Sexual and gender identity disorders. Sexual dysfunctions: problems with desire, orgasm, function and pain. Always consider medical causes. Don’t say, “Gosh, you have this repressed hostility and that’s why you are impotent.” Well, maybe you have diabetes. Thioridazine, Mellaril. Remember there’s three Board important things about thioridazine or Mellaril. Trazodone. What can trazodone do, or Desyrel? Priapism. Painful erection that you can get with trazodone, which is an antidepressant. In reality, you don’t really see a lot of priapism with that. You’ll see women come in and say, “You know what? I can’t have an orgasm anymore since starting Prozac and this is ruining my relationship.” Or you’ll see women come in and say, “You know, I’m not interested in sex anymore, and this is really okay because I don’t like men. Men are a pain in the butt, I’m not in a relationship and actually it makes my life easier.” Similarly you will see men who will say, “Since I started Prozac it takes two hours for an orgasm, and this is terrible. It’s ruining my relationship. I don’t even want to have sex anymore.” Or you’ll have men come in and say, “You know, sex used to be five minutes and now it’s 35 minutes. Sometimes you will see SSRIs used for premature ejaculation specifically.
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Paraphilias. paraphilias are what used to be called the perversions. Commonly associated with males. Include exhibitionism. Guys like to expose themselves and they get sexually aroused by doing that. Fetishism. This is sort of like where a person is into boots, or leather, or rubber, or something like that. Now people will ask, and patients will ask, “Gosh my husband really likes to see me wear boots. Is that pathology?” and the answer is, not necessarily. It’s pathology when the wife comes in and says that the “Husband likes the boot more than he likes me.” Or, “We can’t just have sex. We can’t just make love. It’s 2 o’clock in the morning and I’ve got to put on those damn boots, otherwise he can’t …” It’s a problem when either the spouse or the partner or the law says it’s a problem. Frotteurism (?): rubbing against a non-consenting partner, like on a subway or an elevator. Obviously that’s always going to be a problem because you’ve got a non-consenting partner. Pedophilia: obviously always a problem, sex with children. That’s always considered pathology. Sexual masochism, “I like to be tied up.” Sexual sadism, “I like to tie my partner up” that’s pathology if it interferes with your relationship or the law. But you know, a lot of people will come in and say, “Yeah, I like to tie my wife up, I like it, she likes it.” Not necessarily pathology. Voyeurism: people will come in and say, “Hey, I like to watch Baywatch. Is that pathology?” No. It’s pathology if you have binoculars and you are looking into your neighbors windows and you are now on probation because of your behavior.
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Transvestic fetishism, what used to be called cross-dressing or transvestism. Paraphilia, not otherwise specified, like bestiality, sex with animals, necrophilia, sex with corpses, and telephone scatologia, making dirty phone calls. Transvestic fetishism is a person, usually a male, classically heterosexual. He likes women and likes to wear women’s clothing.
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