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20. Sexual, Gender, Somatoform, Paraphilic Disorders > Sexual Dysfunctions > Flashcards

Sexual Dysfunctions Flashcards

(61 cards)

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1
Q

what are the subtypes of sexual dysfunctions

A

lifelong

acquired

generalized

situational

*can all help to point towards etiology

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2
Q

what 5 factors need to be considered during assessment of sexual dysfunctions

A
  1. partner factors (partners sexual problems, health status)
  2. relationship factors (poor communication, discrepancies in desire)
  3. individual vulnerability factors (poor body image, hx sexual or emotional abuse) or stressors (job loss etc) or psychiatric comorbidity
  4. cultural or religious factors
  5. medical factors relevant to prognosis, course or treatment
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3
Q

is there a diagnosis for a sexual dysfunction attributable to another medical cause

A

no–> no psychiatric diagnosis for this (i.e peripheral neuropathy)

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4
Q

how often much delayed ejaculation occur to meet criterion A of the DSM disorder

A

in almost all or all occasions (75-100% of the time) of PARTNERED sexual activity

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5
Q

what is criterion A for delayed ejaculation

A

either of the following symptoms must be experienced on almost all or all occasions (75-100% of the time) of partnered sexual activity and without the individual desiring the delay:

  1. marked delay in ejaculation
  2. marked infrequency or absence of ejaculation
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6
Q

what is the time criteria for delayed ejaculation

A

persistent for at least 6 months

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7
Q

how does delayed ejaculation change with age

A

more common in men over 50

men above 80 report twice as much difficulty ejaculating as men udner age 59

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8
Q

why is delayed ejaculation more common in men over 50

A

age related loss of fast conducting peripheral sensory nerves
+
age related decreased sex steroid secretion

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9
Q

what psych comorbidity may be related to delayed ejaculation

A

severe forms of MDD

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10
Q

how common is delayed ejaculation

A

the least common male sexual complaint

less than 1% of men, exact prevalence unclear

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11
Q

what is treatment for delayed ejaculation

A

dual sex therapy

extravaginal ejaculation and then gradual vaginal entry after stimulation to a point neat ejaculation

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12
Q

what % of men report always ejaculating during sexual activity

A

75%

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13
Q

what is criterion A for erectile disorder

A

at least ONE of the following symptoms must be experienced on almost all or all (approx. 75-100%) occasions of sexual activity

  1. marked difficulty in OBTAINING and erection during sexual activity
  2. marked difficulty in MAINTAINING and erection during sexual acrivity
  3. marked decrease in erectile RIGIDITY
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14
Q

what is the time criteria for erectile disorder

A

minimum 6 months of symptoms

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15
Q

what testing can help differentiate organic from psychogenic erectile problems

A

nocturnal penile tumescence testing

measured erectile turgidity during sleep

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16
Q

how do you assess vascular integrity when evaluating erectile disorder

A

doppler U/S

intravascular injection of vasoactive drugs

invasive procedures like dynamic infusion cavernosography

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17
Q

how do you assess nerve function when evaluating erectile disorder

A

PUDENDAL nerve conduction studies

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18
Q

what blood tests are often ordered when assessing erectile disorder

A

serum bioavailable or free testosterone

TSH

fasting glucose (diabetes)

serum lipids

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19
Q

what trait is common in men with psychogenic erectile disorder

A

alexithymia

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20
Q

list risk factors for erectile disorder

A

neurotic personality traits

submissive personality traits

alexithymia

depression, PTSD

age

smoking

lack of exercise

diabetes

decreased desire

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21
Q

list common comorbidities with erectile disorder

A

other sexual diagnoses (i.e premature ejaculation)

anxiety and depressive disorders

lower urinary symptoms related to prostatic hypertrophy

DLD

CV disease

hypogonadism

MS

diabetes

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22
Q

what % of men aged 40-80 complain of occasional problems with erections

A

13-21%

and 40-50% of men aged older than 60-70 have significant problems with erections

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23
Q

what % of men experienced erectile problems that hindered penetration during their first sexual experience

A

about 8%

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24
Q

what is criterion A for female orgasmic disorder

A

presence of either of the following symptoms, experienced on all or almost all (75-100%) occasions of sexual activity

  1. marked delay in, marked infrequency in, or absence of orgasm
  2. markedly reduced intensity of orgasmic sensation

(other criteria = 6months, distress, not better explained by another condition)

