Human Sexuality

What are the stages of human sexuality?

- excitement

- orgasm

- resolution

What are the 3 major groups of sexual disorders?

- paraphilias

- gender dysphoria

- sexual dysfx

What are paraphilias?

the excitement stage of sexual activity is associated with sexual objects or orientations different from those usually associated with adult sexual stimulation

What are the types of paraphilias?

- exhibitionism

- transvestism

- voyeurism

- pedophilia

- incest

- sexual sadism/masochism

What is exhibitionism?

the impulsive behavior of exposing the genitalia to unsuspecting strangers in order to achieve sexual excitation

What is transvestism?

recurrent cross-dressing behavior for the purpose of sexual excitation (such behavior can be a part of masturbation foreplay)

What is voyeurism?

- involves the achievement of sexual arousal by watching the activities of an unsuspecting person

- usually in various stages of undress or sexual activity

What is pedophilia?

use of a child of either sex to achieve sexual arousal or gratification

What is incest?

involves a sexual relationship with the person in the immediate family

What is sexual sadism?

the attainment of sexual arousal by inflicting pain upon the sexual object

What is sexual masochism?

is the achievement of pleasure by being humiliated or enslaved

How are paraphilias treated?

- psychological (psychotherapy)

- behavioral (highly skilled psychology specialty)

- social

- pharmacological methods

What are pharmacologic options for the treatment of paraphilias?

- medroxyprogesterone acetate

- fluoxetine

What is gender dysphoria?

distress associated with the incongruence between a person's experienced or expressed gender and a person's biological sex

What is gender dysphoria associated with?

high risk of suicide

What is gender dysphoria in children?

- at least 6 mo w/ 6 criteria:

- a strong desire to be the other gender/insistence that he or she is the other gender

- a strong preference for cross-dressing or simulating opposite gender assigned at birth attire

- a strong preference for cross-gender roles make believe player fantasy

- a strong preference for the toys, games, or activities stereotypically used by the other gender

- a strong preference for playmates of the other gender

- a strong rejection of the typical assigned gender toys

- a strong dislike of one's sexual anatomy

- a strong desire for the primary and or secondary sex characteristics that match one's experienced gender

What is gender dysphoria in adolescents and adults?

- at least 6 mo with 2 criteria

- a marked incongruence between ones experienced/expressed gender and primary and/or secondary sex characteristics

- a strong desire to be rid of 1's primary and/or secondary sex characteristics because of a marked incongruence with one's experienced/expressed gender

- a strong desire for the primary and/or secondary sex characteristics of the other gender

- A strong desire to be of the other gender

- A strong desire to be treated as the other gender

- A strong conviction that one has the typical feelings and reactions of the other gender

What are types of sexual dysfunctions in males?

- ejaculation dysfunction

- ejaculation disturbances (premature, retrograde)

How is ejaculation dysfunction treated?

- tadalafil

- vardenafil

What are types of sexual dysfunctions in females?

- orgasmic disorder

- orgasmic dysfunction

- hypoactive sexual desire disorder

How does orgasmic disorder differ from dysfunction?

- disorder: general lack of sexual response

- dysfunction: difficulty reaching orgasm

What is hypoactive sexual desire disorder?

diminished or absent libido of either sex and maybe a function of organic or psychological difficulties

What are treatment options for hypoactive sexual desire disorder?

- testosterone therapy

- bupropion (off-label)

What are the disruptive, impulse control, and conduct disorders?

- Oppositional defiant disorder

- conduct disorder

- biologic sex disparities

What is oppositional defiant disorder (ODD)?

a pattern of angry/irritable mood, argumentative/defiant behavior, or vindictiveness lasting at least 6 months as evidenced by at least 4 symptoms of the following categories & exhibited during interaction with at least 1 individual (not a sibling)

What are the symptoms of ODD?

- Loses temper ("tantrums")

- Is often touchy or easily annoyed

- Frequently angry & resentful

- Argues with authority figures or with adults

- Often actively defies, or refuses to comply with rules or requests from adults or other authority figures

- Deliberately annoys others

- Blames others for their mistakes or misbehavior

- Has been spiteful or vindictive at least twice within the past 6 months

What are behavioral disturbances?

distress in the individual or others AND/OR negatively impacts other areas of functioning

What is severity of ODD?

1: mild

2: moderate

3+: severe

What is conduct disorder (CD)?

repetitive display of behaviors that violate basic rights of others at age-appropriate social norms

What are criteria to diagnose CD?

- 3+ of the following behavior in the last 12 mo w/ at least 1 in the last 6 mo:

- aggression toward people or animals

- deceitfulness/theft

- destruction of property/vandalism

- major violations of rules

How is CD specified?

- before 10 y/o: childhood onset

- after 10 y/o: adolescent onset

- not enough info: unspecified

How is CD treated?

community intervention (multi-systematic treatment)

What is the prognosis of CD?

- 40% progress to antisocial personality disorder

- never diagnose this <18 y/o

What is pyromania?

deliberate and purposeful fire setting on more than one occasion

What is kleptomania?

recurrent failure to resist impulses to steal objects that are not needed for personal use or for their monetary value

What is required to diagnose pyromania/kleptomania?

tension or effective arousal before the act

What is Tourette's syndrome?

Involuntary actions (motor or vocal tics) that appear by age 18 and last at least 1 year

What are the two kinds of tics?

- Motor tics

- Vocal tics (at least one)

What gender is Tourette's more common in?

boys

What might tics be related to that we need to check?

substance or other neurologic/medical condition

What are the treatment options that are FDA-approved for Tourette's?

- haloperidol

- aripiprazole