PS9.1-2 | Psychosexual Health — Graded Quiz

Correct. Navtej Singh Johar v. Union of India (2018) was the five-judge Constitutional Bench judgment that read down Section 377 IPC to decriminalise consensual sexual acts between adults of the same sex. The Court held that criminalising consensual adult same-sex intimacy violated Articles 14 (equality), 15 (non-discrimination), 19 (freedom of expression), and 21 (personal liberty and dignity). Transgender rights recognition was the subject of NALSA v. Union of India (2014).

Navtej Johar 2018: Section 377 read down — consensual adult same-sex acts decriminalised. NALSA 2014: third-gender recognition. Know both dates and holdings precisely.

These are two distinct landmark judgments: NALSA 2014 = transgender rights (third gender recognition, self-identification). Navtej Johar 2018 = decriminalisation of consensual adult same-sex acts (read down Section 377). Every psychiatrist must cite both correctly.

Correct. The hallmark features of male HSDD are persistently absent sexual fantasies and desire causing clinically significant distress or interpersonal difficulty, in the absence of an organic cause. Normal testosterone, prolactin (rules out hyperprolactinaemia), and thyroid function point to a psychosexual rather than endocrine aetiology. This is a desire-phase disorder; the patient has not complained of erection or ejaculation problems.

Male HSDD: absent desire/fantasy + distress + normal hormones = psychosexual. Always exclude testosterone deficiency, hyperprolactinaemia, hypothyroidism organically before diagnosing psychogenic HSDD.

The core complaint is absent sexual desire and fantasy — a desire-phase problem. Erectile dysfunction is an arousal-phase disorder (ability to achieve/maintain erection). Premature ejaculation and inhibited orgasm are orgasm-phase disorders. Normal hormone profile makes an endocrine cause less likely, pointing to psychosexual male HSDD.

Correct. The patient's depression is the clinical problem requiring treatment. His sexual orientation is not a disorder and requires no intervention. The ethical mandate is to treat the presenting illness (depression) using evidence-based methods. ICD-11 abolished ego-dystonic sexual orientation entirely — it cannot be diagnosed. Conversion therapy is condemned by WHO, WPA, and IPS as harmful and ineffective. Psychoeducation — with the patient's consent — can help address the family's misconceptions. Family pressure alone does not constitute a treatment indication.

Treat the depression. Do not treat the orientation. ICD-11 has no ego-dystonic category. Conversion therapy = always refused. Psychoeducation with consent is the family intervention.

Sexual orientation is not a mental disorder under ICD-11. Conversion therapy is unconditionally condemned. Ego-dystonic sexual orientation was removed from ICD-11 entirely. The only appropriate actions are: treat the depression; educate the patient about the absence of pathology; and, with consent, educate the family. Family pressure is never a treatment indication for orientation change.

Correct. Helen Singer Kaplan's triphasic model describes Desire → Arousal → Orgasm. This was a significant refinement of Masters and Johnson's four-phase model (Excitement → Plateau → Orgasm → Resolution) because Kaplan recognised desire as a distinct psychological phase that precedes and motivates the physiological arousal response. The triphasic model underpins the classification of sexual dysfunctions by phase in ICD-11.

Kaplan triphasic: Desire → Arousal → Orgasm. Masters & Johnson four-phase: Excitement → Plateau → Orgasm → Resolution. ICD-11 uses Kaplan's framework to classify dysfunctions by phase.

Kaplan's triphasic model: Desire → Arousal → Orgasm. Option D describes Masters and Johnson's four-phase model, which does not include desire as a separate phase. Kaplan's addition of the desire phase was clinically significant — it allowed classification of HSDD as distinct from arousal and orgasmic disorders.

Correct. ICD-11 moved gender incongruence from the mental disorders chapter to Chapter 17 (Conditions Related to Sexual Health). The rationale was explicitly stated: being transgender is not a mental illness; the classification is retained to ensure healthcare access (e.g., hormonal therapy, surgical care, psychological support) can be authorised and reimbursed. DSM-5-TR retains 'Gender Dysphoria' as a category but emphasises that the distress (dysphoria), not the identity itself, is the clinical focus.

Gender incongruence (ICD-11): Chapter 17, not mental disorders. Retained for healthcare access. Being transgender is not a mental illness. The identity is not the disorder; distress from incongruence may require support.

ICD-11 deliberately relocated gender incongruence OUT of mental disorders and into Chapter 17. The purpose is to preserve access to gender-affirming care without pathologising the identity. Gender incongruence still appears in ICD-11 (option D is wrong) — for healthcare access, not pathology. Being transgender is not a mental illness.