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25
what is a specifier for female orgasmic disorder
"never experienced an orgasm under any situation"
26
does a woman able to experience orgasm with clitoral stimulation but not during penile-vaginal intercourse meet criteria for female orgasmic disorder
no
27
does the data support associations between specific patterns of personality traits or psychopathology and orgasmic dysfunction
no not generally --> some women may have greater difficulty communicating about sexual issues
28
what % of women do not experience orgasm throughout their lifetime
10%
29
treatment for female orgasmic disorder
dual sex therapy masturbate
30
what is criterion A for female sexual interest/arousal disorder
lack of, or significantly reduced, sexual interest/arousal, as manifested by at least THREE of the following: 1. absent/reduced interest in sexual activity 2. absent/reduced sexual/erotic thoughts or fantasies 3. no/reduced initiation of sexual activity, and typically unresponsive to a partner's attempts to initiate 4. absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approx. 75-100%) of sexual encounters 5. absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues 6. absent/reduced genital or nongenital sensations during sexual activity in almost all or all sexual encounters
31
list some risk factors for female sexual interest/arousal disorder
negative cognitions and attitudes about sexuality past history of mental disorders differences in propensity for sexual excitation and inhibition may also predict likelihood of sexual problems relationship difficulties, partner sexual functioning, developmental history (i.e early relationships with caregivers) some medical conditions (i.e thyroid, diabetes)
32
distressing low desire can also be associated with what other conditions
depression thyroid problems anxiety urinary incontinence arthritis IBD use of alcohol abuse in childhood global mental functioning
33
criterion A for genito-pelvic pain/penetration disorder
persistent or recurrent difficulties with ONE or more of the following: 1. vaginal penetration during intercourse 2. marked vulvovaginal or pelvic pain during intercourse or penetration attempts 3. marked fear or anxiety about vulvovaginal or pelvic pain in anticipation or, during, or as a result of vaginal penetration 4. marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
34
list risk factors for genito-pelvic pain/penetration disorder
sexual and/or physical abuse vaginal infections pain during tampon insertion or the inability to insert tampons before any sexual contact has been an attempted = important RF
35
what % of women in north america report recurrent pain during intercourse
about 15%
36
treatment for genito-pelvic pain/penetration disorder
dilators hypnotherapy behavioural therapy mindfulness
37
criterion A for male hypoactive sexual desire disorder
persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies AND desire for sexual activity --> MUST HAVE BOTH judgment of deficiency is made by the clinician--> taking into account factors that affect sexual functioning such as age, general and sociocultural contexts of the individuals life
38
what must be taken into account when assessing male hypoactive sexual desire disorder
interpersonal context--> a "desire discrepancy" ie in which man has lower desire for sexual activity than partner is not sufficient for diagnosis of male hypoactive sexual desire disorder
39
use of what substance may increase occurrence of low sexual desire
alcohol use
40
what endocrine disorders may contribute to low sexual desire
hyperprolactinemia
41
what % of younger vs older men have problems with sexual desire
about 6% of those age 18-24 and about 41% of those aged 66-74 (but only a small % of these are affected *persistently*)
42
criterion A for premature ejaculation
a persistent and recurrent pattern of ejaculation occurring during partnered sexual activity within aprpoximately ONE MINUTE following vaginal penetration and before the individual wishes it
43
how might someone subjectively experience premature ejaculation (emotionally etc)
sense of LACK OF CONTROL over ejaculation and APPREHENSION about anticipated inability to delay ejaculation on future sexual encounters
44
what areas have been identified on neuroimaging as implicated in premature ejaculation
PET--> primary activation in MESOCEPHALIC TRANSITION ZONE including VENTRAL TEGMENTAL AREA
45
list risk factors for premature ejaculation
anxiety disorders--> especially social anxiety disorder may be associated with DOPAMINE TRANSPORTER GENE polymorphism or SEROTONIN TRANSPORTER GENE polymorphism thyroid disease prostatitis drug withdrawal (i.e opioids)
46
what is the estimated prevalence of premature ejaculation
1-3% (for DSM criteria, though many men have concerns about how soon they ejaculate)
47
list treatments for premature ejaculation
squeeze technique sex therapy behavioural therapy mindfulness SSRIs topical anesthetic cream
48
list substances that can result in sexual dysfunctions in association with intoxication
opioids sedatives, hypnotics, anxiolytics stimulants
49
list medications that can cause sexual dysfunctions in relation to withdrawal from those substances
alchohol opioids sedatives, hypnotics, anxiolytics
50
list medications that can affect sexual function/dysfunction
hormonal contraceptives antidepressants antipsychotics
51
what is the most commonly reported side effect of antidepressant drugs
difficulty with orgasm or ejaculation
52
list some of the sexual problems that can be encountered with antipsychotics
problems with sexual desire, lubrication, ejaculation or orgasm
53
what impact might gabapentin have on sexual function
problems with orgasm
54
what impact might lithium and anticonvulsants have on sexual function
may suppress desire (except lamotrigine)_
55
which has more of a negative impact on sexual function, methadone or buprenorphine
methadone--> rarely seen with buprenorphine
56
what % of people on antipsychotics will experience sexual side effects
about 50%
57
what % of people on MAOIs, TCAs, SSRIs, SNRIs will report sexual side effects
wide range--> 25-80%
58
which drug of abuse has a higher incidence of sexual side effects with chronic use
heroin (when compared to amphetiamines, MDMA)
59
how quickly might antidepressant induced sexual dysfunction start
as soon as 8 days after med onset
60
what % of people with mild-to moderate orgasm delay will experience spontaneous remission within 6 months
about 30%
61
does SSRI induced sexual dysfunction resolve after med stopped?
sometimes can continue after agent is discontinued

20. Sexual, Gender, Somatoform, Paraphilic Disorders (4 decks)

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