Sexuality And Sexual Disorders (Lauren 🌭) Flashcards
Are sexual dysfunctions and sexual paraphilias the same thing?
No
Are you a mature adult
Then act like one
What are the 4 phases of the human sexual response?
Desire
Arousal/Excitement
Orgasm
Resolution
Men usually have _____ orgasm(s) before going to resolution
1
Do women always have 1 orgasm before they go to resolution?
No, may have 0 or may be multiple
What is responsible for so many people’s sex drive going straight to sexual stimuli these days
Porn
If you have a 28yo female patient express that she is having marital problems because her husband is unhappy that they only “hanky panky” once a month, even though she is satisfied, what should your next questions be?
Do you think this is abnormal for ~you~?
Have they ~talked~ about their different desires?
What features of sexual dysfunction would make you think that it has an ORGANIC etiology?
Generalized (not just one part of the sex cycle but all of it)
Gradual onset
Rapid onset when associated with mediation
What features of a sexual dysfunction would make you suspect that it is of a PSYCHOGENIC etiology?
Situational- specific situations just don’t do it for them
Rapid onset
Sexual phobia and aversion
What are some possible psychological causes for sexual dysfunction?
Performance anxiety (Spectatoring)
Inadequate communication with partner
Sexual myths and ignorance
**Intrapsychic issues: fear, guilt, TRAUMA
**Relationship issues: trust, power, control anger that crosses over into bedroom
**Sociocultural values: attitude, religious beliefs
What is spectatoring ?
Watching your own performance (on a camera? In the mirror? I dont know)
Anyways it can add to the performance anxiety one feels when you’re “doing squat thrusts in the cucumber patch”
What are some of the ways you can have “sexual dysfucntion”?
No erection/ lubrication
Initial erection/lube is lost
Premature ejaculation
Retarded ejaculation/femal orgasm dysfunction
How long must symptoms be present in order to diagnose a sexual dysfunction?
(This includes male hypoactive sexual desire disorder, femal sexual interest disorder, erectile disorder, premature ejaculation, female orgasmic disorder, and genito-pelvic pain disroder)
6 months
Couples typically have different levels of desire. This is (normal/abnormal)
Normal
True or false:
there are many variations of “normal”
True.
HE SAID THIS A LOT. BE CAREFUL WITH YOUR LANGUAGE
What kind of things might be going on in someone’s life that may cause them to have lower desire for ”doodle bopping?”
Too busy with family, career, friends, hobby
Relationship issues: anger, control, fear, abuse
Childhood abuse issues
Medical illness
DEPRESSION***
What kind of diseases/drugs can cause lower desire for “jamming the clam?”
Depression
SSRI side effect**
Vascular/neuro disease
Heavy alcohol consumption
Anxiety
What are the DSM5 criteria for males hypoactive sexual desire disorder?
- Absence/deficiency of sexual thoughts, desire, or fantasies for more than 6 months
- Sx cause marked distress/impairment
- Not result of other disease/drug (SSRI, depression, alcohol, etc)
How do you treat male hypoactive sexual desire disorder?
Psychosocial therapy
Bupropion
Testosterone
What are the DSM5 criteria for Female Sexual Interest/Arousal Disorder?
- Absence/deficiency of sexual thoughts, interest, fantasies, initiation of sex, sexual excitement/pleasure, sexual arousal, and/our genital/non-genital sensations during sex for >6 months
- Symptoms cause marked distress/impairment
- Not result of other dieease or drug
If there is interest, there is lack of adequate lubrication (arousal) to permit vaginal sex
What kinds of things other than Female Sexual Interest/Arousal disorder can cause a woman to produce inadequate lubrication for taking ol’ One Eye to the optometrist?
Medical conditions (atrophic vaginitis, infections, estrogen deficiency)
Medication side effects
What are the treatment options for Female Sexual Interest/Arousal disorder?
Artificial lubricants
Local estrogen
Flibanserin (serotonin, dopamine, and NE modulator)
Psychosocial therapy
What are the DSM5 criteria for Erectile Disorder?
- Marked difficulty obtaining or maintaining an erection or marked decrease of erectile rigidity for >6 months
- Sx cause marked distress/impairment
- Not result of other disease or drug
What are some organic factors that may contribute to erectile dysfunction?
Medication side effects
Diabetes
Post surgery (prostatectomy)
Hormonal problems
What are some psychological factors that may contribute to erectile dysfunction?
Anxiety/performance anxiety
Relationship issues: anger, control etc
What are the treatment options for erectile disorder?
Psychosocial therapy
Medications (PDE5 inhibitors)
What are the DSM5 criteria for premature ejaculation?
