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Paraphilias and Sexual Dysfunction Disorders

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