16+ y/o and at least 5 years older than the child.
Exclusive: sexual interest is only in children.
Non-exclusive: usually heterosexual and married.
How difficult is Pedophilic Disorder to treat?
How likely are perps to commit the crime again?
Very difficult.
100% recidivism.