Correct. Sensate focus is a foundational sex therapy technique developed by Masters and Johnson. It uses a graded programme of non-demand, non-goal-oriented pleasuring exercises starting with non-genital touching (Phase 1), progressing to genital touching (Phase 2), and eventually to intercourse (Phase 3). By removing performance pressure ('non-demand'), it breaks the anxiety-failure cycle underlying many psychosexual dysfunctions. It is useful across erectile dysfunction, female arousal disorder, HSDD, and orgasmic difficulties — wherever performance anxiety is a maintaining factor.

Sensate focus = graded non-demand pleasuring to break performance anxiety cycle. Developed by Masters and Johnson. Applicable across psychogenic erectile, arousal, and orgasmic disorders.

Sensate focus is a behavioural sex therapy technique for performance-anxiety-driven dysfunction, not for organic causes like hyperprolactinaemia. Vaginismus treatment uses graduated vaginal dilators (systematic desensitisation applied vaginally) plus relaxation, not sensate focus primarily. The stop-start and squeeze techniques are specific to premature ejaculation control.

Correct. This documentation is multiply wrong: (1) Homosexuality is not a disorder — it cannot be 'noted' as a clinical finding requiring action. (2) Ego-dystonic sexual orientation does not exist in ICD-11 — it cannot be a referral diagnosis. (3) The patient neither expressed distress about her orientation nor requested any intervention — an unsolicited referral for orientation change violates her autonomy, dignity, and rights under MHCA 2017 and NALSA 2014. The psychiatric problem requiring attention is the panic disorder.

Sexual orientation disclosed in clinical context ≠ clinical finding requiring treatment. Document the presenting disorder only. Unsolicited conversion referral = ethical violation. ICD-11 abolished ego-dystonic sexual orientation.

This documentation violates multiple standards: ICD-11 (homosexuality not a disorder; ego-dystonic orientation abolished), MHCA 2017 (dignity and non-discrimination), and NALSA 2014 (right to self-identify). The treating diagnosis is panic disorder. Sexual orientation is a matter of identity, not pathology, and the patient expressed no distress about it.

Correct. SSRIs delay ejaculation as a consequence of their serotonergic action — serotonin inhibits ejaculation via 5-HT2C receptor activation. Dapoxetine is a short-acting SSRI specifically approved for on-demand use in premature ejaculation (taken 1-3 hours before intercourse). Paroxetine and sertraline are used daily off-label with proven efficacy. Sildenafil addresses erectile dysfunction (arousal phase), not ejaculation. Testosterone treats hypogonadal HSDD. Alprazolam may reduce anxiety but has addiction liability and is not a recommended PE treatment.

PE pharmacotherapy: SSRIs (dapoxetine on-demand; paroxetine/sertraline daily off-label) — delay ejaculation via 5-HT2C agonism. Always combine with behavioural techniques (stop-start, squeeze) for best outcomes.

SSRIs (dapoxetine on-demand, or daily paroxetine/sertraline off-label) are the pharmacological mainstay for premature ejaculation, exploiting their ejaculation-delaying serotonergic effect. Sildenafil is for erectile dysfunction. Testosterone is for hypogonadal desire disorder. Alprazolam is not recommended for PE.

Correct. MHCA 2017 Section 18 guarantees every person with mental illness the right to non-discriminatory mental healthcare and treatment, with dignity, and free from cruel, inhuman, or degrading treatment. This provision is directly applicable to LGBTQA+ patients, prohibiting misgendering, pathologising of identity, and discriminatory attitudes in clinical settings. MHCA 2017 also protects confidentiality (Section 23) and advance directives (Section 5), and permits treatment refusal with important safeguards.

MHCA 2017 Section 18: right to non-discriminatory treatment with dignity, including freedom from cruel/inhuman/degrading treatment. Directly protects LGBTQA+ patients from discriminatory clinical encounters.

MHCA 2017 Section 18 guarantees non-discriminatory, dignified care to all persons with mental illness, regardless of their sexual orientation or gender identity. This right is not limited by setting, hospitalisation status, or clinical context.

Correct. HSDD is multifactorial and requires a multimodal approach: (1) Psychoeducation and normalisation — reducing shame and unrealistic expectations; (2) Psychological/sex therapy — CBT targeting negative cognitions about sex, desire, and self-image; sensate focus to reduce performance pressure; (3) Relationship factors — partner communication, intimacy, unresolved conflict; (4) Hormonal evaluation — rule out low testosterone (in postmenopausal women), hyperprolactinaemia, hypothyroidism. PDE-5 inhibitors address arousal (blood flow); they do not treat desire. Progressive dilators are for vaginismus.

HSDD treatment: multimodal — CBT/sex therapy + psychoeducation + relationship work + hormonal evaluation. No single pharmacological agent is first-line. PDE-5 inhibitors are for arousal-phase disorders, not desire-phase.

HSDD management is inherently multimodal. PDE-5 inhibitors address arousal-phase blood flow — they do not treat desire. Progressive dilators are for vaginismus. HSDD requires CBT-based sex therapy, relationship work, psychoeducation, and hormonal evaluation for organic contributors.