Gender Dysphoria, Sexual Dysfunctions, & Paraphilic Disorders Flashcards
(41 cards)
What is the diagnostic criteria for gender dysphoria (GD)?
1) Marked incongruence between one’s assigned (natal) gender and one’s experienced gender
2) Incongruence results in clinically significant distress or functional impairment
3) Symptoms endure at least SIX MONTHS
Describe the onset and course of GD
evident at an early age (2-4y.o)
persist, regardless of social pressure
What is the etiology of GD?
More what happened in utero then the environment.
may have been an absent or atypical hormone (androgen) during critical development period.
Is there any evidence of atypical hormone exposure in utero for GD patients?
yes bed nucleus of the stria terminalis (BNST) in GD
BNST is larger in males than females due to androgen exposure in utero
In male-to - female GD (trans female) describe the BNST
BNST is more similar in size to non transgender females (suggesting lack of androgen exposure)
How does one manage GD cases?
Hormone treatment
transgender living
surgical sex reassignment
What is the diagnosis criteria for sexual dysfunctions?
Problems related to the normal sexual response cycle
Problems persist for at least 6 months
A possible diagnose for sexual dysfunction in females is female sexual interest/arousal disorder, what is the problem in these females?
problems with libido and/or physiological arousal
Another possible diagnose for sexual dysfunction in females is female orgasmic disorder, what is the problem with these females?
a delay in, the inability, or having low intensity orgasms.
The last possible diagnose for sexual dysfunction in females is genito-pelvic pain/penetration disorder, what is the problem with these females?
Difficulties with vaginal penetration or vulvovaginal/pelvic pain during vaginal intercourse or penetration attempts.
What are the male sexual dysfunction diagnosis’s?
1) Male hypoactive sexual desire disorder -> (low libido)
2) Erectile Disorder –> (problems maintaining or attaining an erection)
3) Premature Ejaculation –> (ejaculation occurring during partnered activities within 1 min)
4) Delayed Ejaculation –> (marked delay in, or absence of, ejaculation)
What are the two specifiers for sexual dysfunctions?
generalized or situational
life long or acquired
What are some various causes of sexual dysfunction?
psychological factors are primary
medical condition may co exist but insufficiently explains the symptom
What are ways to assess sexual dysfunction in the patient?
1) Taking a sexual history –> ROUTINELY ask questions
2) Consider whether sexual dysfunction is related to a medication side effect –> SSRIs cause this
3) Consider whether sexual dysfunction is related to recreational drug use –> alcohol…………hmm…
4) Consider whether sexual dysfunction is related to a medical/physical problem –> diabetes, surgery, thyroid, etc.
5) Consider whether the sexual problem is normal for ones age. With age expect –> slower erection, decreased intensity of orgasm, longer refractory period
6) Be familiar with tests to differentiate a psychiatric vs organic basis for a sexual problem
What is the snap gauge test?
determines whether erections occur during REM. If REM erection occur, then the problem is not organic
Does libido wane with age?
not necessarily ( just a decline in certain aspects of sex)
One of the treatment options for sexual dysfunctions is behavioral therapy and specifically dual sex therapy, what does this therapy do?
1) If dysfunction, then both partners are treated
2) Therapy is short term with behavioral focus
* Sex Education
* Communication skills training
* Anxiety reduction through sensate focus exercises
Another treatment options for behavioral sexual dysfunction is treating specific problems. Each card will go through one. 1 –>
- Premature Ejaculation –>
* squeeze technique (partner squeeze the glans penis to cause discomfort)
* Start and stop technique –> partner ceases stimulation of the partner to reduce pleasure
2nd sexual dysfunction specific problem treatment
- Genito-Pelvic Pain/Penetration Disorder
* Use of dilators to expand vaginal opening in conjunction with relaxation techniques
3rd sexual dysfunction specific problem treatment
- Female Orgasmic Disorder
* Strengthen the pubococcygeal muscle to increase orgasm potential.
Besides behavioral sexual dysfunction treatment, pharmacotherapy can be used. Which drugs should be used?
Adjunct to behavioral therapy
1) Stimulants –> increase libido
2) SSRIs –> slow ejaculation
3) Phosphodiesterase-5 (PDE5) inhibitors –> for erections
What does PLISSIT stand for in regards to sexual dysfunction treatment?
Overall Treatment Strategy:
P–> permission (give approval to enjoy sex)
LI –> limited information (provide basic sex education)
SS –> Specific Suggestions
IT –> refer on to specialists (intensive therapy)
The next group of disorders in regard to sex are the paraphilic disorders. The first disorder is paraphilia, describe the diagnostic criteria
an intense and persistent >6 months deviant sexual interest
If an individual:
a) acts on an urge with a non consenting person
b) acts on an urge with a consenting person and the actions cause significant distress/functional impairment
c) does not act on the urge but the urge causes significant distress/functional impairment
what is the definition of deviant?
sexual interest other than for genital stimulation or preparatory fondling with phenotypically normal physically mature consenting human partners.
