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NMSP Exam 3 > Sexual Disorders and Paraphilias > Flashcards

Sexual Disorders and Paraphilias Flashcards

1
Q

What is abnormal sexuality?

A
  • Defining “normal” sexuality is even more difficult
  • Not about a human sexual partner
  • Excludes stimulation of primary sex organs
  • Is compulsive, injurious to self or others
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2
Q

What are some high risk factors for sexual disorders?

A
  • Substance use
  • Limited access to care
  • Poor health literacy (about STI, about STI symptoms, about prevention)
  • Unassertive
  • Poor communication
  • Young age
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3
Q

What are some high risk behaviors for sexual disorders?

A
  • Unprotected: intercourse, mouth-to-genital contact, anal sex
  • Multiple sex partners
  • High-risk partner
  • Sex trade work
  • Self or partner use of IV drugs
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4
Q

What are some undesired outcomes of sexual disorders?

A
  • STI
  • Unwanted pregnancy
  • Relationship complications
  • Poverty
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5
Q

What are the four phases of a sexual response cycle?

A
  1. Desire
  2. Excitement
  3. Orgasm
  4. Resolution
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6
Q

What are the components of the desire phase in the sexual response cycle?

A
  1. Sexual drive
  2. Motivation
  3. Wish fulfillment
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7
Q

What is a part of sexual drive?

A
  • Biological

- Genital sensations and thoughts about sex

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8
Q

What is a part of motivation?

A
  • Psychological

- Willingness to offer your body for sex

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9
Q

What is a part of wish fulfillment?

A
  • Social
  • Hoping for sex, expectations for sex
  • Can be culturally influenced
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10
Q

What are the components of the excitement phase in the the sexual response cycle?

A
  • Arousal
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11
Q

What happens during arousal in the excitement phase?

A
  • Can last several minutes to several hours
  • Erection, vaginal lubrication
  • Nipples harden
  • Increased respiration, tachycardia up to 180 bpm, and a rise in BP
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12
Q

What are the two basic physiological processes that occur during excitement?

A
  1. Vasodilation/constriction: engorgement of blood vessels of the genitals as a result of dilation of the blood vessels
  2. Myotonia: muscle contractions not only in the genitals but throughout the body
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13
Q

What happens during the orgasm phase?

A
  • Peak of sexual pleasure

- Release of sexual tension and the rhythmic contraction of the perinatal muscles and the pelvic reproductive organs

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14
Q

How long do orgasms typically last?

A
  • 3-25 seconds
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15
Q

What happens during the resolution phase?

A
  • Disgorgement of blood from the genitalia
  • Body returns to its resting state
  • If orgasm occurred, resolution is rapid and accompanied by a general sense of well-being
  • If orgasm did not occur, resolution may take up to 2-6 hours
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16
Q

What is the average refractory period for men after resolution?

A
  • 3-10 minutes

- Could be 24 hours or several days

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17
Q

What is the average refractory period for women after resolution?

A
  • Women have no refractory period but do need time for resolution
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18
Q

What is needed to be taught to patients about timing and coordination?

A
  • Timing- teach patients about the sexual response cycle so they know what is normal in themselves and their partner
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19
Q

What is it called when a female has impaired desire?

A
  • Female sexual interest/arousal disorder
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20
Q

What is it called when a male has impaired desire?

A
  • Male hypoactive sexual desire disorder
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21
Q

What is it called when a female has impaired excitement/arousal?

A
  • Female sexual interest/arousal disorder
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22
Q

What is it called when a male has impaired excitement/arousal?

A
  • Erectile disorder
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23
Q

What is it called when a female has impaired orgasm?

A
  • Female orgasmic disorder
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24
Q

What is it called when a male has impaired orgasm?

A
  • Delayed ejaculation

- Premature ejaculation

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25
Q

What is it called when a female has sexual pain?

A
  • Genito-pelvic pain/penetration disorder
26
Q

What is male hypoactive sexual desire disorder?

A
  • Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity.
  • The judgement of deficiency of absence is made by the clinician, taking into account factors that affect sexual functioning, like age and the context of the person’s life, for 6 months
27
Q

What is female sexual interest/arousal disorder?

A

Lack of or significantly reduced sexual interest/arousal with at least 3 of the following:

  1. Absent or reduced interest in sexual activity
  2. Absent or reduced sexual/erotic thoughts or fantasies
  3. None or reduced initiation of sexual activity, unreceptive to partner’s attempt to initiate
  4. Absent or reduced sexual pleasure in 75-100% of encounters
  5. Absent or reduced sexual interest/arousal in response to any internal or external sexual/erotic cues
  6. Absent or reduced genital or non-genital sensations during sexual activity in 75-100% of encounters
28
Q

What is erectile disorder?

A

At least one of the three following symptoms must be experienced on almost all or all occasions of sexual activity for 6 months

  1. Difficulty obtaining an erection
  2. Difficulty maintaining an erection until completion of sexual activity
  3. Marked decrease in erectile regidity
29
Q

What are some ED risk factors?

A
  • HTN or treatment
  • Diabetes
  • Smoking
  • Peripheral vascular disordes
  • CAD
  • Blood lipid abnormalities
  • Peyronie’s disease
  • Priapism treatment
  • Pelvic trauma or surgery
  • Renal failure and dialysis
  • Hypogonadism
  • Alcoholism
  • Antidepressant medication
  • Lack of sexual knowledge
  • Poor sexual technique
  • Interpersonal problems
30
Q

What is female orgasmic disorder?

