Introduction

A disforia de gênero (DG) pode ser entendida como o sofrimento ou desconforto que ocorre quando o sexo biológico e a identidade de gênero de uma pessoa não se alinham.

O interesse pelo assunto aumentou muito na última década no mundo científico. Junto com isso, há um aumento na demanda por serviços especializados em readaptação de gênero, que podem incluir procedimentos irreversíveis para a reatribuição de gênero. Questiona-se a rapidez com que a medicina responde às demandas dos sujeitos que afirmam ser transexuais, com a psicanálise com um dos principais moderadores do tema, pois levanta a discussão sobre a relação entre homofobia e transexualidade.

Objectives

The objective of this article is, based on the approach of a case report about a transgender patient of 18 years, to promote a discussion about gender dysphoria and the medical advances that provide treatment for gender adequacy, as well as to alert to maintain a critical position on the growing demand, suggesting prudence and rigor in evaluations of cases of transsexuality.

Methods

This paper is based on A Case Report

Results

This paper A Case Report

Conclusions

This case brings highlights about challenges and complexities in formulating, treating, and providing services to individuals with combined conditions of mental health changes, especially when when sexuality is placed at the center of the illness process.
Despite the observed growth of specialized services for the care of the transgender public, access is not extended to all who need it, and in the absence of such assistance, transgenders risk seeking clandestine and potentially fatal procedures.

Introduction

Medical trainees represent a young population in which sexual dysfunction should be rare. However, sociocultural differences in the sexual behaviour are important to consider in the assessement sexual health.

Objectives

The aim of this study was to determine the prevalence and factors associated with sexual dysfunction among female medical trainees.

Methods

We conducted an exploratory study among Tunisian medical trainees. Participants were recruited using a convenience sampling by means of medical trainees’ networks. Socio-demographic and sexual features were collected. The sexual function was assessed on female sexual function index (FSFI) scale.

Results

A total of 110 female medical trainees were recruited. The median age was 28 (27; 31) years. The mean age of the first sexual activity was 22.6 ± 3.05 years. Thirty five (31.8%) were married and 78 (70.9%) had a unique sexual partner. Among our participants, 64 (58.2%) had a sexual activity during the last mounth. The prevalence of sexual dysfunction was 45.7%. Sexual desire (Median score = 4.2 (3.6 ; 4.8)) was the most impaired area, followed by orgasm (Median score = 4.4 (2.8 ; 5.2)). A sexual dysfunction was significantly associated with the marital status (p=0.001), partners’ number (p= 0.001) and the frequency of sexual activity (p< 10¯³).

Conclusions

Based on our findings, the sexual behaviour is important to consider for the assessment of the female sexual function among doctors in training. All these features deserve further study in order to introduce necessary preventive measures.

Introduction

Cannabis has a reputation for enhancing sexual function. Several surveys in the 1970s found that both men and women reported that using cannabis enhanced their sexual experience (Dawley HH, 1979).

Objectives

To present a non systematic review on cannabis use as a sexual performance enhancer; to report a case about a paraplegic patient, diagnosed with cannabis induced psychosis.

Methods

Brief review of the english literature published using the Pubmed® database. Key-words: “cannabis and sexual health”; "cannabis and sexual performance enhancement”; “cannabis use and sexual function”. Articles were selected based on the content of the abstract and its relevance. For the case report, information was provided by the patient and clinical records.

Results

We report a case of a 41 years old man, paraplegic after a motocycle accident, with no previous psychiatric history, that goes to the emergency service reporting auditory alucinations, persecutory delusional ideation and self delusional reference after starting to smoke cannabinoids in an effort to enhance his sexual performance. He refers increased libido and increased tactile sensitivity with cannabinoids use, resulting in enhanced sexual pleasure and satisfaction.

Conclusions

There are various hypotheses for why people report cannabis-related enhancement of sexual experiences including the effect of cannabis on heightened perceptions, time distortion, relaxation, and decreased inhibition. However, in recent studies there appears to be more conflict among the results in this research area. Men report both facilitatory and incapacitating effects of their cannabis use. Specifically for paraplegic patients, few relevant studies could be found in our research.

