Sex dysfunction and paraphilias

Question 1

subtypes of sexual dysfunction

Answer 1

lifelong
acquired
generalized
situational

Question 2

definition of delayed ejaculation

Answer 2

either marked delay in ejaculation or infrequency/absence for ejaculation

Question 3

how long do symptoms have to be present for dx of delayed ejaculation

Answer 3

6 months

Question 4

what is common about ejaculation in delayed ejaculation disorder

Answer 4

often can achieve with self-stimulation but not during sex

Question 5

changes in delayed ejaculation disorder with age

Answer 5

prevalence increases
may have reduced volume, force, or sensation

Question 6

what are the predominate contributors to delayed ejaculation disorder

Answer 6

depression
relationship dissatisfaction
medications

Question 7

what types of medications can contribute to delayed ejaculation disorder

Answer 7

tamsulosin
antihypertensives
antidepressants
antipsychotics

Question 8

why does tamsulosin have an effect of ejaculation

Answer 8

medication inhibits a-adrenergic innervation of the ejaculatory system

Question 9

what are the 3 possible manifestations of erectile disorder and how many have to be present for dx

Answer 9

1+:
-difficulty achieving erection
-difficulty maintaining erection
-decrease in erectile rigidity

Question 10

how long do symptoms have to be present for dx of erectile disorder

Answer 10

6 months

Question 11

what is the difference between erectile dysfunction and erectile disorder

Answer 11

dysfunction is the descriptive term for difficulty achieving/maintaining erection and disorder is a diagnostic category of which dysfunction has been present for at least 6 months

Question 12

treatment efficacy in lifelong v. acquired erectile disorder

Answer 12

acquired usually r/t to biologic factors and tends to persist
lifelong tends to be r/t psych factors and is more responsive to tx

Question 13

lab values to assess in the tx of erectile disorder

Answer 13

thyroid function
lipids
fasting glucose (DM)
testosterone levels

Question 14

what is a potential medical cause of erectile disorder

Answer 14

vascular disease

Question 15

what are some characteristics of erectile disorder when the cause is psychological

Answer 15

situational
inconsistent
acute onset

Question 16

onset of erectile disorder when r/t organic cause

Answer 16

tends to be gradual and generalized

Question 17

common comorbidities of erectile disorder

Answer 17

dyslipidemia
cardiovascular disease
hypogonadism
MS
DM

Question 18

possible manifestations of female orgasmic disorder and how many must be present for dx

Answer 18

1+
-delay/infrequency/absence of orgasm
-reduced intensity of orgasm

Question 19

how long must symptoms be present for dx of female orgasmic disorder

Answer 19

6 months

Question 20

what if there is orgasm during clitoral stimulation but not during sex

Answer 20

Does not meet criteria for dx

Question 21

6 possible manifestations of female sexual interest/arousal disorder and how many have to be present for dx

Answer 21

3+
-absent/reduced interest in sex
-absent/reduced sexual thoughts/fantasies
-no/reduced initiation of sex and unresponsive to partner’s initiation
-absent/reduced excitement/pleasure in sexual activities
-absent/reduced arousal in response to sexual cues
-absent/reduced sensations during sexual activity

Question 22

how long must symptoms be present for dx of female sexual interest/arousal disorder

Answer 22

6 months

Question 23

disorders associated with female sexual interest/arousal disorder

Answer 23

depression
thyroid dysfunction
anxiety
incontinence
arthritis
IBS

Question 24

4 possible manifestations of genito-pelvic pain/penetration disorder and how many must be present for dx

Answer 24

persistent/recurrent difficulty w/ 1+:
-vaginal penetration during intercourse
-marked pain during intercourse or penetration attempts
-marked fear/anxiety about pain while anticipating, having, or after intercourse
-marked tensing of pelvic floor muscle during penetration attempts

Question 25

how long must symptoms be present for dx of genito-pelvic pain/penetration disorder

Answer 25

6 months

Question 26

dyspareunia

Answer 26

pain during intercourse

Question 27

vaginismus

Answer 27

involuntary muscle contraction making penetration difficult or impossible

Question 29

additional disorders of pelvic floor/reproductive organs that may be associated with genito-pelvic pain/penetration disorder

