Sexual, Dysfunctional, Paraphilic Disorders And Gender Dysphoria

Question 1

Sexual dysfunction is defined by?

Answer 1

Difficult to function adequately while having sex eg might not become aroused or achieve orgasm

Question 2

What characterises paraphilic disorders?

Answer 2

Sexual arousal occurs primarily in the context of inappropriate objects or individuals - sexual arousal disorders that causes stress or impairment to the individual or cause personal harm or the risk of harm to others.

Question 3

What defines gender dysphoria? P357 and p 389

Answer 3

There is a incongruence and psychological distress and dissatisfaction with the gender one has been assigned at birth. The disorder is not sexual, rather a disturbance in the persons sense of gender identity.

Question 4

Sexual behaviours are strongly influenced by? P 357

Answer 4

Social, generational, cultural, regional, religious, and economic factors

Question 5

What are the stages on the sexual response cycle! P 362

Answer 5

Desire, arousal, orgasm and each are associated with specific sexual dysfunctions. Pain can become associated with sexual functioning in women which leads to an additional dysfunction.

Question 6

Sexual dysfunction - sexual desire disorders is referred to as what for men and what for women? P 363

Answer 6

Men - hypoactive sexual desire disorder
Women - female sexual interest / arousal disorder

Question 7

For women, the deficits in desire and arousal are included together in a sexual disorder called Female sexual interest / arousal disorder. Why ? P 363

Answer 7

In females low sexual interest (desire) is almost always accompanied by a diminished ability to become excited or aroused by erotic cues or sexual activity.

Question 8

Criteria for male hypoactive sexual desire disorder p 364

Answer 8

Question 9

What are the names of the sexual arousal disorders for men and women? P 364

Answer 9

Male - erectile disorder
Female - female sexual interest / arousal disorder (the same for desire type disorders for females)

Question 10

In the past erectile disorder was the most common problem for which men sought help but this changed with the discovery of? P 365

Answer 10

Drugs such as viagra

Question 11

Erectile disorder is characterised by frequent sexual urges and fantasies and a strong desire to have sex, true or false? P 365

Answer 11

True

Question 12

For females who are likely to have low sexual interest (desire) deficits in arousal are reflected in an inability to achieve or maintain what? P 365

Answer 12

Adequate lubtication

Question 13

Criteria for female sexual interest/ arousal disorder p 366

Answer 13

Question 14

An inability to achieve orgasm despite adequate sexual desire and arousal is called what for men (less common) and called what for women p 366?

Answer 14

Men - delayed ejaculation and premature ejaculation

Females - female orgasmic disorder

Question 15

One common experience relating to sexual pain disorder is vulvodynia, which is characterised by?

Answer 15

Chronic pain in the area outside of a woman’s genitals (the vulva) which causes a burning, rawness or stinging sensation often associated with tensing and tightening of the pelvic floor muscle during intercourse. Women with this problem sometimes report childhood maltreatment p 368

Question 16

There are three major aspects to the assessment of sexual behaviour which are? P 369

Answer 16

Interviews
Thorough medical evaluation
Psychological assessment

Question 17

Sexual dysfunction biological contributions:
a number of physical and medical conditions contribute to sexual dysfunction
And
Usually a patient referred to a sexual clinic complains of a wide assortment of sexual problems although one may be of most concern
True or false p370

Answer 17

True on both accounts

Question 18

Sexual dysfunction
Common biological contributions/ causes of erectile dysfunction include? P 370

Answer 18

Neurological diseases and other conditions that affect the nervous system such as diabetes and kidney disease may directly interfere with sexual functioning by reducing sensitivity in the genital area

Question 19

Sexual dysfunction : Biological contributions / causes
Vascular disease is a major cause of sexual dysfunction because? P370

Answer 19

Erections in men and vaginal engorgement in women depend on adequate blood flow

Question 20

Sexual dysfunction: biological contributions / causes
A major physical cause of sexual dysfunction is what? P 370 to 371

Answer 20

Prescription medication.
Drug treatments for high blood pressure may contribute
Antidepressants and antianxiety drugs may interfere with sexual desire and arousal in both men and women

Question 21

Sexual dysfunction: Biological contributions / causes
Cocaine, heroin and alcohol produce widespread sexual function in frequent users. Chronic alcohol use disorder may cause permanent neurological damage and may virtually eliminate the sexual response cycle. Such misuse may lead to what? P 371

Answer 21

Liver and testicular damage
Fertility problems in both men and women

Question 22

Sexual dysfunction: psychological contributions / causes
Anxiety induced by shock threat (you will be shocked if you don’t get aroused) showed that anxiety reduces sexual arousal in some cases. Explain. P 371 to 372

Answer 22

The shock threat although increasing anxiety also increased sexual arousal in sexually functional men.
The shock threat did decrease arousal in sexually dysfunctional men (specifically men with erectile dysfunction.