Introduction

This study surveys patients with schizophrenia or schizoaffective disorder, to understand the relationship between sexual function and treatment with antipsychotic medication.

Objectives

The study compares patients on single versus multiple antipsychotics as well differences between first and second generation agents.

Methods

Patients diagnosed with schizophrenia or schizoaffective disorder are eligible. Once patients are evaluated to ensure they meet enrollment criteria and are consented, they are administered the Positive and Negative Syndrome Scale (PANSS), Abnormal Involuntary Movement Scale (AIMS), and either the International Index of Erectile Function for men, or the Female Sexual Function Index for women. Inclusion criteria include age 18-65, able to participate in a structured interview, fulfill DSM-IV criteria for Schizophrenia or Schizoaffective disorder, and on stable doses of one or more antipsychotic medications for at least six weeks. Exclusion Criteria include patients taking Selective Serotonin Reuptake Inhibitors (SSRIs), and inability to provide informed consent.

Results

Patients taking typical antipsychotic had marginally worse score on sexual function scale. Patients taking multiple antipsychotics scored better on the sexual function scales. Those on prolactin-sparing agents tended to rate sexual function as higher. Clozapine was associated with more sexual dysfunction compared to other antipsychotics. No trend noticed between PANSS scores and sexual dysfunction. No trend noticed related to AIMS scores.

Conclusions

There is high prevalence of sexual dysfunction in schizophrenic patients. Prolactin sparing agents are associated with less sexual dysfunction. There is an advantage to the use of atypical antipsychotics.

Introduction

Since the concept of sexual addiction was first introduced in the 1970's, two schools of thought have emerged amongst sexologists and mental health providers regarding whether hypersexual behavior should be characterized as an addiction, or if it is part of a co-existing psychiatric disorder. The objective of this study is to help clarify this debate.

Objectives

To determine whether hypersexual behavior can appropriately be characterized as an addiction, or rather, a symptom or manifestation of a co-existing psychiatric disorder.

Methods

A literature review was conducted to explore these opposing viewpoints. Articles published from the year 2000 to present relating to the topic of sex addiction, hypersexuality, sexual compulsivity/impulsivity were reviewed to determine whether or not hypersexual behavior can be characterized as an addiction or if it can only co-exist with a current psychiatric disorder.

Results

From a biological standpoint, there are neurochemical changes associated with hypersexual behavior: the limbic system is activated in a manner similar to the reward system in drug addiction. At the same time, sex "addicts" can experience a psychological withdrawal as experienced by those addicted to cocaine or amphetamines.

Conclusions

Despite standard, and even increasing use of the term "sex addiction" in media and popular culture, mental health professionals remain divided in regards to this subject. The proposed inclusion and subsequent rejection of hypersexual disorder in DSM-V highlights this existing debate. The notion of hypersexual behavior as an addiction warrants further exploration, especially since how it is defined may dictate treatment modality.

Introduction

Antipsychotic-related hyperprolactinemia (HPRL) is frequently associated with physical health issues and sexual dysfunction but unfortunately underreported.

Objectives

To evaluate the association of treatment with different antipsychotics and chronic Iatrogenic hyperprolactinemia on patient’s physical health, safety and sexual dysfunction.

Methods

Cross-sectional descriptive and observational study. Lab samples, physical measures, UKU Scale, PRSexDQ_SALSEX to measure sexual dysfunction and blood prolactin levels were obtained after two years of treatment. Fifty patients (62% men) aged 45.84 ± 10.85 years in treatment with antipsychotics (aripiprazole, olanzapine, paliperidone and risperidone) were recruited. Fifty-six percent (n=28) showed normal prolactin levels < 20 ng/ml, 30% (n = 15) mild hyperprolactinemia (PRL level 50-100 ng/ml) and 14% (n=7) severe hiperprolactinemia (PRL levels >100 ng/ml).

