What are the 4 domains of pediatric development?
Motor: Fine and Gross motor
Communication: Speech... Receptive and expressive languate
Problem Solving: Cognition
Social-emotional: temperament, behavioral responses to environment
What is the development of writing?
Develops between 2 to 6 years of age
As writing develops, hand moves closer to tip of pencil
At first, children hold pencil away from tipa nd movements come from shoulder
Later, elbow produces more movement
Finally, fingers and thumb gain control (dynamic tripod)
Mature writing patter observed by 7 years
What are protective factors of childhood development?
- Strong connection with loving family
- Opportunities to interact with other children
- Grow in independence in an environment with appropriate structure
- Resiliency in older children
What are risk factors to childhood development?
- Family poverty
- Parental mental illness
- Child neglect and abuse
- Poor nutrition
- Complex medical conditions
What are the stages of the sexual response cycle?
1. Desire (appetitive)
2. Excitement (arousal)
What are factors affecting the desire stage?
Biological, psychological, and social factors including:
- Partner availabe
- Suggestive matterials present
What are sexual dysfunctions?
Disturbances in any aspect of the sexual response cycle
- Sexual dysfunction due to GMC
- Substance-induced sexual dysfunction
- Desire disorders
- Sexual arousal disorders
- Orgasmic disorders
- Sexual pain disorders
What are the possible desire disorders?
- Hypoactive sexual desire disorder
- Sexual aversion disorder
What is hypoactive sexual desire disorder?
- Global: all forms of sexual expression
- Situational: limited to a partner, activity or context
- Wide range of sexual desire is normal
What is the treatment of hypoactive sexual desire disorder?
- Testosterone if baseline level is low
- Cognitive-behavioral approaches
- Interpersonal or dynamic therapy for couples with primary relationship problems
What is sexual aversion disorder? Treatment?
Decreased frequency of sexual activity due to active aversion to genital sexual contact with the sexual partner
- Anxiety, fear, or disgust experienced when the opportunity for sex arises
- Aversion may be to specific activity or generalized revulsion (previous victimization?)
In vivo desensitization assignments similar to those for phobic disorders
What are the possible sexual arousal disorders?
Female sexual arousal disorder
Male erectile disorder
What is female sexual arousal disorder?
Presistent or recurrent inability to attain or maintain an adequate lubrication-swelling response during teh sexual excitement phase
--> 1/3 of married women experience it
--> may be due to physical factors
What is Male erectile disorder?
Persistent or recurrent inability to attain or maintain an erection adequate for completion of the desired sexual activity
--> most common male sexual disorder
What are the risk factors for Male Erectile Disorder?
Aging (50% are 40-70yrs old)
Primary care patients
Adult male diabetes
Vascular disease, smoking, hypercholesterolemia
What are treatments for male erectile disorder?
- Intracavernosal Injections
- Oral therapies
What are the possible orgasmic disorders?
Female orgasmic disorder
Male orgasmic disorder
What is female orgasmic disorder?
Persistent or recurrent delay in, or absence of, orgasm following a normal excitement phase
--> only a problem if the woman is troubled by it
- 25% of women report infrequent orgasm
Woman has never achieved orgasm
- Prognosis is good
Anorgasmia is situational or episodic
What is male orgasmic disorder?
Persistent or recurrent delay in, or absence of, ograsm following a normal sexual excitement phase
- Situational more common than global
- absence of orgasm more common than delayed orgasm
What is treatment of male orgasmic disorder?
Behavioral interventions to minimize performace anxiety
- Sensate focus
- Increased stimulation prior to vaginal intercourse
Pharmacotherapy: 1-2hrs before anticipated sexual activity
What is premature ejaculation? Treatment?
Persistent or recurrent onset of orgasm and ejaculation with minimal sexual stimulation before, upon, or shortly after penetration and before the individual wishes it
What are the sexual pain disorders?
What is Dyspareunia?
Genital pain that occurs in association with sexual intercourse (during, before, or after)
- More common in females
- May be accompanied by vaginismus
- Phobic avoidnce of sexual activity often develops
What are common medical causes of dyspareunia?
- Episiotomy scar
- Ovarian cysts and tumors
- Pelvic irritation and resulting vaginal atrophy
- Vulvar vestibulitis
What is vaginismus?
Recurrent or persistent involuntary contraction of teh perineal muscles surrounding the outer third of the vagina when vaginal penetration is attempted
- Psych factors important
- Treatment invovles relaxation training followed by graded exposure
What are paraphilias? Treatment?
Recurrent, intense sexual urges, fantasies, or behaviors taht involve unusual objects, activities, or situations
- Cyproterone Acetate
- Medroxyprogesterone Acetate
- Leuprolide Acetate