Sexualidad Flashcards
16.1.
A 23-year-old man presents to a primary care clinic as a new
patient. During the sexual history, he states that he has never had
sexual fantasies or a desire for sexual activity. He notes that he was
teased for this in high school, “but I don’t care. Sex just isn’t
something I’m interested in.” He states that he has a strong group of
friends and enjoys his job as a department store assistant manager.
He has had a girlfriend for the past year, “and she’s not interested in
sex, either.” He reports that he tried masturbating a few times when
he was a teenager, and that each time he ejaculated quickly. He
stopped masturbating “because it didn’t do anything for me.” He
states that he rarely gets erections. He has no medical illnesses and
is on no medications. Vitals are within normal limits. Physical
examination reveals a well-developed, well-nourished male in no
acute distress. Sexual maturity rating is 5. What is the most likely
diagnosis?
A. Male erectile disorder
B. Male hypoactive sexual desire disorder
C. No diagnosis
D. Premature ejaculation
16.1. C. No diagnosis
The patient meets all of the criteria for lifelong male hypoactive sexual
desire disorder except for the lack of psychosocial impact of marked
distress, which is a requirement of all sexual dysfunction diagnoses. He is
satisfied with his relationships and expresses no desire for sexual activity.
Therefore, no diagnosis would be given.
16.2.
A woman can be diagnosed with female sexual interest/arousal
disorder despite the presence of which of the following
circumstances?
A. Vaginal lubrication and congestion
B. Medications which can cause decreased libido
C. Relationship problems with the sexual partner
D. A medical condition which can interfere with arousal
E. A psychiatric condition that can lead to reduced sexual interest
16.2. A. Vaginal lubrication and congestion
Vaginal lubrication is not necessarily caused by arousal, and can be present
in women with or without female sexual interest/arousal disorder.
Relationship problems, substances or medications, and medical or
psychiatric conditions that can lead to the decreased desire must be
excluded before making the diagnosis
16.3.
A 22-year-old male presents to the outpatient clinic with a
complaint of, “It takes me over a half hour to orgasm.” He states that
he first had intercourse at the age of 19, and that he is sexually active
exclusively with women. He has had two previous sexual partners
with whom he had the same difficulty. His girlfriend of 2 months
recently told him that she loved him, which “freaked me out.” He is
on no medications and has no chronic medical illnesses. Vital signs
are within normal limits, and physical examination is
noncontributory. The patient is most likely to experience a more
average time to ejaculation under what circumstance?
A. Anal sex
B. Masturbation
C. Use of sildenafil
D. Sex with a different partner
E. Use of selective serotonin reuptake inhibitor (SSRI)
16.3. B. Masturbation
The patient is describing symptoms of delayed ejaculation. This rarely
occurs during masturbation, and most often occurs during coitus, which
would include anal sex. Sildenafil could be useful for treatment of erectile
dysfunction. Use of an SSRI is often a cause, not a cure, of delayed
ejaculation. Though his girlfriend’s profession of love for him may create
additional anxiety, the problem has been present with all his partners, so
neither his current anxiety nor a change of partners will likely make a
difference
16.4.
What is the maximum length of time from penetration to
ejaculation in which the diagnosis of premature (early) ejaculation
can be made?
A. 15 seconds
B. 30 seconds
C. 1 minute
D. 2 minutes
E. 5 minutes
16.4. C. 1 minute
The diagnosis of premature (early) ejaculation can be given if the time
from penetration until ejaculation is 1 minute or less. Severity is
considered mild if ejaculation occurs between 30 and 60 seconds,
moderate when between 15 and 30 seconds, and severe when less than 15
seconds.
16.5.
In addition to effects on serotonin, tricyclic antidepressant
medications can lead to erectile and ejaculatory dysfunction due to
effects on what neurotransmitter?
A. Norepinephrine
B. Dopamine
C. Acetylcholine
D. Gamma-aminobutyric acid (GABA)
16.5. C. Acetylcholine
Anticholinergic effects of antidepressants such as tricyclics can lead to
problems with erections and delayed ejaculation. Enhanced dopaminergic
activity and increased norepinephrine production by some antidepressants
such as bupropion may increase sex drive. GABA enhancement, such as in
novel antidepressants under development and in benzodiazepines, can
lead to less anxiety and sometimes improved sexual function
16.6.
A 50-year-old man presents to the outpatient clinic for follow-up of
hypercholesterolemia, hyperlipidemia, and borderline hypertension.