Results

Patients without HPRL (aripiprazole 80%) showed somnolence (70.4%), asthenia (60.7%,), difficulty in concentration (57.1%,) and weight gain (25%) while patients with HPRL (paliperidone and risperidone) showed asthenia (72.7%) restlessness (59%) and weight gain (59%). There were significant differences in lower values of FSH (p-value = 0.004), LH (p-value <0.001) and testosterone (p-value <0.001) in the hyperprolactinemic group. Two patients showed amenorrhea in the HPRL group (0 with normal PRL). Patients with HPRL, 81% showed decreased sexual desire (21.4% with normal PRL), 36% erectile dysfunction (21.4% with normal PRL), 45% orgasmic dysfunction (14% with normal PRL) and 22.7% of females showed vaginal lubrication dysfunction (0% with normal PRL). Low values of testosterone correlated with sexual arousal problems (p-value = 0.027).

Conclusions

There was a relationship between HPRL and some physical symptoms, weight increase and sexual dysfunction.

Introduction

Sexual functioning is of special importance in an assesment of the mental status. Psychiatrists, while exceptionally skilled in making general clinical assessments and in eliciting psychopathology during the psychiatric interview, appear not to be nearly as relaxed nor confident in their ability to respond to sexual complaints.

Objectives

This cross-sectional study was designed to determine the prevalence of sexual data gathered by psychiatrists during their assessment of patients at hospital admission.

Methods

We reviewed medical histories from 202 patients hospitalized in our acute inpatient unit over a period of 6 months. Our study variables were diagnosis, age, gender, martial status, and psychopharmacotherapy.

Results

Our results revealed that assessment of sexual functioning was omitted in all medical history examinations. Only in one case of male patient, sexual side effects of neuroleptic medication were mentioned, but the patient was not questionned about them.

Conclusions

As sexual history taking was omitted in all 202 patients, establishing links with the variables represented in this study was impossible. Our results lead us to theorize that in addition to being often overlooked in clinical assesments, sexual complaints may be considered of secondary importance in the acutely ill population. To expand the scale of this research it will be necessary to determine the prevalence of sexual data gathering in outpatient and day care units, as well as survey psychiatrists to capture the interpersonal dimension of taking a sexual history.

Introduction

Rape trauma is particularly traumatic when compared to other forms of trauma. PTSD is one of the most frequent mental disorders found in assault victims. The lifetime prevalence of sexual-assault-related PTSD (SAR-PTSD) can be as high as 50% among victims and its profile has been under recent study.

Objectives

We aim to present the main characteristics of SAR-PTSD, including differences between gender, severity of symptoms and comorbid disorders.

Methods

A selective literature review was conducted using the PubMed and ResearchGate databases, using combinations of the following keywords: “sexual assault”, “rape”, “PTSD” and “sexual related PTSD”.

Results

Sex and gender: The majority of the victims are women while the perpetrators are usually male. Sexual assault predicts SAR-PTSD for both genders. Women have a higher risk of developing SAR-PTSD than men, but men are generally less likely to disclose being raped.

Symptoms Severity: Factors like completed rape, physical injury and life threat interact synergistically in predicting SAR-PTSD risk. Less education, greater perceived life threat, and receipt of more negative social reactions (stigma) upon disclosing assault were related to greater symptom severity. Perceived control over trauma recovery is related to fewer SAR-PTSD symptoms.

Comorbid Findings: Patients with SAR-PTSD are at greater risk of developing a comorbid substance use disorder and show higher symptom severity and poorer treatment outcomes compared to patients with either disorder alone.

Conclusions

The distressingly high rate of SAR-PTSD in survivors of sexual assault is a clear indication for further support to these patients. Future studies with sexual assault male victims are a pressing necessity.

Introduction

Sexuality encompasses both psychological and physical aspects and is highly influenced by religious and cultural particularities of our society. The impact seems particularly strong when it comes to female sexuality.

