Sexual Disorders

Question 1

3 categories of sexual disorders

Answer 1

Sexual Dysfunctions – sexual desire/arousal, Orgasmic Disorders. Sexual pain disorders

Paraphilic Disorders

Gender Dysphoria

Question 2

Sexual Dysfunctions

Criteria

Answer 2

All of the Following:
6 months
clinically significant distress (eg isolation, poor self esteem, unstable relationship)

Not explained by a non sexual mental disorder
Not explained by a severe relationship distress
Not explaind by another
substnace/medication/another medical condition (eg DM)

Question 3

Subtypes in regards to time

Substypes in regards to context

Answer 3

lifelong vs acquired

Generalized vs Situational

Question 4

Female sexual interest/arousal disorder
(criteria, treatment)

Erectile disorder

Answer 4

Criteria for FSIAD – not interested in sex and when they do participate, they don’t like it

Tx – some evdience for topical testosterone; Wellbutrin has a mild pro sexual effect

Question 5

Male hypoactive sexual desire disorder

criteria, tx

Answer 5

take age into account

men with no sexual desire/fantasies

Treatment: androgens, cyproheptadine, busiprone

Question 6

Erectile disorder

Criteria, Treatment

Answer 6

At least one of the three following symptoms must be experienced on almost all or all occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):

Can’t get an erection
Can’t maintain erection
Poor erectional rigidity

Tx –
PDE5 Inhibitors – Slidenafil, Tadalafil

Question 7

Orgasmic Disorders:

Answer 7

Female orgasmic disorder
Premature ejaculation
Delayed ejaculation

Question 8

Female orgasmic disorder:
Criteria

Etiology ?

Treatments?

Answer 8

6 months of no orgamism in all context (eg sex or masturbation)

Clinically significant distress (eg some women are ok with not cumming everytime, and sexually satisfied with the intimacy)

Etiology – stress, anxiety, depression, vulvovaginal atrophy, menopause, secondary to SSRIs

Treatment: some evidence for slidenafil

Question 9

Premature Ejaculation

criteria

treatment:

Answer 9

6 months of < 1 minute following vaginal penetration
(all occasions)

Behavioral strategies: stop start, squeeze, jerk off before

SSRIs - first line meds;

Question 10

Delayed Ejaculation

criteria

Treatent

Answer 10

Marked delay in ejaculation.

Marked infrequency or absence of ejaculation.

6 months

In all contexts

Psychotehrapy

Question 11

Genito-Pelvic Pain/Penetration Disorder

criteria –

tx

Answer 11

Persistent or recurrent difficulties with:
vaginal penetration
pain with intercourse
fear about the pain
tensing and tightening of the pelvic floor muscles

tx: Topical ointments, biofeedback, surgery, TCAs, gabapentin

Question 12

meds that can lower sex drive

meds that don’t

Answer 12

Beta blockers
Amphetamines
Antidepressants --SSRIs 
Antihistamines 
Antipsychotics (increasing prolacting) 

Don't affect drive 
Bupropion
Busiprone
Mirtazapine
Levodopa

Question 13

PARAPHILIC DISORDERS

Definition
Criteria

Treatment

Answer 13

There is a difference between having a paraphilia (i.e. nonpathological sexual preference) and a paraphilic disorder (= paraphilia + significant distress or nonconsenual sexual activity due to urges)

A) the paraphilia x 6 months
B) the negative consequence (significnat diststress or acting on urges with non consenting person)

Treatment:
Antidepressants – for mild d/o (inhibit general sexual functioning)

Hormonal – antilibidinal hormones (block testosterone)
(Medroxyprogesterone, long acting GnRH)

Psychotherapy –

Question 14

GENDER DYSPHORIA

Criteria:

Answer 14

marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration