Block 4 Psych Exam -- Sexual And Gender Identity Disorders

Front 1

What is sexual identity?

Back 1

One's biological sex

Chromosomes, gonads, genitalia, etc.

Front 2

What is gender identity?

Back 2

SUBJECTIVE sense of "maleness" or "femaleness"

Front 3

What is gender role?

Back 3

BEHAVIOR that identifies one as "male" or "female"

Front 4

What is orientation?

Back 4

Whether an indiv. is attracted to same sex, opposite, or both

Front 5

What 4 behavioral dimensions does homosexuality subsume?

Which is most important?

Back 5

Sexual fantasy
Sexual activity
Personal identity
Social role


Fantasy is most important
Ex. person can have homo orientation w/o engaging in homo activity

Front 6

How does concordance rate for homosexuality compare between twins, etc.?

Back 6

Monozygotic > dizygotic > adopted siblings

Some reports of concordance between mono twins, that were reared apart

Front 7

What structure(s) is proposed as link between genotype & phenotype?
(when it comes to sexuality)

Back 7

Interstitial nuclei in the anterior hypothalamus (INAH)

Front 8

What are the four main influences on excitement?

Back 8

Psychological
Neural factors
Vascular factors
Endocrine/metabolic factors

Front 9

What branch of the nervous system is responsible for sexual excitement?
(ie erection)

Back 9

Parasympathetic branch

Front 10

What endocrine/metabolic substances facilitate sexual excitement (2)?

Back 10

Testosterone
Dopamine

Front 11

What endocrine/metabolic substance inhibits sexual excitement?

Back 11

Serotonin

Remember, SSRIs have adverse sexual effects

Front 12

What branch of the nervous system is responsible for orgasm?

Back 12

Sympathetic branch

Front 13

Anti-cholinergic meds can have what sexual side effect(s)?

Back 13

May inhibit arousal
(impotence in men, impaired lubrication in women)

Front 14

Anti-hypertensive meds can have what sexual side effect(s)?

Back 14

Inhibition of orgasm due to decreased sympathetic function

Beta-blockers can decrease arousal

Front 15

Trazodone can have what sexual side effect(s)?

Back 15

Priapism

Front 16

Anti-psychotics can have what sexual side effect(s)?

Back 16

Decreased arousal (DA blockade, anti-cholinergism, inc. prolactin)

Alpha-blockade can cause anorgasmia

Front 17

SSRIs can have what sexual side effect(s)?

Back 17

Inhibited arousal and orgasm
(due to increased serotonin levels)

Front 18

Spironolactone, steroids, and estrogens can have what sexual side effect(s)?

Back 18

Decreased sexual desire and arousal
(via anti-androgenic effects)

Front 19

Alcohol, opiates and cocaine can have what sexual side effect(s)?

Back 19

Interference w/ both arousal and orgasm

Front 20

What is hypoactive sexual desire disorder defined as?

Back 20

Deficiency/absence of BOTH sexual fantasies and desire

Front 21

What 2 main sexual dysfunctions is Hypoactive Sex Desire often assoc. w/?

Back 21

Impaired arousal
Impaired orgasm

Front 22

What is the treatment for Hypoactive Sex Desire Disorder?

Back 22

Sex education
Individual or couple's therapy
Courtship exercises

Front 23

What is sexual aversion disorder defined as?

Back 23

Active aversion to genital sexual contact with the sexual partner

Libido IS present, but anxiety, fear or disgust interferes

Front 24

What is the treatment for Sexual Aversion Disorder?

Back 24

Graded in vivo desensitization at careful pace

NOTE: similar to the treatment for Phobic Disorder

Front 25

What is Female Sexual Arousal Disorder defined as?

Back 25

Recurrent inability to attain or maintain adequate lubrication-swelling response

Front 26

What other disorders does Female Sex Arousal Disorder often appear with (2)?

Back 26

Hypoactive Sex Arousal Disorder
Female Orgasmic Disorder

Front 27

What medical conditions are common causes of Female Arousal Disorder (4)?

Back 27

Post-menopausal state (most common cause)
Atrophic vaginitis
Diabetes mellitus
Lactation

Front 28

What is the treatment for Female Sex Arousal Disorder?

Back 28

Estrogen replacement therapy and topical lubricant

Front 29

What is the most common presenting complaint at sex therapy clinics?

Back 29

Male Erectile Disorder

Front 30

What is the prevalence of Male ED?

Back 30

Overall -- 3% - 9%
Ages 20-30 -- 7%
Ages 40-70 -- 50%

Front 31

What % of men with ED actually seek treatment?

