Sexual Disorders and Paraphilias

Question 1

High-risk factors include: (5)

Answer 1

Substance abuse

Limited access to care

Poor health literacy

Unassertiveness

Poor communication skills

Question 2

High-risk behvaior includes: (5)

Answer 2

Unprotected intercourse, oral, anal

Multiple partners

High-risk partner

IVD use by self or partner

Question 3

What are the 4 phases of the sexual response cycle?

Answer 3

1. Desire
2. Excitement
3. Orgasm
4. Resolution

Question 4

What are the components of phase 1 (desire)? (3)

Answer 4

1. Sexual drive
   - biological
   - genital sensations and thoughts about sex
2. Motivation
   - psychological
   - willingness to offer body for sex
3. Wish fulfillment
   - social
   - hope/expectations for sex
   - may have cultural influence

Question 5

What is phase 2 (excitement)?

What are the 2 basic phsyiological processes that occur?

Answer 5

Arousal, which lasts minutes to hours

• erection and vaginal lubrication
• nipples harden
• increased respiration, HR and BP

1. Vasodilation/vasoconstriction - engorgement of BVs in the genitals.
2. Myotonia - muscle contractions throughout the body.

Question 6

How long does a typical orgasm (phase 3) last?

Answer 6

3-25 sec.

Question 7

What occurs during phase 4 (resolution)?

What happens if an orgasm occurred vs. did not occur?

Answer 7

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.

Question 8

What are the gender differences in resolution in men vs. women?

Answer 8

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.

Question 9

What is the focus for educating patients on their sex life?

Answer 9

Teach patients about the sexual response cycle so they know what is normal for themselves and their partner.

*timing and coordination

Question 10

What dysfunctions occur in males and females if there is an impaired response in phase 1 (desire)?

Answer 10

Male - Male hypoactive sexual desire disorder

Female - Female sexual interest/arousal disorder

Question 11

What dysfunctions occur in males and females if there is an impaired response in phase 2 (excitement/arousal)?

Answer 11

Male - Erectile disorder

Female - Female sexual interest/arousal disorder

Question 12

What dysfunctions occur in males and females if there is an impaired response in phase 3 (orgasm)?

Answer 12

Male - Delayed ejaculation and Premature ejaculation

Female - Female orgasmic disorder

Question 13

What is Male Hypoactive Sexual Desire Disorder?

Answer 13

Persistent or recurring deficient/absent sexual fantasies and desire taking into consideration the patient’s age and their context for life for 6 mo.

Question 14

How is Female Sexual Interest/Arousal Disorder diagnosed?

Answer 14

Lack or reduced sexual interest/arousal with at least 3 symptoms for 6 mo.

Question 15

How is ED diagnosed?

Answer 15

At least 1 of the following 3 symptoms on almost all (75-100%) occasions of sexual activity for 6 mo:

1. Difficulty obtaining an erection
2. Difficulty maintaining an erection until completion
3. Marked decrease in rigidity

Question 16

What is Female Orgasmic Disorder?

Answer 16

Persistent or recurrent delay in, or absence of, orgasm or reduced intensity (75%-100%) following a normal sexual excitement phase, for 6 month

Question 17

What is Delayed Ejaculation?

Answer 17

Either of the following symptoms must be experienced on almost all or all occasions, for 6 months:

1. Marked delay in ejaculation
2. Marked infrequency or absence of ejaculation

Question 18

What is Premature Ejaculation?

Answer 18

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

Question 19

What is Genito-Pelvic Pain Penetration Disorder?

Answer 19

Persistent or recurrent difficulties with 1or more of following, for 6 months:

1. Vaginal penetration during intercourse
2. Marked vulvovaginal or pelvic pain during penetration on intercourse.
3. Marked fear or anxiety about pain preceding, during or as a result of vaginal penetration.
4. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.

Question 20

What is Sensate Focus?

Answer 20

No intercourse allowed for a time period, then systemically re-introduce sexual stimulation.

Question 21

How is Paraphilia defined?

Answer 21

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.

Question 22

At what age do paraphilias onset?

Which sex is more common to have one?

Are the married, single, etc.?

Answer 22

Early onset (< 18 y/o)

Male > Female

50% are married

Question 23

How are non-victimizing paraphilias viewed?

Answer 23

Usually as an “alternative sexual lifestyle”.

There is no severe comorbid psychopathologies and they are unlikely to present for treatment.

Question 24

What do people with victimizing paraphilias tend to use as a defense mechanism?

What disorder has a high comorbidity?

Answer 24

“Rationalizing”

Antisocial Personality Disorder

Question 25

What is Sexual Masochism Disorder?

Answer 25

Person derives sexual pleasure from suffering (humiliation, beaten, bound) – real acts, not simulation.

Question 26

What is Sexual Sadism Disorder?

Answer 26

Sexual arousal from the physical or psychological suffering of another person.

“Partner” may or may not have consented

Question 27

What us Exhibitonism?

What us the intent usually?

Which sex is more common?

Answer 27

Exposure of genitals to unsuspecting strangers in public.

Evoke their shock or fear - victim usually non-consenting.

Males

Question 28

What is Fetishistic Disorder?

Answer 28

Sexual arousal from non-living objects or specific focus on non-genital body parts (shoes, panties, etc.).

Question 29

What is Frotteuristic Disorder?

What sex and age is most common?

Answer 29

Touching or rubbing against a non-consenting person.

Male, usually 15-25 years old.

Question 30

What is Transvestic Disorder?

Answer 30

Sexually arousing fantasies, urges, or behaviors about cross-dressing.

*Not related to gender identity.

Question 31

What is Voyeuristic Disorder?

What type of patient must it be in order to meet the criteria?

Answer 31

Sexual arousal by watching an unsuspecting person who is naked, disrobing, or engaging in sexual activity.

Must be 18+ years old.

Question 32

What is Pedophilic Disorder?

What ages must the perp and victim be to meet the criteria?

What is the exclusive vs. non-exclusive types?

Answer 32

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.

Question 33

How difficult is Pedophilic Disorder to treat?

How likely are perps to commit the crime again?

Answer 33

Very difficult.

100% recidivism.