Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria Flashcards by Gabriella C Maher

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

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What is required for all Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria?

All require that the individual experience distress associated with other symptoms

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How are sexual dysfunctions defined?

Problems associated with sexual intercourse, often (but not always) with a biological basis, that cause to psychological distress

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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

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How is gender dysphoria defined?

Biological and genetic gender is inconsistent with his or her perceived gender

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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

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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

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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

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What is the prognosis for Delayed Ejaculation?

Usually good, particularly with treatment

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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

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What is the etiology for Erectile Disorder?

Diseases like hypertension, diabetes, and cardiovascular disease
Lifestyle factors like obesity, and infectious processes

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What is the prognosis for Erectile Disorder?

Treatable, particularly if the underlying physiological cause can be identified and reversed

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What treatment is used for Erectile Disorder?

Symptomatic treatment of erectile dysfunction is possible using medication

May not be acceptable to all individuals

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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

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What is the etiology for Female Orgasmic Disorder?

Inadequate tone in the perivaginal muscles
Anxiety
Illness
Neurological conditions
Medications

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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

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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