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1

Gender identity

The psychological sense of being male or female. For most its consistent with their physical or genetic sex

2

Gender Dysphoria

(prev. called gender identity disorder) applies to thos who expierence distress or impaired functioning as result of conflict between their anatomic sex and gender identity. Dysphoria means “difficult to bear” and refers to feelings of dissatisfaction or discomfort in ones gender. Often begins in childhood.

3

Transgender identity

those who have the psychological sense of belonging to one gender while possessing the sexual organs of another. Not all of transgenders hae dysphoria. (only those who demonstrate distress)
- Many do not warrant diagnosis of dysphoria

4

Sex Reassignment Surgery -5

1. Male to female more successful.
2. Hormone treatments promote development of secondary sex characteristics.
3. Generally positive effects on life after surgery.
4. Postoperative adjustment tend to be better for female to male.
5. Men seeking surgery outnumber women by 3 to 1

5

Psychodynamic perspective of transgender identity

Close mother son relationships, empty relation with parents, fathers who were absent. These family cicumstances foster strong identitfication with the mother in young males, leading to reversal of expected gender roles and identity. Girls with weak mothers may overly identify with fathers.

6

Learning theory of transgender identity

points to fathers absence in the case of boys to the unavailability of male role models. Children brought up by parents who had wanted children of other gender and who encouraged cross dressing may learn socialization patterns and develop gender identity disorder
*However, those with these kinds of families usually don’t develop gender identity disorders

7

Biological perspective of transgender identity -2

1. May result from effects of male sex hormones in brain during prenantal development. high levels of testostoren during prenatal development leads to more masculinized children.
2. Distrubance in endocrine environment during gestations leads brain to become differenctiated with respect to gender identity in one direction while genitals develop in another.
3. Brain differences in transponders

8

Sexual Dysfunctions (2)
- Prevalence
- Types/Groups

Persistent problems with sexual interest, arousal, or response. Classified in two categories: lifelong vs. acquired and general vs situational
- Worldwide review estimated they effect 40-45% of adult women and 20-30% of adult men.
- Groups: Disorders involving problems with sexual interest, desire, arousal. Disorders involving problems with orgasm. Problems involving pain during intercourse


9

Disorders of interest and arousal

1. Male hypoactive sexual desire disorder
2. Female sexual interest/arousal disorder
3. Erectile disorder

10

Male hypoactive sexual desire disorder
- Prevalence

have little if any desire for sexual activity or lack sexual erotic thoughts
- 8 to 25%

11

Female sexual interest/arousal disorder

- lack of or reduced level of sexual interst, drive, or arousal
- 10-55%

12

Erectile Disorder
- to diagnose?
Prevalence rates (age ranges)

to diagnose requires problem be persistent for period of about six months or longer and that it occurs on all or almost all (75-100%) occasions of sexual activity. - 50% of men in the 40-70 age range experience some degree of this.
- 1-10% under age 40
- 20-40% in men in their 60s

13

Orgasm Disorders

Female orgasmic disorder, Delayed ejaculation, premature ejaculation

14

Female orgasmic disorder
-Prevalence
To diagnose?

persistent difficulty achieving orgasm despite adequate stimulation. Also includes a reduction in intensity of orgasims. To diagnose must be present for six months, and occurs on almost all occasions.
- 10-42%

15

Delayed ejaculation
-Prevalence
To diagnose?

persistent delay in achieving orgasm despite arousal (formerly called male orgasmic disorder) To diagnose must be present for six months, and occurs on almost all occasions
- Less than 1-10%

16

Premature ejaculation
-Prevalence
To diagnose?

recurrent pattern of ejaculation occurring within one minute of vaginal sex
- 30% report rapid and 1-2% report within one minute

17

Genito-pelvic-pain penetration disorder
- prevalence?

Women who have pain and difficutly engagning in intercourse. Cannot be explained by underlying medical condition. However, most can be traced to underlying med condition.
- about 15% in North America report pain
- Vaginismus happens when muscles surrounding vagina involuntarily contract whenever vaginal penetration is attempted. Not a medical condition but a conditional response in which contact triggers an involuntary spasm of vaginal musculature preventing penetration.

18

Psychological perspective of sexual dysfunctions
- Emphasizes (5)
- Women
- Men
- Erection
- irrational beliefs

-Emphasize the role of anxiety, lack of sexual skills, irrational beliefs, perceived causes of events, and relationship problems.
- Women who have trouble becoming aroused may harbor deep seated anger towards partner
- Performance anxiety represents an excessive concern about the ability to perform successfully. - Western cultures make connection between how man performs and sense of manhood.
- a reflex and cannot be forced. Erectile reflex is controlled by the parasympathetic branch of the autonomic nervous system and activation of the symthatic branch when we are nervous can prevent the reflex. (therefore heightened arousal can trigger rapid ejac)
- Albert Ellis: underlying irrational belifs and attitudes can contribute to sexual dysfunctions: 1. We must have approval at all times of everyone who is important to us 2. We must be thoroughly competent at everything we do
If we cannot accept occasional disappointing sexual experience we may catastrophize the single episode. If we insit that every experience must be perfect, we set stage for failure

19

Biological perspective for sexual dysfunctions (6)
- ED(4)

1. Low testosterone levels and disease can dampen sexual desire. Testostorene involved in both males and females. (Adrenal glands and ovaries are sites in Women were testo is produced)
2. However, those with sexual dysfunctions usually have normal levels of hormones
3. Cardiovascualr problems like impaired blood flow to penis can cause erectile disorder. Erectile disorder shares common risk factors with CVD which should alert doctors that it may be an early sign of heart disease.
4. Erectile disorder is linked to obesity in men and men with urinary and prostate problems
5. ED and delayed ejaculation may result from multiple sclerosis, a disease in which nerve cells lose their protective coatings that facilitate the smooth transmission of nerve impulses
6. Other forms of nerve damage, chronic kidney disease, hypertension, cancer, and emphysema can also impair erectile response as can endocrine disorders that suppress testo production.

