Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria Flashcards
Name the sexual dysfunctions
- Delayed ejaculation
- Erectile Disorder
- Female Orgasmic Disorder
- Female Sexual Interest/Arousal Disorder
- Genito-Pelvic Pain/Penetration Disorder
- Male Hypoactive Sexual Desire Disorder
What is required for all Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria?
All require that the individual experience distress associated with other symptoms
How are sexual dysfunctions defined?
Problems associated with sexual intercourse, often (but not always) with a biological basis, that cause to psychological distress
How are paraphilic disorders defined?
Sexual arousal associated with atypical/unacceptable stimuli or behaviors
The individuals experience intense sexual arousal to atypical objects, situations, fantasies, or individuals
How is gender dysphoria defined?
Biological and genetic gender is inconsistent with his or her perceived gender
What are the implications for function for Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria?
- Self-esteem, self-concept
- Physical and psychological distress
- Sexual and social occupations with partner or spouse
- Affect social interactions
- Affect family relationship
- Confusion with roles
- In some cases, high risks with legal responsibility
What is the diagnostic criteria for Delayed Ejaculation?
- One or both on most occasions when intercourse is attempted: Significant delay in ejaculation and/or Absence of ejaculation
- At least six months
- Symptoms are distressing to the individual
What is the etiology of Delayed Ejaculation?
- Physiological/ physical factors- illness, injury, drug side effects, and lifestyle
- Psychological factors- distress, anxiety, depression, relationship distress
- Combined
What is the prognosis for Delayed Ejaculation?
Usually good, particularly with treatment
What is diagnostic criteria for Erectile Disorder?
One or more on most occasions when intercourse is attempted:
- Difficulty obtaining an erection
- Difficulty maintaining an erection
- Decrease in erectile rigidity
Symptoms have persisted at least six months
Symptoms cause distress
What is the etiology for Erectile Disorder?
- Diseases like hypertension, diabetes, and cardiovascular disease
- Lifestyle factors like obesity, and infectious processes
What is the prognosis for Erectile Disorder?
Treatable, particularly if the underlying physiological cause can be identified and reversed
What treatment is used for Erectile Disorder?
Symptomatic treatment of erectile dysfunction is possible using medication
May not be acceptable to all individuals
What is the diagnostic criteria for Female Orgasmic Disorder?
One or more during most intercourse:
- Delay, infrequency or absence of orgasm
- Reduced intensity of orgasm
Symptoms have persisted for at least six months
Symptoms cause distress
What is the etiology for Female Orgasmic Disorder?
- Inadequate tone in the perivaginal muscles
- Anxiety
- Illness
- Neurological conditions
- Medications
What is the prognosis for Female Orgasmic Disorder?
Good if a psychological issue is resolved
If a medical issue, prognosis depends on course of medical condition
What treatments are used for Female Orgasmic Disorder?
Psychoanalytic psychotherapy
Cognitive-behavioral therapy
Medical attention to underlying physical problem
What is the diagnostic criteria for Female Sexual Arousal Disorder?
Reduced sexual interest or arousal including:
- Reduced interest in sex
- Lack of initiation of sex and generally unreceptive response to partner’s interest
- Reduced sexual excitement, pleasure, sensation, most of the time (consistent with life stage, and sociocultural considerations)
Symptoms have persisted for at least six months
Symptoms cause distress
What is the etiology for Female Sexual Arousal Disorder?
A complex interaction among physical (infection, neurological condition) and psychological (anxiety, stress) factors
What is the prognosis for Female Sexual Arousal Disorder?
With appropriate treatment, the majority of individuals improve significantly
What treatment is used for Female Sexual Arousal Disorder?
- Psychological treatments like cognitive behavioral therapy
- Communication skills training
- Sex education and couple therapy
- Hormone therapy
What is the diagnostic criteria for Genito-Pelvic Pain/Penetration Disorder?
