Sexual Dysfunctions, Gender Dysphoria, and Paraphilic Disorders

Question 1

Rule-outs before diagnosing sexual dysfunction

Answer 1

1. Nonsexual mental disorder
2. Serious life stressor
3. Medical conditions or medications

Question 2

Sexual dysfunction specifiers

Answer 2

1. Onset (lifelong v. acquired)
2. Extent (generalized v. situational)
3. Severity

Does not apply to Genito-Pelvic Pain/Penetration Disorder

Question 3

Types of sexual dysfunctions

Answer 3

1. Erectile Disorder
2. Premature Ejaculation
3. Genito-Pelvic Pain/Penetration Disorder
4. Female Orgasmic Disorder

Question 4

Erectile Disorder criteria

Answer 4

1. 1+ symptoms during 75-100% of sexual activities
2. Duration > 6 months

Question 5

Ruling out organic etiology for Erectile Disorder

Answer 5

1. Random erections
2. Morning erections
3. Erections when masturbating or w/ different sexual partner

Question 6

Erectile Disorder treatment

Answer 6

1. Behavioral techniques
2. Medication to increase blood flow to penis (Viagra, Cialis)

Question 7

Erectile Disorder behavioral techniques

Answer 7

1. Reducing performance anxiety (“sensate focus”)
2. Increasing sexual stimulation

Question 8

Sensate focus

Answer 8

1. Non-sexual touching
2. Sexual touching
3. Sex

Question 9

Premature Ejaculation criteria

Answer 9

1. Ejaculation w/in 1 minute or before desired
2. Duration > 6 months
3. 75-100% of sexual activities

Question 10

Premature Ejaculation treatment

Answer 10

1. Sensate focus
2. Start-stop or pause-squeeze techniques to control ejaculation
3. Medications to increase serotonin and delay ejaculation (Paroxetine)

Question 11

Genito-Pelvic Pain/Penetration Disorder criteria

Answer 11

1. 1+ symptoms (vaginal penetration, pain during sex, anxiety related to pain, tensing of pelvic floor muscles during penetration)
2. Duration > 6 months

Question 12

Genito-Pelvic Pain/Penetration Disorder etiology

Answer 12

1.Sexual or physical abuse
2. Vaginal infections

Question 13

Genito-Pelvic Pain/Penetration Disorder treatment

Answer 13

1. Relaxation training
2. Sensate focus
3. Topical anesthetic
4. Vaginal dilators
5. Kegels

Question 14

Female Orgasmic Disorder critieria

Answer 14

1. Delayed/infrequent/absent OR less intense
2. All or almost all sexual activities
3. Duration > 6 months

Question 15

Female Orgasmic Disorder treatment

Answer 15

1. First line = directed masturbation (especially for lifelong course)
2. Other cognitive-behavioral techniques
3. Sex education
4. Sensate focus
5. Anxiety reduction techniques
6. Mindfulness training
7. Communication skills training

Question 16

Gender Dysphoria criteria (children)

Answer 16

1. Incongruence between assigned and experienced gender
2. 6+ of 8 symptoms
3. Duration > 6 months
4. Distress or impairment

Question 17

Gender Dysphoria criteria (adolescents and adults)

Answer 17

1. Incongruence between assigned and experienced gender
2. 2+ of 6 symptoms
3. Duration > 6 months
4. Distress or impairment

Question 18

Gender Dysphoria treatment models

Answer 18

1. Gender-affirmative model*
2. Dutch protocol

Question 19

Dutch protocol

Answer 19

Assumes gender dysphoria persists into adolescence for small group

1. < 12 yo = “watchful waiting”
2. 12 yo = social transition, puberty blockers
3. 16 yo = hormones
4. 18 yo = surgery

Question 20

Gender-affirming model

Answer 20

1. Gender dysphoria valid at any age
2. Gender variations = NOT disorders
3. Gender presentation = diverse, cultural
4. Gender can be fluid = NOT binary
5. Psychological problems due to negative reactions to person rather than simply dysphoria
6. Social transition > puberty blockers, hormones, surgery

Question 21

Common gender-affirming surgery outcomes

Answer 21

1. Less dysphoria
2. Improved self-satisfaction
3. Low regret
4. Males > females
5. Positive = screening, mental stability, social support, fewer surgical complications

Question 22

Paraphilia

Answer 22

1. Intense, persistent sexual interest
2. Atypical
3. Distress or impairment

Question 23

Paraphilia treatment

Answer 23

1. CBT + group therapy, marital therapy, medication*
2. Cognitive
3. Behavioral
4. Medication

Question 24

Cognitive treatment for Paraphilia

Answer 24

1. Cognitive restructuring
2. Empathy and skills training

Question 25

Behavioral treatment for Paraphilia

Answer 25

1. Covert sensitization
2. Orgasmic reconditioning

Question 26

Covert sensitization

Answer 26

1. Imaginal
2. Replace arousal with undesirable response

Question 27

Orgasmic reconditioning

Answer 27

1. Imaginal
2. Replace paraphilic with normative fantasy

Question 28

Medications for Paraphilia

Answer 28

Reduce sexual desire but have side effects and high risk for relapse

1. Gonadotropic-releasing hormines (Lupron)
2. Antiandrogens that block testosterone production (Depo-Provera)

Question 29

Five types of paraphilic disorders

Answer 29

1. Frotteuristic Disorder
2. Transvestic Disorder
3. Pedophilic Disorder
4. Fetishistic Disorder
5. Exhibitionistic Disorder

Question 30

Frotteuristic Disorder criteria

Answer 30

1. Rubbing against non-consenting adults
2. Duration > 6 months
3. Acting on urges OR distress/impairment

Question 31

Transvestic Disorder criteria

Answer 31

1. Cross-dressing for arousal
2. Duration > 6 months
3. Distress/impairment

Question 32

Transvestic Disorder and sexual orientation

Answer 32

1. Most males identify as heterosexual
2. May engage in sexual activity with men (especially while cross-dressed)

Question 33

Pedophilic Disorder criteria

Answer 33

1. Sexual activity with children < 13 yo
2. Acting on urges or distress/impairment
3. Must be > 16 yo
4. Must be 5+ years older than child

Question 34

Fetishistic Disorder criteria

Answer 34

1. Nonliving object or non-genital body part
2. Duration > 6 months
3. Distress/impairment

Question 35

Exhibitionistic Disorder criteria

Answer 35

1. Exposing genitals to unsuspecting person
2. Acting on urges OR distress/impairment
3. Disclosed or denied despite evidence

Question 36

Three subtypes of Exhibitionistic Disorder

Answer 36

1. Exposure to prepubertal children
2. Exposure to physically mature people
3. Both