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20. Sexual, Gender, Somatoform, Paraphilic Disorders > Sexual Dysfunctions > Flashcards

Sexual Dysfunctions Flashcards

1
Q

what are the subtypes of sexual dysfunctions

A

lifelong

acquired

generalized

situational

*can all help to point towards etiology

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2
Q

what 5 factors need to be considered during assessment of sexual dysfunctions

A
  1. partner factors (partners sexual problems, health status)
  2. relationship factors (poor communication, discrepancies in desire)
  3. individual vulnerability factors (poor body image, hx sexual or emotional abuse) or stressors (job loss etc) or psychiatric comorbidity
  4. cultural or religious factors
  5. medical factors relevant to prognosis, course or treatment
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3
Q

is there a diagnosis for a sexual dysfunction attributable to another medical cause

A

no–> no psychiatric diagnosis for this (i.e peripheral neuropathy)

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4
Q

how often much delayed ejaculation occur to meet criterion A of the DSM disorder

A

in almost all or all occasions (75-100% of the time) of PARTNERED sexual activity

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5
Q

what is criterion A for delayed ejaculation

A

either of the following symptoms must be experienced on almost all or all occasions (75-100% of the time) of partnered sexual activity and without the individual desiring the delay:

  1. marked delay in ejaculation
  2. marked infrequency or absence of ejaculation
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6
Q

what is the time criteria for delayed ejaculation

A

persistent for at least 6 months

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7
Q

how does delayed ejaculation change with age

A

more common in men over 50

men above 80 report twice as much difficulty ejaculating as men udner age 59

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8
Q

why is delayed ejaculation more common in men over 50

A

age related loss of fast conducting peripheral sensory nerves
+
age related decreased sex steroid secretion

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9
Q

what psych comorbidity may be related to delayed ejaculation

A

severe forms of MDD

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10
Q

how common is delayed ejaculation

A

the least common male sexual complaint

less than 1% of men, exact prevalence unclear

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11
Q

what is treatment for delayed ejaculation

A

dual sex therapy

extravaginal ejaculation and then gradual vaginal entry after stimulation to a point neat ejaculation

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12
Q

what % of men report always ejaculating during sexual activity

A

75%

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13
Q

what is criterion A for erectile disorder

A

at least ONE of the following symptoms must be experienced on almost all or all (approx. 75-100%) occasions of sexual activity

  1. marked difficulty in OBTAINING and erection during sexual activity
  2. marked difficulty in MAINTAINING and erection during sexual acrivity
  3. marked decrease in erectile RIGIDITY
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14
Q

what is the time criteria for erectile disorder

A

minimum 6 months of symptoms

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15
Q

what testing can help differentiate organic from psychogenic erectile problems

A

nocturnal penile tumescence testing

measured erectile turgidity during sleep

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16
Q

how do you assess vascular integrity when evaluating erectile disorder

A

doppler U/S

intravascular injection of vasoactive drugs

invasive procedures like dynamic infusion cavernosography

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17
Q

how do you assess nerve function when evaluating erectile disorder

A

PUDENDAL nerve conduction studies

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18
Q

what blood tests are often ordered when assessing erectile disorder

A

serum bioavailable or free testosterone

TSH

fasting glucose (diabetes)

serum lipids

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19
Q

what trait is common in men with psychogenic erectile disorder

A

alexithymia

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20
Q

list risk factors for erectile disorder

A

neurotic personality traits

submissive personality traits

alexithymia

depression, PTSD

age

smoking

lack of exercise

diabetes

decreased desire

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21
Q

list common comorbidities with erectile disorder

A

other sexual diagnoses (i.e premature ejaculation)

anxiety and depressive disorders

lower urinary symptoms related to prostatic hypertrophy

DLD

CV disease

hypogonadism

MS

diabetes

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22
Q

what % of men aged 40-80 complain of occasional problems with erections

A

13-21%

and 40-50% of men aged older than 60-70 have significant problems with erections

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23
Q

what % of men experienced erectile problems that hindered penetration during their first sexual experience

A

about 8%

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24
Q

what is criterion A for female orgasmic disorder

A

presence of either of the following symptoms, experienced on all or almost all (75-100%) occasions of sexual activity

  1. marked delay in, marked infrequency in, or absence of orgasm
  2. markedly reduced intensity of orgasmic sensation

(other criteria = 6months, distress, not better explained by another condition)

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25
Q

what is a specifier for female orgasmic disorder

A

“never experienced an orgasm under any situation”

26
Q

does a woman able to experience orgasm with clitoral stimulation but not during penile-vaginal intercourse meet criteria for female orgasmic disorder

A

no

27
Q

does the data support associations between specific patterns of personality traits or psychopathology and orgasmic dysfunction

A

no not generally

–> some women may have greater difficulty communicating about sexual issues

28
Q

what % of women do not experience orgasm throughout their lifetime

A

10%

29
Q

treatment for female orgasmic disorder

A

dual sex therapy

masturbate

30
Q

what is criterion A for female sexual interest/arousal disorder

A

lack of, or significantly reduced, sexual interest/arousal, as manifested by at least THREE of the following:

