Sexual Disorders and Paraphilias Flashcards
(61 cards)
1
Q
What is abnormal sexuality?
A
- Defining “normal” sexuality is even more difficult
- Not about a human sexual partner
- Excludes stimulation of primary sex organs
- Is compulsive, injurious to self or others
2
Q
What are some high risk factors for sexual disorders?
A
- Substance use
- Limited access to care
- Poor health literacy (about STI, about STI symptoms, about prevention)
- Unassertive
- Poor communication
- Young age
3
Q
What are some high risk behaviors for sexual disorders?
A
- Unprotected: intercourse, mouth-to-genital contact, anal sex
- Multiple sex partners
- High-risk partner
- Sex trade work
- Self or partner use of IV drugs
4
Q
What are some undesired outcomes of sexual disorders?
A
- STI
- Unwanted pregnancy
- Relationship complications
- Poverty
5
Q
What are the four phases of a sexual response cycle?
A
- Desire
- Excitement
- Orgasm
- Resolution
6
Q
What are the components of the desire phase in the sexual response cycle?
A
- Sexual drive
- Motivation
- Wish fulfillment
7
Q
What is a part of sexual drive?
A
- Biological
- Genital sensations and thoughts about sex
8
Q
What is a part of motivation?
A
- Psychological
- Willingness to offer your body for sex
9
Q
What is a part of wish fulfillment?
A
- Social
- Hoping for sex, expectations for sex
- Can be culturally influenced
10
Q
What are the components of the excitement phase in the the sexual response cycle?
A
- Arousal
11
Q
What happens during arousal in the excitement phase?
A
- Can last several minutes to several hours
- Erection, vaginal lubrication
- Nipples harden
- Increased respiration, tachycardia up to 180 bpm, and a rise in BP
12
Q
What are the two basic physiological processes that occur during excitement?
A
- Vasodilation/constriction: engorgement of blood vessels of the genitals as a result of dilation of the blood vessels
- Myotonia: muscle contractions not only in the genitals but throughout the body
13
Q
What happens during the orgasm phase?
A
- Peak of sexual pleasure
- Release of sexual tension and the rhythmic contraction of the perinatal muscles and the pelvic reproductive organs
14
Q
How long do orgasms typically last?
A
- 3-25 seconds
15
Q
What happens during the resolution phase?
A
- Disgorgement of blood from the genitalia
- Body returns to its resting state
- If orgasm occurred, resolution is rapid and accompanied by a general sense of well-being
- If orgasm did not occur, resolution may take up to 2-6 hours
16
Q
What is the average refractory period for men after resolution?
A
- 3-10 minutes
- Could be 24 hours or several days
17
Q
What is the average refractory period for women after resolution?
A
- Women have no refractory period but do need time for resolution
18
Q
What is needed to be taught to patients about timing and coordination?
A
- Timing- teach patients about the sexual response cycle so they know what is normal in themselves and their partner
19
Q
What is it called when a female has impaired desire?
A
- Female sexual interest/arousal disorder
20
Q
What is it called when a male has impaired desire?
A
- Male hypoactive sexual desire disorder
21
Q
What is it called when a female has impaired excitement/arousal?
A
- Female sexual interest/arousal disorder
22
Q
What is it called when a male has impaired excitement/arousal?
A
- Erectile disorder
23
Q
What is it called when a female has impaired orgasm?
A
- Female orgasmic disorder
24
Q
What is it called when a male has impaired orgasm?
A
- Delayed ejaculation
- Premature ejaculation
25
What is it called when a female has sexual pain?
- Genito-pelvic pain/penetration disorder
26
What is male hypoactive sexual desire disorder?
- Persistently or recurrently deficient (or absent) sexual fantasies and desire for sexual activity.
- The judgement of deficiency of absence is made by the clinician, taking into account factors that affect sexual functioning, like age and the context of the person's life, for 6 months
27
What is female sexual interest/arousal disorder?
Lack of or significantly reduced sexual interest/arousal with at least 3 of the following:
1. Absent or reduced interest in sexual activity
2. Absent or reduced sexual/erotic thoughts or fantasies
3. None or reduced initiation of sexual activity, unreceptive to partner's attempt to initiate
4. Absent or reduced sexual pleasure in 75-100% of encounters
5. Absent or reduced sexual interest/arousal in response to any internal or external sexual/erotic cues
6. Absent or reduced genital or non-genital sensations during sexual activity in 75-100% of encounters
28
What is erectile disorder?
At least one of the three following symptoms must be experienced on almost all or all occasions of sexual activity for 6 months
1. Difficulty obtaining an erection
2. Difficulty maintaining an erection until completion of sexual activity
3. Marked decrease in erectile regidity
29
What are some ED risk factors?
- HTN or treatment
- Diabetes
- Smoking
- Peripheral vascular disordes
- CAD
- Blood lipid abnormalities
- Peyronie's disease
- Priapism treatment
- Pelvic trauma or surgery
- Renal failure and dialysis
- Hypogonadism
- Alcoholism
- Antidepressant medication
- Lack of sexual knowledge
- Poor sexual technique
- Interpersonal problems
30
What is female orgasmic disorder?
