mental health - gender & sexuality

Sex assigned at birth= __________________

Gender= _____________________

Gender traits= _________________

Male or Female

Boy or Girl

Masculine or Feminine

sex and gender congruence =

Cisgender

-Ex: male identifying as a boy

-Ex: female identifying as a girl

sex and gender incongruence =

Transgender

-Ex: male identifying as a girl

-Ex: female identifying as a boy

a person's identity in relation to the gender or genders to which they are attracted to

Sexual Orientation

What are the different types of sexual orientation

Heterosexual- attracted to opposite binary gender

Homosexual- attracted to same binary gender

Bisexual- attracted to both binary genders

Pansexual- attracted to all genders (non binary)

Asexual- attracted to no gender

Distress concerning a marked incongruence between one's experienced/expressed gender and assigned gender

Gender Dysphoria

Gender Dysphoria S/Sx in children

Onset of symptoms typically around age 2-4

Strong preference for other gender clothing

Strong preference for other gender role in "make believe" or "pretend"

Strong preference for toys, games, or activities stereotypically associated with other gender; and rejection of those associated with assigned gender

Strong preference for playmates of the other gender

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

Gender Dysphoria S/Sx in adolescents & adults

A strong desire to be rid of one's primary or secondary sex characteristics

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

A strong desire to be of another 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

How is Gender Dysphoria diagnosed?

Clinical Interview by a mental health specialist

-Identify diagnostic criteria presented in the DSM 5

Diagnostic Criteria for Gender Dysphoria

DSM-5 Highlights:

-Marked incongruence between one's experienced/expressed gender and assigned gender

-6+ symptoms present in children vs. 2+ symptoms present in adolescents/adults

-6+ month duration

-Symptoms causing clinically significant distress or impairment in social, school, or other important areas of functioning

Gender Dysphoria Management

Purpose= to reduce clinically significant distress and prevent comorbid psychiatric conditions (Ex: Depression, Suicide, Anxiety)

Methods:

-Individual

-Psychotherapy

-Group Therapy

-Family Therapy

-Medications such as SSRI's

What are some external causes of clinically significant distress

Stigma= a mark of disgrace

-Ex: Public opinion

Biases= disproportionate weight in favor of or against an idea

-Ex: Hiring practices

Stereotyping= a widely held oversimplified idea of a particular person or thing

-Ex: Drag Queens

A disturbance of processes in sexual functioning

Sexual Disorders

-Sexual function is VERY complex, so there are many possible etiologies for Sexual Dysfunction

S/Sx of Female Sexual Interest/Arousal Disorder

Distress concerning any of the following: lack of sexual desire, lack of erotic thoughts/fantasies, absent/reduced initiation of sexual activity, or impaired arousal in 75-100% of sexual encounters for 6+ months

S/Sx of Female Orgasmic Disorder

Distress concerning an inability to achieve orgasm despite normal libido and sexual excitement for 6+ months

S/Sx of Genito-Pelvic Pain/Penetration Disorder (GPPD) in Females

Distress concerning difficulty having intercourse, genito-pelvic pain, fear of pain or vaginal penetration, and/or tension of the pelvic floor muscles for 6+ months

S/Sx of Male Hypoactive Sexual Desire Disorder

Distress concerning persistent or recurrently deficient sexual or erotic thoughts, fantasies, and desire for sexual activity for 6+ months

S/Sx of Delayed Ejaculation (Formerly named Male Orgasmic Disorder)

Distress concerning delayed or absent ejaculation/orgasm within 75-100% of sexual activity over 6 months

S/Sx of Premature (early) ejaculation

Distress concerning early ejaculation/orgasm (within 1 minute of penetration) within 75-100% of sexual activity over 6 months

S/Sx of Erectile Dysfunction

Distress concerning the inability to obtain or sustain an erection within 75-100% of sexual activity over 6 months

How are Sexual Disorders diagnosed?

Labs (ex: hormone eval) and procedures (ex: pelvic exam) can be done to identify biological etiologies

Clinical diagnosis following the DSM-5 Criteria

-Occurs for 6 months

-Present in 75-100% of sexual encounters (if applicable)

-Causing significant distress or impairment of functioning

Testosterone supplementation can be used in what Sexual Disorders

Female Sexual Interest/Arousal Disorder or Male Hypoactive Sexual Desire Disorder

Phosphodiesterase type 5 (PDE-5) Inhibitors can be used for

both male and female sexual disorders

-Ex: Sildenafil (Viagra), Tadalafil (Cialis)

ADEs of Phosphodiesterase type 5 (PDE-5) Inhibitors

priapism, facial flushing, nasal stuffiness, visual disturbances, dyspepsia, and syncope

*Do NOT use in conjunction with Nitrates*

Ex: Sildenafil (Viagra), Tadalafil (Cialis)

Flibanserin (Addyi) is prescribed for women with

low libido not associated with medical or mental health problems

-REMS program only

Flibanserin (Addyi) requires daily doses for several weeks before benefit is seen and should be discontinued if there is no improvement after

8 weeks

ADEs of Flibanserin (Addyi)

CNS depression, hypotension, $

Bremelanotide (Vyleesi) MOA and PK

MOA- Activates melanocortin receptors

Administered via subcutaneous injection 45 minutes before sexual activity (max 8 doses/month)

Bremelanotide (Vyleesi) ADEs

Nausea (40%), transient rise in blood pressure

Physical Therapy can be used to reduce muscle spasms/tension of the pelvic floor in what condition

Genito-Pelvic Pain/Penetration Disorder (GPPD)

Any intense and persistent sexual interest other than consensual stimulation of mature adult genitalia =

Paraphilia

Paraphilia that is causing distress to patient or others =

Paraphilic Disorder

Voyeuristic Disorder

spying on others in private activities

Exhibitionist Disorder-

exposing genitals to others without consent

Pedophilic Disorder

sexual focus on children

Fetishistic Disorder-

using nonliving objects or non-sexual body parts for pleasure

Sexual Sadism/Masochism Disorder

undergoing humiliation, bondage, or suffering for sexual pleasure

Management options for Paraphillic Disorders

Counseling

-Used in all forms of Paraphilic Disorders

Hormonal therapies

-Androgen blockers used more frequently in Voyeuristic, Exhibitionist, Pedophilic, Fetishistic, and Sadism/Masochism Disorder

Antidepressants and anti-anxiety medications

-Can be used to reduce the negative feelings towards paraphilias