20

Harvard ED study

by Eric Rimm of Harvard found that ED associated with having large waist, physically inactive, and drinking too much alcohol (or not drinking). Common link among these factors may be high levels of cholesterol. Chlosterol can impede blood flow to the penis.

21

Psychotropics effects
- drugs

1 in 3 women who use SSRI’s have impaired or lack of orgasm. Tranqs such as Valium and Xanax cause orgasmic disorders in both men and women. Some high blood and cholesterol drugs can impair arousal too.
- Depressants such as alcohol, heroin can depress testo production which diminish sexual desire

22

Sociocultural perspective of sexual dysfunctions

−Greater incidence of erectile dysfunction in cultures with more restrictive attitudes toward premarital sex, sex among females, sex in marriage, and extramarital sex.

23

Treatment of sexual dysfunctions (2)

1. Until William Masters and Virginia Johnson in 1960’s, there was no treatment for most sexual dysfunctions. Their sex therapy uses CBT techniques in a brief therapy
2. Today there is more emphasis on biological factors in sex problems and medical treatments like Viagra. ED drugs represent 5$ billion income

24

Treatment for low sex drive or desire (3)

1. Therapist may help those with low sex drive rekindle their appetite through the use of self stimulation (masturbation) together with erotic fantasies.
2. When working with couples, therapist can prescribe mutual pleasuring exercises.
3. Some cases of low sex desire are assoc with hormonal defeciences. Males can use testo gel patch. However, testo treatments can lead to liver damage and possible prostate cancer

25

Treatment of sexual arousal (2)
- sexual arousal

-sexual arousal results in the pooling of blood in the genital region, causing erection in the male and vaginal lubrication in the female. These changes in blood flow are reflexes
1. Men and Women with arousal disorders are first educated that they need not do anything to become arousad. As long as the problem is psychological they only need to expose themselves to sexual stimulation under relaxed conditions.
2. Masters and Johnson have a couple counter performance anxiety by engaging in sensate focus exercise- nondemand sexual contacts; sensuous exercises that do not demand sexual arousal in the form of lubrication or erection. Partners begin by massaging one another without touching the genitals. Uses communication to guide eachother. Countermands anxiey bcause there is no demand for sexual arousal.

26

Treatment for disorders of orgasm
- For women

Women with orgasm disorder often harbor underlying beliefs that sex is dirty or sinful. Treatment in these cases includes modification of negative attitueds about sex. In either case Masters and Johnson would first work with the couple and first use sensate focus exercises to lessen performance anxiety, open channels of communications, and help the couple acquire sexual skills. The woman directs her parent to stimulate her; by taking charge the woman is psychologically freed from the stereotype of the passive submissive female role. Masters and Johnson preferred working with the couple in cases of female dysfunction, but others prefer working with just the woman by directing her to masturbate. Directed masturbation provides women opportunities to learn about their own bodies at their own pace and has success rate of 70-90%.

27

Treatment for orgasm disorders
- For men

-Delayed ejaculation has received little attention in the clinical literature. Treatment focuses on increasing stimulation and reducting performance anxiety.
-- Most widely used behavioral approach to treating premature ejaculation called the stop-start or stop-and-go technique was introduced in 1956 by a urologist, James Semans. Partners suspend sexual activity when the man is about to ejaculate and then resume stimulations when his sensations subside. Repeated practice enables him to regulate ejaculation by sensitizing him to the cues that precede ejaculator reflex. High success rates buy high relapse rates.

28

Treatment for Genital pain disorders

-Treatment of painful interecours generally requires medical intervention to determine and treat problems such as urinary tract infections.
-Cases of vaginismus use psycho treatment to relieve pain. Represents a psychologically based fear of penetration rather than a medical problem. Treatment includes combo of behavioral methods like relaxation and gradual exposure to desensitize the vaginal musculature to penetration by having the women insert fingers or plastic dilators.

29

Biological treatment for sexual dysfunctions
1. ED
2. lack of sexual desire
3. Premature ejaculation

1. ED frequently has organic causes so most used is medicine
Viagra and Cialis increase blood flow to penis and are safe. Combining psychotherapy with meds is more effective
When pills don’t work, self-injection in penis of drug that increases blood flow may be used or vacuum erection device that works like penis pump. Surgery may be used to unblock blood vessels
2. Problems of sexual desire should not be treated in isolation but in a larger context that takes inot account psychological, cultural, andinterpersonal contexts.
3. SSRI's work by increasing serotonin which can have side effect of delaying ejaculation

30

Paraphilic Disorders
- Types (6)

unusual or atypical pattersn of sexual attraction that involve sexual arousal in response to atypical stimuli. Involve strong and recurrent sexual arousal to atypical stimuli as evidenced by fantasies, urges, or behaviors (acting upon the urges for a period of six months or longer)
-Almost never diagnosed in women with exception of masochism
1. Exhibitionism 2. Fetishism 3. Trasvestism 4. Voyeurism 5. Frotterurism 6. Pedophilla