1. MEDICAL SEXOLOGY doc.MUDr.Alexandra Žourková,CSc. Dept. of Psychiatry, Dept. of Psychiatry, Masaryk University, Brno 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 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 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 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 PHASE OF SEXUAL RESPONSE CYCLE SEXUAL DISORDER DESIRE - HYPOACTIVE SEXUAL DESIRE DISORDER DESIRE DISORDER - SEXUAL AVERSION DISORDER DISORDER

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

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

9. TYPES OF SEXUAL DYSFUNCTIONS MALE 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 ERECTION THAT IS RECCURENT AND RECCURENT AND PERSISTENT PERSISTENT NEVER POTENT WITH A PARTNER A PARTNER POTENT IN PAST BUT SUBSEQUENTLY SUBSEQUENTLY DEVELOPMENT ERECTILE DEVELOPMENT ERECTILE DISORDER DISORDER

10. TYPES OF SEXUAL DYSFUNCTIONS MALE 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 VOLUNTARY CONTROL OVER THE EJACULATORY OVER THE EJACULATORY REFLECT REFLECT

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

12. TYPES OF SEXUAL DYSFUNCTIONS FEMALE 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 EROTIC PLEASURE FROM SEXUAL STIMULATION SEXUAL STIMULATION

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

14. TYPES OF SEXUAL DYSFUNCTIONS FEMALE TYPES OF SEXUAL DYSFUNCTIONS FEMALE T Y P E D E F I N I T I O N VAGINISMDYSPAREUNIA 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 P A R A P H I L I A S COMPONENT OF SEXUAL MOTIVATION SEXUAL DEVIATION SEXUAL IDENTIFICATION GENDER IDENTITY GENDER IDENTITY SEXUAL ORIENTATION SEXUAL BEHAVIOR TRANSSEXUALISMPEDOPHILIAFETHISISM 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 GENDER IDENTITY DISORDER(TRANSSEXUALISM)  PERSISTENT SENSE OF DISCOMFORT ABOUT ONE`S ANATOMICAL SEX AND STRONG DESIRE TO CHANGE ONE`S GENITALS AND SECONDARY SEX CHARACTERISTICS

17. TYPES OF SEXUAL DEVIATIONS T Y P E D E F I N I T I O N TRANSVESTICFETHISISM 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 FETHISISMPEDOPHILIA  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 EXHIBITIONISMVOYEURISM  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  REPEATEDLY LOOKING AT UNSUSPECTING PEOPLE WHO ARE DISROBING OR ENGANGING IN SEXUAL ACTIVITY

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 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 2. BIOLOGICAL THERAPY A – R E V E R S I B L E  HORMONAL (CYPROTERON ACETATE – ANDROCUR MEDROXYPROGESTERONACETATE – DEPO – PROVERA (CYPROTERON ACETATE – ANDROCUR MEDROXYPROGESTERONACETATE – DEPO – PROVERA

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

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