Sexual Problems - Davis & Pedersen Flashcards Preview

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Flashcards in Sexual Problems - Davis & Pedersen Deck (16)
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1
Q

What are the four steps in the sexual response cycle?

A
  1. Desire
  2. Arousal/Excitement
  3. Orgasm
  4. Resolution
2
Q

What are the four diagnostic categories of sexual problems?

A
  • Desire
    • Male Hypoactive Sexual Desire Disorder
  • Arousal
    • Female Sexual Interest/Arousal Disorder
    • Erectile Disorder
    • Substance/Medication-Induced Sexual Dysfunction
  • Orgasm
    • Female Orgasmic Disorder
    • Premature (Early) Ejaculation
    • Delayed Ejaculation
  • Pain
    • <strong>​</strong>Genito-Pelvic Pain/Penetration Disorder
3
Q

What sexual problem includes persistently or recurrently deficient sexual/erotic thoughts or fantasies and desire for sexual activity; and judgement of deficiency made by the clinician, taking into account factors that affect sexual functioning, such as age and sociocultural contexts of the individual’s life?

A

Male Hypoactive Sexual Desire Disorder

4
Q

What sexual problem includes absent/reduced:

  • Interest in sexual activity
  • Sexual/erotic thoughts or fantasies
  • Initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate
  • Sexual excitement/pleasure during sexual activity in almost all or all sexual encounters
  • Is this a change? Causing significant impairment in life?
  • Sexual interest/arousal in response to any internal or external sexual/erotic cues
  • Genital or nongenital sensations during sexual activity in almost all or all sexual encounters
A

Female Sexual Interest/Arousal Disorder

5
Q

What sexual problem includes marked difficulty in obtaining an erection during sexual activity, marked difficulty in maintaining an erection until the completion of sexual activity, and/or marked decrease in erectile rigidity?

A

Erectile Disorder

6
Q

What sexual problem includes a clinically significant disturbance in sexual function that developed during or soon after substance intoxication or withdrawal or after exposure to a medication?

A

Substance/Medication-Induced Sexual Dysfunction

7
Q

What sexual problem includes a marked delay in, marked frequency of, or absence of orgasm; and/or markedly reduced intensity of orgasmic sensations?

A

Female Orgasmic Disorder

8
Q

What sexual problem includes a marked delay in ejaculation, and/or marked infrequency or absence of ejaculation?

A

Delayed Ejaculation

9
Q

What sexual problem includes a persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it; ejaculation before they want to?

A

Premature (Early) Ejaculation

10
Q

What sexual problem includes persistent or recurrent difficulties with one or more of the following:

  • Vaginal penetration during intercourse
  • Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts
  • Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration
  • Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
A

Genito-Pelvic Pain/Penetration Disorder

11
Q

Why do things go wrong in sexual relationships?

A
  • Sexual attitudes, values, and beliefs
  • Inadequate information and myths
  • Psychopathology ⇒ depression, anxiety
  • A sexual problem can compound on psychopathology
  • Poor body image
  • Sexual trauma
  • Conflicts about gender identity or sexual orientation
  • Specific sexual phobias or aversions
  • Fear of loss of control
  • Relationship factors
  • New partner
  • Low attraction, poor sex technique, marital conflict (low commitment and trust)
  • Hormonal factors
  • Vascular factors
  • Neurological factors
  • Drugs:
    • Psychotropic - risk for sexual problems because they are serotonergic
    • Antipsychotics
    • Antidepressants
    • Anxiolytics
    • Sedatives
    • Anticonvulsants and lithium
    • Antihypertensives
    • Oral estrogen
    • Recreational/street drugs - alcohol, heroin, methadone, cigarettes, caffeine
  • Other health issues - chronic illness, obesity, poor stamina
12
Q

What are the four levels of treatment in the PLISSIT Model of Sex Therapy?

A
  • Permission (P)
  • Limited Information (LI)
  • Specific Suggestions (SS)
  • Intensive Therapy (IT)
13
Q

What parts of the PLISSIT Model of Sex Therapy can primary care physicians manage?

A
  • Permission (P)
    • reassuring patients that thoughts, feelings, fantasies, etc. are okay
  • Limited Information (LI)
    • provide info that is specific to his/her sexual concern
  • Specific Suggestions (SS)
    • activities and “homework” exercises that can be recommended to patients to help them reach their goal
14
Q

What are five drug treatments for sexual response disorders?

A
  • Testosterone (patch, gel)
  • Viagra, Levitra, Staxyn, Cialis (PO)
  • Penile injections of alprostadil (Caverject)
  • Transurethral alprostadil (MUSE)
    • penile suppository
  • Bremelanotide (melanocortin agonist)
    • in development now (tan, skinny, & horny)
15
Q

What are some possible treatments for SRI related sexual disorders (SSRIs, TCAs, Effexor)?

A
  • Reduce dose
  • Switch agents (Wellbutrin (bupropion) or Remeron (mirtazapine))
  • Augment with Wellbutrin (bupropion)
  • Cyproheptadine (Periactin, 1-2 hrs b4 sex)
    • very sedating
  • Weekend holiday from the SRI (excluding Prozac)
16
Q

When should you defer sex therapy?

A
  • Depression
  • Severe psychopathology
  • Chemical abuse, dependency
  • Spousal abuse
  • Active extramarital affair
  • Severe marital distress