Sexual Dysfunctions Flashcards
Sensate focus
Psychotherapy used to treat Male Hypoactive Sexual Disorder where partners learn to touch each other without the pressure to complete a sexual act
Sexual Aversion Disorder
Presentation: Extreme and phobic avoidance of genital contact w/ others; could be associated sexual abuse, incest, bad parental memories, performance anxiety, fear of pregnancy or damage to genitals
PE/Labs: Pt. has anxiety and fear when presented w/ sexual activity
Pharm: Anti-anxiety meds
Psych: Sex Counseling
Female Sexual Interest/Arousal Disorder
Presentation: Inability to maintain physiological sexual responses until completion of sex that presents as decreased interest and lack of pleasure; symptoms must have been present for >6 months
PE/Labs: TSH, FSH, LH levels could be decreased; may see thinned genital tissue on pelvic exam; may be issues with partner
Pharm: Fibanserin, Bremalanotide, Estrogen therapy
Psych: Behavioral therapy, self-stimulation, lubrication
Delayed Ejaculation
Presentation: Delay/Lack of male orgasm following normal excitement phase
PE/Labs: History of surgery/injury; possible retrograde ejaculation (orgasm would still occur) or emission failure (no orgasm)
Pharm: Sympathomimetrics in retrograde ejaculation; sildenafil and imipramine in psychotropic induce Male Orgasmic disorder
Psych: Physical stimulation, vibrator, sex therapy
Male Erectile Disorder
Presentation: Inability to maintain an erection until the end of sexual activity; usually a middle-aged man and the issue is psychological, an erection in the morning confirms this as could penile tumescence
- Primary=never been able to achieve erection
- Secondary=Person previously could achieve erection
PE/Labs: Penile abnormalities should be noted as should the absence of an epididymis and vas deferens
Pharm: Treatment of underlying medical causes, removal of offending medications such as SSRIs
Female Orgasmic Disorder
Presentation: Delay or lack of an orgasm following normal excitement phase, most common female sexual dysfnxn
PE/Labs: Minimum duration of 6 months; essentially the same as the other female arousal disorder
Psych: Behavior
Substance/Medication Induced Sexual Dysfunction Disorder
Presentation: Could be pharmacologic, medical (endocrine, vascular, systemic disease), or psychological
PE/Labs: Depressed testosterone; asses for ETOH, SSRIs, abuse, other issues
Pharm: If- anti-depressant induced =» switch to buproprion (less side effects)
-menopause induced =» give estrogen/testosterone
*Sildenafil and imipramine successful in male psychotropic-induced orgasmic disorders
Premature Ejaculation
Presentation: Occurs w/in one minute of vaginal penetration; most common male sexual disorder
Pe/Labs: Sx must be present for at least 6 months
Pharm: SSRIs and TCAs
Psych: Squeeze as glans as man is about to ejaculate; stop having sex for a sec
Genito-Pelvic Pain/Penetration Disorder
Presentation: Pelvic floor muscles around the vagina tighten upon penetration preventing the penetration of any object including tampons into the vagina; can be assoc. from strained relationships and post-partum stress
PE/Labs: On pelvic exam, look for thinning of genital tissues, tightening of the vaginal muscle especially when penetrating, phobia of intercourse or pain
Pharm: Anti-inflammatories
Psych: Vaginal muscle exercises, counseling
Paraphilic Disorders
Presentation: Intense, sexually arousing fantasies that are sometimes criminal; includes exhibitionism, fetishism, pedophilia masochism, necrophilia, sadism
PE/Labs: Most commonly occurs from heterosexual family member; should do HIV screen if indicated and psychological assessment
Pharm: SSRIs or anti-androgens to decrease sex drive
Psych: Behavior therapy and insight-oriented therapy (patient tries to understand why they need to perform this act)
Gender Dysphoria
Presentation: Pt. feels as if they are in the body of the wrong sex and also presents w/ wearing clothes of opposite sex, desire to take on opposite sex role as a child, desire to be treated and act like opposite gender
PE/Labs: Normal PE
-If seeking SRS, should have lifelong cross-gender identity, absence of psychopathology, otherwise fnxn normally socially
Pharm: Cross-sex hormones, LHRH, spironolactone, fulamide, SRS possible
Psych: Couseling, SRS, social and legal transition
Male Hypoactive Sexual Disorder
Presentation: Decreased sexual thoughts and awareness of cues; may be no dysfunction when involved in sexual acts
PE/Labs: Decreased testosterone; assess for sleep, alcohol intake, stress, abuse before puberty
Pharm: Testosterone injections if necessary
Therapy: Treat underlying sexual abuse or depression; sensate focus
