Gender Dysphoria, Sexual Dysfunction And Paraphilias

Question 1

What does cisgender mean?

Answer 1

Someone’s sex assigned at birth and gender identity correspond in the expected way

Question 2

What does cross dresser mean?

Answer 2

A person who dresses as the binary opposite gender expression for relaxation and fun. Generally refers to a man who occasionally wears clothes of the opposite sex, wears makeup and accessories associated with women.

They are usually heterosexual

Question 3

What does gay mean?

Answer 3

Experiencing attraction solely to some members of the same gender

Question 4

What is gender expression?

Answer 4

External display of one’s gender, combination of clothing, grooming, demeanor, social behavior, scales or masculinity and femininity

Question 5

What is gender identity?

Answer 5

Internal perception of one’s gender, how they label themselves. A person’s internal deeply held sense of their gender. Refers to an individual’s identifications man, woman, both or neither

Question 6

What is gender nonconforming ?

Answer 6

A gender identity label that indicates a person who identifies outside of the gender identity

Question 7

What does gender queer mean?

Answer 7

An umbrella term for many gender non-conforming or non-binary identifies (e.g., agender bigender, genderfluid)

Question 8

What does queer mean?

Answer 8

Umbrella term for persons who do not identify as straight +/- cisgender

Question 9

What is sexual orientation?

Answer 9

Type of sexual, romantic, emotional attraction one has to capacity to feel for some others, based on gender relationship between the person and the people they are attracted to. The physical, romantic +/- emotional attraction to another person. Not the same as sexual preference

Question 10

What is sexual preference?

Answer 10

Types of sexual intercourse, stimulation and gratification one likes to receive and participate in

Question 11

What is transgender?

Answer 11

An umbrella term for anyone whose sex assigned at birth and gender identity do not correspond in the expected way. A gender description for someone who has transitioned( or transitioning) from living as one gender to another. Used as an adjective, not a noun

Question 12

What is a transsexual?

Answer 12

A person who identifies psychologically as a gender/sex other than the one to which they were assigned at birth. Transexuals often wish to transform their bodies hormonally and surgically to match their inner sense of gender/sex. Many transgender people do not identify as transsexual - ask which term + pronoun a person prefers

Question 13

Contrast gender identity and gender role/expression

Answer 13

Gender identity: who you are on the inside

Gender role/expression: your expression of gender in society

Question 14

What is gender dysphoria?

Answer 14

When gender identity and gender role don’t match

-feels trapped in the wrong, e.g., biologically (sex assigned at birth) male, gender role male, gender identity female, attracted to male

Question 15

When do you know gender role and gender identity don’t match?

Answer 15

3-4 years

Question 16

When do you know your sexual preference or sexuality?

Answer 16

Puberty

Question 17

When do cross dresser behaviors become appearent?

Answer 17

Parents report cross gender behaviors were appearent before 3 years

Question 18

What are the diagnostic criteria of gender dysphoria?

Answer 18

A marked incongruence between one’s gender assigned at birth and one’s experienced gender

The incongruence results in clinically significant distress or functional impairment

Symptoms endure 6 month

Question 19

What is the etiology of sexual dysfunction ?

Answer 19

Psychological factors are the primary cause

• anxiety
• guilt
• body image

A medical condition may co-exist but in sufficiently explains the symptoms

Question 20

How can sexual therapy be used took treat sexual dysfunction?

Answer 20

Dual sex therapy- emphasis is on treating the couple when the person is in a relationship

Short term with behavioral focus

Sex education

Communication skills

Anxiety reduction through senate focus exercises (e.g., non-coital activities progressing not coital activities

Question 21

How can sexual dysfunction be treated, aside from sexual therapy?

Answer 21

Psychotherapy- feelings of guilt, poor self-esteem, anxiety, fear

Orgasm-
1. Squeeze-squeeze coronal ridge of the glans penis to cause discomfort (premature ejaculation)

2. Stop and go- partner ceases stimulation of the partner to reduce pleasure

Pain

• dilators
• relaxation

Pharmacotherapy

Question 22

How can pharmacotherapy be used to treat sexual dysfunction?

Answer 22

Pharmacotherapy- medications may be useful adjunct to behavioral therapy

• Vasodilating substances such as Viagra for erectile disorder
• SSRI to slow ejaculation in premature ejaculation

Question 23

What is a paraphilia ?

Answer 23

Sexual stimuli or acts that are deviations from “normal” sexual behaviors but are necessary for some persons to experience arousal and orgasm

• intense and persistent
• at least 6 months
• manifested by fantasy, urges and behaviors

Question 24

When does paraphilia become a disorder?

Answer 24

Paraphilia becomes a disorder if any of the following are present:

• Someone acts on the urge with a non-consenting person OR
• someone acts on the urge with a consenting person (or thing) and the actions cause significant distress/functional impairment OR
• Someone does not act on the urge, but the urge causes significant distress/functional impairment

Question 25

What is exhibitionism?

Answer 25

Type of paraphilia disorder Sexual arousal from exposing genitals to unsuspecting stranger Typical features: - female victim - masturbation during act - no attempt to involve the observer

Question 26

What is voyeurism?

Answer 26

A type of paraphilia disorder where sexual arousal from observing unsuspected person naked or in the process of disrobing or engaging in sexual identity. Person is Atleast 18 years old Typical features: - female victim - masturbation during act - no attempt to further involve the stranger

Question 27

What is fetishism?