Objectives

Our aim was to identify the attitudes, beliefs, and knowledge on female sexuality in the Tunisian adolescent and young-adult population

Methods

A cross-sectional university-based survey was conducted in September 2014 in the Cap-Bon, a peninsula in northeastern of Tunisia. A sample of 100 students was recruited using a self-administered questionnaire. Demographic characteristics, sexual life data, and knowledge on the physical and psychological aspects of female sexuality were assessed.

Results

The sample was formed of 58% of males with a mean age of 19.8 years. The majority lived in urban environments and only 40% were sexually active. Half of the students reached the threshold of 50% of correct answers. The majority of participants lacked knowledge on the anatomy of women’s external genital organs, female orgasm and women’s role during sexual intercourse. Contraception’s role in the dissociation between pleasure and reproduction was not acknowledged by half of the students. On the other hand, preliminaries were accepted by the majority. Gender, sexual activity, level of study and living environment didn’t statistically impact the results.

Conclusions

Knowledge on female sexuality appears to be limited among young people in Tunisia underlying the necessity of a national sex-education program.

Introduction

Tourette Syndrome (TS) is a chronic disorder characterized by tics. The Diagnostic and Statistical Manual of Mental Disorders lists the most used criteria, and focuses on these motor and vocal phenomena. However, patients may have other associated features or comorbidities: impulsivity, depression, anxiety, obsessive-compulsive disorder, attention-deficit hyperactivity disorder, among others. We present the case of a patient who was hospitalised for two weeks and explore his psychopathology.

Objectives

Discuss the psychopathology and comorbidities of TS through the analysis of a clinical case.

Methods

Description of the case and literature review using Pubmed.

Results

We present the case of a 34-year-old male who was admitted at our Acute Inpatient Ward due to depressive symptoms along with anxiety, suicidal ideation and hetero-aggressive outbursts. He had been diagnosed in infancy with Tourette syndrome, but in adulthood had poor treatment and follow-up adherence. Exploration of the history led to an understanding of the development of depressive symptoms, and other problems were gradually unearthed as well. His tics were predominantly motor, and was impulsive is his actions, being unable to keep up a regular job. He also had a fetishistic disorder: he had no sexual encounters with women, deriving sexual excitement and pleasure from the observation, recording (through photographs) and cataloguing of women’s nails. This was a growing encumbrance in the family and in the patient’s life, leading to discordance.

Conclusions

Tourette is a neuropsychiatric syndrome that encompasses more than just tics. Being able to understand the various shades of this disorder is useful to adequately help these patients.

Introduction

Help-seeking for sexual dysfunctions relies on various factors. But, there is a scarcity of evidence.

Objectives

To identify the factors having a role on help-seeking behavior among patients with sexual dysfunctions in the context of a developing country.

Methods

This cross-sectional, qualitative study was done using purposeful sampling among the patients of sexual dysfunctions attending the psychiatry outpatient department of Bangabandhu Sheikh Mujib Medical University (BSMMU). Based on data saturation, 18 in-depth interviews (IDI), 2 key informant interviews (KII) and 1 focus group discussion (FGD) with 4 participants were performed after taking proper consent. Interviews were audio-recorded, then transcribed and analyzed manually using the thematic analysis method. Deviant cases were critically explored and explained in a separate theme.

Results

Most participants were male, 20-35 years of age, literate and urban. Premature ejaculation and female sexual interest/arousal disorder were the most common. The identified factors were classified into 3 major classes- disease and treatment factors, psychological factors, and social and cultural factors. Perception of severity impelled in early help-seeking, while the duration of illness and lack of improvement led to seeking help from various sources. Educational background, habitat, gender, social beliefs, advice given by others, fear of upcoming marriage and relationship problems were also found as important factors. Previous awareness and sexual misconceptions among the participants and their advisors played a pivotal role.

Figure 1: The factors having role on help-seeking behavior

Conclusions

This study will help to develop a service delivery system for sexual dysfunctions patients in the context of a developing country.