Answer 29

interstitial cystitis constipation vaginal infection endometriosis IBS

Question 30

definition of male hypoactive sexual desire disorder

Answer 30

little/no erotic fantasies or sexual desire for at least 6 months (must meet both criteria)

Question 31

definition of premature ejaculation

Answer 31

persistent/recurrent pattern of ejaculation within 1 minute of penetration that lasts at least 6 months

Question 32

what are 3 things that may be associated with premature ejaculation

Answer 32

prostatitis thyroid disease drug withdrawal

Question 33

6 meds that have the highest rates of sexual dysfunction

Answer 33

citalopram fluoxetine fluvoxamine paroxetine sertraline venlafaxine

Question 34

gender dysphoria

Answer 34

distress from incongruence between expressed and assigned gender

Question 35

transgender

Answer 35

gender identity is different than assigned gender

Question 36

cisgender

Answer 36

gender identity congruent with birth assigned gender

Question 37

transexual

Answer 37

one who seeks or is undergoing transition from one gender to another

Question 38

how long must symptoms be present for dx of gender dysphoria

Answer 38

6 months

Question 39

8 possible manifestations of gender dysphoria in children and how many must be present for dx

Answer 39

6+ -insistence/desire to be other gender -preference for cross-dressing -preference for cross-gender roles in play -preference for toys/games/activities typically associated with other gender -preference for playmates of other gender -rejection of toys associated with assigned gender -dislike for one's own sexual anatomy -desire for sex characteristics that match expressed gender

Question 40

6 possible manifestations of gender dysphoria in adolescents/adults and how many must be present for dx

Answer 40

2+ -incongruence between expressed gender and secondary sex characteristics -desire to be rid of sex characteristics -desire for sex characteristics of other gender -desire to be other gender -desire to be treated as other gender -conviction that they have thoughts/feelings/rxns of other gender

Question 41

typical onset of gender dysphoria without a disorder of sexual development

Answer 41

between 2-4 years

Question 42

what disorder is more common in those with gender dysphoria than in the general population

Answer 42

Autism

Question 43

mild premature ejaculation

Answer 43

within 30 seconds to 1 minute

Question 44

moderate premature ejaculation

Answer 44

within 15-30 seconds

Question 45

sever premature ejaculation

Answer 45

within 15 seconds

Question 46

orgasmic anhedonia

Answer 46

ejaculation remains intact but there is no physical sensation of orgasm

Question 47

what is trazadone rarely associated with

Answer 47

priapism

Question 48

medications that can enhance sex drive

Answer 48

wellbutrin clomipramine selegiline

Question 49

what antihistamine medication may reduce SSRI-induced delayed orgasm

Answer 49

cyproheptadine

Question 50

what anticholinergic medication may reverse SSRI-induced orgasmic dysfunction

Answer 50

amantadine

Question 51

how does sildenafil work and what is it prescribed for

Answer 51

nitric oxide enhancer that facilitates the inflow of blood to the penis Erectile disorder

Question 52

how long does sildenafil take to work and how long does it last

Answer 52

effect in 1 hour may last up to 4 hours

Question 53

common side effects of sildenafil

Answer 53

HA flushing dyspepsia

Question 54

sildenafil in women

Answer 54

increases lubrication but not necessarily desire

Question 55

alprostadil delivery

Answer 55

PO, transurethral and injectable

Question 56

effect time of alprostadil

Answer 56

effect in 2-3 minutes lasts up to 1 hour

Question 57

how can SSRIs treat sexual dysfunction

Answer 57

can prolong sexual response in those with premature ejaculation

Question 58

dopaminergic meds and sexual dysfunction

Answer 58

may increase libido and improve sexual performance

Question 59

dopaminergic drugs that can be used to treat sexual dysfunction

Answer 59

L-dopa (dopamine precursor) bromocriptine (dopamine agonist)

Question 60

effects of hormone therapy on sexual function

Answer 60

-androgens increase sex drive -estrogen may decrease libido

Question 61

what medications may treat compulsive sexual behaviors

Answer 61

antiandrogens (estrogen and progesterone)

Question 61

psychotherapies used to treat sexual dysfunction

Answer 61

dual-sex therapy behavioral therapy mindfulness group therapy hypnotherapy analytically oriented therapy

