sexual dysfunction and gender dysphoria Flashcards
diagnostic criteria for delayed ejaculation
-at least 1 manifestation for at least 6 months not better explained by another medical/mental disorder or substance
2 possible manifestations of delayed ejaculation
-marked delay in ejaculation
-marked infrequency/absence of ejaculation
specifiers for delayed ejaculation
lifelong
acquired
generalized
situational
mild, mod, severe
diagnostic criteria for erectile disorder
-1+ manifestation most/all of the time for at least 6 months that causes clinically significant distress not better explained by another medical/mental disorder or substance
3 possible manifestations of erectile disorder
-difficulty obtaining erection
-difficulty maintaining erection
-decrease in erectile rigidity
-
difference between erectile dysfunction and erectile disorder
erectile dysfunction is a singular problem. Erectile disorder is persistent erectile dysfunction for 6+ months
risk factors for erectile disorder
age
smoking
lack of exercise
diabetes
decreased desire
erectile disorder is predictive of what medical issue
CAD
when should you test for low testosterone with erectile disorder
especially with DM, hypoactive desire, and non-responders to phosphodiesterase inhibitors
what mental disorder is closely associated with erectile disorder
depression
diagnostic criteria for female orgasmic disorder
one or both
marked delay/infrequency of orgasm
marked reduced intensity of orgasm
how long do sx have to persist for dx of female orgasmic disorder
at least 6 months
diagnostic criteria for female sexual interest/arousal disorder
lack/reduced sexual interest for at least 6 months that causes clinically significant distress and is not better explained by another medical/mental disorder or a substance
6 possible manifestations of female sexual interest/arousal disorder
-absent/reduced interest in sex
-absent/reduced sexual thoughts/fantasies
-no/reduced initiation or unresponsive to partner
-absent/reduced pleasure in most/all sexual encounters
-absent/reduced arousal r/t sexual cues
-absent/reduced genital sensation during sexual activity
diagnostic criteria for genito-pelvic pain/penetration disorder
at least 1 persistent/recurrent difficulty for at least 6 months
4 possible areas of difficulty in genito-pelvic pain/penetration disorder
-vaginal penetration during intercourse
-vulvo-vaginal/pelvic pain during penetration attempts
-fear/anxiety about pain
-tensing of pelvic floor during penetration attempts
dyspareunia
pain during intercourse
vaginismus
involuntary muscle contraction making penetration difficult or impossible
vulvodynia
idiopathic vulvar pain lasting 3+ months
diagnostic criteria for male hypoactive sexual desire disorder
persistent little/no fantasies or sexual desire lasting at least 6 months that causes clinically significant distress and is not better explained by another medical/mental disorder or substance
diagnostic criteria for premature ejaculation
persistent pattern of ejaculation within 1 minute of penetration lasting at least 6 months causing clinically significant distress not better explained by another medical/mental disorder or a substance
what medical conditions are associated with premature ejaculation
-thyroid disease
-prostatitis
-drug withdrawal
substances most frequently associated with sexual dysfunction
alcohol
opioids
sedatives
hypnotics
anxiolytics
stimulants
antidepressants
antipsychotics
hormone contraceptives
gender dysphoria definition
distress from incongruence between expressed and assigned gender
transgender
gender identity is different than birth-assigned gender
cisgender
gender identity congruent with birth assigned gender
transexual
one who seeks or is undergoing transformation from one gender to another
how many manifestations must be present for gender dysphoria dx in children
6+
8 possible manifestations of gender dysphoria in children
-strong desire to be another gender
-strong preference for cross-dressing
-cross-gender roles in make-believe play
-strong preference for toys/games typically used by opposite sex
-preference for playmates of opposite gender
-strong rejection of toys typically used by assigned gender
-strong dislike of own sexual anatomy
-desire for sex characteristics that match expressed gender
how many manifestations must be present for dx of gender dysphoria in adolescents/adults
2+
6 possible manifestations of gender dysphoria in adolescents/adults
-incongruence between expressed gender and sex characteristics
-strong desire to be rid of own sex characteristics
-strong desire for sex characteristics of other gender
-strong desire to be other gender
-strong desire to be treated as other gender
-conviction that they have thoughts/feelings/reactions of other gender
categories of paraphilic disorders
anomalous activity preferences
anomalous target preferences
subcategories of anomalous activity preference paraphilias
courtship disorders
algolagnic disorders
courtship paraphilic disorders
voyeuristic
exhibitionistic
frotteuristic
what does algolagnic disorder mean
associated with pain and suffering