Introduction

Attention deficit hyperactivity disorder (ADHD) is a neuropsychiatric condition that causes a range of symptoms, including hyperactivity, difficulty paying attention, and behavioral problems. Sexual functioning is one of the areas that’s less investigated. Probably due to the impulse and novelty seeking behavior characteristic of this disorder, adolescence were found to have an early initiation of sexual activities, more sexual partners and a more risky sexual behavior. However, there’s growing interest in the impact that the symptoms of ADHD have in the sexual functioning in adult ADHD patients.

Objectives

Understanding the impact of ADHD symptoms in sexual function and health in adult patients population

Methods

literature search in Sexual Medicine and Adult ADHD publications.

Results

There´s a scarcity of studies concerning this topic. However, it is believed that the distractedness and inattentiveness may result in decreased sexual arousal and orgasmic problems. Inner restlessness may be relieved by frequent masturbation and results in hyper-sexuality. Psychiatric comorbid disorders, which are highly prevalent in ADHD, and their psychopharmacological treatment may also lead to an increased prevalence of sexual dysfunctions and other sexual disorders in ADHD. In studies, it was found that the prevalence of sexual dysfunctions in ADHD group was significantly higher than control group, with an impact on sexual satisfaction.

Conclusions

It seems that the adult ADHD population is in greater risk of presenting difficulties in sexual functioning. So, screening for sexual disorders should be considered in this population.

Introduction

Pelvic organ prolapse represents a public health problem due to its high prevalence from 2,9 to 11,4 % (Lousquy and., 2009). The laparoscopic promontofixation has become since few years a gold standard treatement for pelvic organ prolapse in the population of young active women (Coksuer and al.2011). Few are the studies that showed the short and long term impact of this treatement on both sexuality and quality life.

Objectives

To evaluate the impact of laparoscopic promontofixation on sexuality and healthrelated quality of life and sexuality

Methods

A study was carried out including 30 women presented with at least stage 2 pelvic organ prolapse (Baden and Walker) who underwent laparoscopic promontofixation. Sexual function and health-related quality of life were evaluated using the Pelvic Incontinence Sexual Questionnaire (PISQ-12) and the Pelvic Floor Impact Questionnaire (PFIQ-7), respectively.

Results

The patients’ mean age was 58.1 ± 7.2 years. The anatomical success rate (stage 0 or 1) was 100% at 3 months and at the moment of the study with a mean follow-up of 37 months (36—48 months). PISQ-12 and PFIQ-7 scores were significantly improved at the moment of the study (P < 0.001 and P = 0.001, respectively)

Conclusions

Laparoscopic promontofixation improves sexuality and quality of life at short and medium terms.

Introduction

In Tunisia, traditions of marriage are still preserved by certain regions of the country : the taboo of sexuality and the requirement of the preservation of virginity until marriage mark the Tunisian mentality till this day.

Objectives

To discuss the impact of the Tunisian culture related to marriage on the precipitation of psychotic disorders in the bride.

Methods

A case report and a review of litterature via PubMed using the terms : « nuptial, psychosis, bride, sexuality».

Results

A 31-year-old woman with no personal desease, developped a mutism, refusal of food and heteroagressiveness since the day after the wedding.

The wedding party went well and it was consumed on the first night without any real incidents, yet, Ms. H was very anxious about the loss of her virginity and especially because of the low bleeding she had.

The day after the wedding day, the bride was especially worried because of the presence of her family waiting in front of the bedroom to see the the blood-stained sheet : proof of the virginity of their daughter and the virility of the husband. In fact, incertain of the reaction of the family, the patient left her house early without informing her husband and was found by the police. Later, she developped an incoherent speech, audio-visual hallucinations and delusions against those around her.

Conclusions

In Tunisia, despite the progress made in terms of equality betwen men and women, women's sexuality still suffer from certain taboos.

Marriage seems to be decisive in the emergence of psychiatric disorders, particularly psychotic ones.

