[N108] LEC 3.9 - Gender Dysphoria, Sexual Dysfunctions, and Paraphilias

Diagnosed when an individual has a strong and persistent sense of incongruence between experienced or expressed gender and the gender assigned at birth

Gender dysphoria

What was the initial belief about the development of gender dysphoria (GD) in the 1970s?

A) It was entirely a learned environmental pathology

B) It was caused by genetic factors alone

C) It was due to hormonal imbalances

D) It was not recognized as a condition

A) It was entirely a learned environmental pathology

How do genes contribute to gender identity in relation to gender dysphoria?

A) Genes have no influence on gender identity

B) Gender identity is determined solely by environmental factors

C) Gender identity is an inherited, complex multifactorial polygenic trait

D) Gender identity is determined by a single gene

C) Gender identity is an inherited, complex multifactorial polygenic trait

True or false? The modern understanding of gender is that it is a spectrum that includes the “cis-gender” and “transgender” umbrella

True

According to Sigmund Freud, from what does gender dysphoria in children arise?

A) Oedipal triangle conflicts

B) Hormonal imbalances

C) Genetic mutations

D) Childhood trauma

A) Oedipal triangle conflicts

A desire for sexual involvement with a parent of the opposite sex and concomitant sense of rivalry with the parent of the same sex

Oedipus complex

At what age did Freud attribute the Oedipus complex to occur in children?

A) 1-2 years old

B) 3-5 years old

C) 6-8 years old

D) 10-12 years old

B) 3-5 years old

What is the duration requirement for a diagnosis of gender dysphoria in children and adults?

6 months

What is a strong preference in playmates for children with gender dysphoria?

A) A strong preference for playmates of the other gender

B) A preference for same-gender playmates

C) No particular preference in playmates

D) Avoidance of all playmates

A) A strong preference for playmates of the other gender

What conviction might adults with gender dysphoria hold about their feelings and reactions?

A) A strong aversion to discussing gender

B) A strong belief in the importance of their assigned gender

C) A conviction that gender is irrelevant

D) A strong conviction that they have the typical feelings and reactions of the other gender

D) A strong conviction that they have the typical feelings and reactions of the other gender

True or false? The aim of psychotherapy is to treat gender dysphoria

False; aim is to help them to feel comfortable in their gender identity and allowing them realistic chances

Which of the following is NOT a criteria for starting hormonal therapy for gender dysphoria?

A) Persistent and well-documented gender dysphoria

B) Capacity to consent for the treatment

C) A desire to change gender

D) Mental or medical underlying issues are in control

C) A desire to change gender

Why is counseling against cigarette smoking recommended for transgender women on estrogen therapy?

A) Cigarette smoking diminishes the effect of estrogen

B) Cigarette smoking enhances the effect of estrogen

C) Smoking increases testosterone levels

D) Smoking decreases testosterone levels

A) Cigarette smoking diminishes the effect of estrogen

What is the recommended frequency of clinical and laboratory evaluation during the first year of hormone therapy for transgender females?

A) Every month

B) Every 3 months

C) Every 6 months

D) Every year

B) Every 3 months

What is the recommended hormone therapy approach for transgender men (FTM)?

A) Testosterone injectables

B) Oral testosterone

C) Estrogen therapy

D) No hormone therapy

A) Testosterone injectables

True or false? Oral hormones are not recommended for transgender men (FTM)

True, due to the first-pass effect through the intestines and liver

Which of the following is NOT part of the routine labs essential for transgender men (FTM) on testosterone therapy?

A) Hemoglobin and hematocrit

B) Liver function

C) Cholesterol

D) Diabetes screening

E) Kidney function

E) Kidney function

Transgender men (FTM) undergoing testosterone therapy need to be monitored for their hematocrit and hemoglobin ___

A) Every month for the first year then 3x a year

B) Every 3 months for the first year then 1-2x a year

C) Every 6 months for the first year then 2-3x a year

B) Every 3 months for the first year then 1-2x a year

True or false? During the first few months, testosterone therapy causes permanent changes, such as the deepening of the voice and enlarged clitoris

False; these occur after 3-6 months

The following are effects of testosterone therapy during the first few months, EXCEPT:

A) Increased muscle mass

B) Increased acne

C) Deepening of the voice

D) Increased libido

E) Cessation of menses

C) Deepening of the voice

• This occurs after 3-6 months

What is a prerequisite for starting surgical therapy for gender dysphoria?