Question 23

Sexual dysfunction: psychological contributions / causes
Sexually functional men demonstrated significantly less arousal when in the narrative distraction condition. Did this research show the same for sexually dysfunctional men? P 372

Answer 23

No. Sexually dysfunctional men did not experience a reduction in arousal

Question 24

Sexual dysfunction: psychological contributions / causes
What was the cognitive thought process and response by sexually dysfunctional individuals when confronted with the possibility of having sex ? P 373

Answer 24

Tend to expect the worst and find the situation relatively negative and unpleasant. As far as possible they avoid becoming aware of any sexual cues (and therefore are not aware of how aroused they are physically thus underreporting their arousal. They may also distract themselves with negative thoughts.

Question 25

Sexual dysfunction: psychological contributions / causes
Sexual arousal is strongly determined by psychological factors ( particularly cognitive and emotional factors). Explain this interaction of psychological and biological factors. P 373

Answer 25

The cognitive and emotional factors are powerful enough to determine whether blood flows to the appropriate areas of the body (such as the genitals)

Question 26

Sexual dysfunction; Social and cultural contributions / causes.
What is erotophobia? P 374

Answer 26

It refers to a negative cognitive set - learning early that sexuality can be negative and somewhat threatening, and the responses developed reflect this belief.

Question 27

What is vaginismus?

Answer 27

Recurring involuntary muscle spasms in the outer third of the vagina that interfere with sexual intercourse.
A sexual pain disorder p 368 and discussed again on p 374

Question 28

Social and cultural contributions/ causes
Sexual dysfunction
What is script theory? P 374

Answer 28

Script theory of sexual functioning - we all operate by following scripts that reflect social and cultural expectations and guide our behaviour.

Question 29

Sexual dysfunction
Social and cultural contributions and causes
Individuals May experience specific negative events or traumatic events after a period of well adjusted sexuality, p 374

Answer 29

Examples given on page 374

Question 30

Sexual dysfunction
Social and cultural contributions and causes
Script theory helps to understand sexual functioning in individuals and across cultures. For examples, a person who learns that sexuality is potentially dangerous, dirty or forbidden is more vulnerable to developing sexual dysfunction later in life. Give a couple of examples p 374

Answer 30

Vaginismus is relatively rare in North America but considerably more prevalent in Ireland, Turkey, and Iran (meaning this pattern is most evident in cultures with restrictive attitudes towards sex

Question 31

Paraphillic Disorders: arousal disorders
What is Fetishistic disorder p 379

Answer 31

Sexually Attracted to non living objects such as women’s underwear, shoes are popular,
Is associated with two classes of objects or activities
1 an inanimate object or
2 a source of specific tactile stimulation such as clothing made out of rubber
A third source of attraction sometimes called partialism is part of the body such as foot, buttocks or hair

Question 32

Paraphillic Disorders: arousal disorders
What is sexual sadism and sexual masochism disorders p 382

Answer 32

Both are associated with either inflicting pain or humiliation (sadism) or suffering pain and humiliation (masochism) and becoming sexually aroused is specifically associated with violence and injury in these conditions.

Question 33

Assessing and treating paraphilic disorders
Psychological treatment p387
What is covert sensitisation?

Answer 33

Patients associate sexually arousing images in their imagination with some reasons why the behaviour is harmful or dangerous. Before treatment the patient knows about these reasons but the immediate pleasure and strong reinforcement the sexual activity provides is enough to overcome any thoughts of possibly harm or danger that might arise in the future.

Question 34

Describe the difference between transvestic fetishism (a paraphilic disorder) and gender dysphoria p 390

Answer 34

Paraphilic disorder - usually males, who are sexually aroused by wearing articles of clothing associated with gender performances not associated with their assigned sex. Primary purpose is sexual gratification.
Gender dysphoria - primary purpose is the desire to live life openly in a manner consistent with that of the person’s gender

Question 35

Gender dysphoria - causes
What causes have been identified in terms of gender dysphoria? P 391

Answer 35

Yet to uncover any specific biological contribution to gender dysphoria or alternative gender experience.
Twin studies; Estimates that genetics contribute about 62% to creating vulnerability and that about 38% of vulnerability comes from nonshared environmental factors.
P392 maybe slightly higher levels of testosterone or estrogen at critical periods of development. No evidence yet
Other factors such as excessive attention and physical contact from mothers may play a role p392
Very loose relationship between gender nonconforming and later sexual development p 392 to 393

Question 36

Gender dysphoria; Treatment p 393
What are the guidelines for gender nonconforming people? P 393

Answer 36

Treatment guidelines published by American psychological association highlight the diversity of the problems facing gender nonconforming individuals and encourage a holistic approach (helping to build resilience, working within existing family structures and collaborating with other care providers)

Question 37

Gender dysphoria; Treatment p 393
What are the guidelines for gender dysphoria adults P 393

Answer 37

To begin with the least intrusive step of full psychological evaluation and education before proceeding to partially reversible steps such as administration of gonadal hormones to bring about desired secondary sex characteristics. The final step being nonreversible anatomy altering gender affirming surgery