Behavioral Med Understanding Sexual Behavior/Sexual Dysfunction and Gender Dysphoria

1) wanting

2) liking

3) satiety

What are the phases of the pleasure cycle in terms of the role of the brain in the sexual response?

1) excitement (few minutes to several hours)

2) plateau (extends to brink of orgasm)

3) orgasm (climax - shortest phase; lasts only a few seconds)

4) resolution (post climax)

What are the 4 phases of the sexual response cycle?

excitement

Which of the 4 phases of the sexual response cycle?:

increased:

- muscle tension

- vital signs (HR, RR)

- skin flush (esp in women)

- vagina and penile lubrication

- blood flow to genitals

*clitoral, labial, testicular, and penile swelling

*nipples harden, scrotum tightens

plateau

Which of the 4 phases of the sexual response cycle?:

- vaginal wall color change (turn dark purple)

- RR, HR, BP inc

- genitals highly sensitive to touch (may be painful)

*clitoris retracts under clitoral hood to avoid direct stimulation

*testicles withdraw into scrotum

- muscle spasms: feet, face, hands

orgasm

Which of the 4 phases of the sexual response cycle?:

- continuing inc in vitals

- involuntary muscle contractions (vagina, uterus, base of penis --> semen ejaculation, feet for both male and female)

- sudden, forceful release of sexual tension

- entire body rash, or "sex flush"

resolution

Which of the 4 phases of the sexual response cycle?:

- body slowly returns to NL function, size, and color

- general sense of well-being, intimacy, fatigue

- phase change (women may return rapidly to orgasm phase; men have refractory period)

male: short refractory phase; ready for round 2 after that's over

female: single-orgasm event, multiple orgasm, plateau w/o orgasm

Differentiate between male and female sexual response.

linear model of sexual response - both sexes

1) excitement

2) plateau

3) orgasm

4) resolution

What is the masters and johnson theoretical model of sexual response?

dual control model of sexual response

sexual response balance between excitatory and inhibitory processes

2 questionnaires

What is the kinsey institute (john bancroft and erick janssen) theoretical model of sexual response?

proposed circular sexual response pattern (for women)

pleasant and satisfying sexual experiences may have a reinforcing effect

4 stages:

1) seduction (desire)

2) sensations (excitement, plateau)

3) surrender (orgasm)

4) reflection (resolution)

What is the whipple and brash-mcgreer theoretical model of sexual response?

importance of emotional intimacy, sexual stimuli, relationship satisfaction

What is the basson model theoretical model of sexual response?

aphrodisiac

substance that increases sexual desire vs fertility, impotence, sexual (dys)function

1) testosterone

2) mirapex (pramipexole)

3) bremelanotide

What main drugs might be considered aphrodisiacs by many?

pills, potions/lotions, pumps

*nothing can increase the "NL" phallic size

*also consider losing suprapubic fat (so you don't have a "buried penis")

What male enhancement products may be used?

Peyronie's dz

penis curves as a result of scar tissue buildup

partner

What type of orgasm?:

- sperm-selecting insuck process perhaps shaped by natural selection and involving oxytocin release

emotional

What type of orgasm?:

- "good-sex orgasms" received higher pleasure and sensation ratings than solitary-masturbatory

- "not-as good-sex orgasms" received lower ratings

men most likely teens to middle age

women most likely 20-39 y/o

What is the incidence/prevalence of masturbation in society?

erectile disorder/dysfunction

inability to achieve or maintain erection sufficient for satisfactory sexual performance

female orgasmic disorder

difficulty achieving orgasm, substantially decreased intensity of orgasm, or both

female sexual interest/arousal disorder

persistent or recurrent inability to attain sexual arousal or to maintain arousal until the complexion

genito-pelvic pain/penetration disroder

pain in genital or pelvic area during vaginal intercourse or penetration attempts (dyspareunia)

involuntary tightening of muscles around pelvic floor with penetration attempt

paraphilia

pattern of disturbed erotic arousal that is usually fairly well developed before puberty

an atypical variant that is problematic as per society

True

True or false:

- Almost all of the paraphilic disorders are likely criminal (not the milder forms).

1) anxiety or early emotional trauma interferes with NL psychosexual development

2) standard pattern of arousal replaced by another pattern, sometimes through early exposure to highly charged sexual experiences that reinforce the pt's experience of sexual pleasure

3) the pattern of sexual arousal often acquired symbolic and conditioning elements (i.e., fetish)

What 3 processes are required in order for something to be a paraphilia?

paraphilic disorder

any intense and persistent sexual interest other than a sexual interest in general stimulation or preparatory fondling with phenotypically NL, physically mature, consenting human partners

non-human object

1) fetishistic d/os

2) transvestic d/o

suffering or humiliation of oneself or one's partner

3) sexual sadism d/o

4) sexual masochism d/o

children

5) pedophilic d/o

other non-consenting person

6) voyeuristic d/o

7) frotteuristic d/o

8) exhibitionistic d/o

What are the 8 recognized paraphilic disorders?