  1. absent/reduced interest in sexual activity
  2. absent/reduced sexual/erotic thoughts or fantasies
  3. no/reduced initiation of sexual activity, and typically unresponsive to a partner’s attempts to initiate
  4. absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approx. 75-100%) of sexual encounters
  5. absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues
  6. absent/reduced genital or nongenital sensations during sexual activity in almost all or all sexual encounters
31
Q

list some risk factors for female sexual interest/arousal disorder

A

negative cognitions and attitudes about sexuality

past history of mental disorders

differences in propensity for sexual excitation and inhibition may also predict likelihood of sexual problems

relationship difficulties, partner sexual functioning, developmental history (i.e early relationships with caregivers)

some medical conditions (i.e thyroid, diabetes)

32
Q

distressing low desire can also be associated with what other conditions

A

depression

thyroid problems

anxiety

urinary incontinence

arthritis

IBD

use of alcohol

abuse in childhood

global mental functioning

33
Q

criterion A for genito-pelvic pain/penetration disorder

A

persistent or recurrent difficulties with ONE or more of the following:

  1. vaginal penetration during intercourse
  2. marked vulvovaginal or pelvic pain during intercourse or penetration attempts
  3. marked fear or anxiety about vulvovaginal or pelvic pain in anticipation or, during, or as a result of vaginal penetration
  4. marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
34
Q

list risk factors for genito-pelvic pain/penetration disorder

A

sexual and/or physical abuse

vaginal infections

pain during tampon insertion or the inability to insert tampons before any sexual contact has been an attempted = important RF

35
Q

what % of women in north america report recurrent pain during intercourse

A

about 15%

36
Q

treatment for genito-pelvic pain/penetration disorder

A

dilators

hypnotherapy

behavioural therapy

mindfulness

37
Q

criterion A for male hypoactive sexual desire disorder

A

persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies AND desire for sexual activity
–> MUST HAVE BOTH

judgment of deficiency is made by the clinician–> taking into account factors that affect sexual functioning such as age, general and sociocultural contexts of the individuals life

38
Q

what must be taken into account when assessing male hypoactive sexual desire disorder

A

interpersonal context–> a “desire discrepancy” ie in which man has lower desire for sexual activity than partner is not sufficient for diagnosis of male hypoactive sexual desire disorder

39
Q

use of what substance may increase occurrence of low sexual desire

A

alcohol use

40
Q

what endocrine disorders may contribute to low sexual desire

A

hyperprolactinemia

41
Q

what % of younger vs older men have problems with sexual desire

A

about 6% of those age 18-24 and about 41% of those aged 66-74

(but only a small % of these are affected persistently)

42
Q

criterion A for premature ejaculation

A

a persistent and recurrent pattern of ejaculation occurring during partnered sexual activity within aprpoximately ONE MINUTE following vaginal penetration and before the individual wishes it

43
Q

how might someone subjectively experience premature ejaculation (emotionally etc)

A

sense of LACK OF CONTROL over ejaculation and APPREHENSION about anticipated inability to delay ejaculation on future sexual encounters

44
Q

what areas have been identified on neuroimaging as implicated in premature ejaculation

A

PET–> primary activation in MESOCEPHALIC TRANSITION ZONE including VENTRAL TEGMENTAL AREA

45
Q

list risk factors for premature ejaculation

A

anxiety disorders–> especially social anxiety disorder

may be associated with DOPAMINE TRANSPORTER GENE polymorphism or SEROTONIN TRANSPORTER GENE polymorphism

thyroid disease

prostatitis

drug withdrawal (i.e opioids)

46
Q

what is the estimated prevalence of premature ejaculation

A

1-3% (for DSM criteria, though many men have concerns about how soon they ejaculate)

47
Q

list treatments for premature ejaculation

A

squeeze technique

sex therapy

behavioural therapy

mindfulness

SSRIs

topical anesthetic cream

48
Q

list substances that can result in sexual dysfunctions in association with intoxication

A

opioids

sedatives, hypnotics, anxiolytics

stimulants

49
Q

list medications that can cause sexual dysfunctions in relation to withdrawal from those substances

A

alchohol

opioids

sedatives, hypnotics, anxiolytics

50
Q

list medications that can affect sexual function/dysfunction

A

hormonal contraceptives

antidepressants

antipsychotics

51
Q

what is the most commonly reported side effect of antidepressant drugs

A

difficulty with orgasm or ejaculation

52
Q

list some of the sexual problems that can be encountered with antipsychotics

A

problems with sexual desire, lubrication, ejaculation or orgasm

53
Q

what impact might gabapentin have on sexual function

A

problems with orgasm

54
Q

what impact might lithium and anticonvulsants have on sexual function

A

may suppress desire

(except lamotrigine)_

55
Q

which has more of a negative impact on sexual function, methadone or buprenorphine

A

methadone–> rarely seen with buprenorphine

56
Q

what % of people on antipsychotics will experience sexual side effects

A

about 50%

57
Q

what % of people on MAOIs, TCAs, SSRIs, SNRIs will report sexual side effects

A

wide range–> 25-80%

58
Q

which drug of abuse has a higher incidence of sexual side effects with chronic use

A

heroin (when compared to amphetiamines, MDMA)

59
Q

how quickly might antidepressant induced sexual dysfunction start

A

as soon as 8 days after med onset

60
Q

what % of people with mild-to moderate orgasm delay will experience spontaneous remission within 6 months

A

about 30%

61
Q

does SSRI induced sexual dysfunction resolve after med stopped?

A

sometimes can continue after agent is discontinued

20. Sexual, Gender, Somatoform, Paraphilic Disorders (4 decks)

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