MEDICAL SEXOLOGY doc MUDr Alexandra ourkov CSc Dept

MEDICAL SEXOLOGY doc. MUDr. Alexandra Žourková, CSc. Dept. of Psychiatry, Masaryk University, Brno

BASED ON EDUCATION IN - GYNECOLOGY - PSYCHIATRY - ENDOCRINOLOGY - UROLOGY

SEXOLOGICAL EXAMINATION - SEXUAL HISTORY - CURRENT FUNCTIONING - SOMATIC EXAMINATION - PLETHYSMOGRAPHY

SEXUAL RESPONSE CYCLE § § DESIRE FANTASIES ABOUT SEXUAL ACTIVITY AND THE DESIRE TO HAVE SEXUAL ACTIVITY EXCITEMENT PSYCHOLOGICAL AND/OR PHYSICAL STIMULATION ERECTION OF THE PENIS LUBRICATION IN THE VAGINA

SEXUAL RESPONSE CYCLE § ORGASM INVOLUNTARY CONTRACTIONS (URETHRA, MUSCLES OF THE PENIS, LOWER THIRD OF THE VAGINA … EMOTIONS § RESOLUTION A SUBJECTIVE SENSE OF WELL-BEING §

DSM-IV SEXUAL DISORDERS RELATED TO A SEXUAL RESPONSE PHASE OF SEXUAL RESPONSE CYCLE SEXUAL DISORDER DESIRE - HYPOACTIVE SEXUAL DESIRE DISORDER - SEXUAL AVERSION DISORDER

DSM-IV SEXUAL DISORDERS RELATED TO A SEXUAL RESPONSE PHASE OF SEXUAL RESPONSE CYCLE EXCITEMENT SEXUAL DISORDER - FEMALE SEXUAL AROUSALDISORDER - MALE ERECTILE DISORDER

DSM-IV SEXUAL DISORDERS RELATED TO A SEXUAL RESPONSE PHASE OF SEXUAL RESPONSE CYCLE SEXUAL DISORDER ORGASM - FEMALE ORGASMIC DISORDER - PREMATURE EJACULATION

TYPES OF SEXUAL DYSFUNCTIONS MALE TYPE IMPOTENCE (MALE ERECTILE DISORDER) - LIFELONG - SECONDARY DEFINITION IMPAIRMENT OF PENILE ERECTION THAT IS RECCURENT AND PERSISTENT NEVER POTENT WITH A PARTNER POTENT IN PAST BUT SUBSEQUENTLY DEVELOPMENT ERECTILE DISORDER

TYPES OF SEXUAL DYSFUNCTIONS MALE TYPE PREMATURE EJACULATION DEFINITION INABILITY TO EXPERT VOLUNTARY CONTROL OVER THE EJACULATORY REFLECT

TYPES OF SEXUAL DYSFUNCTIONS MALE TYPE MALE ORGASMIC DISORDER - LIFELONG - ACQUIRED DEFINITION INHIBITION OF THE EJACULATORY REFLEX NEVER EJACULATED WITH PARTNER EJACULATED NORMALY IN THE PAST BUT SUBSEQUENTLY DEVELOPED THIS DIFFICULTY

TYPES OF SEXUAL DYSFUNCTIONS FEMALE TYPE DEFINITION FEMALE SEXUAL INABILITY TO DERIVE AROUSAL DISORDER EROTIC PLEASURE FROM SEXUAL STIMULATION

TYPES OF SEXUAL DYSFUNCTIONS FEMALE TYPE ORGASMIC DISORDER - LIFELONG - ACQUIRED DEFINITION SPECIFIC DIFFICULTY IN REACHING ORGASM NEVER EXPERIENCED ORGASM BY ANY MEANS OF STIMULATION EXPERIENCED ORGASM BUT SUBSEQUENTLY DEVELOPMENTS THIS DIFFICULTY

TYPES OF SEXUAL DYSFUNCTIONS FEMALE TYPE DEFINITION VAGINISM IMPENETRABILITY OF THE VAGINA BECAUSE OF INVOLUNTARY SPASM OF THE VAGINAL MUSCLES DYSPAREUNIA PAIN ON INTERCOURSE

PARAPHILIAS COMPONENT OF SEXUAL MOTIVATION SEXUAL IDENTIFICATION GENDER IDENTITY SEXUAL ORIENTATION SEXUAL BEHAVIOR SEXUAL DEVIATION TRANSSEXUALISM PEDOPHILIA FETHISISM TRANSVESTIC FETHISISM EXHIBITIONISM VOYERISM, SADISM MASOCHISM

TYPES OF SEXUAL DEVIATIONS TYPE DEFINITION GENDER IDENTITY § PERSISTENT SENSE OF DISCOMFORT ABOUT DISORDER (TRANSSEXUALISM) ONE`S ANATOMICAL SEX AND STRONG DESIRE TO CHANGE ONE`S GENITALS AND SECONDARY SEX CHARACTERISTICS

TYPES OF SEXUAL DEVIATIONS TYPE TRANSVESTIC FETHISISM DEFINITION DRESING IN CLOTHES APPROPRIATE TO THE OPPOSITE SEX FOR PURPOSES OF AROUSAL

TYPES OF SEXUAL DEVIATIONS TYPE FETHISISM PEDOPHILIA DEFINITION § USE OF A NONHUMAN OBJECTS AS THE PREFERRED METHOD TO ACHIEVE SEXUAL EXCITEMENT § HAVING SEXUAL CONTACT WITH PREPUBERTAL CHILDREN AS THE PREFERRED MEANS TO ACHIEVE SEXUAL EXCITEMENT

TYPES OF SEXUAL DEVIATIONS TYPE DEFINITION EXHIBITIONISM § EXPOSURE OF THE GENITALS IN PUBLIC TO UNSUSPECTING STRANGERS TO ACHIEVE SEXUAL EXCITIMENT VOYEURISM § REPEATEDLY LOOKING AT UNSUSPECTING PEOPLE WHO ARE DISROBING OR ENGANGING IN SEXUAL ACTIVITY

TYPES OF SEXUAL DEVIATIONS TYPE SEXUAL MASOCHISM DEFINITION § OBTAINING SEXUAL GRATIFICATION TROUGH EXPERIENCING MENTAL SUFFERING OR BODILY PAIN SEXUAL SADISM § INFLICTING PHYSICAL OR PSYCHOLOGICAL PAIN ON ANOTHER TO ACHIEVE SEXUAL EXCITEMENT

TREATMENT OF PARAPHILIAS 1. P S Y C H O T H E R A P Y § TO HELP PATIENTS IDENTIFY THE FEELINGS AND PHANTASIES THAT PROMPT DEVIANT SEXUAL BEHAVIOR § TO FIND MORE ACCEPTABLE MEANS OF OBTAINING SEXUAL GRATIFICATION

TREATMENT OF PARAPHILIAS 2. BIOLOGICAL THERAPY A – REVERSIBLE § HORMONAL (CYPROTERON ACETATE – ANDROCUR MEDROXYPROGESTERONACETATE – DEPO – PROVERA

TREATMENT OF PARAPHILIAS 2. BIOLOGICAL THERAPY A – REVERSIBLE § NEUROLEPTICS (DEPOT FORMS) § THYMOPROPHYLACTIS (LITHIUM, CARBAMAZEPINE) § SSRI (EXPERIMENTAL)

TREATMENT OF PARAPHILIAS 2. BIOLOGICAL THERAPY B – IRREVERSIBLE - SURGICAL § § CASTRATION STEREOTACTIC NEUROSURGERY (ONLY ON REQUEST AND INFORMAL CONSENT)

References : § § Waldinger R. J. : Psychiatry for medical students, Washington, DC : American Psychiatric Press, 1997 Kaplan HI, Sadock BJ, Grebb JA. : Kaplan and Sadock´s synopsis of psychiatry, Baltimore: Williams and Wilkins, 1997