Sexual Disorders and Paraphilias

Question 1

Abnormal sexuality excludes what?

Answer 1

Stimulation of primary sex organs

Question 2

High-risk factors in human sexual behavior

Answer 2

• Substance use
• Limited access to care
• Poor health literacy
  
  • About STIs, STI symptoms, and prevention
• Unassertive
• Poor communication skills

Question 3

High-risk human sexual behaviors

Answer 3

• Unprotected
  
  • Intercourse
  • Oral sex
  • Anal sex
• Multiple sex partners
• High-risk partner
• Sex trade work
• Self or partner use of IV drugs

Question 4

High-risk factors and behaviors lead to…

Answer 4

• STI
• Unwanted/unplanned pregnancy
• Relationship complications

Question 5

Sexual response cycle (4)

Answer 5

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

Question 6

Components of phase 1 (desire) of the sexual response cycle

Answer 6

1. Sexual drive
   
   • Biological
   • Genital sensations and thoughts about sex
2. Motivation
   
   • Psychological
   • Willingness to offer your body for sex
3. Wishful fulfillment
   
   • Social
   • Hoping for sex, expectations for sex
   • Can be culturally influenced

Question 7

Components of phase 2 (excitement​) of the sexual response cycle

Answer 7

Arousal

• Lasts several min to hours
• Erection; vaginal lubrication
• Nipples harden
• Increased RR, HR (up to 180 bpm), and BP

Question 8

Two physiological processes that occur during the excitement stage of the sexual response cycle

Answer 8

1. Vasodilation/constriction
   
   • Engorgement of blood vessels of the genitals as a result of dilation of vessels
2. Myotonia
   
   • Muscle contractions not only in the genitals but throughout the body

Question 9

Components of phase 3 (orgasm​) of the sexual response cycle

Answer 9

• 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

Question 10

Components of phase 4 (resolution​) of the sexual response cycle

Answer 10

• Disengorgement of blood from genitalia
• Body returns to resting state

Question 11

If an orgasm occurred, what is the resolution phase like?

Answer 11

• Rapid
  
  • ​Accompanied by a general sense of well-being

Question 12

If orgasm did not occur, what is the resolution phase like?

Answer 12

Resolution may take up to 2-6 hours

Question 13

Average resolution period in males

Answer 13

3-10 minutes, to 24 hours, to several days for a refractory period

Question 14

Average resolution period in females

Answer 14

Need time for resolution

Question 15

Do females have a refractory period in the sexual response cycle?

Answer 15

No

Question 16

What is important when discussing sexual health with patients?

Answer 16

Education

Question 17

Male hypoactive sexual desire disorder

• Characteristics
• Time criteria

Answer 17

• Persistent or recurrently deficient (or absent) sexual fantasies and desire for sexual activity
• 6 months

Question 18

What must the clinician take into account when diagnosing a patient with male hypoactive sexual desire disorder?

Answer 18

Age and context of the persons life over 6 months

Question 19

Female sexual interest/arousal disorder

• Criteria

Answer 19

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

Question 20

Criteria for erectile disorder (ED)

Answer 20

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

Question 21

Risk factors for erectile disorder

Answer 21

• 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

Question 22

Female orgasmic disorder

• criteria

Answer 22

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**

Question 23

Criteria for delayed ejaculation

Answer 23

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

Question 24

Premature ejaculation

• Criteria

Answer 24

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

Question 25

Genito-pelvic pain penetration disorder * Criteria

Answer 25

**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

Question 26

Psychological cycle of sexual dysfunction

Answer 26

Performance pressure ⇨ Fear of failure ⇨ anxiety that interferes with some phase of the sexual response ⇨ sexual dysfunction actually experienced

Question 27

Behavior therapies useful in sexual disorders

Answer 27

* Sensate focus * Squeeze technique; start-stop method * Relaxation technique * Masturbation

Question 28

Define paraphilia

Answer 28

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**

Question 29

Legal (non-victimizing) types of paraphilias

Answer 29

* Fetishism * Sexual masochism (injury to self) * Transvestic fetishism * [Mild] Sexual sadism (injury to others)

Question 30

Illegal (victimizing) types of paraphilias

Answer 30

* Voyeurism * Exhibitionism * Pedophilia * Sexual sadism

Question 31

Legal (non-victimizing) paraphilias are often described as

Answer 31

Alternative sexual lifestyle * They have no severe co-morbid psychopathologies * Not likely to present for treatment

Question 32

What high comorbidity is associated with Illegal (victimizing) paraphilias

Answer 32

Antisocial personality disorder

Question 33

Sexual masochism disorder

Answer 33

Derives sexual pleasure from **suffering** (humiliation, beaten, bound) * Real acts, not simulation

Question 34

Hypoxyphilia aka autoerotic asphyxiation

Answer 34

Sexual arousal by oxygen deprivation obtained by means of: * chest compression * noose * ligature * plastic bag * mask * chemical (amyl nitrate)

Question 35

Most common motivation for hypoxyphilia

Answer 35

fantasy of bondage and pain

Question 36

Effects associated with hypoxyphilia

Answer 36

* Dizziness * Lightheadedness * Increased intensity of orgasm

Question 37

Classic population associated with hypoxyphilia

Answer 37

Middle class, caucasian males \< 30 y/o **without** history of mental illness

Question 38

Sexual sadism disorder

Answer 38

Sexual arousal from the physical or psychological **suffering of another person** * Partner may or may not have consented

Question 39

Define Exhibitionism

Answer 39

Exposure of genitals to **unsuspecting** strangers in public * victim is usually nonconsenting

Question 40

Intent of exhibitionism

Answer 40

Evoke shock or fear

Question 41

Fetishistic disorder

Answer 41

Sexual arousal from **non-living objects** or specific focus on **non-genital** body parts Common examples: women's shoes or panties; feet

Question 42

Frotteuristic disorder

Answer 42

**Touching or rubbing** against a non-consenting person * Implies rubbing genitals on another person * Typically males 15-25 y/o

Question 43

Transvestic disorder

Answer 43

**Sexually arousing** fantasies, urges or behaviors about cross-dressing * Not related to gender identity

Question 44

Voyeuristic disorder

Answer 44

Sexual arousal by **watching** an unsuspecting person who is naked, disrobing, or engaging in sexual activity * Perpetrator must be 18+; "peeping Tom"

Question 45

Define pedophilic disorder

Answer 45

Sexual fantasies, urges or activity with a prepubescent child (usually \< 13 y/o)

Question 46

What is the criteria for the perpetrator in order to define pedophilic disorder

Answer 46

Must be 16+ and at least 5 years older than the child

Question 47

Exclusive pedophilic disorder

Answer 47

Sexual interest only in children

Question 48

Non-exclusive pedophilic disorder

Answer 48

Usually heterosexual and married with interest in and aroused by children

Question 49

Risk factors for the tendency of a convicted pedophile to reoffend

Answer 49

* Male victims * Stranger victims * Prior sex offenses * Lack of a cohabitation history with adult partners