He is on simvastatin, and was told at his last visit 6 months ago that
he would benefit from weight loss. He reports that he has had three
episodes of “squeezing” chest pain, nausea, shortness of breath, and
sweating over the last 2 months. The episodes last around 5 minutes.
He takes over-the-counter sildenafil for erectile dysfunction. He is
5′8″ and 113 kg (250 lb), body mass index (BMI) is 38. Vitals are
within normal limits except for blood pressure, which is 140/95.
Physical examination is unremarkable. An ECG shows no chronic
ischemia. What medication is contraindicated in the management of
this patient’s symptoms?
A. Metoprolol
B. Nitroglycerin
C. Ranolazine
D. Amlodipine
E. Aspirin
16.6. B. Nitroglycerin
The patient is experiencing episodes of angina, for which antianginals such
as aspirin, nitrates, beta-blockers, statins, calcium channel blockers, and
ranolazine can be used. In patients on sildenafil, nitrates are
contraindicated, as the combination can cause a dangerous, and sometimes
fatal, drop in blood pressure
16.7.
Sildenafil has what sexual effect on women?
A. Increased arousal
B. Vaginal lubrication
C. Increased orgasm intensity
D. Loosening of pelvic floor muscles
E. Decreased pelvic pain
16.7. B. Vaginal lubrication
Sildenafil can result in vaginal lubrication, but not increased arousal or
orgasm. Pelvic pain from vaginismus is caused by involuntary pelvic floor
muscle tightening, which sildenafil does not affect.
16.8.
A 35-year-old woman presents to her OB/GYN physician with a
complaint of low sexual desire for the last 2 years. She states that she
has been in therapy for the last 8 months to address possible
relationship factors, and though the communication with her
husband has improved, libido remains low. She denies vaginal pain
or dryness. She has no chronic medical or mental illnesses and is on
no medications. Vital signs are within normal limits. Physical
examination is noncontributory. What evidence-based
pharmacologic agent could be effective for this patient?
A. Sildenafil
B. Yohimbine
C. Desvenlafaxine
D. Fluoxetine
E. Flibanserin
16.8. E. Flibanserin
Flibanserin is U.S. Food and Drug Administration (FDA) approved for
generalized hypoactive sexual desire disorder. Pharmacotherapy can be
used by itself or along with psychotherapy such as insight-oriented or
behavioral sex therapy. Sildenafil does not help with desire. Acute
depression can contribute to decreased libido, for which antidepressants
such as desvenlafaxine and fluoxetine could be helpful. Yohimbine has
been used as an aphrodisiac, but has not been shown in studies to be
effective.
16.9.
What is the sexual side effect a woman is likely to experience from
estrogen replacement therapy used to relieve symptoms of
menopause?
A. Decreased libido
B. Vaginal dryness
C. Vaginal mucous membrane thinning
D. Dyspareunia
16.9. A. Decreased libido
Estrogen therapy, regardless of purpose of use, can lead to decreased
libido, and is sometimes used to treat compulsive sexual behavior in men.
However, it prevents vaginal mucous membrane thinning and facilitates
lubrication, the latter of which can be a cause of dyspareunia. Androgens,
such as testosterone, can help with the decreased libido caused by
estrogen
16.10.
A 25-year-old woman presents to a sex therapist for help with “my
fear of intimacy and sex.” She reports that she was sexually
assaulted when she was 21 years old, and since then has been on
dates but has had no sexual contact, including kissing. “When he
leans in to kiss me, I freeze up and start sweating.” She has been in
therapy for posttraumatic stress disorder (PTSD), which she feels
is helpful for working through the trauma, and is now ready to
“become physical in a relationship again.” She wants to overcome
anxiety from holding hands, and eventually progress to
intercourse. What type of therapy is most likely to help her achieve
her goal?
A. Dual-sex therapy
B. Mindfulness
C. Group therapy
D. Behavior therapy
E. Analytically oriented sex therapy
16.10. D. Behavior therapy
Much like with the treatment of phobias, behavior therapy can be helpful
for patients who fear sexual interaction. The patient will first learn
relaxation techniques to decrease anxiety, then progress to exposure and
response prevention. Dual-sex therapy focuses on communication between
partners who are both in a sexually distressing situation. Group therapy
provides support for patients who share similar sexual problems, and
sometimes uses behavioral techniques within the groups for treatment of
sexual problems. Mindfulness is a cognitive technique used to center on
sensations that lead
to arousal or orgasm. Analytically oriented sex therapy
helps patients learn or relearn sexual satisfaction, and is sometimes
combined with behavioral treatments to treat sexual dysfunctions
16.11.
