Sexual & Gender Identity Disorders - Beat the Boards!

Sexual & Gender Identity DisordersSexual Disorders

2/9/2010

Sexual & Gender Identity Disorders

Jack Krasuski, MD American Physician Institute for Advanced Professional Studies DrJack@

Question: What is different between men and women in their sexual response cycles?

A.Engorgement of genitals during arousal B.Nipple erection C.Increase in respiration during arousal D.Refractory period after orgasm

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Question: Which of the following statements regarding paraphilias is true?

A. Paraphilias are found equally among men and women

B. Paraphilias usually do not cause distress C. The paraphilia of fetishism involves watching

naked people D. Paraphilias can benefit from treatment

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Question: The most prevalent male sexual disorder is which of the following?

A. Premature ejaculation B. Erectile dysfunction C. Orgasmic disorder D. Hypoactive sexual desire disorder

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877-225-

8384 877-225-

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Sexual & Gender Identity DisordersSexual Disorders

2/9/2010

Question: A 22 year old woman presents to clinic with the complaint that she doesn't want to have sex with her boyfriend because it seems "disgusting." She has had three previous relationships end because of her refusal to have sex. She does, however, wish to have close companionship and is disappointed by her breakups precipitated by her feelings toward sex. Her most likely diagnosis is?

A. Hypoactive Sexual Desire Disorder B. Dyspareunia

C. Sexual Aversion Disorder D. Female Orgasmic Disorder E. Female Sexual Arousal Disorder

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Question: When the outer third of the vagina spasms during sexual intercourse in a manner that prevents intercourse or causes pain, this is most likely a manifestation of which disorder?

A. Anorgasmia B. Dyspareunia C. Sexual Disorder NOS D. Somatization Disorder E. Vaginismus

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Question: Male Erectile Disorder is associated with disturbance in which stage of the sexual response cycle?

A. Desire B. Arousal C. Orgasmic D. Resolution E. Recurrence

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Question: Cognitive distortions present in pedophiles are likely to include versions of all of the following except?

A. Sex is a sign of love and mutuality B. I am guiding the child to mature relations C. Children are sexual beings too D. Sexual impulses are controllable E. Adults have a right to have sexual

relations with whom they choose

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Copyright 2009 Krasuski

877-225-

8384 877-225-

8384

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Sexual & Gender Identity DisordersSexual Disorders

2/9/2010

Question: A 22 year old biological male presents to clinic, stating, "I'm transgender and need to be cleared by psychiatry to begin receiving hormone therapy." He endorses having feelings that he's `a woman trapped in a man's body' for as long as he can remember. Despite this, he does not wish to undergo sex reassignment surgery. His most likely diagnosis is?

A. Gender Identity Disorder B. Gender Identity Disorder NOS C. Transvestic Fetishism, With Gender Dysphoria D. Sexual Dysfunction NOS E. Sexual Orientation Disorder

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Lecture Agenda

The sexual response cycle Sexual Dysfunctions Paraphilias Gender Identity Disorders

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Sexual Response Cycle

Linear Stage Theory Desire Stage Arousal Stage Orgasmic Stage Resolution Stage

Cycle Theory

Emotional closeness, sexual arousal, and sexual desire form a reinforcing cycle

More consistent with female sexual response

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Desire Stage

Sexual drive/libido Motivation/desire to have sex Involves sexual fantasies Lasts for minutes to hours to days

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Copyright 2009 Krasuski

877-225-

8384 877-225-

8384

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Sexual & Gender Identity DisordersSexual Disorders

2/9/2010

Arousal Stage

Psychological and physiological stimulation Penile erection / vaginal lubrication & engorgement Nipple erection in both sexes Increase in heart rate, blood pressure, and respiration in both sexes Stage of sexual activity Lasts minutes to hours

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Orgasmic Stage

Peaking of sexual pleasure ? Ejaculation Rhythmic contraction of perineal muscles Involuntary pelvic thrusting Involuntary contractions of anal sphincters Blood pressure and pulse increase acutely Lasts 5-15 seconds Obligatory refractory period in men Women can have multiple orgasms

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Resolution Stage

Disgorgement of blood from genitalia-- detumescence Sense of well-being and relaxation Refractory period in men for minutes to hours No refractory period in women

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Sexual Dysfunctions DSM-IV

Sexual Desire Disorders

Hypoactive Sexual Desire Disorder Sexual Aversion Disorder

Sexual Arousal Disorders

Female Sexual Arousal Disorder Male Erectile Disorder

Orgasmic Disorders

Female Orgasmic Disorder Male Orgasmic Disorder 16 Premature Ejaculation

Sexual Pain Disorders

Dyspareunia Vaginismus

Sexual Dysfunction Due to GMC Substance-Induced Sexual Dysfunction Sexual Dysfunction NOS

Copyright 2009 Krasuski

877-225-

8384 877-225-

8384

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Sexual & Gender Identity DisordersSexual Disorders

2/9/2010

Sexual Dysfunctions: Subtypes

Onset

Lifelong Type Vs. Acquired Type

Context

Generalized Type Vs. Situational Type

Etiologic Factors

Due to Psychological Factors Due to Combined Factors: Psychological plus GMC or substance

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Diagnosis: Clarification

Biological Factors (GMC / Substance) Psychological Factors

Sexual Dysfunction -

Due To Psychological Factors Only

Sexual Dysfunction -

Due To Combined

Factors

Sexual Dysfunction Due to GMC Or Substance

Induced

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Sexual Dysfunction: Psychosexual Factors

Psychiatric disorders Stress Relationship conflicts Abuse / Trauma (current or past)

Physical Emotional Sexual

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Copyright 2009 Krasuski 877-2258384 877-2258384

Sexual Dysfunction: Biological Factors

GMC

Neuro, Endocrine, Vascular

Medications

Antihypertensives, Chemotherapeutic agents, CNS medications

Substances

Alcohol and other drugs

Biological Correlates

Age and gender

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