- Recurrent pattern of ejaculation during sex within one minute AND before the individual wishes. >6 months
- Cause marked distress/impairment
- Not result of other disease or drug
If a man always ejacualtes 30 seconds into “pickling the prime meridian,” and he and his wife are both extremely happy with their sex life, can you diagnose him with premature ejactulation?
No, both partners are happy and it’s not causing any marked distress/impairment
What is the etiology of premature ejaculation?
Early conditioning**
Anxiety
Lack of awareness of subtle penile sensations, especially sensations just prior to orgasmic threshold
What are the treatment options for premature ejaculation?
Self-treatment like distraction (thinkgin about baseball), squeezing, stopping etc
Low dose SSRIs**
What is the average normal duration of “gland to gland combat?”
5-7 minutes
What are the DSM5 criteria for Female Orgasmic Disorder?
- Marked delay, in frequency, absence, or reduced intensity of orgasm >6 months
- Causes marked distress/impairment
- Not a result of other disease of drug
What kinds of questions do you need to ask your patient who you think has Female Orgasmic Disroder?
Is it primary (Lifelong) or secondary (Acquired)?
Is it situational or generalized? With masturbation vs with partner. Is there both mental and physical stimuli ?
What are the treatment option for female orgasmic disorder?
Patient Education
Psychosocial Interventions
Meds: Echinacea or Sildenafil
What are the DSM5 criteria for Genito-Pelvic Pain/Penetration Disorder?
- Persistent/recurrent difficulties in one of the following for >6 months:
- vaginal penetration during intercourse
- marked vulvovaginal or pelvic pain during intercourse
- marked anticipatory fear or anxiety about the pain
- marked tensing or tightening of pelvic floor muscles during attempted vaginal penetration
What are some of the components that can contribute to Genito-Pelvic Pain/Penetration disorder?
Past abuse
Strong negative conditioning
Anxiety component
Sexual component
What is the treatment for Genito-Pelvic Pain/Penetration Disorder?
Trauma therapy (ex: EMDR)
What are the Psychosocal Therpaies you can use for sexual dysfucntions?
Sex Therapy
CBT
How does Sex Therapy treat sexual dysfunction disorders?
Treats the couple
Identify and discuss problems
Suggests Sexual exercises at home
What are some sexual exercises at home you can do if you have a sexual dysfucntion disorder
Gradual heightening of sensory awareness
Progressively increase level of sexual contact
Does Sex Therapy take many years to fix a sexual dysfunction disorder?
No, it is usually a short term thing. “Cognitive stuff doesn’t take long”
How does Cognitive Behaviroal Therapy help sexual dysfucntion disroders?
Approaches the disorder as a learned maladddaptive behavior (that needs to be ~unlearned~)
Cognitive restructuring
Partner communication training
Systematic desensitization
Muscle relaxation
Assertiveness training
What is the DSM5 definition of paraphilias?
Deviations for what are considered normal sexual interests and behaviors.
Recurrent, intense, sexually arousing fantasies, urges or behaviors involving either:
- Nonhuman objects
- The suffering/humiliation of self or partner
- Children or non-consenting persons
Occurs over at least 6 months
Causes significant distress to self/others or impairment in social, occupational, or other important areas of functioning
If someone thinks about fantasies involving children, but never acts on it and it doesn’t cause distress or impairment, is it a priobelm?
No
Paraphilias are usually a means to release _______ _______ and ________
Sexual energy
Frustration
What are paraphilias often associated with?
Concealment
Guilt/shame
Financial and legal problems
Do people with paraphilias cooperate well with treatment?
No, they are resistant to change
What kind of technology did Dr. Stoehr say is problematic for paraphiliacs?
On-line material because it is unfiltered access 💻
💄🦶🏻👠🍆💦
What is the Psychoanalytical (Freudian) theory regarding paraphilias?
They result from unsuccessful negotiating in normal developmental phases of courtship.
Urges are repressed and the re-expressed in paraphilas
What does the Classical Conditioning theory say regarding paraphilias?
They are classically conditioned to associate the object with sexual arousal, and then they get subsequent negative reinforcement due to normal sex being unpleasant for them.
(Men only)
Do women become classically conditioned to be sexually aroused by shoes, leather, underwear, etc?
No. Women dont usually become conditioned to ~objects~
What is exhibitionism?
Flashing 🧥
Indecent exposure
What are the DSM5 criteria for exhibitionism?
- Recurrent, intense, sexually arousngin fantasies, sexual urges or behaviors that involve exposing their genitals to unsuspecting strangers
- “Impairment”
Why do Exhibitionists have so much fun flashing their “21st Digit” to strangers?
It evokes shock and fear in the victim, which they derive pleasure from.
The excitement increases with the risk of being discovered
What sexual paraphilia is this:
- Recurrent intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing or engaging in sexual activity
- “Impairment”
Voyeurism
If you had to paint a picture of the type of person most likely to engage in voyeurism, what would that person look like?
