Sexual Health

Question 1

Sexual Identity:

Gender Identity:

Sexual Orientation:

Sexual Behavior:

Answer 1

Sexual Identity: biological sexual characteristics

Gender Identity: a person’s sense of “maleness” or “femaleness.”

Sexual Orientation: homosexual, heterosexual, bisexual.

Sexual Behavior: The Physiological Responses

Question 2

• Sexual behavior that is destructive to a person(s), cannot be directed toward a partner, is inappropriately associated with guilt and anxiety, or is compulsive.

Answer 2

Abnormal sexuality:

Question 3

Sexual function depends on two complex and delicate neurologic pathways:

Answer 3

(1) a connection between the brain and the genitals; and
(2) a reflex loop between the genitals and spinal cord. Both involve the central nervous system (CNS), peripheral nervous system (PNS), and autonomic nervous system (ANS).

Question 4

Involves difficulty with 1 or more aspect of the sexual response cycle

Result from biological, psychological or interpersonal causes

• May be due to combination of causes

Must cause significant distress to the individual

Not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stress

Question 5

: dysfunction has always been present

vs

: occur after interval when function has been normal: More common than primary sexual dysfunction

Answer 5

Primary (lifelong) sexual dysfunction

Secondary (acquired) sexual dysfunction

Question 6

General medical conditions
• Diabetes: erectile dysfunction

• Pelvic adhesions: dyspareunia
• Medication side effects • SSRIs: delayed orgasm
• Substance abuse
• Alcohol: erectile dysfunction

• Hormonal or neurotransmitter alterations

Answer 6

Biological Causes of Sexual Dysfunction

Question 7

Examples of Physiolgocial causes of sexual dysfunciton

Answer 7

Relationship problems, Stress, Depression, Anxiety, Guilt, Performance anxiety

Erectile dysnf: have morning wood and can masturbate

Question 8

Disorders of Sexual Desire

Answer 8

• Hypoactive

• Reduced or absent fantasies of desires
• Up to 20% of population, more common in women

• Sexual Aversion: Aversion to ALL sexual contact

Question 9

1+ symptoms occurring >75% of the time

Difficulty in obtaining erection during sexual activity

Difficult maintaining erection until completion of sexual activity

Marked decreased in erectile rigidity

Answer 9

Erectile Disorder (Arousal disorder)

Question 10

Absent/reduced interest in sexual activity, sexual/erotic thoughts or fantasies, no/reduced initiation of sexual activity, unreceptive to partner’s attempts to initiate, absent/reduced interest to any internal/external sexual cues

Up to 33% of females

Answer 10

Female Sexual Arousal Disorder

Question 11

Anorgasmia/Female Orgasmic Disorder

• Either symptom present ______

Marked delay in, marked infrequency of, or absence of orgasm

Markedly reduced intensity of orgasmic sensations

• 5% of married women > 35y/o never achieved orgasm • Overall prevalence from all causes: 30%
• Likelihood to have orgasm increases with age

Answer 11

>75% of sexual activity

Question 12

• Either symptoms present >75% of partnered sexual activity

• Marked delay in ejaculation
• Marked infrequency of absence of ejaculation

Answer 12

Delayed (retarded) Ejaculation

Question 13

• Persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before individual wishes it

Answer 13

Premature (Early) Ejaculation

Question 14

Recurrent or persistent involuntary contraction of the perineal muscles surrounding the outer third of the vagina that prevents penile insertion

In some cases, even the anticipation of vaginal insertion may result in muscle spasm

Answer 14

Vaginismus

Question 15

Genital pain that is associated with sexual intercourse

Most commonly experienced during coitus, it may also occur before or after intercourse

Answer 15

Dyspareunia

Question 16

Can occur in both males and females, more common in females

• In females: the pain may be described as superficial during intromission or as deep during

penile thrusting
• Chronic pelvic pain common complaint in women with history of sexual assault

