Paraphilias and Sexual Dysfunction Disorders

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Exhibitionism, Fetishism, Pedophilia, Sexual Masochism, Voyeurism, Hypoactive sexual desire disorder, sexual aversion disorder

What are paraphilias?

Group of disorders characterized by sexual arousal to objects, situations and individuals that are not deemed socially acceptable and cause significant distress/functional impairment to the patient

Sexual arousal from objects associated with the human body

Fetishism

Sexual arousal from dressing or playing the role of the opposite sex

Transvetic Fetishism

Sexual arousal from inflicting pain

Sexual sadism

Sexual arousal from receiving pain

Sexual masochism

What is the most common paraphilia?

pedophilia

What is the difference between pedophilia and ephebophilia?

Pedophilia = prepubescent
Ephebophilia = pubescent - 18yo

Sexual pleasure from exposure to unsuspecting strangers

Exhibitionism
*Illegal

Sexual pleasure from rubbing up against unsuspecting strangers

Frotterism
*Illegal

Sexual pleasure form spying of sexual or private acts of unsuspecting strangers

Voyeurism

What parts of the hx in a patient c/o erectile dysfunction decreases the likelihood that the complaint is d/t somatic factors?

(1) morning erection, (2) erections during masturbation

What is the effect of antipsychotic medication on sexual function?

Antidopaminergic effects increase circulating prolactin, resulting in gynecomastia and impaired arousal

T/F H/o being sexually abused is a risk factor for developing pedophilia.

TRUE

A strong persistent identification with the opposite sex

Gender Identity Disorder

At what age does cross gender role play normally take place?

2-4yo

Harry Benjamin Standard of Care for Gender Reassignment

Prior to consideration for reassignment:
(1) Letters of recommendation from mental health professionals
(2) Must be >18yo
(3) Must undergo 1 year of hormonal therapy
(4) Successfully live in a cross gender role continuously for one year

What are the disorders of sexual desire?

1. Hypoactive Sexual Desire Disorder- pt w/ low sexually interest that is distressing to the pt
2. Sexual Aversion Disorder - pt w/ absent sexual desire that is distressing to the pt
*Tx = psychotherapy

What physiologic conditions should be ruled out in pts c/o male impotence?

DM2, PVD

What are the disorders of orgasm?

1. Premature Ejaculation - tx w/ sexual techniques ("squeeze" method), SRRIs (Sertraline)
2. Anorgasmia - if pt is on SSRI, switch to Bupropion

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