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Behavioral Science IV


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What are the normal phases of sexual functioning?
Appetitive (desire)

Excitement (erection)

Plateau (Incr HR,BP,Resp,Skin Flush, intensification of erection)

Orgasm (vaginal/uterine contraction, expulsion semen)

Resolution (Men,refractory, Women restim possible)
What happens to sexual functioning with aging?
Men - slower erection/ejaculation, longer refractory period

Women - less lubrication, vaginal shortening,thinning,dryness
What is primary sexual dysfunction? Secondary?
Primary - orgasm never achieved

Secondary - men - inability to maintain despite past erections
What is the triad associated with hyposexuality?
Reduced or absent interest in sex. (Appetitive phase disorder)

Key psych triad: Problems in Relationship, Performance Anxiety, Fear of Consequences(STD,Pain,Etc)

Psychotic Disorders
Bipolar Mood Disorder
Define paraphilia and name some.
Disorders of appetitive phase.

Exhibitionism, etc

Exhibitionism - exposing genitals

Fetishism - inanimate objects

Frotteurism - rubbing penis against nonconsenting, nonaware woman
Pedophilia (how define?)
Sexual Masochism
Sexual sadism
Children (perpetrator must be at least 16 and 5 years older than victim)

Recieving physical suffering

Causing physical suffering
Transvestic Fetishism


Wearing women's underclothing

observing sexual activity/undressing

Sexual problems in the excitement phase (define and name causes)
Inability to maintain erection (40% exp at some time)

Inability to maintain vaginal lubrication, relaxing vagina (60%)

Key Triad:
Comorbid psychopathology
Recreational Drug Use/Meds

Peripheral Vasc Disease
Perineal surgery/radiation
renal failure
Aortic occlusion at iliac bifurcation (Leriche syndrome)
peripheral neuropathy
Multiple Sclerosis
Spinal cord transection
What are some treatment for excitement phase disorders?
Relaxation training
Sensate focus (increase awareness of touch/sens stimuli to decrease pressure for orgasm)

Relaxation training
Hormone injections
Penile injections
Vacuum pump
Plateau phase disorders?

Primary Sexual Pain Disorders
Dyspareunia - pain during coitus (2nd to endometriosis, tissue trauma, insuff lubrication, hymenal tags, phemosis, meds)

Vaginismus - involuntary muscle spasms before/during coitus, penetration impossible (tx. mech dilation)
Orgasmic Phase Problems

Premature Ejaculation
Female Orgasmic Disorder
Premature ejaculation - Primary due to key triad
Secondary due to meds/drugs
Tx-Squeeze technique when ejac. inevitability felt, stops ejaculation and backward conditions.

Female Orgasmic Disorder- delayed/absent orgasm.
Primary - partner trust
Secondary - genital pathology, endocrinopathy, meds, alcohol, drugs
What are the effects of the following substances on sexuality:


Alcohol: Incr libido acutely, chronic liver damage increases estrogen, decr arousal

Incr libido (direct brain stim)


Cocaine - Incr libido, priapism

Heroin - Decr libido, inhibits ejaculation (less with methadone)

Marijuana - Incr libidio acutely, lowered GnRH/Testosterone with chronic use
What substances are connected with increased aggression?
High dose Marijuana

HEROIN is NOT assoc
At what age do children understand death?
Children under 5 do not understand death.
Understand permanence of death at age 8.
What are the Kubler-Ross stages of dying?
Death (Denial)
Arrives (Anger)
Bringing (Bargaining
Grave (Grief/depression)
Adjustments (Acceptance)
What are the risk factors for suicide completion?
S (Sex-male)
A (Age - elderly, teens)
D (Depression)
P (Previous Attempt)
E (Ethanol)
R (Rational Thought)
S (Sickness)
O (Organized Plan)
N (No Spouse)
S (Social Support Lacking)
What are exceptions to informed consent?
Patient not legally competent
Implied consent in emergency
Therapeutic Privilege - withold info when would harm patient or undermine decision-making capacity
Waiver by patient of right
What are factors that substantiate decision making capacity?
1. Patient makes/communicates choice
2. Patient is informed
3. Decision stable over time.
4. Decision consistent with patient values/goals.
5. Decision not result hallucinations/delusions.
What are two types of written advance directives and which takes precedence?
Living will = patient direct witholding life-sustaining tx in terminal disease or vegetative states.

Durable Power of Attorney - patient designates surrogate to make medical decisions (may also specify decisions themselves) Surrogate retains power UNTIL REVOKED BY PATIENT.
Define Beneficence
Physicians have ethical responsibility to act in patient's best interest. Patient hold's ultimate decision making power (with informed decisions)
What are exceptions to confidentiality?
1. Likely Harm to others (impaired auto drivers)
2. Possible Harm to self
3. No alternative to warn those at risk
4. Doctor can take steps to prevent harm

Tarasoff Rules - patient must warn potential victims of their patients plans
What are the requirements of a civil suit under negligence?

What is the burden of proof in a malpractice suit?
Dereliction (physician breach of duty to patient)
Damage (patient suffers harm)
Direct (breach of duty causes harm)

Burden of proof - "more likely than not".

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