Paraphilic Disorders, Sexual Dysfunction Flashcards
(52 cards)
what are the sexual dysfunction disorders
-delayed ejaculation
-erectile d.o
-female orgasmic d.o
-female sexual interest/arousal d.o
-genito-pelvic pain/penetration d.o
-male hypoactive sexual desire d.o
-premature ejaculation
-substance/medication-induced sexual dysfunction
dsm-5 criteria for sexual dysfxn disorders
-dysfunction is not better explained by a nonsexual mental d.o
-dysfxn is not better explained by relationship stress
-not attributable to substances/meds or a medical condition
in order for delayed ejaculation dx, when must symptoms occur
-on almost all occassions
-apx 75-100% of partnered sexual activity
for 6 months
2 types of delayed ejaculation
-delay in ejaculation
-infrequency/absence of ejaculation
t/f: there are FDA approved drugs for delayed ejaculation
f!
they are all used off label
what drugs are used off label for delayed ejaculation
testosterone
buspirone
amantadine
oxytocin
cabergoline
non pharm tx for delayed ejaculation (2)
CBT
masturbatory retraining
dsm 5 for erectile d.o
at least one of the 3 following sx on almost all occassions of sexual activity (75-100%) x 6 months:
-difficulty obtaining an erection during sex
-difficulty maintaining an erection until completion of sex
-decrease in erectile rigidity
pharm for erectile d.o (2)
-phosphodiesterase inhibitors -> sildenafil, tadalafil etc
-intraurethral/intracavernosal prostaglandins
non pharm for erectile d.o (2)
-vacuum erection devices
-surgical implants
dsm 5 for female orgasmic d.o
presence of either of the following sx on almost all or all (75-100%) of occasions of sex:
-delay/infrequency/absence of orgasm
-reduced intensity of orgasmic sensations
first line tx for female orgasmic d.o
directed masturbation
basically a voice that provides instructions while the pt masturbates
what do you think when you see a pt who is completely disinterested in sex and is not receptive to partner’s attempts to initiate foreplay - she also never achieves orgasm when they have sex and it is affecting her relationship
female sexual interest/arousal d.o
dsm 5 for female sexual interest/arousal d.o
lack of, or significantly reduced, sexual interest/arousal based on at least 3 of the following sx for a minimum of 6 months:
-absent/reduced interest in sex
-absent/reduced sexual/erotic thoughts or fantasies
-no/reduced initiation of sexual activity/unreceptive to partner’s attempts to initiate
-absent/reduced sexual excitement/pleasure during sex
-absent/reduced sexual interest/arousal in response to any sexual/erotic cues
-absent/reduced genital or nongenital sensations during sex
tx for female sexual arousal interest/arousal d.o
education about sexual anatomy and fxn:
-nonphysical/physical nongenital/non penetrative genital stimulation
-CBT
-hormones (testosterone)
dsm 5 for genito-pelvic pain/penetration d.o
persistent/recurrent difficulties w. one more more of the following for at least 6 months:
-vaginal penetration during intercourse
-vulvovaginal or pelvic pain, or penetration attempts
-fear/anxiety about vulvovaginal or pelvic pain in anticipation of or as a result of vaginal penetration
-tensing or tightening of pelvic floor muscles during attempted penetration
tx for genito-pelvic pain/penetration d.o (5)
-treat the cause: ex topical estrogen for atrophic vaginitis
-education about chronic pain related to sex
-CBT
-pelvic floor PT
-progressive desensitization
what do you think when you see a man w. a lack of desire for sex w. his wife which causes distress x 1 year - his wife is hurt and it is affecting their marriage - he used to be into sex and they would have it more often - he is active and competes in triathlons, no significant PMH
male hypoactive sexual desire d.o
persistently or recurrently deficient (or absent) sex/erotic thoughts/fantasies and desire for sex for at least 6 months
male hypoactive sexual desire d.o
tx for male hypoactive sexual desire d.o
-testosterone
-sex therapy
dsm 5 for premature ejaculation d.o
-ejaculation w.in 1 minute following vaginal penetration and before pt wishes it to happen
-must occur almost all or all the time (75-100%) x at least 6 months
tx for premature ejaculation d.o
-SSRIs
-topical anesthetics
-sex therapy
-TCAs
condition in both men and women in which patients have difficulties w. sexual desire, arousal, and/or orgasm due to a s.e of certain meds (legal or illicit)
substance/medication induced sexual dysfxn
what are the paraphilic disorders
-voyeuristic d.o
-exhibitionistic d.o
-frotteuristic d.o
-sexual masochism d.o
-sexual sadism d.o
-fetihistic d.o
-pedophilic d.o
-transvestic d.o
