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Block 4 PSYCH Exam -- Sexual and Gender Identity Disorders


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What is sexual identity?
One's biological sex

Chromosomes, gonads, genitalia, etc.
What is gender identity?
SUBJECTIVE sense of "maleness" or "femaleness"
What is gender role?
BEHAVIOR that identifies one as "male" or "female"
What is orientation?
Whether an indiv. is attracted to same sex, opposite, or both
What 4 behavioral dimensions does homosexuality subsume?

Which is most important?
Sexual fantasy
Sexual activity
Personal identity
Social role

Fantasy is most important
Ex. person can have homo orientation w/o engaging in homo activity
How does concordance rate for homosexuality compare between twins, etc.?
Monozygotic > dizygotic > adopted siblings

Some reports of concordance between mono twins, that were reared apart
What structure(s) is proposed as link between genotype & phenotype?
(when it comes to sexuality)
Interstitial nuclei in the anterior hypothalamus (INAH)
What are the four main influences on excitement?
Neural factors
Vascular factors
Endocrine/metabolic factors
What branch of the nervous system is responsible for sexual excitement?
(ie erection)
Parasympathetic branch
What endocrine/metabolic substances facilitate sexual excitement (2)?
What endocrine/metabolic substance inhibits sexual excitement?

Remember, SSRIs have adverse sexual effects
What branch of the nervous system is responsible for orgasm?
Sympathetic branch
Anti-cholinergic meds can have what sexual side effect(s)?
May inhibit arousal
(impotence in men, impaired lubrication in women)
Anti-hypertensive meds can have what sexual side effect(s)?
Inhibition of orgasm due to decreased sympathetic function

Beta-blockers can decrease arousal
Trazodone can have what sexual side effect(s)?
Anti-psychotics can have what sexual side effect(s)?
Decreased arousal (DA blockade, anti-cholinergism, inc. prolactin)

Alpha-blockade can cause anorgasmia
SSRIs can have what sexual side effect(s)?
Inhibited arousal and orgasm
(due to increased serotonin levels)
Spironolactone, steroids, and estrogens can have what sexual side effect(s)?
Decreased sexual desire and arousal
(via anti-androgenic effects)
Alcohol, opiates and cocaine can have what sexual side effect(s)?
Interference w/ both arousal and orgasm
What is hypoactive sexual desire disorder defined as?
Deficiency/absence of BOTH sexual fantasies and desire
What 2 main sexual dysfunctions is Hypoactive Sex Desire often assoc. w/?
Impaired arousal
Impaired orgasm
What is the treatment for Hypoactive Sex Desire Disorder?
Sex education
Individual or couple's therapy
Courtship exercises
What is sexual aversion disorder defined as?
Active aversion to genital sexual contact with the sexual partner

Libido IS present, but anxiety, fear or disgust interferes
What is the treatment for Sexual Aversion Disorder?
Graded in vivo desensitization at careful pace

NOTE: similar to the treatment for Phobic Disorder
What is Female Sexual Arousal Disorder defined as?
Recurrent inability to attain or maintain adequate lubrication-swelling response
What other disorders does Female Sex Arousal Disorder often appear with (2)?
Hypoactive Sex Arousal Disorder
Female Orgasmic Disorder
What medical conditions are common causes of Female Arousal Disorder (4)?
Post-menopausal state (most common cause)
Atrophic vaginitis
Diabetes mellitus
What is the treatment for Female Sex Arousal Disorder?
Estrogen replacement therapy and topical lubricant
What is the most common presenting complaint at sex therapy clinics?
Male Erectile Disorder
What is the prevalence of Male ED?
Overall -- 3% - 9%
Ages 20-30 -- 7%
Ages 40-70 -- 50%
What % of men with ED actually seek treatment?
Only 10%
What is the most common cause of male ED?
What artery provides the majority of blood supply to the penis?
Pudendal artery
What does psychological treatment for male ED entail (4)?
Couple's therapy
Sensate focus exercises
Graded, in vivo desensitization, leading to entry
What are Sensate Focus exercises?
Ex. in which each partner pays increased attention to their own senses
(take turns progressing through stages of touching)
What are the injectable options for treating male ED pharmacologically (3)?
Papaverine -- smooth muscle relaxant
Phenoxybenzamine -- alpha-adrenergic blocker
Prostglandin E1
What are the pill options for treating male ED pharmacologically (3)?
Sildenafil -- Viagra
Vardenafil -- Levitra
Tadalafil -- Cialis (NOTE: long acting [DOA up to 36 hrs.])
What is primary anorgasmia?
Never having achieved orgasm
What is secondary anorgasmia?
Only being anorgasmic in certain situations
What % of the population is primary anorgasmic?
5 - 10%
What % of the population is secondary anorgasmic?
Up to one third of the population

NOTE: response to treatment is 50% and variable
Why may anorgasmia appear before ED in general medical conditions?
Sympathetic innervation of penis is more sensitive to insult
What are NON-pharmacologic treatment options for male org. disorder (3)?
Sensate focus exercises
Increased stimulation prior to coitus
Anal stimulation
What are pharmacologic treatment options for male org. disorder (2)?
Cyprohepatadine -- 5-HT antagonist
Yohimbine -- alpha-2 antagonist
Lifelong premature ejaculation is more common in what age group?
Younger men (40%)
Acquired prem. ejaculation is associated w/ what 2 other problems?
Male ED
Performance anxiety
What is a non-pharmacologic treatment option for prem. ejaculation?
Start/stop or squeeze technique
What is dyspareunia?

Who experiences it?
Genital pain associated with sexual intercourse

Almost always in women
What general medical conditions may cause dyspareunia (4)?
Estrogen deficiency (decreased lubrication)
Post-radiation therapy effects
Vulvar vestibulitis
What are treatment options for dyspareunia (3)?
Relaxation exercises
Exploratory masturbation
What is vaginismus?
Persistent, INVOLUNTARY, contraction of perineal muscles
Occurs during, or in anticipation of vaginal penetration
What 3 psych. factors may play a role in vaginismus?
Previous dyspareunia
Sexual abuse
Childhood teachings about sex
What are treatment options for vaginismus (4)?
Relaxation training
Gradual self-exploration
Attempts at insertion (finger, dilator, etc.)
Sensate focus exercises
What are paraphilias?

How long must they persist to qualify?
Intense sexually arousing fantasies, urges
Involve either non-human objects, suffering/humiliation, non-consenting persons

Must persist > 6 months
What is frotteurism?
Touching or rubbing against a non-consenting person
What is sexual masochism?
RECEIVING humiliation or suffering
What is sexual sadism?
INFLICTING humiliation or suffering
What is partialism?
Exclusive focus on part of the body
What is coprophilia?
Inclusion of feces in sexual fantasy
What is klismaphilia?
Inclusion of enemas in sexual fantasy
What group of people do paraphilias appear in?
Almost exclusively in men
What are treatment options for paraphilias?
STOP the behavior
Remove external reinforcers
Remove internal reinforcers
(Behavioral and cognitive therapy, Anti-androgen meds)
What is gender identity disorder defined as?
Strong and persistent cross-gender identification
The desire to be, or insistence that one is, of the other sex

MUST also be evidence of discomfort about one's assigned sex
(or, a sense of inappropriateness in gender role of assigned sex)
When does gender identity disorder typically begin?
Between ages of 2 and 4

NOTE: most kids w/ GID do NOT remain that way as adults
When considering reassignment surgery, what must be ruled out (3)?
Borderline personality disorder
Effeminate homosexual w/ adjustment disorder
Transvestite w/ adjustment disorder

NOTE: you can treat all of the above w/ psychotherapy

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