Sexual Problems - Davis & Pedersen Flashcards
What are the four steps in the sexual response cycle?
- Desire
- Arousal/Excitement
- Orgasm
- Resolution
What are the four diagnostic categories of sexual problems?
-
Desire
- Male Hypoactive Sexual Desire Disorder
-
Arousal
- Female Sexual Interest/Arousal Disorder
- Erectile Disorder
- Substance/Medication-Induced Sexual Dysfunction
-
Orgasm
- Female Orgasmic Disorder
- Premature (Early) Ejaculation
- Delayed Ejaculation
-
Pain
- <strong></strong>Genito-Pelvic Pain/Penetration Disorder
What sexual problem includes persistently or recurrently deficient sexual/erotic thoughts or fantasies and desire for sexual activity; and judgement of deficiency made by the clinician, taking into account factors that affect sexual functioning, such as age and sociocultural contexts of the individual’s life?
Male Hypoactive Sexual Desire Disorder
What sexual problem includes absent/reduced:
- Interest in sexual activity
- Sexual/erotic thoughts or fantasies
- Initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate
- Sexual excitement/pleasure during sexual activity in almost all or all sexual encounters
- Is this a change? Causing significant impairment in life?
- Sexual interest/arousal in response to any internal or external sexual/erotic cues
- Genital or nongenital sensations during sexual activity in almost all or all sexual encounters
Female Sexual Interest/Arousal Disorder
What sexual problem includes marked difficulty in obtaining an erection during sexual activity, marked difficulty in maintaining an erection until the completion of sexual activity, and/or marked decrease in erectile rigidity?
Erectile Disorder
What sexual problem includes a clinically significant disturbance in sexual function that developed during or soon after substance intoxication or withdrawal or after exposure to a medication?
Substance/Medication-Induced Sexual Dysfunction
What sexual problem includes a marked delay in, marked frequency of, or absence of orgasm; and/or markedly reduced intensity of orgasmic sensations?
Female Orgasmic Disorder
What sexual problem includes a marked delay in ejaculation, and/or marked infrequency or absence of ejaculation?
Delayed Ejaculation
What sexual problem includes a persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it; ejaculation before they want to?
Premature (Early) Ejaculation
What sexual problem includes persistent or recurrent difficulties with one or more of the following:
- Vaginal penetration during intercourse
- Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts
- Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration
- Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
Genito-Pelvic Pain/Penetration Disorder
Why do things go wrong in sexual relationships?
- Sexual attitudes, values, and beliefs
- Inadequate information and myths
- Psychopathology ⇒ depression, anxiety
- A sexual problem can compound on psychopathology
- Poor body image
- Sexual trauma
- Conflicts about gender identity or sexual orientation
- Specific sexual phobias or aversions
- Fear of loss of control
- Relationship factors
- New partner
- Low attraction, poor sex technique, marital conflict (low commitment and trust)
- Hormonal factors
- Vascular factors
- Neurological factors
- Drugs:
- Psychotropic - risk for sexual problems because they are serotonergic
- Antipsychotics
- Antidepressants
- Anxiolytics
- Sedatives
- Anticonvulsants and lithium
- Antihypertensives
- Oral estrogen
- Recreational/street drugs - alcohol, heroin, methadone, cigarettes, caffeine
- Other health issues - chronic illness, obesity, poor stamina
What are the four levels of treatment in the PLISSIT Model of Sex Therapy?
- Permission (P)
- Limited Information (LI)
- Specific Suggestions (SS)
- Intensive Therapy (IT)
What parts of the PLISSIT Model of Sex Therapy can primary care physicians manage?
- Permission (P)
- reassuring patients that thoughts, feelings, fantasies, etc. are okay
- Limited Information (LI)
- provide info that is specific to his/her sexual concern
- Specific Suggestions (SS)
- activities and “homework” exercises that can be recommended to patients to help them reach their goal
What are five drug treatments for sexual response disorders?
- Testosterone (patch, gel)
- Viagra, Levitra, Staxyn, Cialis (PO)
- Penile injections of alprostadil (Caverject)
- Transurethral alprostadil (MUSE)
- penile suppository
- Bremelanotide (melanocortin agonist)
- in development now (tan, skinny, & horny)
What are some possible treatments for SRI related sexual disorders (SSRIs, TCAs, Effexor)?
- Reduce dose
- Switch agents (Wellbutrin (bupropion) or Remeron (mirtazapine))
- Augment with Wellbutrin (bupropion)
- Cyproheptadine (Periactin, 1-2 hrs b4 sex)
- very sedating
- Weekend holiday from the SRI (excluding Prozac)
