Psychiatry
Psychosexual and Gender Identity Disorders
Psychosexual and gender identity disorders for MBBS and NEET-PG: sexual response cycle, sexual dysfunction, gender dysphoria and paraphilias, mapped to NMC codes PS13.
MedNext Academy | 3 min read
Psychosexual and Gender Identity Disorders
Psychosexual and gender identity disorders for MBBS and NEET-PG: sexual response cycle, sexual dysfunction, gender dysphoria and paraphilias, mapped to NMC codes PS13.
This chapter covers the psychosexual and gender identity disorders. It reviews the sexual response cycle, the categories of sexual dysfunction with their organic and psychogenic causes, the concept of gender dysphoria as distinct from sexual orientation, and the paraphilias, alongside a sensitive approach to assessment and behavioural treatment.
High-yield: Psychosexual and Gender Identity Disorders
- The human sexual response cycle described by Masters and Johnson has four phases: excitement, plateau, orgasm and resolution.
- Sexual dysfunctions are grouped into disorders of desire, arousal, orgasm and sexual pain.
- Erectile dysfunction is the persistent inability to achieve or maintain an erection, and it has both organic and psychogenic causes.
- Premature ejaculation is ejaculation occurring sooner than desired, often with a psychological or learned component.
- Organic causes of sexual dysfunction include diabetes, vascular disease, endocrine disorders, medication and substance use.
- Selective serotonin reuptake inhibitors and antihypertensives are common drug causes of sexual dysfunction.
- Phosphodiesterase-5 inhibitors such as sildenafil are used for erectile dysfunction and are contraindicated with nitrates because of severe hypotension.
- Gender identity refers to a person's internal sense of their gender, which is distinct from sexual orientation.
- Gender dysphoria is the distress arising from a mismatch between experienced gender and sex assigned at birth.
- Paraphilias are recurrent, intense sexual interests involving atypical objects, situations or activities.
- A paraphilic disorder is diagnosed only when the interest causes distress or impairment, or harms or risks harm to others.
- Homosexuality is not a disorder and has been removed from psychiatric classification.
- Sensate focus and other behavioural techniques are core to the psychological treatment of sexual dysfunction.
- A sensitive, non-judgemental approach and exclusion of organic and drug causes underpin the assessment of psychosexual problems.
Sexual dysfunction and gender identity
- **Response cycle:** Excitement, plateau, orgasm, resolution (Masters and Johnson).
- **Dysfunction categories:** Disorders of desire, arousal, orgasm and sexual pain.
- **PDE-5 inhibitors:** Sildenafil for erectile dysfunction; contraindicated with nitrates.
- **Gender dysphoria:** Distress from mismatch of experienced gender and sex assigned at birth; distinct from orientation.
NMC competencies in this chapter
- **PS13.1:** Magnitude and aetiology of psychosexual disorders
- **PS13.2:** Clinical features of psychosexual and gender identity disorders
- **PS13.3:** Indications and interpretation of investigations
- **PS13.4:** Treatment including behavioural methods
- **PS13.5:** Family education and counselling
- **PS13.6:** Pharmacological basis and side effects of therapies
- **PS13.7:** Conditions for specialist referral
Frequently Asked Questions
What are the phases of the sexual response cycle?
Masters and Johnson described four phases: excitement, plateau, orgasm and resolution. Sexual dysfunctions are classified by which phase or aspect is affected.
Why are PDE-5 inhibitors contraindicated with nitrates?
Phosphodiesterase-5 inhibitors like sildenafil and nitrates both lower blood pressure, and combined they can cause severe, dangerous hypotension, so the combination is contraindicated.
What is gender dysphoria?
It is the distress that arises from a mismatch between a person's experienced gender and the sex assigned at birth. It is distinct from sexual orientation, and gender identity is not the same as orientation.
When is a paraphilia a disorder?
A paraphilia becomes a paraphilic disorder only when it causes the person distress or impairment, or when it harms or risks harm to others, such as a non-consenting person.
Continue reading
MBBSAll Psychiatry chapters
Continue through the Psychiatry chapter map.
Continue studying Psychiatry
Explore clinician-written learning resources, structured revision and practice across the MedNext platform.
Open in the MedNext appSee plans