In addition to significant distress from or acting on sexual fantasies
or impulses, what is required to diagnose an individual with a
paraphilic disorder?
A. Intense sexual arousal from the fantasy or impulse
B. Involvement of a nonconsenting person in the fantasy or impulse
C. Acting on the fantasy or impulse would be a criminal offense
D. Lack of sexual response to typical erotic stimuli
E. Having a sexual fantasy or impulse outside of typical erotic
stimuli
16.11. A. Intense sexual arousal from the fantasy or impulse
All paraphilic disorders require at least 6 months of “recurrent and intense
sexual arousal” from the sexual fantasy or impulse. They do not all involve
a nonconsenting person (such as with fetishistic disorder or sexual
masochism disorder) or result in a criminal offense if acted upon (such as
with fetishistic disorder or transvestic disorder). Simply having a sexual
fantasy or impulse outside of typical erotic stimuli (a paraphilia) is
necessary but not sufficient for a diagnosis of a paraphilic disorder. A
person with a paraphilic disorder often has a lack of a sexual response to
normophilic sexual interests, but this is not a criterion for the diagnosis.
16.12.
What ages of the child and patient and age difference between
them are required for a diagnosis of pedophilia?
Child Patient Age differenc
A. <10 years ≥16 years ≥3 years
B. <14 years ≥18 years ≥3 years
C. <10 years ≥18 years N/A
D. <14 years ≥16 years ≥5 years
E. <10 years ≥16 years N/A
F. <14 years ≥18 years ≥5 years
16.12. D. <14 years ≥16 years ≥5 years
To make a diagnosis of pedophilia, the child must be under 14 years old,
the patient must be at least 16 years old, and there must be at least a 5-year
age difference. These age requirements can be different than those for
statutory rape, which can vary from state to state
16.13.
A 24-year-old man tells a psychiatrist that he has engaged in acts
of exposing his penis to unsuspecting women for the last 5 years.
He states that he has done this about 30 times, has never been
caught, and that he does it for a “sexual rush,” usually when he has
been drinking. He also states that he saw his neighbor having sex
through her window when he was 10 years old. Since then, he has
sought out opportunities, often when drunk, to watch unsuspecting
people engage in sexual activity or in states of undress, and
masturbates during or soon afterward. He states that he has had a
girlfriend for the last year with whom he is sexually active, and
wants to stop the voyeuristic and exposing behaviors before she
finds out. What factor most predicts that he will be successful in
treatment?
A. Alcohol use prior to the behaviors
B. Having more than one paraphilia
C. Being in a sexual relationship
D. The age of his first voyeuristic act
16.13. C. Being in a sexual relationship
Though paraphilic disorders are challenging to treat, some factors, such as
engaging in regular sexual activity, having a single paraphilia, and selfreferral,
are good treatment predictors. Poor prognostic indicators include
the presence of substance abuse and early age of onset
16.14.
A 31-year-old single man presents to an outpatient primary care
clinic to establish care. During the sexual history, he states that he
has had around 30 sexual partners a year for the past 10 years. He
describes a “need” to have intercourse resulting in orgasm. He
notes that he has had a few girlfriends over the years, but they have
broken up with him “because I can’t stop cheating.” He has tried
several times to decrease the behavior, but relapses within a few
weeks each time. He was fired once because he would not stop
using a dating app while at work. What is the most likely comorbid
disorder in this patient?
A. Bipolar disorder
B. Major depressive disorder
C. Substance use disorder
D. Obsessive compulsive disorder
E. Narcissistic personality disorder
16.14. C. Substance use disorder
Sex addiction has many of the same signs as an addiction due to a
substance use disorder, which is the most common comorbidity.
Treatment can also follow a similar course by way of 12-step groups such as
Sexaholics Anonymous, Love Addicts Anonymous, and Sex Addicts
Anonymous.
16.15.
Gender identity is developed in most children by what age?
A. 2 to 3 years
B. 3 to 4 years
C. 4 to 5 years
D. 5 to 6 years
E. 6 to 7 years
16.15. A. 2 to 3 years
By 2 to 3 years of age, most children who have an unambiguous sexual
identity have developed a secure identification of being male or female.