Unmarried male in 20’s or 30’s
What is a wonderful luxury available to voyeurs that allows them to explore their fantasies without victimizing anyone else?
Voyeur webpages/cam sites of “dressing rooms” etc but the people in the videos know that the cameras are there and are just pretending that they dont
What paraphilia involves rubbing against and touching a non-consenting person?
Frotteurism
🚌🛩🚉
What types of settings does frotteurism usually take place?
In crowded situations, they will attempt to rub their genitals against another person
Are these things considered frotteurism:
Accidental touching
Inappropriate grabbing
Copping a feel
Yes. These are not innocent. They are total violations of someone’s personal space.
What are the DSM5 criteria for fetishism?
- Recurrent, intense sexually arousing fantasies, urges, or behaviors involving non living objects or non-genital body part
- “Impairment”
- Patient do not limit the fetish objects to articles of female clothing used in cross dressing or to devices designated for the purpose of tactile genital stimulation
What do fetishists ~do~ with the object/body part they are attracted to?
It is invariably used for masturbation
👙🦵🏽🦶🏻👠👡👝🧳🧥💅🏻👒
What is the common name for “Transvestic Fetishism?”
Cross Dressing
If you had to describe the kind of person most likely to engage in transvestic fetishism/cross dressing, what would they look like?
Heterosexual**
Married men
Do Gender Dysphoria and Drag Queens fall under the category of Transvestic Fetishism (crossdressing)?
NO!!!!
If you get off to being humiliated, beaten, bound, or made to suffer, you are a (masochist/sadist)
Masochist
(Masochist: Me)
⛓🔪🏓🤺💩
What kind of fun activities may be arousing to someone who is a masochist?
Restraint⛓
Bondage
Paddling🏏
Beating 🤼♀️
Verbal abuse 🗣
Getting peed on 🚿
Getting pooped on 💩
Forced cross-dressing👠
Infantilism 🍼
Hypoxyphilia (occluding carotids)
If someone is a masochist, can they also be a sadist?
Yes, that is called **sadomasochism*
Why do paraphilias ruin “normal” sex for people?
Because it is ~learned behavior~ aka ~classical conditioning~ and that person only wants that form of sex now
What are the DSM5 criteria for sadism?
- Recurrent, intense, sexually arousing fantasies, urges, or behaviors involving act in which psychological or physical suffering of the victim is sexually exciting
- The person has acted on these urges with a NON CONSENTING person, or the sexual urges and fantasies cause marked distress or interpersonal difficulty
- “Impairment”
At what age do sadistic fantasies often begin, vs when sadisitic activities begin
Fantasies in childhood
Activities in early adulthood
What personality disorder may be associated with Sadism?
ASPD
What are the DSM5 criteria for pedophilia?
- Recurrent, intense, sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child (13 yrs or younger)*
- The patient must be age 16 or older and at least 5 years older than the child involved
- “Impairment”
How might pedophiles try to rationalize their behavior?
They are providing “educational value”
The child derives sexual pleasure, so it’s not abuse
The child is sexually provocative, and he/she wanted this
🤢
Coerced intercourse is also known as:
RAPE
What age and gender are most victims of pedophilia?
Girls between 8 and 11
What is meant by the victim to perpetrator cycle when it comes to pedophiles?
Victims of child sex abuse grow up and replace their feelings of ‘defeat’ with ‘triumph.’ (“Now I can control someone else”)
It artificially props up their self esteem
Is all child sexual abuse committed by people who meet the DSM5 criteria for pedophilia?
No, there are sex offenders who do not ~prefer~ children, the opportunity just presented itself
What factors have a poor prognosis for the course of all paraphilias?
Multiple paraphilias
Early age of onset
Comorbid substance abuse**
High frequency of behavior (or it’s their only form of sex)
They are getting psychiatric help due to referral by law enforcement (not by their own volition)
What are some factors that have a good prognosis for the course of all paraphilias?
Only one paraphilia
Self-referral for treatment
Sense of Guilt over their behavior****
History of otherwise normal sexual behavior
What kinds of psychotherapy are available for the treatment of paraphilias?>
CBT- addresses rationalizations and distorted thinking
Social skills training- intimacy development (learn how to get aroused without the shoe, foot, etc), communication, sex ed
12-step programs
Group therapy- address denial, healthy remorse, relapse prevention, call each other out on their BS
Individual psychotherapy
What kinds of medications can be added to psychotherapy for the treatment of paraphilias?
SSRIs for mild cases
Antiandrogens/Chemical castrations (victim based paraphilias)
Mood stabilizers (Valproic acid) and antipsychotics for aggressive behaviors