Recurrent difficulties with:
- Vaginal penetration during sex
- Pain during vaginal intercourse
- Anxiety about pelvic pain
- Tensing of the pelvic floor in anticipation of pain
Symptoms persist for at least six months
Symptoms cause distress
What is the etiology of Genito-Pelvic Pain/Penetration Disorder?
Psychological: Anxiety (anticipation of pain), stress, and tension
Physical: Abdominal abnormalities
Mixed: Childbirth- inadequate healing following childbirth; anxiety about resuming sexual relations
What is the prognosis for Genito-Pelvic Pain/Penetration Disorder?
Varied depending on etiology
What treatment is used for Genito-Pelvic Pain/Penetration Disorder?
Treatment of any underlying medical conditions
Behavioral interventions
Estrogen for peri- or post-menopausal women
What is the diagnostic criteria for Male Hypoactive Sexual Desire Disorder?
Reduced sexual thoughts or fantasies and desire for sexual activity (consistent with life stage, and sociocultural considerations)
Symptoms persist for at least six months
Symptoms cause distress
What is the etiology for Male Hypoactive Sexual Desire Disorder?
Almost always psychological in nature
Anxiety about sex or sexual performance
Trauma
Unusual arousal pattern
What is the prognosis for Male Hypoactive Sexual Desire Disorder?
Good with psychotherapy
What treatments are used for Male Hypoactive Sexual Desire Disorder?
Psychotherapy
Couples therapy
What is the etiology of Paraphilic disorders?
Not well understood, but several hypotheses:
- Dysfunction in hormonal balance
- Genetic abnormalities
- Neuropsychiatric deficits
What is the prognosis for Paraphilic disorders?
Poor
Chronic, stable, rarely worsen or improve
What are the implications for function for Paraphilic Disorders?
- Dysfunctional sexual and social occupation
- Difficulty with relationship
- May also affect work, self-care
- Carry high risk of legal difficulties
What treatments are used for Paraphilic Disorders?
Pharmacologic treatments like serotonin and testosterone
Cognitive-behavioral therapy
But limited evidence about efficacy of treatments
What is the diagnostic criteria for Gender Dysphoria?
Incongruence between self-perceived gender and assigned gender, for at least six months, with at least two of:
- Incongruence between experienced gender and sex characteristics
- Desire to be rid of sex characteristics because of this incongruence
- Wish to have the sex characteristics of the other gender
- Wish to be and to be treated as the other gender
- Has romantic and sexual feelings or reactions of the other gender
Symptoms are associated with distress
What is the etiology of Gender Dysphoria?
Not well understood, but almost certainly biological- complicated genetic and hormonal events
What is the prognosis for Gender Dysphoria?
Variable
Depends on the degree of support in his/her social network
Individual must decide what course of action to take, gender reassignment being the most extreme but in some cases, offering the best outcome
What are the implications for function for Gender Dysphoria?
- Affects most performance areas due to psychological distress, particularly social occupation
- Self-esteem, self-identity, role
- May affect academic for school-aged individuals
- May affect emotional regulation, cognition
What treatments are used for Gender Dysphoria?
Psychotherapy
Gender reassignment with accompanying therapy to assist in adaptation to new gender
What are the implications for OT for Sexual Dysfunctions?
- Address issues of self-concept, self-esteem, social interaction
- Identify performance areas that are strengths and assist to enact them
- Provide opportunities for emotional expression through non-verbal mechanisms (e.g. creative arts)
- For paraphilias, redirect to socially acceptable occupations
- For gender dysphoria, assist in adjustment to new gender role
- None of these is well-documented in the OT literature
What are the cultural and lifespan considerations for Sexual related Disorders?
- Cultural differences in gender roles and acceptable sexual expression
- Cultural differences in willingness to seek help
- Level of acceptance and support network
- Gender dysphoria often emerges in childhood or adolescence: Potential for victimization, bullying, social isolation