Introduction

Not only gender identity disorder is often accompanied by mental illnesses, but vice versa: there are higher rates of homosexuality and cross-sexual behavior in people with mental illnesses compared to general population. Understudied is the question how gender identity depends on certain diseases and pathological features?

Objectives

This study seeks to address how gender identity is affected in patients with mental illnesses.

Methods

The sample consisted of 80 patients, 44 women and 36 men with aged 16-29 with schizotypal disorder, histrionic personality disorder and schizoid personality disorder. Their gender self-identity matched biological sex. The structure of gender identity was measured by adapted version of Bem Sex-Role Inventory, projective drawings.

Results

Almost half (46,1%) of schizotypic patients demonstrated opposite gender identity according to projective drawings. That highly correlated with results of Bem inventory (r=0,658; sig=,001). They had higher anxiety (χ²=8,234; df=2; p=,004) and more sexual problems (χ²=5,733; df=2; p=,033), than such patients whose projected gender identity matched their biological sex. In addition, an undifferentiated type of identity associated with extreme disadaptation was detected in 23% of these patients. Inverted gender identity was rarely met among patients with personality disorders. Most of them (65,7%) had accordingly masculine and feminine types. Although androgenic gender identity was found only in 15,5% cases whereas in general population it rates circa 80% and is connected to higher adaptation potential.

Conclusions

This study demonstrates how gender identity is transformed in mental illnesses and is connected to general psychological problems, such as anxiety, sexual problems, disadaptation.

Introduction

Cardiologists play an important role in assisting cardiac patients who experience sexual dysfunction to learn how to live with their disability and return to normal sexual activity. Therefore, it is necessary that cardiologists assess these problems in this group of patients.

Objectives

The aim of the present study was to evaluate the attitudes and performance of cardiologists regarding sexual issues in patients with cardiovascular diseases.

Methods

A nationwide survey was conducted in a sample of cardiologists, representative of Iranian cardiologists, in 2015. Appropriate questionnaires were developed and used to ask participants about their attitudes, performance, and barriers regarding discussing sexual issues with patients with cardiovascular disease.

Results

The study population consisted of 202 cardiologists with a mean age of 44.25 years (SD = 8.45). Overall, 93.15% of cardiologists agreed with the importance of discussing sexual issues with their patients. Almost 76.7% of cardiologists agreed they had a responsibility to deal with patients' sexual problems, and 79.9% of them were aware of the association of cardiovascular disease with sexual problems of cardiac patients, but only 33% of them were confident in their knowledge and skills in this regard. Only 10.6% of cardiologists reported they frequently or always assessed sexual problems with their patients, but 51.50% of them stated they were responding to patients' questions about sexual problems. There was a significant association between performance and responsibility.

Conclusions

The results of this study indicate a gap between cardiologist's attitudes and their actual performance.

Introduction

Vaginismus may represent a physical manifestation of an underlying psychological problem, which makes it indispensable to understand its origin and the affected women’s perception.

Objectives

The aim of our study was to investigate the psychosomatic profile of pregnant patients suffering from vaginismus and the difficulties in management.

Methods

We interviewed 20 pregnant patients with vaginismus who presented at our obstetric emergency department between October 2016 and March 2017. Included patients were interviewed by one expert psychiatrist and gynecologist. All interviews were conducted using a standardized questionnaire. In order to determine the patients’ anxiety and depression level, the State-Trait Anxiety Inventory (STAI), Form Y-A and B was used.

Results

We were able to include 20 pregnant patients with vaginismus out of 540 patients (3,7%). In 85% primary vaginismus was diagnose, whereas in 15% it was secondary. Mean age was 25.6 years, socio-economic status was average in 90% and most women showed a high level of education (50% university degree). All women described a feeling of anxiety and anger immediately before sexual intercourse. Within our study population, 40% of women have never sought medical consultation regarding their vaginismus before. In none of the women, any physical cause could be identified for their vaginismus. 25% reported irregular follow-up visits with subjectively bad experiences during attempts of vaginal examinations. Cesarean section was chosen due to their vaginismus in 75%.