A
  • Persistent or recurrent delay in, or absence of, orgasm or reduced intensity following a normal sexual excitement phase, for 6 months
31
Q

What is delayed ejaculation?

A

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
32
Q

What is premature ejaculation?

A
  • 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
33
Q

What is genito-pelvic pain penetration disorder?

A

Persistent or recurrent difficulties with 1 or more of the 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
34
Q

What is the vicious cycle of sexual dysfunction?

A
  • Performance pressure which causes fear of failure
  • Fear of failure causes anxiety that interferes with some phase of sexual response
  • The anxiety causes sexual dysfunction that is actually experienced which causes more fear of failure
35
Q

What is the general approach for treatment in sexual disorders?

A
  1. Evaluate and treat underlying medical conditions
  2. Consider medication side effects
  3. Education, if needed
  4. Behavior therapy, if needed
  5. Refer to counseling, if relationship problems
36
Q

What are some behavioral therapies?

A
  • Sensate focus: no intercourse allowed for a time period, then systematically re-introduce sexual stimulation
  • Squeeze technique; start stop method (for premature ejaculation)
  • Relaxation techniques: can include systematic desensitization
  • Masturbation: increases knowledge and awareness of personal preferences
37
Q

What is paraphilia?

A
  • 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
38
Q

What are some legal types (non-victimizing) of paraphilias?

A
  • Fetishism
  • Sexual masochism
  • Transvestic fetishism
  • Sexual sadism (mild)
39
Q

What are some illegal types (victimizing) of paraphilias?

A
  • Voyeurism
  • Exhibitionism
  • Pedophilia
  • Sexual sadism
40
Q

What is some background behind paraphilic disorders?

A
  • Rare in US

- Early onset (

41
Q

What is seen in non-victimizing paraphilias?

A
  • No severe comorbid psychopathologies
  • Not likely to present for treatment
  • Instead, described as “alternative sexual lifestyle”
42
Q

What is seen in victimizing paraphilias?

A
  • Unlikely to seek treatment
  • Tend to use “rationalizing” as defense mechanism
  • Antisocial personality disorder has high comorbidity
43
Q

What is sexal masochism disorder?

A
  • Derives sexual pleasure from suffering (humiliation, beaten, bound)– Real act, not stimulation
44
Q

What is asphyxiaphilia or hypoxyphilia?

A
  • Hypoxyphilia involves sexual arousal by oxygen deprivation obtained by means of chest compression, noose, ligature, plastic bag, mask, or chemical
  • May be engaged in either alone or with a partner
  • Risk of sudden death may also serve to increase the sexual pleasure by feeling in “mortal danger”
  • Cerebral hypoxia makes a person dizzy and light-headed and may increase the intensity of orgasm
45
Q

Who usually does hypoxyphilia?

A
  • Middle-class, caucasian males, <30 years with no history of mental illness
46
Q

What is the most common motivation of hypoxyphilia?

A
  • Fantasy of bondage and pain
47
Q

What is sexual sadism disorder?

A
  • Sexual arousal from the physical or psychological suffering of another person
  • “Partner” may or may not have consented
48
Q

What is exhibitionism?

A
  • Exposure of genitals to unsuspecting strangers in public
  • Victim is usually non consenting
  • Males
49
Q

What is the intent of exhibitionism?

A
  • Evoke their shock or fear
50
Q

What is fetishistic disorder?

A
  • Sexual arousal from non-living objects or specific focus on non-genital body parts
51
Q

What are some common examples of fetishistic disorder?

A
  • Women’s shoes or panties

- Feet

52
Q

What is Frotteuristic disorder?

A
  • Touching or rubbing against a non-consenting person

- Males, usually 15-25 years old

53
Q

What is transvestic disorder?

A
  • Sexually arousing fantasies, urges, or behaviors about cross-dressing
  • Not related to gender identity
54
Q

What is voyeuristic disorder?

A
  • Sexual arousal by watching an unsuspecting person who is naked, disrobing, or engaging in sexual activity
  • Must be 18+ years old
55
Q

What is pedophilic disorder?

A
  • Sexual fantasies, urges, or activity with prepubescent child (usually <13 years old)
  • Must be aged 16+ and at least 5 years older than the child
56
Q

What is exclusive pedophilia?

A
  • Sexual interest only in children
57
Q

What is non-exclusive pedophilia?

A
  • Usually heterosexual and married
58
Q

What are some risk factors for recidivism (risk to repeat offense)?

A
  • Male victims
  • Stranger victims
  • Prior sex offenses
  • Lack of a cohabitation history with adult partners
59
Q

What are some other rare paraphilia?

A
  • Telephone, computer scatologia
  • Necrophilia
  • Zoophilia
  • Coprophilia (feces)
  • Klismaphilia (enemas)
  • Urophilia (urine)
60
Q

What are some behavior therapies but have a low success rate?

A
  • Aversive therapy –> reduce pleasure
  • Desensitization –> neutralize anxiety
  • Social skills training –> form better interpersonal relationships
  • Orgasmic reconditioning –> teach more appropriate mental imagery for sexual fantasies
61
Q

How well do RX work in treating pharaphilias?

A
  • Low success rate

NMSP Exam 3 (18 decks)

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