A) Continuous hormonal treatment for about a year and living in the desired gender role

B) A diagnosis of mental health disorders

C) Completion of a specific number of therapy sessions

D) Financial stability

A) Continuous hormonal treatment for about a year and living in the desired gender role

What is a common top surgery desired by transgender women (MTF)?

A) Breast augmentation

B) Scrotoplasty

C) Phalloplasty

D) Metoidioplasty

A) Breast augmentation

This procedure for transgender women (MTF) includes penectomy and vaginoplasty

Gonadectomy

What is the purpose of a gonadectomy for transgender women (MTF)?

A) To improve fertility

B) To increase breast size

C) To enhance vocal pitch

D) To remove the main source of testosterone from the body

D) To remove the main source of testosterone from the body

What are vaginal dilators used for in transgender women (MTF)?

A) To aid in breast augmentation

B) To maintain anatomy if sexual intercourse is a goal

C) To reduce facial hair

D) To manage hormone levels

B) To maintain anatomy if sexual intercourse is a goal

What surgical procedure involves releasing the clitoris from its ligament and adding tissue to increase length and girth in transgender men (FTM)?

Metoidioplasty

True or false? Scrotoplasty involves testicular implants and phalloplasty involves penile implants

True

Extremely common but rarely recognized by physicians; represent inhibitions in the appetitive or psychophysiologic changes 

Sexual dysfunctions

Sexual desire disorder: deficiency or absence of sexual fantasies and a lack of desire for sexual activity

Hypoactive sexual desire disorder

Sexual desire disorder: aversion to and active avoidance of genital sexual contact that causes distress

Sexual aversion disorder

1. Female sexual arousal disorder: inadequate _____

2. Male erectile disorder: inadequate _____

1. Lubrication

2. Erection

Disruption in the orgasm phase; in the orgasm phase, there is a persistent or recurrent delay in or absence of orgasm following sexual excitement phase 

Orgasmic disorder

This is a persistent, recurrent onset of orgasm and ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it, causing marked distress and interpersonal difficulty 

Premature ejaculation

Persistent or recurrent involuntary contractions of the perineal muscles surrounding the outer third of the vagina when vaginal penetration with penis, finger, tampon, or speculum is attempted

Vaginismus

Recurrent, intensely sexually arousing fantasies; sexual urges or behaviors generally involving non-human objects, or the suffering or humiliation of oneself or partner

Paraphilias

Paraphilia: exposure of the genitals to a stranger, sometimes involving masturbation

Exhibitionism

Paraphilia: use of nonliving objects (the fetish) to obtain sexual excitement and/or achieve orgasm

Fetishism

When does fetishism usually start?

Adolescence

Paraphilia: touching and rubbing against a nonconsenting person, usually in a crowded place from which the person with frotteurism can make a quick escape

Frotteurism

True or false? Frotteurism usually occurs between the ages of 15-25 years old, and the frequency declines after that 

True

Paraphilia: sexual activity with a prepubescent child (generally 13 years or younger) by someone at least 16 years old and 5 years older than the child

Pedophilia

Paraphilia: the act of being humiliated, beaten, bound, or otherwise made to suffer

Sexual masochism

Paraphilia: the act of observing an unsuspecting person who is naked, in the process of undressing, or engaging in sexual activity

Voyeurism

Paraphilia: acts in which the psychological or physical suffering of the victim is sexually arousing to the person

Sexual sadism

Which therapy approaches are used for treating sexual dysfunction?

A) Psychodynamic therapy

B) Interpersonal therapy

C) Rational emotive therapy

D) Master Johnson's behavioral therapy

E) All of the above

E) All of the above

The following pharmacologic treatments have proven efficacy and safety for erectile dysfunction, EXCEPT:

A) Sildenafil

B) Tadalafil

C) Vardenafil

D) SSRIs

D) SSRIs

What is the standard treatment for severe paraphilias in adults?

A) Anti-androgen treatment + Cognitive Behavioral Therapy (CBT)

B) Cognitive Behavioral Therapy (CBT) alone

C) Anti-Hormonal therapy alone

D) Serotonergic agents and naltrexone

A) Anti-androgen treatment + Cognitive Behavioral Therapy (CBT)

This medication for the treatment of paraphilias has shown high efficacy working in a similar way to physical castration but being reversible at any time

Gonadotropin-releasing hormone analogue

True or false? SSRIs have been used in severe types of paraphilia and in cases of sexual compulsions and juvenile paraphilias

False; mild types of paraphilia