Back 31

Only 10%

Front 32

What is the most common cause of male ED?

Back 32

Diabetes

Front 33

What artery provides the majority of blood supply to the penis?

Back 33

Pudendal artery

Front 34

What does psychological treatment for male ED entail (4)?

Back 34

Education
Couple's therapy
Sensate focus exercises
Graded, in vivo desensitization, leading to entry

Front 35

What are Sensate Focus exercises?

Back 35

Ex. in which each partner pays increased attention to their own senses
(take turns progressing through stages of touching)

Front 36

What are the injectable options for treating male ED pharmacologically (3)?

Back 36

Papaverine -- smooth muscle relaxant
Phenoxybenzamine -- alpha-adrenergic blocker
Prostglandin E1

Front 37

What are the pill options for treating male ED pharmacologically (3)?

Back 37

Sildenafil -- Viagra
Vardenafil -- Levitra
Tadalafil -- Cialis (NOTE: long acting [DOA up to 36 hrs.])

Front 38

What is primary anorgasmia?

Back 38

Never having achieved orgasm

Front 39

What is secondary anorgasmia?

Back 39

Only being anorgasmic in certain situations

Front 40

What % of the population is primary anorgasmic?

Back 40

5 - 10%

Front 41

What % of the population is secondary anorgasmic?

Back 41

Up to one third of the population

NOTE: response to treatment is 50% and variable

Front 42

Why may anorgasmia appear before ED in general medical conditions?

Back 42

Sympathetic innervation of penis is more sensitive to insult

Front 43

What are NON-pharmacologic treatment options for male org. disorder (3)?

Back 43

Sensate focus exercises
Increased stimulation prior to coitus
Anal stimulation

Front 44

What are pharmacologic treatment options for male org. disorder (2)?

Back 44

Cyprohepatadine -- 5-HT antagonist
Yohimbine -- alpha-2 antagonist

Front 45

Lifelong premature ejaculation is more common in what age group?

Back 45

Younger men (40%)

Front 46

Acquired prem. ejaculation is associated w/ what 2 other problems?

Back 46

Male ED
Performance anxiety

Front 47

What is a non-pharmacologic treatment option for prem. ejaculation?

Back 47

Start/stop or squeeze technique

Front 48

What is dyspareunia?

Who experiences it?

Back 48

Genital pain associated with sexual intercourse

Almost always in women

Front 49

What general medical conditions may cause dyspareunia (4)?

Back 49

Infections
Estrogen deficiency (decreased lubrication)
Post-radiation therapy effects
Vulvar vestibulitis

Front 50

What are treatment options for dyspareunia (3)?

Back 50

Education
Relaxation exercises
Exploratory masturbation

Front 51

What is vaginismus?

Back 51

Persistent, INVOLUNTARY, contraction of perineal muscles
Occurs during, or in anticipation of vaginal penetration

Front 52

What 3 psych. factors may play a role in vaginismus?

Back 52

Previous dyspareunia
Sexual abuse
Childhood teachings about sex

Front 53

What are treatment options for vaginismus (4)?

Back 53

Relaxation training
Gradual self-exploration
Attempts at insertion (finger, dilator, etc.)
Sensate focus exercises

Front 54

What are paraphilias?

How long must they persist to qualify?

Back 54

Intense sexually arousing fantasies, urges
Involve either non-human objects, suffering/humiliation, non-consenting persons

Must persist > 6 months

Front 55

What is frotteurism?

Back 55

Touching or rubbing against a non-consenting person

Front 56

What is sexual masochism?

Back 56

RECEIVING humiliation or suffering

Front 57

What is sexual sadism?

Back 57

INFLICTING humiliation or suffering

Front 58

What is partialism?

Back 58

Exclusive focus on part of the body

Front 59

What is coprophilia?

Back 59

Inclusion of feces in sexual fantasy

Front 60

What is klismaphilia?

Back 60

Inclusion of enemas in sexual fantasy

Front 61

What group of people do paraphilias appear in?

Back 61

Almost exclusively in men

Front 62

What are treatment options for paraphilias?

Back 62

STOP the behavior
Remove external reinforcers
Remove internal reinforcers
(Behavioral and cognitive therapy, Anti-androgen meds)

Front 63

What is gender identity disorder defined as?

Back 63

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)

Front 64

When does gender identity disorder typically begin?

Back 64

Between ages of 2 and 4

NOTE: most kids w/ GID do NOT remain that way as adults

Front 65

When considering reassignment surgery, what must be ruled out (3)?

Back 65

Borderline personality disorder
Effeminate homosexual w/ adjustment disorder
Transvestite w/ adjustment disorder

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