Question 62

how are paraphilic behaviors divergent

Answer 62

they involve aggression, victimization, and extreme one-sidedness

Question 63

exhibitionism

Answer 63

recurrent urge to expose genitals to strangers there is sexual excitement prior to exposure and orgasm r/t masturbation during or after exposure

Question 64

sexual focus of fetishism

Answer 64

objects that are intimately associated with the body or nongenital body parts

Question 65

frotteurism

Answer 65

rubbing penis against fully clothed women to achieve orgasm that usually occurs in crowded places

Question 66

how old do children have to be for sexual desire to be considered pedophilia

Answer 66

under 14 patient must be over 16 and at least 5 years older than victim

Question 67

sexual masochism

Answer 67

sexual urges/fantasies involving being humiliated, beaten, bound, or otherwise made to suffer

Question 68

subtypes of sexual masochism

Answer 68

asphyxiophilia erotic asphixiation

Question 69

sexual sadism

Answer 69

sexual arousal d/t the suffering of others must have either acted on fantasies or they cause significant distress

Question 70

what is another name for voyeurism

Answer 70

scopophilia

Question 71

voyeurism

Answer 71

preoccupation/fantasies of observing people while naked or engaged in grooming or sexual activity usually accompanied by maturbation

Question 72

transvestism

Answer 72

fantasies/urges to dress as opposite gender for arousal and as an adjunct to masturbation/coitus

Question 73

coprophilia

Answer 73

sexual pleasure associated with defacationur

Question 74

urophilia

Answer 74

sexual desire associated with urination

Question 75

klismaphilia

Answer 75

use of enemas for sexual stimulation

Question 76

what are the 5 types of psych interventions for treatment of paraphilias

Answer 76

external control reduction of sex drive tx of comorbidities CBT dynamic psychotherapy

Question 77

external control as treatment for paraphilias

Answer 77

physically eliminating opportunities for individual to act on urges

Question 78

4 psychosexual factors that sexuality depends on

Answer 78

sexual identity sexual orientation gender identity sexual behavior

Question 79

what is the role of the cortex in sexual behavior

Answer 79

involved in controlling sexual impulses and controlling sexual stimuli

Question 80

areas of the cortex that are particularly active during sexual stimulation

Answer 80

orbitofrontal cortex L anterior cingulate cortex right caudate nucleus

Question 81

role of brain stem in sexual behavior

Answer 81

exerts inhibitory/excitatory control over spinal cord and sexual reflexes

Question 82

dopamine effect on libido

Answer 82

increased dopamine increases libido

Question 83

serotonin effect on sexual function

Answer 83

exerts inhibitory effect

Question 84

phosphodiesterase-5 inhibitors for sexual dysfunction

Answer 84

sildenafil vardenafil tadalafill

Question 85

brand name of sildenafil

Answer 85

viagra

Question 86

brand name of vardenafil

Answer 86

levitra

Question 87

brand name of tadalafil

Answer 87

cialis

Question 88

high fat meals with phosphodiesterase-5 inhibitors

Answer 88

absorption delayed up to 60 minutes and peak concentration not as strong

Question 89

half life of sildenafil and vardenafil

Answer 89

3-4 hoursalf li

Question 90

half life of tadalafil

Answer 90

18 hours

Question 91

what enzyme metabolizes phosphodiesterase-5 inhibitors

Answer 91

3A4

Question 92

medication used to treat priapism

Answer 92

phenylephrine

Question 93

intracavernosal injection for priapism

Answer 93

phenylephrine

Question 94

what are some of the more potent 3A4 inhibitors

Answer 94

ketoconazole itraconazole mibefradil

Question 95

typical dosage and range of sildenafil

Answer 95

50mg PO 1h prior to sexual activity range is 25-100mg

Question 96

starting dose of sildenafil for patients >65 and w/ cirrhosis or renal impairment

Answer 96

25mg

Question 97

how often can you use sildenafil

Answer 97

no more than daily

Question 98

typical dosage and range for vardenafil

Answer 98

10mg PO 1h prior to sex range 5-20mg

Question 99

typical dose and range for tadalafil

Answer 99

10mg PO prior to sex range 5-20mg

Question 100

what else is used to treat erectile dysfunction but does not work as well as phosphodiesterase-5 inhibitors

Answer 100

yohimbine