ch.9 Flashcards
Sexual and Gender Identity Disorders
What is “normal” vs. “abnormal” sexual behavior?
Normative facts and statistics
Cultural considerations
Gender differences in sexual behavior and attitudes
DSM-5 disorders of sexuality and gender
Gender dysphoria
Sexual dysfunctions
Paraphilias
Overview of Sexual Dysfunctions
Sexual dysfunctions
Involve desire, arousal, and/or orgasm
Pain associated with sex can lead to additional dysfunction
Must now be present for 6+ months in order to make diagnosis
Must lead to impairment or distress in order to be considered a disorder
Prevalence
Sexual difficulties are extremely common and not always distressing
One study: 40% of men had some difficulty with erection/ejaculation, 63% of women had problems with arousal/orgasm
Males and females experience parallel versions of most dysfunctions
Classification of sexual dysfunctions
Lifelong vs. acquired
Generalized vs. situational
Psychological factors alone
Psychological factors combined with medical condition
Male Hypoactive Sexual Desire Disorder: An Overview
Little or no interest in any type of sexual activity
Masturbation, sexual fantasies, and intercourse are rare
Accounts for half of all complaints at sexuality clinics
Affects 5% of men
Female Sexual Interest/Arousal Disorder: An Overview
Lack of or significantly reduced sexual interest/arousal
Typically manifesting in:
reduced sexual interest
reduced sexual activity
fewer sexual thoughts
reduced arousal to sexual cues
reduced pleasure or sensations during almost all sexual encounters
Female Orgasmic Disorder
Marked delay, absence or decreased intensity of orgasm in almost all sexual encounters
Not explained by relationship distress or other significant stressors
1 in 4 women has significant difficulty achieving orgasm
Genito-Pelvic Pain/Penetration Disorder
In females, difficulty with vaginal penetration during intercourse, associated with one or more of the following:
Pain during intercourse or penetration attempts
Fear/anxiety about pain during sexual activity
Tensing of pelvic floor muscles in anticipation of sexual activity
Premature ejaculation
Ejaculation occurring within ~1 minute of penetration and before it is desired
Most prevalent sexual dysfunction in adult males
Affects 21% of all adult males
Most common in younger, inexperienced males
Problem tends to decline with age
Erectile Disorder
Difficulty achieving or maintaining an erection
Sexual desire is usually intact
Most common problem for which men seek treatment
Prevalence increases with age
60% of men over 60 experience erectile dysfunction
Assessing Sexual Behavior
Comprehensive interview
Detailed history of sexual behavior, lifestyle, and associated factors
Medical examination
Must rule out potential medical causes of sexual dysfunction
Psychophysiological evaluation
Exposure to erotic material
Determine extent and pattern of sexual arousal
Males – penile strain gauge (measures erection)
Females – vaginal photoplethysmograh (measures blood flow to vaginal walls, indicative of arousal)
Causes and Treatment of Sexual Dysfunction
Biological contributions
Physical disease, medical illness, prescription medications
Use and abuse of alcohol and other drugs
Anti-hypertensive medication
Psychological contributions
People with sexual dysfunction are more likely to experience anxiety and negative thoughts about sexual encounters
May actively avoid awareness of sexual cues, so not in touch with their own sexual response
Example: Men with PE tend to distract themselves purposefully to avoid orgasm, leading to even lower ejaculatory control
Social and cultural contributions
Erotophobia – learned negative attitudes about sexuality
Negative or traumatic sexual experiences
Deterioration of interpersonal relationships, lack of communication
Interaction of psychological and physical factors
Treatment of Sexual Dysfunction
Education alone can be surprisingly effective
Masters and Johnson’s psychosocial intervention
Education about sexual response, foreplay, etc.
Sensate focus and nondemand pleasuring
Sexual activity with the goal of focusing on sensations without trying to achieve orgasm
Decreases performance anxiety
Additional psychosocial procedures
Squeeze technique – premature ejaculation
Masturbatory training – female orgasm disorder
Use of dilators – vaginismus
Exposure to erotic material – low sexual desire problems
Medical Treatment of Sexual Dysfunction
Erectile dysfunction Viagra – is it really the wonder drug? Headache side effects, many discontinue Injection of vasodilating drugs into the penis Testosterone Penile prosthesis or implants Vascular surgery Vacuum device therapy Few medical procedures exist for female sexual dysfunction
Paraphilic Disorders: Clinical Descriptions and Causes
Nature of paraphilic disorders – misplaced sexual attraction and arousal
Focused on inappropriate people or objects
Often multiple paraphilic patterns of arousal
High comorbidity with anxiety, mood, and substance use disorders
Manifest in fantasies, urges, arousal or behaviors
Paraphilia is not always disordered
Only considered disordered when the individual
Experiences clinically significant distress or impairment OR
Acts on urges with a nonconsenting person
DSM-5 paraphilic disorders
Fetishistic disorder Voyeuristic disorder Exhibitionistic disorder Frotteuristic disorder Transvestic disorder Sexual sadism disorder Sexual masochism disorder Pedophilic disorder
Fetishistic Disorder
Sexual attraction to nonhuman objects
Objects can be inanimate and/or tactile
Examples
May include rubber, hair, feet, objects such as shoes
Frotteuristic Disorder
Persistent pattern of seeking sexual gratification from rubbing up against unwilling others
Often occurs in crowds and/or confining situations from which the other person cannot escape
Examples: Crowded elevator or subway
Voyeuristic and Exhibitionistic Disorders
Voyeurism
Observing an unsuspecting individual undressing, naked or engaged in sexual activity
Risk associated with “peeping” may intensify sexual arousal
Exhibitionism
Exposure of genitals to unsuspecting strangers
Element of thrill and risk is necessary for sexual arousal
Transvestic Disorder
Sexual arousal with the act of cross-dressing
Males may (rarely) show highly masculine compensatory behaviors
Most do not show compensatory behaviors
Many are married and the behavior is known to spouse
Not inherently pathological; only considered disordered if it causes significant distress or impairment
Sexual Sadism and Sexual Masochism Disorders
Sexual sadism
Inflicting pain or humiliation to attain sexual gratification
Sexual masochism
Suffering pain or humiliation to attain sexual gratification
Sexual Sadism, Paraphilia and Rape
Some rapists are sadists, but most are not
Most rapists do not show paraphilic patterns of arousal
Rapists tend to show sexual arousal to violent sexual and non-sexual material
Pedophilic Disorder
Overview
Pedophilia – sexual attraction to prepubescent children
Vast majority of sufferers are males
Pedophilia is rare, but not unheard of, in females
In some cases, pedophilic urges are limited to incest (i.e., young members of one’s own family)
Many sufferers do not act on desires
Some engage in compensatory moral behavior
Pedophilia
Associated features
Incestuous males may be aroused by adult women
Male pedophiles are usually not aroused by adult women
Some rationalize the behavior
E.g., consider pedophilic activity to be an act of affection or a teaching experience
Often engage in other moral compensatory behavior
Causes of Paraphilic Disorders
Difficulty forming “normal” relationships
Deficits in typical sexual experiences
Relationship difficulties in childhood or adolescence
Early experiences may lead to sexual associations by chance > then reinforced through masturbation
Often have very high sex drive
Suppressing unwanted fantasies may paradoxically increase them
