Psychosexual Disorders

Question 1

Low libido

Answer 1

Establish there are no physical health problems

Treatment is mainly psychological

Communication is encouraged

Question 2

Low libido management

Answer 2

Sensate Focus Therapy
- Intercourse is banned
- Non-genital caressing (focus on pleasure and relaxation)
- Genital touching to achieve arousal and subsequent orgasm
- In time, intercourse occurs naturally

Timetabling Sex
- Helps partners with different libidos reach a compromise

Question 3

Hypersexuality

Answer 3

CBT-based treatments
Can also use SSRIs, GnRH therapies and anti-androgens

Question 4

Erectile dysfunction risk factors

Answer 4

Stop smoking, exercise, reduce weight and alcohol, stress management

Treat diabetes, hypertension etc.

Review medication (e.g. mirtazapine is associated with placebo-level sexual dysfunction whereas SSRIs have a much higher rate)

Question 5

Erectile dysfunction management

Answer 5

Psychological Approaches

Physical Treatments
- 1st line: Phosphodiesterase-5 inhibitors (e.g. sildenafil (Viagra))
- Intracavernosal prostaglandin self-injections before intercourse
- Vacuum pumps
- Plastic dome and pump placed over the penis creating a vacuum to produce an erection
- This is maintained by slipping a tight ring around the base of the penis
- Topical Therapies - alprostadil
- Surgery – penile prosthesis

Question 6

Disorders of gender identity

Answer 6

Hormone therapy

Gender reassignment surgery

Patient must demonstrate the ability to live successfully in their desired gender
before surgery can be considered