Sexual Disorders and Paraphilias Flashcards
What is abnormal sexuality?
- 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
What are some high risk factors for sexual disorders?
- Substance use
- Limited access to care
- Poor health literacy (about STI, about STI symptoms, about prevention)
- Unassertive
- Poor communication
- Young age
What are some high risk behaviors for sexual disorders?
- Unprotected: intercourse, mouth-to-genital contact, anal sex
- Multiple sex partners
- High-risk partner
- Sex trade work
- Self or partner use of IV drugs
What are some undesired outcomes of sexual disorders?
- STI
- Unwanted pregnancy
- Relationship complications
- Poverty
What are the four phases of a sexual response cycle?
- Desire
- Excitement
- Orgasm
- Resolution
What are the components of the desire phase in the sexual response cycle?
- Sexual drive
- Motivation
- Wish fulfillment
What is a part of sexual drive?
- Biological
- Genital sensations and thoughts about sex
What is a part of motivation?
- Psychological
- Willingness to offer your body for sex
What is a part of wish fulfillment?
- Social
- Hoping for sex, expectations for sex
- Can be culturally influenced
What are the components of the excitement phase in the the sexual response cycle?
- Arousal
What happens during arousal in the excitement phase?
- Can last several minutes to several hours
- Erection, vaginal lubrication
- Nipples harden
- Increased respiration, tachycardia up to 180 bpm, and a rise in BP
What are the two basic physiological processes that occur during excitement?
- Vasodilation/constriction: engorgement of blood vessels of the genitals as a result of dilation of the blood vessels
- Myotonia: muscle contractions not only in the genitals but throughout the body
What happens during the orgasm phase?
- Peak of sexual pleasure
- Release of sexual tension and the rhythmic contraction of the perinatal muscles and the pelvic reproductive organs
How long do orgasms typically last?
- 3-25 seconds
What happens during the resolution phase?
- 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
What is the average refractory period for men after resolution?
- 3-10 minutes
- Could be 24 hours or several days
What is the average refractory period for women after resolution?
- Women have no refractory period but do need time for resolution
What is needed to be taught to patients about timing and coordination?
- Timing- teach patients about the sexual response cycle so they know what is normal in themselves and their partner
What is it called when a female has impaired desire?
- Female sexual interest/arousal disorder
What is it called when a male has impaired desire?
- Male hypoactive sexual desire disorder
What is it called when a female has impaired excitement/arousal?
- Female sexual interest/arousal disorder
What is it called when a male has impaired excitement/arousal?
- Erectile disorder
What is it called when a female has impaired orgasm?
- Female orgasmic disorder
What is it called when a male has impaired orgasm?
- Delayed ejaculation
- Premature ejaculation
What is it called when a female has sexual pain?
- Genito-pelvic pain/penetration disorder
What is male hypoactive sexual desire disorder?
- 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
What is female sexual interest/arousal disorder?
Lack of or significantly reduced sexual interest/arousal with at least 3 of the following:
- 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 attempt to initiate
- Absent or reduced sexual pleasure in 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 encounters
What is erectile disorder?
At least one of the three following symptoms must be 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 regidity
What are some ED risk factors?
- 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
What is female orgasmic disorder?
- Persistent or recurrent delay in, or absence of, orgasm or reduced intensity following a normal sexual excitement phase, for 6 months
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 1 or more of the 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 the vicious cycle of sexual dysfunction?
- 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
What is the general approach for treatment in sexual disorders?
- Evaluate and treat underlying medical conditions
- Consider medication side effects
- Education, if needed
- Behavior therapy, if needed
- Refer to counseling, if relationship problems
What are some behavioral therapies?
- 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
What is paraphilia?
- 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
What are some legal types (non-victimizing) of paraphilias?
- Fetishism
- Sexual masochism
- Transvestic fetishism
- Sexual sadism (mild)
What are some illegal types (victimizing) of paraphilias?
- Voyeurism
- Exhibitionism
- Pedophilia
- Sexual sadism
What is some background behind paraphilic disorders?
- Rare in US
- Early onset (
What is seen in non-victimizing paraphilias?
- No severe comorbid psychopathologies
- Not likely to present for treatment
- Instead, described as “alternative sexual lifestyle”
What is seen in victimizing paraphilias?
- Unlikely to seek treatment
- Tend to use “rationalizing” as defense mechanism
- Antisocial personality disorder has high comorbidity
What is sexal masochism disorder?
- Derives sexual pleasure from suffering (humiliation, beaten, bound)– Real act, not stimulation
What is asphyxiaphilia or hypoxyphilia?
- 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
Who usually does hypoxyphilia?
- Middle-class, caucasian males, <30 years with no history of mental illness
What is the most common motivation of hypoxyphilia?
- Fantasy of bondage and pain
What is sexual sadism disorder?
- Sexual arousal from the physical or psychological suffering of another person
- “Partner” may or may not have consented
What is exhibitionism?
- Exposure of genitals to unsuspecting strangers in public
- Victim is usually non consenting
- Males
What is the intent of exhibitionism?
- Evoke their shock or fear
What is fetishistic disorder?
- Sexual arousal from non-living objects or specific focus on non-genital body parts
What are some common examples of fetishistic disorder?
- Women’s shoes or panties
- Feet
What is Frotteuristic disorder?
- Touching or rubbing against a non-consenting person
- Males, 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?
- 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?
- 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
What is exclusive pedophilia?
- Sexual interest only in children
What is non-exclusive pedophilia?
- Usually heterosexual and married
What are some risk factors for recidivism (risk to repeat offense)?
- Male victims
- Stranger victims
- Prior sex offenses
- Lack of a cohabitation history with adult partners
What are some other rare paraphilia?
- Telephone, computer scatologia
- Necrophilia
- Zoophilia
- Coprophilia (feces)
- Klismaphilia (enemas)
- Urophilia (urine)
What are some behavior therapies but have a low success rate?
- Aversive therapy –> reduce pleasure
- Desensitization –> neutralize anxiety
- Social skills training –> form better interpersonal relationships
- Orgasmic reconditioning –> teach more appropriate mental imagery for sexual fantasies
How well do RX work in treating pharaphilias?
- Low success rate
