This week, we're taking a look at Sexual and Gender Identity Disorders. It's important that you feel comfortable bringing up the issue of sex with your clients; they may present with feelings of shame, embarrassment, anger or confusion and it's essential that you demonstrate your ability to work with them by introducing sex as an acceptable topic for discussion. Differential diagnosis is one of the most likely forms it will take on the exam.
During an initial appointment, the social worker asks a husband and wife their reasons for seeking treatment. The wife hesitantly tells the social worker that it is because of "bedroom issues." Her husband cuts in and states that approximately a year ago, his wife seemed to lose interest in him sexually and that nothing he has done has been able to change this; he ends by saying, "I think she's having an affair." The wife insists, "I'm not cheating on him! It's not that I don't want to have sex with HIM, I don't want to have sex with ANYONE. I just don't feel that way anymore." What is the most likely diagnosis in this case?
A. Sexual Aversion Disorder
B. Female Sexual Arousal Disorder
C. Hypoactive Sexual Desire Disorder
Sexual and Gender Identity Disorders are broken down into 3 groups: Sexual Dysfunctions (all of the above fall into this category), Paraphilias, and Gender Identity Disorders. With the exception of Pedophilia (which should be pretty easy for most of us to remember), all of the Paraphilias end with "ism", which can help you identify them readily on the test. Sexual Dysfunctions all involve a disturbance in sexual desire or the sexual response cycle which causes marked distress and interpersonal difficulty. Paraphilias are characterized by recurrent, intense sexual urges, fantasies or behaviors that involve unusual objects, activities or situations, and cause significant distress or impairment. Gender Identity Disorders are characterized by strong and persistent cross-gender identification combined with a persistent discomfort with one's assigned sex.
C is the correct answer; Hypoactive Sexual Desire Disorder is characterized by persistent and recurrently deficient (or absent) sexual fantasies and desire for sexual activity (the person does not have the desire to engage in sexual activity). A is not the best answer because Sexual Aversion Disorder is characterized by an extreme aversion or avoidance of all (or most) genital sexual contact. B is not the best answer because Female Sexual Arousal Disorder is characterized by persistent or recurrent inability to attain or maintain the physiological responses associated with sexual arousal. D is not the best answer because Dyspareunia is characterized by genital pain associated with sexual intercourse.
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