what are the algolagnic paraphilias
sexual masochistic disorder
sexual sadism disorder
what are the subcategories of anomalous target preference paraphilias
directed at another
directed elsewhere
anomalous target preference paraphilia directed at another
pedophilic disorder
anomalous target preference paraphilias directed elsewhere
fetishistic
transvestic
length of time symptoms must be present to qualify as paraphilic disorder
at least 6 months
what is common to all paraphilia diagnostic criteria
-manifested by urges/fantasies/behaviors
-have either acted on them or is causing distress/impairment
-symptoms for at least 6 months
voyeuristic disorder
intense sexual arousal from watching someone naked, disrobing, or engaged in sexual behavior
which paraphilias have an age requirement of 18 years
voyeuristic
exhibitionistic
what is the age requirement for pedophilic disorder
at least 16 and 5 years older than victim
specifiers for all paraphilic disorders
-in a controlled environment
-in full remission
criteria for paraphilia to be in full remission
no acting on urges or associated distress for at least 5 years in an uncontrolled environment
when can patients who deny urges or distress be dx with a paraphilic disorder
when there is evidence they have acted on urges
what lends credibility to a paraphilic behavior being recurrent
multiple victims on multiple occasions
what is the most common potentially law breaking sexual behavior
voyeurism
common paraphilic comorbidities
-other paraphilic disorders
-depressive, anxiety, bipolar disorders
-substance use disorder
-conduct/antisocial personality disorders
exhibitionistic paraphilic disorder
sexual arousal from exposing genitals to unsuspecting persons
specifiers unique to exhibitionistic disorder
sexually aroused by exposing genitals to children, adults, or both
frotteuristic disorder
intense sexual arousal from touching/rubbing against unsuspecting victims
sexual masochism disorder
recurrent intense sexual arousal r/t being humiliated, beaten, bound, or otherwise made to suffer
specifier unique to sexual masochism disorder
with asphyxiophilia
what is different about diagnostic criteria in sexual masochism as opposed to the other paraphilias
applies to those who freely admit paraphilic interests
what if there are paraphilic behaviors but they do not cause distress/impairment
they are considered paraphilias (sexual interests) not necessarily disorders
sexual sadism disorder
recurrent intense sexual arousal from the suffering of others
what is a typical associated feature of both sexual sadism and masochism
extensive use of sadomasochistic porn
pedophilic disorder
recurrent intense sexual arousal from prepubescent children
specifiers unique to pedophilic disorder
-exclusive type (attracted only to children)
-nonexclusive type
-attracted to males
-attracted to females
-attracted to both
3 types of emotional congruence with children
-prefer social interactions with children over adults
-feel like they have more in common with children
-choosing occupations or volunteer activities to be close to children
when do most paraphilias begin to manifest
adolescence
diagnostic tests for pedophilic disorder
penile plethysmography
viewing time
what is the difference between child sexual abuse in pedophilia as opposed to antisocial personality disorder
in antisocial personality disorder it is typically d/t easy access to the child and in pedophilia it is due to attraction to child
fetishistic disorder
recurrent intense sexual arousal from nonliving objects or specific nongenital body parts
what differentiates fetishistic disorder from cross-dressing
fetishistic disorder is not dx if fetish objects are exclusively clothing items for cross-dressing or inanimate objects made for sexual stimulation
specifiers unique to fetishistic disorder
-body
-nonliving object
other
what is the primary means of sexual arousal in fetishistic disorder
whatever the fetish object is. Arousal can often not be achieved without it
Partialism in fetishistic disorder
exclusive focus on body part
transvestic disorder
recurrent intense sexual arousal from cross-dressing
specifiers unique to transvestic disorder
with fetishism
with autogynephilia
transvestic disorder with fetishism
sexually aroused by fabrics
transvestic disorder with autogynephilia
sexually aroused by thoughts/images of self as a woman
what increases likelihood of gender dysphoria with transvestic disorder
autogynephilia
what decreases chances of gender dysphoria with transvestic disorder
fetishism
difference in masturbation associated with transvestic disorder in younger and older men
usually leads to erection and masturbation in younger men. Older men may refrain or delay erection and masturbation to prolong cross-dressing session
purging and acquisition pattern of behavior in transvestic disorder
spends a great deal of money on clothes, discards them in an effort to stop cross-dressing, then begins to acquire them again
sexual arousal v. desire in transvestic disorder as one ages
may feel less sexual arousal even though desire to cross-dress remains the same or heightens
