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Flashcards in Sexual Disorders Deck (14):
1

3 categories of sexual disorders

Sexual Dysfunctions -- sexual desire/arousal, Orgasmic Disorders. Sexual pain disorders

Paraphilic Disorders

Gender Dysphoria

2

Sexual Dysfunctions

Criteria

All of the Following:
6 months
clinically significant distress (eg isolation, poor self esteem, unstable relationship)

Not explained by a non sexual mental disorder
Not explained by a severe relationship distress
Not explaind by another
substnace/medication/another medical condition (eg DM)

3

Subtypes in regards to time

Substypes in regards to context

lifelong vs acquired


Generalized vs Situational

4

Female sexual interest/arousal disorder
(criteria, treatment)


Erectile disorder





Criteria for FSIAD -- not interested in sex and when they do participate, they don't like it

Tx -- some evdience for topical testosterone; Wellbutrin has a mild pro sexual effect

5

Male hypoactive sexual desire disorder
(criteria, tx)

take age into account

men with no sexual desire/fantasies

Treatment: androgens, cyproheptadine, busiprone

6

Erectile disorder
(Criteria, Treatment)

At least one of the three following symptoms must be experienced on almost all or all occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):

Can't get an erection
Can't maintain erection
Poor erectional rigidity


Tx --
PDE5 Inhibitors -- Slidenafil, Tadalafil

More invasive treatment: vaccume, pumps etc
-

7

Orgasmic Disorders:

Female orgasmic disorder
Premature ejaculation
Delayed ejaculation

8

Female orgasmic disorder:
Criteria

Etiology ?


Treatments?

6 months of no orgamism in all context (eg sex or masturbation)

Clinically significant distress (eg some women are ok with not cumming everytime, and sexually satisfied with the intimacy)


Etiology -- stress, anxiety, depression, vulvovaginal atrophy, menopause, secondary to SSRIs

Treatment: some evidence for slidenafil

9

Premature Ejaculation

criteria


treatment:

6 months of < 1 minute following vaginal penetration
(all occasions)


Behavioral strategies: stop start, squeeze, jerk off before

SSRIs - first line meds;

10

Delayed Ejaculation

criteria

Treatent

Marked delay in ejaculation.

Marked infrequency or absence of ejaculation.

6 months

In all contexts

Psychotehrapy

11

Genito-Pelvic Pain/Penetration Disorder

criteria --

tx

Persistent or recurrent difficulties with:
vaginal penetration
pain with intercourse
fear about the pain
tensing and tightening of the pelvic floor muscles


tx: Topical ointments, biofeedback, surgery, TCAs, gabapentin

12

meds that can lower sex drive


meds that don't

Beta blockers
Amphetamines
Antidepressants --SSRIs
Antihistamines
Antipsychotics (increasing prolacting)


Don't affect drive
Bupropion
Busiprone
Mirtazapine
Levodopa

13

PARAPHILIC DISORDERS

Definition
Criteria


Treatment

There is a difference between having a paraphilia (i.e. nonpathological sexual preference) and a paraphilic disorder (= paraphilia + significant distress or nonconsenual sexual activity due to urges)

A) the paraphilia x 6 months
B) the negative consequence (significnat diststress or acting on urges with non consenting person)


Treatment:
Antidepressants -- for mild d/o (inhibit general sexual functioning)

Hormonal -- antilibidinal hormones (block testosterone)
(Medroxyprogesterone, long acting GnRH)

Psychotherapy --

14

GENDER DYSPHORIA

Criteria:

marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration