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MEDICAL SEXOLOGY

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

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MEDICAL SEXOLOGY

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

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

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

  4. SEXUAL RESPONSE CYCLE D E S I R E • FANTASIES ABOUT SEXUAL ACTIVITY AND THE DESIRE TO HAVE SEXUAL ACTIVITY E X C I T E M E N T • PSYCHOLOGICAL AND/OR PHYSICAL STIMULATION • ERECTION OF THE PENIS • LUBRICATION IN THE VAGINA

  5. SEXUAL RESPONSE CYCLE O R G A S M • INVOLUNTARY CONTRACTIONS (URETHRA, MUSCLES OF THE PENIS,LOWER THIRD OF THE VAGINA … • EMOTIONS R E S O L U T I O N • A SUBJECTIVE SENSE OF WELL-BEING

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

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

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

  9. TYPES OF SEXUAL DYSFUNCTIONS MALE T Y P E D E F I N I T I O N • IMPOTENCE • (MALE ERECTILE • DISORDER) • - LIFELONG • SECONDARY IMPAIRMENT OF PENILE ERECTION THAT IS RECCURENT AND PERSISTENT NEVER POTENT WITH A PARTNER POTENT IN PAST BUT SUBSEQUENTLY DEVELOPMENT ERECTILE DISORDER

  10. TYPES OF SEXUAL DYSFUNCTIONS MALE T Y P E D E F I N I T I O N PREMATURE EJACULATION INABILITY TO EXPERT VOLUNTARY CONTROL OVER THE EJACULATORY REFLECT

  11. TYPES OF SEXUAL DYSFUNCTIONS MALE T Y P E D E F I N I T I O N INHIBITION OF THE EJACULATORY REFLEX NEVER EJACULATED WITH PARTNER EJACULATED NORMALY IN THE PAST BUT SUBSEQUENTLY DEVELOPED THIS DIFFICULTY • MALE ORGASMIC • DISORDER • LIFELONG • ACQUIRED

  12. TYPES OF SEXUAL DYSFUNCTIONS FEMALE T Y P E D E F I N I T I O N FEMALE SEXUAL AROUSAL DISORDER INABILITY TO DERIVE EROTIC PLEASURE FROM SEXUAL STIMULATION

  13. TYPES OF SEXUAL DYSFUNCTIONS FEMALE T Y P E D E F I N I T I O N ORGASMIC DISORDER - LIFELONG - ACQUIRED SPECIFIC DIFFICULTY IN REACHING ORGASM NEVER EXPERIENCED ORGASM BY ANY MEANS OF STIMULATION EXPERIENCED ORGASM BUT SUBSEQUENTLY DEVELOPMENTS THIS DIFFICULTY

  14. TYPES OF SEXUAL DYSFUNCTIONS FEMALE T Y P E D E F I N I T I O N VAGINISM DYSPAREUNIA IMPENETRABILITY OF THE VAGINA BECAUSE OF INVOLUNTARY SPASM OF THE VAGINAL MUSCLES PAIN ON INTERCOURSE

  15. P A R A P H I L I A S COMPONENT OF SEXUAL MOTIVATION SEXUAL DEVIATION SEXUAL IDENTIFICATION GENDER IDENTITY SEXUAL ORIENTATION SEXUAL BEHAVIOR TRANSSEXUALISM PEDOPHILIA FETHISISM TRANSVESTIC FETHISISM EXHIBITIONISM VOYERISM, SADISM MASOCHISM

  16. TYPES OF SEXUAL DEVIATIONS T Y P E D E F I N I T I O N • PERSISTENT SENSE • OF DISCOMFORT ABOUT ONE`S ANATOMICAL SEX • AND STRONG DESIRE TO CHANGE ONE`S GENITALS AND SECONDARY SEX CHARACTERISTICS GENDER IDENTITY DISORDER (TRANSSEXUALISM)

  17. TYPES OF SEXUAL DEVIATIONS T Y P E D E F I N I T I O N TRANSVESTIC FETHISISM DRESING IN CLOTHES APPROPRIATE TO THE OPPOSITE SEX FOR PURPOSES OF AROUSAL

  18. TYPES OF SEXUAL DEVIATIONS T Y P E D E F I N I T I O N FETHISISM PEDOPHILIA • 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

  19. TYPES OF SEXUAL DEVIATIONS T Y P E D E F I N I T I O N • EXPOSURE OF THE GENITALS IN PUBLIC TO UNSUSPECTING STRANGERS TO ACHIEVE SEXUAL EXCITIMENT • REPEATEDLY LOOKING AT UNSUSPECTING PEOPLE WHO ARE DISROBING OR ENGANGING IN SEXUAL ACTIVITY EXHIBITIONISM VOYEURISM

  20. TYPES OF SEXUAL DEVIATIONS T Y P E D E F I N I T I O N SEXUAL MASOCHISM SEXUAL SADISM • OBTAINING SEXUAL GRATIFICATION TROUGH EXPERIENCING MENTAL SUFFERING OR BODILY PAIN • INFLICTING PHYSICAL OR PSYCHOLOGICAL PAIN ON ANOTHER TO ACHIEVE SEXUAL EXCITEMENT

  21. 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

  22. TREATMENT OF PARAPHILIAS 2. BIOLOGICAL THERAPY A – R E V E R S I B L E • HORMONAL (CYPROTERON ACETATE – ANDROCUR MEDROXYPROGESTERONACETATE – DEPO – PROVERA

  23. TREATMENT OF PARAPHILIAS 2. BIOLOGICAL THERAPY A – R E V E R S I B L E • NEUROLEPTICS (DEPOT FORMS) • THYMOPROPHYLACTIS (LITHIUM, CARBAMAZEPINE) • SSRI (EXPERIMENTAL)

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

  25. 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

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