sexual disorders

Question 1

sexual desire disorders

Answer 1

female sexual interest disorder
male hypoactive sexual desire disorder
sexual aversion disorder

Question 2

hypoactive sexual interest d/o

Answer 2

1- persistently deficient sexual fantasies/ desires for sexual activity for one’s age and context
2- causes distress or difficulty
3- not better accounted for by another disorder, not d/t substance or general medical condition

Question 3

tx for female sexual interest disorder

Answer 3

couples therapy
bremelanotide (inc libido in 90% pts), subQ method in testing now (intranasal had adverse effects on BP)
flibanserin- a 5HT-1a agonist, 5HT-2a antagonist; *Severe hypotension with EtOH and CYP3A4 inhibitors

Question 4

male hypoactive sexual desire disorder

Answer 4

persistently or recurrently deficient sexual/erotic thoughts or fantasies and desire
min 6 months
causes distress
not explained by another disorder

Question 5

tx male hypoactive sexual desire disorder

Answer 5

psychotherapy, testosterone
? bremelanotide
D2-agonist (cabergoline, pramipexole, ropinirole) - may inc desire but may lead ot hypersexuality condition/ psychosis

Question 6

sexual aversion disorder (DSM4)

Answer 6

1- persistent/recurrent extreme aversion and avoidance of genital contact w sexual partner
2- causes distress or difficulty
3- not explained by another axis 1 disorder (except another sexual dysfunction)

Question 7

tx sexual aversion disorder

Answer 7

graduated exposure
CBT
stress reduction, relaxation
relation therapy (if relation or communication problems)

Question 8

sexual aversion from PTSD and tx

Answer 8

sexual abuse or other traumatic experiences caused disorder

tx: work through these disorders

Question 9

sexual arousal disorders

Answer 9

female/male sexual arousal disorder

male erectile disorder

Question 10

female sexual arousal disorder

Answer 10

1- persistent/recurrent inability to attain or maintain until completion of activity, an adequate lubrication-swelling response of excitement
2- causes distress or difficulty
3- not better accounted for by axis 1 d/o (except sexual dysfunction), and not d/t substance or general medical condition

Question 11

sexual arousal disorder tx

Answer 11

focus on relationship issues, improved communication (verbal and nonverbal), non-sexual intimacy, education about sexuality
topical cream Femprox for females (under development)- contains PGE1

Question 12

male erectile disorder

Answer 12

1- persistent/recurrent inability to attain or maintain adequate erection until completion of activity
2- causes distress or difficulty
3- not better accounted for by axis 1 d/o (except sexual dysfunction), substance, or medical condition

Question 13

erectile dysfunction tx

Answer 13

PDE5-I (sildenafil, vardenafil, tadalafil)
injection therapy: papaverine, phentolamine, PGE1
penile prosthesis or pump

Question 14

orgasmic disorders

Answer 14

female and male orgasmic disorders
premature ejaculation
delayed ejaculation

Question 15

orgasmic disorder criteria

Answer 15

1- persistent/recurrent delay or absence of orgasm following normal sexual excitement phase (although there is always variation in type/intensity of stimulation that triggers orgasm)
2- causes distress or difficulty
3- not accounted for by another d/o, substance, medical condition

Question 16

tx orgasmic disorders

Answer 16

Hitachi magic wand
sialidase (enzyme to regrow damaged nerve)
yohimbine - male impotence
Wellbutrin ?
cabergoline (D2-agonist) - dec prolactin - may help achieve orgasm partially or fully

Question 17

premature ejaculation

Answer 17

1- persistent/recurrent ejaculation with minimal stimulation before, on, soon after penetration and before desired; must account for age, recent frequency of sexual activity, duration of excitement phase, etc.
2- distress
3- not d/t substance (like opioid withdrawal)

Question 18

tx premature ejaculation

Answer 18

SSRI
tramadol- atypical oral analgesic; mu agonist and inc NE and 5HT
clomipramine (TCA)- side effect = delayed ejaculatory response
desensitizing creams- apply to penis, may cause contamination and dec sensitivity of partner

Question 19

delayed ejaculation

Answer 19

delayed ejaculation during 75%+ partnered sexual activity
minimum of 6 months duration
tx: sex therapy, no known meds yet

Question 20

sexual pain disorders

Answer 20

dyspareunia, vaginismus

Question 21

dyspareunia

Answer 21

1- recurrent/persistent genital pain a/w sexual intercourse in male or female
2- distress
3- not d/t vaginismus/lack of lubrication exclusively, not d/t axis 1 d/o, substance, or medical condition