Conclusions

Pregnant women with vaginismus are at risk of non-follow-up during their pregnancy due to underlying feelings of shame and experienced lack of understanding by medical staff.

Introduction

Intersex variation is a morphological and physiological anomaly where an individual is born with congenital conditions in which development chromosomal, gonadal, or anatomical sex is atypical. So, the reproductive organs differ from those typically associated as being male or female.The incidence of genital anomalies is estimated to occur in 1 in 4,500 live births. Each intersex condition is determined by the external genital appearance, internal genital structures, and fertility potential.

Objectives

To do a review of the literature about this issue.

Methods

We have done a review of the literature using Pubmed as a source.

Results

Intersex disorders are rare congenital malformations with over 80% being diagnosed with congenital adrenal hyperplasia.

It can be challenging to determine the correct gender at birth and a detailed understanding of the embryology and anatomy is crucial. Evidence shows that endocrine-disrupting chemicals in the environment can cause reproductive variation through dysregulation of normal reproductive tissue differentiation, growth, and maturation if the fetus is exposed to them during critical developmental times in utero. Historically, the incidence and prevalence in intersex have been difficult to quantify as few studies have been conducted classifying the numerous physical presentations of Intersex or quantifying specific intersex conditions at birth.

Surgical correction techniques have been developed and can provide satisfactory cosmetic and functional results. The discussion of the management of patients with intersex disorders continues.

Conclusions

Management of intersex conditions is complex and involves a person's gender identity, gender role behavior, sexual orientation, sexual functioning, and psychological adjustment.

Introduction

The origin of the word gender came from the Old French "gendre" that meant “kind, sort, genus.” Gender dysphoria according to Diagnostic and Statistical Manual of Mental disorders is defined as a “marked incongruence between their experienced or expressed gender and the one they were assigned at birth.”

Objectives

To do a review about this issue.

Methods

Pubmed was used as a bibliographic source

Results

Nineteenth and 20th century theories of gender variance and views of appropriate treatment were pathologizing and highly stigmatizing to transgender people. Today's mental health professionals should be familiar with the history in this area as it is not unusual for gender-variant patients to have apprehensions about seeking mental healthcare or to raise questions about their providers' views and approach to treatment considering that history.

Transgender health advocates have worked to address societal discrimination against transgender people, including stigmatization of identity, discrimination in schools, workplaces, and healthcare, and to improve access to care.

Surgical correction techniques have been developed and can provide satisfactory cosmetic and functional results. The discussion of the management of patients with intersex disorders continues.

Conclusions

It is important to have a basic understanding of how to conduct an initial consultation of gender dysphoria even if it is an uncommon presentation in general practice. Management should be individualised and may involve a combination of social work, education, counselling, hormone therapy and surgery.

Introduction

Male hypoactive sexual desire disorder (MHSDD), part of a cluster of other sexual dysfunction diagnoses and emerged as a reformulated entity in the DSM-5, is defined as a persistent or recurrent deficiency of sexual thoughts or fantasies and desire for sexual activity that causes either significant distress or interpersonal difficulty.

Objectives

To review the state of knowledge about MHSDD.

Methods

A non-systematized review of the literature was performed.

Results

MHSDD is associated with changes in quality of life measures, with a particular number of those affected experiencing some psychiatric comorbid conditions like mood or anxiety problems. Although estimated as a common problem it is difficult, as a frequently undiagnosed condition, to define with more accuracy its prevalence rates.

Conclusions

MHSDD presents as a complex clinical entity that should require a careful evaluation where often multiple possible explanations need to be explored. Treatment for low sexual desire in men should be etiologically oriented and its comorbid conditions should also be addressed.

