Sexuality and Sexual Assault Flashcards
What is the traditional model for human sexual response?
a linear sequence of desire, arousal, plateau of constant high arousal, peak intensity arousal and orgasm, possible repeat orgasm, and then resolution
What about women’s sexuality isn’t explained by or doesn’t fit with the traditional, linear model of sexual response?
- they are sexual for many reasons and sexual desire may initially be absent
- sexual stimuli are integral to the women’s sexual responses
- the phases of desire and arousal overlap
- emotions and many congenital sensations frequently overshadow the genital sensations in terms of importance
- arousal and orgasm are not separate
- orgasm may not be necessary for satisfaction
Give an example of how arousal may precede sexual desire in a woman?
- a woman may be primarily motivated by a wish to be closer to her partner rather than sexual desire
- if sexual arousal is experienced, the stimuli continue, the woman remains focused, and the arousal is enjoyed, she may then experience sexual desire to continue the experience for the save of the sexual sensations
What are the components of subjective sexual arousal in women?
- mental sexual excitement proportional to how exciting the woman finds the stimulus and context
- vulvar and vaginal congestion
- pleasure from stimulating the engorging vulva and anterior vaginal wall
- increased and modified lubrication
- vaginal nonvascular smooth muscle relaxation
- pleasure from stimulating congenital areas
- other somatic changes such as a rise in blood pressure, heart rate, muscle tone, respiratory rate, and temperature
Which neurotransmitters are thought to have a positive effect on sexual response and which are thought to have a negative effect?
- NE, DA, oxytocin, and serotonin via 5-HT-1A/1C receptors have a positive effect
- prolactin, GABA, and serotonin via other receptors have a negative effect
Describe the pelvic changes seen in the sexual response phases of:
- excitement
- plateau
- orgasm
- resolution
- excitement: clitoris increases in diameter, labia increase in size, uterus pulls up and away from the vagina, cervix pulls up from the vagina, the vagina begins to lubricate
- plateau: the clitoris is retracted, the labia minor increase in size and color bright red, the Batholin glands begin secretion, the uterus is fully elevated, and the vaginal entrance contracts to produce a grasping effect while the inner vaginal barrel expands
- orgasm: the uterus contracts, semen pools in the vaginal barrel, the rectal sphincter contracts in rhythm with the uterus, and the orgasmic platform of the vagina contracts
- resolution: the uterus drops back to its normal position, the cervix drops into the seminal pool, and the orgasmic platform resolves
How is sexual dysfunction defined?
as the various ways in which an individual is unable to participate in a sexual relationship the way he or she would wish
What is female sexual interest/arousal disorder?
- a DSM-V disorder defined as a reduced or absent interest in sexual activity including lack of erotic thoughts an cues
- patients have no interest in initiating sexual activity or responding to that from the partner, they have reduced or absent sensations during sexual activity, and the problem causes marked distress or interpersonal difficulty
What is female orgasmic disorder?
a marked delay in, infrequency of, reduced intensity of, or absence of orgasm following a normal excitement phase which causes interpersonal difficulty or distress
What is gentiopelvic pain/penetration disorder?
- recurrent or persistent genital pain associated with sexual intercourse, aka dyspareunia, which causes marked distress or interpersonal difficulty
- or recurrent or persistent involuntary spasms of the musculature of the outer third of the vagina that interferes with sexual intercourse, aka vaginismus, which does the same
- although true muscle spasm hasn’t been documented, reflexive muscle tightening, fear of vaginal entry, and pain with its attempt are characteristic
Which medications are likely to augment sexual response?
antidepressants that activate dopaminergic, noradrenergic, 5-HT1A, or 5-HT2C receptors
Which medications are likely to decrease sexual desire and diminish sexual response?
- SSRIs have been linked to a decrease in sexual desire
- medications that activate non-5-HT1A and non-5-HT2C, GABA, and prolactin receptors are likely to diminish sexual responsiveness
- for example, SERMs, codeine, alcohol, cyproterone acetate, medroxyprogesterone at high doses, some beta-blockers, anticonvulsants, and oral contraceptives have been known to affect sexual response
What group of conditions commonly affect sexual response?
those associated with a loss of adrenal androgen production and/or loss of estrogen production
What effect does estrogen have on sexual reponsiveness in females?
- thought to have a direct effect by supporting vulvar and vaginal congestion
- thought to have an indirect effect by influencing mood and receptiveness
What three simple questions can be used to screen for sexual dysfunction?
- are you sexually active?
- do you have any sexual concerns?
- do you have any pain associated with sex?
