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Flashcards in Psych-Sexual and Gender Identity Disorders Deck (23):
1

Stages of the sexual response cycle

Desire (appetite or craving) -> Excitement (erection) -> Orgasm -> Resolution (different in males and females)

2

What characterizes a sexual dysfunction?

Disturbance of sexual response cycle, symptoms persist of 6+ months and cause significant distress.

3

For the past 6 months a patient has had significant distress due to a marked delay or absence of ejaculation in almost all sexual experiences. His symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What things need to be specified in his diagnosis?

Delayed ejaculation needs to be specified lifelong vs. acquired, generalized vs. situational (more common) and mild, moderate or severe.

4

Treatment for delayed ejaculation

Behavioral interventions: sensate focus (increase stimulation and reduce performance anxiety. Pharmacotherapy: cyproheptadine and yohimbine (1-2 hrs before sex, makes you sleepy).

5

For the past 6 months a patient has had significant distress due to difficulty in obtaining an erection during intercourse and decreased erectile rigidity. His symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What are risk factors for this condition?

Erectile disorder risks include aging, diabetes, vascular disease, smoking and hypercholesterolemia.

6

Treatment for erectile disorder

Assess vascular diseases. Can treat with testosterone (for hypogonadism), bromocriptine (for hyperprolactinemia), psychotherapy, penile prosthesis and medications (PDE5 inhibitors: sildenafil, vardenafil, tadalafil)

7

For the past 6 months a patient has had significant distress due to difficulty in obtaining an orgasm and reduced intensity when it comes.Her symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. How common is this?

Female orgasmic disorder is reported in ~25% of women, but only 25% of them are distressed about it.

8

For the past 6 months a patient has had significant distress due to lack of interest or arousal in sexual activity or fantasies. She denies initiating sexual activity, has reduced pleasure in encounters and reduced sensation. Her symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What is your diagnosis?

Female sexual interest/arousal disorder. 

9

For the past 6 months a patient has had significant distress due to absent sexual thoughts or fantasies and decreased desire for sexual activity. His symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What is your diagnosis?

Male Hypoactive Sexual Desire Disorder

10

For the past 6 months a patient has had significant distress due to recurring ejaculation occurring within 1 minute following vaginal penetration and before the individual wishes it to occur. His symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What is your diagnosis?

Premature Ejaculation. Mild = 30s - 1 min. Moderate = 15-30s. Severe = < 15s.

11

Treatment for premature ejaculation

Behavioral: stop, start, squeeze. Pharmacologic: SSRIs and clomipramine.

12

For the past 6 months a patient has had significant distress due to pain on vaginal penetration, pain during intercourse and fear/anxiety about pain in anticipation of intercourse. Her symptoms are not better explained by another mental disorder, severe relationship distress, life stressors or medications. What is your diagnosis?

Genito-Pelvic Pain/Penetration Disorder

13

For the past 6 months a patient has had significant distress due to sexual dysfunction. Further exam reveals the symptoms are correlated with medication. It is note better explained by sexual dysfunction that is not substance/medication induced, it does not occur exclusively during delirium and it causes significant distress. What is your diagnosis?

Substance/Medication Induced Sexual Dysfunction

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14

Sexual dysfunction due to disease

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15

Recurrent, intense sexual arousal, fantasies and urges involving anomalous sexual activity. What is it called when you act on these urges and that action causes distress?

Paraphilic disorders.

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16

Etiology of paraphilic disorders

Learning theory (early sexual experiences), biologic basis and other psychiatric conditions

17

Treatment of paraphilic disorders

Prison, Behavioral therapy (to help them see consequences and correct cognitive distortions), anti-androgens to reduce testosterone (last resort) and SSRIs (decrease libido and decrease intrusive thoughts) and Naltrexone (reduce addictive behaviors)

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18

One’s biological sex, also used to refer to one’s sexual preference

Sexual identity

19

One’s subjective sense of maleness or femaleness

Gender identity

20

Behaviors an individual engages in that identify the individual as male or female

Gender role

21

Strong and persistent cross-gender identification and distress associated with incongruence of one’s personal experience with gender and their assigned gender.

Gender dysphoria

22

Treatment for gender dysphoria

Hormone therapy/sexual reassignment therapy

23

3 major types of sexual disorders 

Sexual dysfunctions, paraphilic disorders, gender dysphoria