men (nearly always)

Do more men or women present with paraphilic d/os?

fantasies

private mental images associated with explicitly erotic feelings, accompanied by physiologic response to sexual arousal

men - visual

women - tactile

Men are more likely to be sexually aroused by __________ stimuli, while women are by _________ stimuli.

break link between stimulus and inappropriate response

What is CBT's goal for people with paraphilic disorder?

reduce testosterone and sex drive; antiandrogen rx

What is drug therapy's goal for people with paraphilic disorder?

exhibitionism

urges, fantasies, behaviors involving exposing one's genitals to unsuspecting strangers for the purpose of sexual arousal

flashing people to make them uncomfy

fetishism

use inanimate object to elicit sexual arousal (e.g., clothing)

almost ALWAYS enacted privately

transvestic d/o (transvestic fetishism)

involves recurrent, intense sexual arousal from cross-dressing

greatly distressed by or cannot function well bc of desire to cross-dress

mainly in heterosexual men

gender dysphoria

someone who is a gender feeling like they are trapped in another gender's body (but does NOT have any kind of sexual response behind it)

transvestism

men prefer to wear women's clothing and vice versa

most cross-dressers express this rather than having a transvestic disorder

do not have an inner sense of belonging to the opposite sex or wish to change their sex

frotteurism

act of rubbing one's genitals against a non-consenting person

a form of sexual assault

toucherism

involving one's hands to touch the erotic areas of a stranger without their consent, usually in a crowded public place

frotteurism & toucherism

A dx of ________________ requires acting on the urges to touch a non-consenting person and being distressed by it. The acts, when carried out, typically occur in crowded places and are brief and fleeting.

pedophilic d/o

individual who has, over a 6-month period, had recurrent sexual urges and arousing fantasies that involve sexual interactions with a prepubescent child (<13 y/o)

AND

has either acted on these urges or is distressed by them

*pt must be at least 16 y/o

*pt must be 5 yrs older than victim

childhood sexual abuse

49% of pedophiles have a personal hx of _________________, more likely by a male abuser.

sexual masochism disorder

intentional participation in being humiliated, beated, bound, or otherwise abused to experience sexual excitement

usually btwn consenting adults (the other person would be the sexual sadist)

can be done alone too tho

sexual sadism disorder

inflict physical or mental suffering (humiliation, terror, etc) on sex partner to stimulate sexual excitement and orgasm

NOT RAPE

dangerous if associated with antisocial PD

telephone scatologia

obscene phone calls for sexual pleasure (call to someone who is unsuspecting)

voyeurism

continuously experiences strong sexual arousal from observing an unsuspecting person who is either naked, undressing, or engaging in sexual activity

must occur for 6 months

pt must be ≥18 y/o

necophilia

sexual pleasure in having sex with the dead

zoophilia (beastiality)

sexual pleasure in having sex with animals

partialism

sexual interest with an exclusive focus on a specific part of the body

Acrotomophilia

____________________ is a form of partialism with consists of arousal and facilitation/attainment of orgasmic response to partner who is an amputee.

hypoxyphilia

erotic asphyxiation

asphyxiaphilia

autoerotic asphyxia

applying some sort of mechanism to keep you from being able to breathe to the point where you pass out

person engaging in activity sometime called a "gasper"

intentionally cut off O2 to brain for sexual arousal

urophilia

pleasure from urine or urination

associated with smelling, feeling, or tasting urine, urinating on someone, being urinated on

coprophilia aka scatophilia

interest/pleasure in feces or filth

klismaphilia

sexual arousal introducing liquids into rectum and colon via anus

enemas (but not bc you actually need it)

scoptophilia/scopophilia

deriving sexual pleasure from looking (i.e., porn)

pleasure derived from looking at erotic objects

hypersexuality

"excessive sexual drive" (satyriasis, nymphomania)

"excessive masturbation"

"hypersexual d/o"

recurrent intense sexual fantasies, urges, and behavior

men - satyriasis

women - nymphomania

Hypersexuality, or "excessive sexual drive" is considered as ______________ for men and ________________ for women.

don juanism

male paraphilia

insecurity about masculinity and/or latent homosexuality

masked by multiple sexual liaisons with different female partners

interaction fulfilled without emotional and financial commitment

False

True or false:

- All transgender and gender diverse people experience gender dysphoria.

gender dysphoria (gender identity disorder)

The following criteria belong to which disorder?:

- Criterion A: "a marked difference btwn the individuals' expressed/experienced gender and the gender others would assign him or her, and it must continue for at least 6 months"

*adults - 2 criteria required

*children - 6 criteria required

- Criterion B: "this condition causes clinically significant distress or impairment in social, occupational, or other important areas of functioning."