1. Sexuality – normalities and abnormalities Katalin Tolvay MD. DEOEC English Program

2. Sexuality A topic of very great interest Definition of normality and abnormality varies by time and culture (e.g. homosexuality) Dysfunctions are very common High rate of latent morbidity

3. Phases of human sexuality Appetitive stage Excitement stage Orgasmic stage Resolution stage

4. Phases of human sexuality The patterns of response may vary widely between the sexes Desire –males: more goal-oriented, females: more diffuse and emotional drive Women may experience the stages of sexual response in a nonlinear manner Different time of stages in men and women

5. Disorders Dysfunctions Paraphilias Disorders of sexual identity

6. Sexual dysfunctions Primary or secondary Subjective or objective General or situation/partner-linked Total or partial Disorders of each phase Sexual pain disorders

7. Sexual dysfunctions Organic causes: Mental disorders Neurological disorders Cardiovascular disorders Gynaecological/urological disorders Endocrine and metabolic disorders Alcohol, drug, medication related Developmental disorders Infections After medical procedures

8. Sexual dysfunctions Sexual desire disorders (hypoactive sexual desire disorder, sexual aversion disorder) Sexual arousal disorders (erectile dysfunction, female sex. arousal disorder) Orgasmic disorders (female orgasmic disorder, premature ejaculation, delayed orgasm) Sexual pain disorders (dyspareunia, vaginism)

9. Sexual dysfunctions Assessment Very detailed history (semi-structured interview) with both members of the couple Organic causes should be excluded or treated

10. Sexual dysfunctions Clinical management Dual sex therapy (Masters & Johnson) Sensual focus exercises The squeeze technique Couple therapy Psychoeducation Cognitive therapy

11. Sexual dysfunctions Pharmacotherapy: Sildenafil Apomorphin Tadalafil SSRI-s Vacuum pump Surgical implantations Lubricants

12. Paraphilias The object or method of sexual gratification is pathological Prevalence rates unknown Limited treatment options Types: exhibitionism, fetishism, frotteurism, pedophilia, voyeurism, transvestic fetishism, sexual sadism/masochism, other

13. Gender identity disorders Transsexualism Strong and persistant cross-gender identification Persistent discomfort with anatomical sex Sex-changing surgery and hormon treatment.

14. Sleep disorders Katalin Tolvay MD. DEOEC English Program

15. Need for sleep Infancy: 17-18 hours a day, policyclic 3-5 years:diurnal rhythm Adolescence/adulthood: 7-8 hours Elderly: rate reduces, short superficial daily sleeps Great individual differences

16. Functions of sleep Biological function not known Deep sleep: regeneration REM-phase: brain development, cognitive elaboration, memory functions

17. Sleep disorders Dyssomnias 1.Insomnia 2.Hypersomnia 3.Narcolepsy 4.OSAS Parasomnias 1.Pavor nocturnus (sleep terror) 2.Somnambulism (sleepwalking) 3.Nightmares

18. Insomnia Physical (secondary due to physical illness) Physiological Psychological Psychiatric Pharmacological

19. Insomnia Primary or secondary Transient or persistent Often the first symptom of a mental disorder Risks Consequences

20. Insomnia Assessment: History Examination Rating scales Objective tests (lab. tests, polysomnography, sleep lab)

21. Insomnia Treatment options: Sleep hygiene Cognitive- behavior therapy Treatment of primary illness Sleeping pill: non-BZD BZD receptor- agonists (zolpidem, zopiclon, zaleplon) or intermideate half-life BZD (cinolazepam, brotizolam)

22. Insomnia Treatment options: Sedating AD-s (trazodone, mirtazapin, mianserin) Melatonin Long-acting melatonin: Circadin Melatonin agonist: agomelatin