Introduction

Hipersexuality Disorder is being conceptualized in diverse ways, such as a sexual addiction, sexual compulsivity and sexual impulsivity.The proposed criteria for the DSM-5 characterize Hypersexual Disorder as a repetitive and intense preoccupation with sexual fantasies, urges, and behaviors, leading to adverse consequences and clinically significant distress or impairment in social, occupational, or other important areas of functioning. This approach follows a addiction model for the etiology of this disorder. Other authors have proposed an ABC model (Stein, 2008), which includes affective dysregulation, behavioural addiction and cognitive dyscontrol, creating a integrative theory explanatory for this disorder etiology. Boredom is considered a transitory affective/psychological state, to what some individuals may be more prone to, and can have a role in this model. Some authors' contruct proposal of hipersexuality posits boredom as an important dysphoric mood state triggering hypersexual behavior.

Objectives

This work aims to review the literature regarding the hypothesized correlation between boredom and hipersexuality.

Methods

Review of the literature and research studies published until 2019, using Pubmed and Google Scholar using key-words: hipersexuality, boredom, sexual addiction, sexual compulsivity, sexual impulsivity.

Results

Most studies showed a positive association between hipersexual behavior and boredom.

Conclusions

Hipersexuality Disorder can be explained through several factors and scientific community has not yet reached a conclusion. Regarding boredom, current literature identifies a link between it and hipersexuality. Although, further research is needed to better clarify and understand the relationship between the two concepts and other factors regarding hipersexuality etiology.

Introduction

Ovotesticular Disorder of Sexual Development (DSD) refers to an extremely rare form of DSD, where adult gender identity is unpredictable and variable at birth and may evolve as the child grows.

Objectives

To review the literature regarding Ovotesticular DSD, gender atribution and gender dysphoria and reflect in how medical attitudes can impact patient’s life’s.

To present a clinical case about an individual with 46 XX karyotype and with Ovotesticular DSD, which was surgically interventioned twice, so her phenotype could match with her genotype. Afterwards presenting symptoms of gender dysphoria.

Methods

Review of the literature, using Google Scholar and Pubmed with the keywords: ovotesticular, DSD, gender dyshoria, medical intervention.

Results

Data from small case series suggests that patients reared in either sex can be satisfied with their sex assignment, but gender dysphoria also may occur. The clinical case is about a 16 years old adolescent with 46XX karyotype and born with bilateral female and male gonads. It was decided by the medical team and her parents for the removal of dysgenetic gonads in early chilhood and for a vaginoplasty when she was 14 years old. From two years now, she has described what seem to be a case of Gender Dysphoria.

Conclusions

Adult gender identity is difficult to predict in Ovotesticular DSD and therefore consensus and DSD advocacy groups have recommended that genital surgery be deferred until the child is old enough to confirm his or her gender identity. Medical intervention should be weighed very careful, unless it can be warmful.

Introduction

Paraphilias characterize unusual sexual behaviors and desires and the data on how to treat paraphilias in the general population is limited.

Objectives

To describe how data derives from online communities of people with paraphilias can improve hospital-based care for paraphilias.

Methods

This study aggregates data from past research on digital communities of people afflicted by zoophilia, pedophilia, and BDSM to illustrate the unique needs of these patients.

Results

The longitudinal studies of zoophilia, pedophilia, and BDSM online communities showed that there is an overwhelming lack of resources available to people with paraphilias. The majority of the patient are distrustful of providers and fear legal consequences for their sexual interests. Online forums serve as a platform for connecting with others, seeking health advice, and sharing coping strategies for unusual sexual attractions. Rarely any participant has used these discussion sites to meet in person with other people affected by the same paraphilias. Most participants share similar concerns and most (over 80%) report feeling lonely. Online forums offer an insight into the minds of people with paraphilias who have never been hospitalized or psychiatrically treated. This information may help especially inexperienced providers to learn the psychology of paraphilias and to inform health promotion strategies, using the internet as a medium for disseminating health advice.

Conclusions

Paraphilias affect very few individuals and available psychiatric treatments are so stigmatizing that most people choose to seek support online instead. We may use online discussion forums as a way to study and offer support to those struggling with unusual sexual attractions.