Answer 27

A paraphilia disorder where sexual aroudal is derived from objects (shoes, gloves, stockings) or highly specific sexual focus on non-genital part Devices used for tactile stimulation do not qualify as fetish Typical features: - Masturbation accompanies a multi sensory fondling of the object - Object May be required in order to get aroused

Question 28

What is transvestism?

Answer 28

Sexual arousal by cross dressing -wearing clothing of the opposite sex Typical features: - unrelated to gender dysphoria - cross dressing may involve a single article of clothing or complete dressing as opposite sex - Distress May be manifested as “purging and acquisition” behavior

Question 29

What is frotteurism?

Answer 29

-sexual arousal From touching or rubbing against a non consenting person Typical features: -Occurs in crowded places - Frottuer fantasies about a relationship - frottage tends to be their sole sexual outlet

Question 30

What is sexual sadism?

Answer 30

Sexual arousal from causing the physical and psychological suffering of another person

Question 31

What is sexual masochism ?

Answer 31

Sexual arousal from receiving physical and psychological suffering —> humiliation, beaten, bound, asphyxia

Question 32

What are the typical features of sexual masochism and sadism?

Answer 32

S and M acts (simulation) May occur between consenting partners as normal variety - True S and M acts are NOT simulated. If they occur between non-consenting partners or if distress/harm results, then acts are diagnosable - Actions tend to increase in severity over time for both sadist and masochist to achieve arousal

Question 33

What is pedophilia?

Answer 33

Sexual arousal from prepubescent child The child typically is less than 13 years old (depends on whether they have reached puberty) -Perpetrator is at least 16 years old AND at least 5 years older than the child

Question 34

What are the typical features of pedophilia?

Answer 34

Involves viewing, fondling, oral sex(cunnilingus or Felatio) Lack of remorse, and use of rationalization to justify actions

Question 35

What is the epidemiology of pedophilia?

Answer 35

People with paraphilic disorders are: - rare and almost exclusively males - frequent offenders

Question 36

Give onset and course of pedophilia

Answer 36

- urges typically start in childhood/teens with actions becoming better defined with age - disorders are chronic and associated with a high recidivism rate after treatment/ prison release

Question 37

Give the etiology of paraphilias

Answer 37

Multifactorial and unknown Theories: psychological factors -improper identification with opposite sex parent - exhibitionism and voyeurism —> calm anxiety about castration - fetishism —> shoe fetishism, the shoe symbolizes the female penis - pedophilia and sadism —> compensation for powerlessness - masochism —> overcome fear of injury and sense of powerlessness by showing they are impervious to harm - Early childhood abuse —>spanking, enemas, verbal humiliation (classical conditioning)

Question 38

Give the THEORIES of paraphilia

Answer 38

Biological factors: -Abnormal hormone levels—> testosterone levels affecting sex drive -Neurological —> frontal lobe dysfunction, serotonin Dysregulation affecting impulse control Psychological-environmental factors: ``` Classical conditioning (e.g., in fetishism) -the object /situation was paired with sexual excitement in the past ``` Imitation(e.g., in pedophilia) -the person imitating abuse that was sustained in the past (I.e., the person is “identifying with the aggressor”)

Question 39

Summarize methods of paraphilia disorders

Answer 39

Behavioral therapy - aversion and CBT reduction of sexual drives Treatment of comorbid conditions External control

Question 40

How can behavioral therapy be used to treat paraphilic disorders?

Answer 40

Aversion therapy -when engaging in paraphilia, a noxious stimulus is applied to the patient -when fantasizing about the paraphilia, the patient imagines an aversive consequence —> covert sensitization CBT -social skills, sex education, development of victim empathy, cognitive restructuring

Question 41

How can we reduce sexual drives to treat paraphilic disorders?

Answer 41

Antiandrogens (Depo-provera) - decreased serum testosterone levels —> decrease sex drives - Chemical castration - Non-compliance is a problem

Question 42

How can comorbid conditions of paraphilias be treated?

Answer 42

Depression , anxiety SSRI —> decrease libido, control impulse and reduce obsessions

Question 43

How can external controls be used to treat paraphilia?

Answer 43

Eliminate opportunities for the perpetrator to act on the urges

Question 44

How does registration on the sex offenders list occur?

Answer 44

Person convicted of certain sex crimes must register in the jurisdiction in which they work or attend school - update information: annually, every 6 months or every 3 months - duration : 15 years, 25 years or for life

Question 45

What law allows for the sex offenders list to be made publicly available ?

Answer 45

Notification: this information is made publicly available -Megan’s law- Megan Kanka was raped and murdered by a repeat sex offender

Question 46

What legal issues have involved the registered sex offenders list?

Answer 46

Sex offenders have challenged the registration and notification laws - they cannot be punished twice - the registry is punitive US Supreme Court rejected their argument

Question 47

When was being gay, ceased being considered an ailment ?

Answer 47

DSM eliminated homosexuality as a disorder in 1973; it was not listed after DSM-II

Question 48

When and how is sexual orientation determined?

Answer 48

Sexual orientation is not alterable. It is established in-utero after a subtle difference in hormone exposure changes brain development. Conversion therapies