Answer 16

• Dyspareunia

Question 17

• Used to treat sexual desire, arousal and orgasmic disorders

Answer 17

Sensory-focused exercises

Question 18

• Used to treat premature ejaculation

Answer 18

Squeeze technique

Question 19

Relaxation, hypnosis, systematic desensitization
•

Answer 19

Aids with reducing anxiety associated with sexual performance • May be helpful with vaginismus

Question 20

Dilators can help with

Answer 20

Dilators
• Useful to treat vaginismus

Question 21

SSRIs: delay orgasm, therefore treat

Answer 21

premature ejaculation

Question 22

Opioid antagonists and vasodilators can be used to treat

Answer 22

erectile

disorders

Question 23

PDE5 inhibitors (sildenafil) can be used to treat

Answer 23

erectile dysfunction

Question 24

Intracorporeal injection of vasodilators, implantation of prosthetic devices used to treat

Answer 24

erectile dysfunction

Question 25

Sense of self as being male or female Differential exposure to prenatal sex hormones May or may not agree with physiologic sex or gender role (ie. GID)

Answer 25

Gender identity

Question 26

Expression of one’s gender identity in society Societal pressure to conform to sexual norms May or may not agree with gender identity or physiologic sex

Answer 26

Gender Role

Question 27

Persistent and unchanging preference for people of the same sex or opposite sex for love and sexual expression Differential exposure to prenatal sex hormones Genetic influences True bisexuality is uncommon; most people have a sexual preference

Answer 27

Sexual Orientation

Question 28

* A condition in which a person has been assigned one gender, usually on the basis of their sex at birth, but identifies as belonging to another gender and feels significant discomfort or is unable to deal with the situation. * There must be evidence of a strong and persistent cross-gender identification. * This cross-gender identification must not merely be a desire for any perceived cultural advantages of being the other sex. * There must also be evidence of **persistent discomfort** about one's assigned sex or a sense of inappropriateness in the gender role of that sex.

Answer 28

Gender Identity Disorder [Gender Dysphoria]

Question 29

conditions for most sexual reassignment surgeries

Answer 29

* Standard is for the patient to live a cross-gendered lifestyle for 3-12 months. * For some this “test” may change their minds due to difficulties relating to friends, family, co-workers, etc. * Patients that undergo SRS must also undergo hormonal treatment

Question 30

• Affects 70-85% of postpartum women * Considered NORMAL! * Relatively mild emotional disturbance * Mood lability, tearfulness, anxiety, insomnia • Onset peaks 3-5 days post-delivery * Typically resolves within 2 weeks * Transient with little intervention required

Answer 30

• “Maternity blues” or “Baby blues”

Question 31

Most common complication of childbirth • Incidence: = 10-12% Highest rates in adolescent mothers Onset typically within 2-12 weeks • Some consider PPD risk up to 1 year • However, vast majority will have had symptoms during pregnancy If previous episode of PPD, 25% chance of relapse with subsequent pregnancies

Answer 31

Postpartum Depression

Question 32

Risk for post partum depression

Answer 32

* History of depression * Stressful life events * Conflictual relationship with baby’s father • Short inter-pregnancy interval * Low birth weight infant * Frequent infant health problems

Question 33

Risk to infant in mom with post partum depression

Answer 33

Infant Risks Decreased IQ Slowed language development Delayed motor development Delayed cognitive development – object permanence Less emotional expressiveness Decreased concentration Impaired attachment Increased psychiatric disorders in children

Question 34

Maternal risk in post partum depression

Answer 34

* Difficulty breastfeeding * Missed pediatric outpatient appointments & increased emergency room visits * Marital and relationship difficulties

Question 35

Sexual dysfunction is defined as d

Answer 35

ifficulty with 1 or more aspect of the sexual response cycle; the dysfunction must be distressing to patient in order to be diagnostic.

Question 36

\_\_\_\_sexual dysfunction is more common than primary sexual dysfunction.

Answer 36

Secondary

Question 37

In order to diagnose GID, there must be evidence of

Answer 37

persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender role of that sex.