- Persistent or recurrent delay in, or absence of, orgasm or reduced intensity following a normal sexual excitement phase, for 6 months
31
What is delayed ejaculation?
Either of the following symptoms must be experienced on almost all or all occasions, for 6 months
1. Marked delay in ejaculation
2. Marked infrequency or absence of ejaculation
32
What is premature ejaculation?
- Persistent or recurrent ejaculation with partnered sexual activity within approximately 1 minute following penetration and before the patient prefers it, for 6 months for almost all or all occasions of sexual activity
33
What is genito-pelvic pain penetration disorder?
Persistent or recurrent difficulties with 1 or more of the following for 6 months:
1. Vaginal penetration during intercourse
2. Marked vulvovaginal or pelvic pain during penetration on intercourse
3. Marked fear or anxiety about pain preceding, during or as a result of vaginal penetration
4. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
34
What is the vicious cycle of sexual dysfunction?
- Performance pressure which causes fear of failure
- Fear of failure causes anxiety that interferes with some phase of sexual response
- The anxiety causes sexual dysfunction that is actually experienced which causes more fear of failure
35
What is the general approach for treatment in sexual disorders?
1. Evaluate and treat underlying medical conditions
2. Consider medication side effects
3. Education, if needed
4. Behavior therapy, if needed
5. Refer to counseling, if relationship problems
36
What are some behavioral therapies?
- Sensate focus: no intercourse allowed for a time period, then systematically re-introduce sexual stimulation
- Squeeze technique; start stop method (for premature ejaculation)
- Relaxation techniques: can include systematic desensitization
- Masturbation: increases knowledge and awareness of personal preferences
37
What is paraphilia?
- Any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners, for at least 6 months
38
What are some legal types (non-victimizing) of paraphilias?
- Fetishism
- Sexual masochism
- Transvestic fetishism
- Sexual sadism (mild)
39
What are some illegal types (victimizing) of paraphilias?
- Voyeurism
- Exhibitionism
- Pedophilia
- Sexual sadism
40
What is some background behind paraphilic disorders?
- Rare in US
| - Early onset (
41
What is seen in non-victimizing paraphilias?
- No severe comorbid psychopathologies
- Not likely to present for treatment
- Instead, described as "alternative sexual lifestyle"
42
What is seen in victimizing paraphilias?
- Unlikely to seek treatment
- Tend to use "rationalizing" as defense mechanism
- Antisocial personality disorder has high comorbidity
43
What is sexal masochism disorder?
- Derives sexual pleasure from suffering (humiliation, beaten, bound)-- Real act, not stimulation
44
What is asphyxiaphilia or hypoxyphilia?
- Hypoxyphilia involves sexual arousal by oxygen deprivation obtained by means of chest compression, noose, ligature, plastic bag, mask, or chemical
- May be engaged in either alone or with a partner
- Risk of sudden death may also serve to increase the sexual pleasure by feeling in "mortal danger"
- Cerebral hypoxia makes a person dizzy and light-headed and may increase the intensity of orgasm
45
Who usually does hypoxyphilia?
- Middle-class, caucasian males, <30 years with no history of mental illness
46
What is the most common motivation of hypoxyphilia?
- Fantasy of bondage and pain
47
What is sexual sadism disorder?
- Sexual arousal from the physical or psychological suffering of another person
- "Partner" may or may not have consented
48
What is exhibitionism?
- Exposure of genitals to unsuspecting strangers in public
- Victim is usually non consenting
- Males
49
What is the intent of exhibitionism?
- Evoke their shock or fear
50
What is fetishistic disorder?
- Sexual arousal from non-living objects or specific focus on non-genital body parts
51
What are some common examples of fetishistic disorder?
- Women's shoes or panties
| - Feet
52
What is Frotteuristic disorder?
- Touching or rubbing against a non-consenting person
| - Males, usually 15-25 years old
53
What is transvestic disorder?
- Sexually arousing fantasies, urges, or behaviors about cross-dressing
- Not related to gender identity
54
What is voyeuristic disorder?
- Sexual arousal by watching an unsuspecting person who is naked, disrobing, or engaging in sexual activity
- Must be 18+ years old
55
What is pedophilic disorder?
- Sexual fantasies, urges, or activity with prepubescent child (usually <13 years old)
- Must be aged 16+ and at least 5 years older than the child
56
What is exclusive pedophilia?
- Sexual interest only in children
57
What is non-exclusive pedophilia?
- Usually heterosexual and married
58
What are some risk factors for recidivism (risk to repeat offense)?
- Male victims
- Stranger victims
- Prior sex offenses
- Lack of a cohabitation history with adult partners
59
What are some other rare paraphilia?
- Telephone, computer scatologia
- Necrophilia
- Zoophilia
- Coprophilia (feces)
- Klismaphilia (enemas)
- Urophilia (urine)
60
What are some behavior therapies but have a low success rate?
- Aversive therapy --> reduce pleasure
- Desensitization --> neutralize anxiety
- Social skills training --> form better interpersonal relationships
- Orgasmic reconditioning --> teach more appropriate mental imagery for sexual fantasies
61
How well do RX work in treating pharaphilias?
- Low success rate
