Assignment: Case Analysis in Rare Sexual Medicine Conditions

Overview

This assignment invites students to apply clinical reasoning, treatment planning, and biopsychosocial assessment skills to rare sexual medicine conditions covered in the textbook.
Students will receive three clinical vignettes, each inspired by cases and syndromes described in Textbook of Rare Sexual Medicine Conditions (e.g., Penile Dysmorphic Disorder, Post-SSRI Sexual Dysfunction, Persistent Genital Arousal Disorder, etc.).

Students will choose two of the three vignettes and write an applied analysis for each.

Assignment Instructions

For each chosen vignette:

1. Assessment:
• Identify the likely diagnosis (based on DSM-5, ICD-11, or textbook definitions).
• Discuss the key symptoms, contributing factors, and differential diagnoses.
• Integrate the biopsychosocial model in your assessment (biological, psychological, social factors).
2. Treatment Planning:
• Outline a proposed treatment plan (including biological, psychological, and relational/educational components).
• Identify whether the condition warrants a multidisciplinary approach and explain which professionals should be involved.
• Discuss how treatment goals should be prioritized (symptom relief, sexual function, relational repair, emotional processing, etc.).
3. Clinical Considerations:
• Note potential ethical concerns, patient distress, or therapist countertransference issues.
• Reflect on how stigma or misinformation might affect the therapeutic relationship.
• Consider any research limitations or controversies surrounding the disorder (as discussed in the textbook).
4. Integration and Reflection:
• Explain how this case illustrates the complexity of sexual medicine and how theory informs practical treatment.
• Include 2–3 academic references from the textbook or related literature.

Formatting Guidelines

• Length: 1,200–1,500 words per vignette (2,400–3,000 total).
• Citation Style: APA 7th edition.
• Sources: Primarily Textbook of Rare Sexual Medicine Conditions; additional peer-reviewed references may be included.
• Submission: Upload as a single Word or PDF document.

THE VIGNETTES

Vignette 1: The Body Image Preoccupation

Daniel, a 31-year-old heterosexual man, presents with persistent anxiety about the size and appearance of his penis. Although he has been told by two physicians that his measurements are within the normal range, Daniel remains convinced that he is “abnormally small.” He reports avoiding dating, public restrooms, and situations such as gym locker rooms for fear of humiliation. He spends several hours daily researching “enlargement” procedures online and frequently compares himself to men in pornography. Recently, he has been exploring surgical options and admits to using a vacuum-pumping device that caused mild bruising. Daniel describes a pattern of self-criticism extending to other aspects of his body, though the genital concern is dominant. He denies any current sexual dysfunction but admits to avoiding intimacy due to “performance shame.” His medical history is unremarkable; however, he reports a history of teasing during adolescence and a distant, emotionally critical father.

Vignette 2: The Post-Medication Syndrome

Nadia, age 27, discontinued a selective serotonin reuptake inhibitor (SSRI) nearly two years ago after a depressive episode resolved. Within weeks of stopping the medication, she noticed a complete loss of genital sensation, reduced desire, and what she calls “numb orgasms.” Multiple gynecologic exams have found no abnormalities, and hormonal testing is normal. Physicians have alternately attributed her symptoms to “stress” or “lingering depression,” leaving her feeling dismissed and invalidated. She now experiences significant relational strain with her partner, who interprets her lack of responsiveness as rejection. Nadia reports feeling detached from her body and worries that “the medication permanently broke me.” She avoids intimacy and has begun experiencing intrusive memories of pleasurable experiences she can no longer feel, describing these as “grief for my old self.”

Vignette 3: The Persistent Arousal

Evelyn, a 45-year-old married woman, reports ongoing genital arousal sensations that occur spontaneously and last for hours. She clarifies that these sensations are not linked to desire or fantasy and are often painful rather than pleasurable. They intensify during periods of anxiety and after long car rides. Evelyn has undergone extensive gynecological and neurological testing, all returning normal results. Her physician suggested that “it might be psychological,” which she perceived as invalidating. She feels intense shame, avoids sexual activity with her husband, and has developed panic attacks when the symptoms flare. Her husband alternates between confusion and frustration, misinterpreting her avoidance as disinterest. Evelyn has a history of childhood sexual abuse, which she has previously addressed in therapy. She denies hypersexual behavior, though she sometimes attempts orgasm to relieve discomfort, which only worsens the symptoms.

For Finding References, without academic library access, please use the following:

1. PubMed Central (PMC) – Free Full-Text Articles

• Website: https://www.ncbi.nlm.nih.gov/pmc/
• Description: The U.S. National Library of Medicine’s free repository of biomedical and psychological research.
• How to use:
• Search using key terms like “Persistent Genital Arousal Disorder treatment” or “Post-SSRI Sexual Dysfunction psychosexual therapy.”
• Filter results by “Free full text.”
• Tip: Encourage them to click the “Similar articles” option for related studies.

2. Google Scholar (with Free PDF Filters)

• Website: https://scholar.google.com
• How to use effectively:
• Enter search terms such as “Body Dysmorphic Disorder genital subtype sex therapy”
• Add filetype:pdf or click the [PDF] links on the right-hand side to access free versions.
• Tip: Ask them to filter by year (e.g., since 2018) to ensure current references.

3. ResearchGate

• Website: https://www.researchgate.net
• Description: Social network for researchers where authors often upload free, full-text versions of their papers.
• Tip: Students can create a free account and message authors for copies of paywalled studies—they almost always share them.

4. Directory of Open Access Journals (DOAJ)

• Website: https://www.doaj.org
• Description: Peer-reviewed, open-access journals from around the world.
• Good journals to browse:
• Sexual and Relationship Therapy (many open-access papers)
• Frontiers in Psychology (Sexuality Section)
• International Journal of Sexual Health (selected open articles)

5. Taylor & Francis Open Access

• Website: https://www.tandfonline.com/openaccess
• Description: Includes many freely available articles on psychosexual therapy, couple therapy, and sexual health education.
• Search examples:
• “Cognitive-behavioral therapy for sexual dysfunction”
• “Mindfulness and sexual function”

6. SpringerOpen & BMC Journals

• Website: https://www.springeropen.com/
• Description: Springer’s open-access branch; includes BMC Women’s Health, BMC Psychology, and Archives of Sexual Behavior (some open articles).

7. APA PsycArticles Open Access

• Website: https://psycnet.apa.org/search
• How to use:
• Type “sex therapy” or “sexual dysfunction treatment” and check the Open Access filter.
• APA occasionally features open-access special issues on clinical practice.

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