Question 22

causes of dyspareunia

Answer 22

congenital: endometriosis, vaginal septa, thickened undilatable hymen, introitus hypoplasia, ovarian cysts
acquired: infection, vulvar vestibulitis, tumor (e.g. fibroid), xerosis (dryness, esp post-menopause), interstitial cystitis, uterine prolapse, surgical complications
acq or cong: retroverted uterus, vaginismus

Question 23

gender differences in dyspareunia

Answer 23

significantly more common in women (20%)

causes in men: infection, interstitial cystitis, Peyronie’s disease, tight foreskin, frenulum brevis

Question 24

tx dyspareunia

Answer 24

sexual lubricant, positions that limit depth of penetration, estrogen tx (vaginal dryness in post-menopausal women), surgery (some cases)

Question 25

vaginismus

Answer 25

1- recurrent/persistent involuntary spasm of outer 1/3 vaginal musculature that interferes w sexual intercourse 2- distress 3- not better accounted for by axis 1 d/o (somatization), general medical condition

Question 26

vaginismus tx

Answer 26

vaginal dilators- teach women how to override involuntary contractions w graduated vaginal insertion exercises

Question 27

exhibitionism

Answer 27

1- over 6 months, recurrent and intense arousing fantasies, urges, or behaviors involving exposing genitals to unsuspecting stranger 2- acted on these urges or urges cause distress or difficulty

Question 28

fetishism

Answer 28

1- over 6 months, recurrent intense fantasies, urges, or behaviors involving use of nonliving objects 2- cause distress or impairment of functioning 3- fetish objects not limited to female clothing for cross-dressing or devices for tactile stimulation

Question 29

frotteurism

Answer 29

1- over 6 months, recurrent sexually arousing fantasies, urges, behaviors involving touching and rubbing against a non-consenting person 2- acted on these urges or urges cause distress or difficulty

Question 30

sexual sadism

Answer 30

1- over 6 months, recurrent intense fantasies, urges, or behaviors involving real (not simulated) acts in which psychological or physical suffering of victim is exciting to person 2- cause distress or functional impairment

Question 31

sexual masochism

Answer 31

1- over 6 months, recurrent intense fantasies, urges, or behaviors involving real (not simulated) acts of being humiliated, beaten, bound, or otherwise made to suffer 2- cause distress or functional impairment

Question 32

transvestic fetishism

Answer 32

1- over 6 months, a heterosexual male has recurrent intense fantasies, urges, or behaviors involving cross-dressing 2- cause distress or functional impairment

Question 33

voyeurism

Answer 33

1- over 6 months, recurrent intense fantasies, urges, or behaviors involving observation of unsuspecting person who is naked, disrobing, or engaging in sexual activity 2- acted on urges or urges/fantasies cause distress

Question 34

pedophilia

Answer 34

1- over 6 months, recurrent intense fantasies, urges, or behaviors involving sexual activity with a prepubescent child or children (13 and younger) 2- acted on urges or urges/fantasies cause distress 3- person is at least 16 and at least 5 years older than child/children in criterion A (does not include late adolescent in sexual relationship w 12-13 year old)

Question 35

hebephilia

Answer 35

sexual attraction to adolescents that are post-pubertal, but not yet at age of legal consent aka Lolita syndrome

Question 36

breakdown of pedophile sex offenders

Answer 36

29% are relatives 60% are acquaintances 11% are strangers

Question 37

other paraphilias NOS mentioned in DSM

Answer 37

``` telephone scatologia (obscene phone calls) necrophilia (corpses) partialism (exclusive focus on one part of body) zoophilia (animals coprophilia (feces) klismaphilia (enemas) urophilia (urine) emetophilia (vomit) ```

Question 38

tx paraphilias

Answer 38

CBT, psychodynamic therapy, group therapy/ support groups meds: antidepressants, anti-androgens (MPA, cyproterone acetate, leuprolide acetate), GnRH analogs * to reduce libido

Question 39

gender dysphoria disorder

Answer 39

1- strong and persistent cross-gender identification; 4+ of: repeatedly states desire or insistence of being other sex, insist on wearing opposite gender's clothing, preference for cross-sex role in make-believe play, desire to partake in stereotypical activities of other sex, strong preference for playmates of other sex 2- persistent discomfort w sex or sense of inappropriateness in gender role of that sex 3- not concurrent with physical intersex condition

Question 40

gender identity disorder tx

Answer 40

hormone therapy - may help w breast development (M to F) or body and facial hair development, muscle tone, and lower voice (F to M) sexual reassignment surgery - genital and non-genital reconstruction

Question 41

sex addiction

Answer 41

recurrent compulsive sexual activity that interferes w functioning and/or exposes sufferer to unacceptable levels of risk * NOT currently accepted as a diagnosis in DSM tx: self help group, SSRI, anti-androgens, CBT