12. Psychosexual Medicine

Question 1

Premature ejaculation

Answer 1

• Inability to delay ejaculation sufficiently during intercourse
• Ejaculation occurs in 1 minute or less after the beginning of intercourse
• Ejaculation occurs in the absence of sufficient erection to make intercourse possible

Question 2

Management of premature ejaculation

Answer 2

• Squeeze technique: squeeze penis when about to orgasm
• Vaginal containment
• SSRI
• Dapoxetine

Question 3

Orgasmic Disorder

Answer 3

• Delayed or infrequent or total absence of orgasm
• Reduction int eh intensity of orgasmic sensations

Question 4

Erectile Dysfunction

Answer 4

• Difficult to erect
• Difficult to maintain erection until completion of sex
• Decrease in erectile rigidity

Question 5

Penile erection depends on ___ activity

Answer 5

parasympathetic
-> smooth muscle relaxation and cause hypotension

Question 6

Causes of erectile dysfunction include

Answer 6

• Anxiety (increase sympathetic tone)
• DM
• Venous incompetency
• Dialysis
• Spinal cord injury

Question 7

Genito-pelvic pain/penetration disorder (non-organic vaginismus)

Answer 7

Pelvic or vulvovaginal pain during intercourse or during penetration attempts
Fear or anxiety about pain in anticipation of, during or as a result of vaginal penetration
Tensing and tightening of the pelvic floor muscles during attempted penetration

Question 8

Non-organic dyspareunia

Answer 8

For woman: pain experienced at entry of vagina either throughout intercourse or when deep thrusting occurs
For man: pain experienced during sexual response

Question 9

Paraphilia

Answer 9

Recurrent intense sexual urges and fantasies involving unusual objects or activities within a duration of 6 months
- person either acts on the urges or is markedly distressed by them

Question 10

Fetishism

Answer 10

Recurrent and intense sexual arousal from the usage of non-living objects or highly specific focus on non-genital body parts

Question 11

Transvestic Disorder

Answer 11

Recurrent and intense sexual arousal from cross-dressing but no intention of permanently changing gender

Question 12

Exhibitionistic Disorder

Answer 12

Recurrent and intense sexual arousal from exposure of one’s genitals to an unsuspecting person (‘Flashing’)

Question 13

Voyeuristic Disorder

Answer 13

Recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing or engaging in sexual activity

Question 14

Paedophilic Disorder

Answer 14

Recurrent and intense sexual arousal or fantasies involving sexual activity with a prepubescent child, or children under 13 years old
*patient must be be at least 16 yo and at least 5 years older than the child/children

Question 15

Sexual masochism disorder

Answer 15

Recurrent and intense sexual arousal from the act of being humiliated, beaten, bound or made to suffer

Question 16

Gender dysphoria disorder

Answer 16

Person does not prefer one’s biological gender and interested to engage in behaviours associated with opposite gender

Question 17

Sexual sadism disorder

Answer 17

Recurrent and intense sexual arousal from the physical or psychological suffering of another person

Question 18

Gender dysphoria in Children

Answer 18

Over at least 6 months, there must be marked incongruence between one’s expressed and assigned gender, manifested by 6 of the following:

1. Persistent and strong wish to be of the other gender
2. Boys: Persistent preference for cross dressing in female attire; Girls: Persistent preference for wearing only typical masculine clothing
3. Strong preference for cross-gender roles during play
4. Strong preference to engage in activities typically done by the other gender
5. Strong desire to be with playmates of the other gender
6. Boys: reject masculine toys; Girls: reject feminine toys
7. Strong dislike for one’s sexual anatomy
8. Strong wish that primary and secondary sexual characteristics would match one’s experienced gender

Question 19

Gender dysphoria in Adults

Answer 19

Over at least 6 months, there must be marked incongruence between one’s expressed and assigned gender, manifested by 2 of the following:

1. Marked incongruence between one’s experienced gender and primary and secondary characteristics
2. Strong desire to get rid of one’s primary and/or secondary sex characteristics
3. Strong desire for the primary and/or secondary characteristics of the the other gender
4. Strong desire to be of the other gender
5. Strong desire to be treated as the other gender
6. Strong conviction of having typical feelings and reactions of other gender

Question 20

Management of erectile dysfunction

Answer 20

Phosphodiesterase 5 inhibitor
- Sildenafil, vardenafil

Question 21

Management for non-organic vaginismus

Answer 21

• Sensate focus therapy
• Dilators

Question 22

Common side effects of PDE-5 inhibitors

Answer 22

• headache
• facial flushing
• nasal congestion
• change in colour vision

Question 23

How to differentiate between organic and psychogenic erectile dysfunction?

Answer 23

Presence of early morning erections

Question 24

Dopamine increases libido while serotonin decreases sexual urges

Answer 24

-

Question 25

Priapism

Answer 25

Priapism is a condition in which a penis remains erect for hours in the absence of stimulation or after stimulation has ended. - three types: ischemic, nonischemic, and recurrent ischemic - Most cases are ischemic - Ischemic priapism is generally painful while nonischemic priapism is not

Question 26

What medication is associated with priapism?

Answer 26

Trazodone