Sexual Disorders and Paraphilias Flashcards
Abnormal sexuality excludes what?
Stimulation of primary sex organs
High-risk factors in human sexual behavior
- Substance use
- Limited access to care
- Poor health literacy
- About STIs, STI symptoms, and prevention
- Unassertive
- Poor communication skills
High-risk human sexual behaviors
- Unprotected
- Intercourse
- Oral sex
- Anal sex
- Multiple sex partners
- High-risk partner
- Sex trade work
- Self or partner use of IV drugs
High-risk factors and behaviors lead to…
- STI
- Unwanted/unplanned pregnancy
- Relationship complications
Sexual response cycle (4)
- Desire
- Excitement
- Orgasm
- Resolution
Components of phase 1 (desire) of the sexual response cycle
- Sexual drive
- Biological
- Genital sensations and thoughts about sex
- Motivation
- Psychological
- Willingness to offer your body for sex
- Wishful fulfillment
- Social
- Hoping for sex, expectations for sex
- Can be culturally influenced
Components of phase 2 (excitement) of the sexual response cycle
Arousal
- Lasts several min to hours
- Erection; vaginal lubrication
- Nipples harden
- Increased RR, HR (up to 180 bpm), and BP
Two physiological processes that occur during the excitement stage of the sexual response cycle
- Vasodilation/constriction
- Engorgement of blood vessels of the genitals as a result of dilation of vessels
- Myotonia
- Muscle contractions not only in the genitals but throughout the body
Components of phase 3 (orgasm) of the sexual response cycle
- Peak of sexual pleasure
- Release of sexual tension and the rhythmic contraction of the perinatal muscles and pelvic reproductive organs
- Orgasms typically last 3-25 seconds
Components of phase 4 (resolution) of the sexual response cycle
- Disengorgement of blood from genitalia
- Body returns to resting state
If an orgasm occurred, what is the resolution phase like?
-
Rapid
- Accompanied by a general sense of well-being
If orgasm did not occur, what is the resolution phase like?
Resolution may take up to 2-6 hours
Average resolution period in males
3-10 minutes, to 24 hours, to several days for a refractory period
Average resolution period in females
Need time for resolution
Do females have a refractory period in the sexual response cycle?
No
What is important when discussing sexual health with patients?
Education
Male hypoactive sexual desire disorder
- Characteristics
- Time criteria
- Persistent or recurrently deficient (or absent) sexual fantasies and desire for sexual activity
- 6 months
What must the clinician take into account when diagnosing a patient with male hypoactive sexual desire disorder?
Age and context of the persons life over 6 months
Female sexual interest/arousal disorder
- Criteria
Lack of or significantly reduced sexual interest/arousal with at least 3 of the following for 6 months:
- Absent or reduced interest in sexual activity
- Absent or reduced sexual/erotic thoughts or fantasies
- None or reduced initiation** of sexual activity, **unreceptive to partner’s attempts
- Absent or reduced sexual pleasure (75-100% of encounters)
- Absent or reduced sexual interest/arousal in response to any internal or external sexual/erotic cues
- Absent or reduced genital or non-genital sensations during sexual activity in 75-100% of sexual encounters
Criteria for erectile disorder (ED)
At least one of the three following symptoms experienced on almost all or all occasions of sexual activity for 6 months:
- Difficulty obtaining an erection
- Difficulty maintaining an erection until completion of sexual activity
- Marked decrease in erectile rigidity
Risk factors for erectile disorder
- HTN, DM
- Smoking
- CVD, PVD
- Dyslipidemia
- Peyronies disease, Priapism tx
- Pelvic trauma/surgery
- Renal failure and dialysis
- Hypogonadism
- Alcoholism
- Antidepressant side effects
- Poor sexual technique, lack of sexual knowledge
Female orgasmic disorder
- criteria
Persistent or recurrent delay in, or absence of, orgasm or reduced intensity (75-100%) following a normal sexual excitement phase, for 6 months
**Ensure adequate stimulation**
Criteria for 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
Premature ejaculation
- Criteria
Persistent or recurrent ejaculation with partnered sexual activity within approximately 1 minute following penetration and before the patient prefers it, for 6 months on almost all or all occasions
Genito-pelvic pain penetration disorder
- Criteria
Persistent or recurrent difficulties with one or more of the following for 6 months:
- Vaginal penetration during intercourse
- Marked vulvovaginal or pelvic pain during 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
Psychological cycle of sexual dysfunction
Performance pressure ⇨ Fear of failure ⇨ anxiety that interferes with some phase of the sexual response ⇨ sexual dysfunction actually experienced
Behavior therapies useful in sexual disorders
- Sensate focus
- Squeeze technique; start-stop method
- Relaxation technique
- Masturbation
Define paraphilia
Any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypicaly normal, physically mature, conseting human partners for at least 6 months
Legal (non-victimizing) types of paraphilias
- Fetishism
- Sexual masochism (injury to self)
- Transvestic fetishism
- [Mild] Sexual sadism (injury to others)
Illegal (victimizing) types of paraphilias
- Voyeurism
- Exhibitionism
- Pedophilia
- Sexual sadism
Legal (non-victimizing) paraphilias are often described as
Alternative sexual lifestyle
- They have no severe co-morbid psychopathologies
- Not likely to present for treatment
What high comorbidity is associated with Illegal (victimizing) paraphilias
Antisocial personality disorder
Sexual masochism disorder
Derives sexual pleasure from suffering (humiliation, beaten, bound)
- Real acts, not simulation
Hypoxyphilia aka autoerotic asphyxiation
Sexual arousal by oxygen deprivation obtained by means of:
- chest compression
- noose
- ligature
- plastic bag
- mask
- chemical (amyl nitrate)
Most common motivation for hypoxyphilia
fantasy of bondage and pain
Effects associated with hypoxyphilia
- Dizziness
- Lightheadedness
- Increased intensity of orgasm
Classic population associated with hypoxyphilia
Middle class, caucasian males < 30 y/o without history of mental illness
Sexual sadism disorder
Sexual arousal from the physical or psychological suffering of another person
- Partner may or may not have consented
Define Exhibitionism
Exposure of genitals to unsuspecting strangers in public
- victim is usually nonconsenting
Intent of exhibitionism
Evoke shock or fear
Fetishistic disorder
Sexual arousal from non-living objects or specific focus on non-genital body parts
Common examples: women’s shoes or panties; feet
Frotteuristic disorder
Touching or rubbing against a non-consenting person
- Implies rubbing genitals on another person
- Typically males 15-25 y/o
Transvestic disorder
Sexually arousing fantasies, urges or behaviors about cross-dressing
- Not related to gender identity
Voyeuristic disorder
Sexual arousal by watching an unsuspecting person who is naked, disrobing, or engaging in sexual activity
- Perpetrator must be 18+; “peeping Tom”
Define pedophilic disorder
Sexual fantasies, urges or activity with a prepubescent child (usually < 13 y/o)
What is the criteria for the perpetrator in order to define pedophilic disorder
Must be 16+ and at least 5 years older than the child
Exclusive pedophilic disorder
Sexual interest only in children
Non-exclusive pedophilic disorder
Usually heterosexual and married with interest in and aroused by children
Risk factors for the tendency of a convicted pedophile to reoffend
- Male victims
- Stranger victims
- Prior sex offenses
- Lack of a cohabitation history with adult partners
