Lecture 4b - Sexual disorders

Question 1

Categories of sexual dysfunctions

Answer 1

1. Sexual interest, desire and arousal
2. Orgasmic disorder
3. Sexual pain

Question 2

Interest/arousal disorder in women - Criteria

Answer 2

1. Diminished, absent, or reduced frequency of at least 3 of the following for 6 months or more:
   +interest in sexual activity
   +sexual/erotic thoughts or fantasies
   +Initiation of sexual activity and responsiveness to partner’s attempts to initiate
   +Sexual excitement/pleasure during 75% sexual encounters
   +Sexual interest/arousal elicited by any internal or external erotic cues
   +Genital or nongenital sensations during 75% sexual encounters.
2. Causes marked distress or interpersonal problems.
3. Not due to a medical illness, another psychological disorder (except another sexual dysfunction or the effects of a drug)

Question 3

Criteria for Hypoactive sexual desire disorder in Men

Answer 3

1. sexual fantasies and desires, deficient or absent
2. causes marked distress or interpersonal problems
3. Not due to a medical illness, another psychological disorder (except another sexual dysfunction) or the effects of a drug.

Question 4

Criteria for Male Erectile disorder

Answer 4

On at least 75% of sexual occasions:
+Inability to attain an erection
+Inability to maintain an erection for completion of sexual activity
+Marked decrease in erectile rigidity interferes with penetration or pleasures
+Not due to a medical illness, another psychological disorder (except another sexual dysfunction) or the effects of a drug.

Question 5

Kinds of Orgasmic disorders

Answer 5

1. Female orgasmic disorder
2. Early ejaculation disorder
3. Delayed ejaculation disorder

Question 6

What is Female orgasmic disorder?

Answer 6

Absence of orgasm after sexual excitement

Question 7

What is early ejaculation disorder?

Answer 7

Ejaculation that occurs too quickly

Question 8

What is delayed ejaculation disorder?

Answer 8

Persistent difficulty ejaculating

Question 9

Criteria for Female Orgasmic disorder

Answer 9

On at least 75% of sexual occasions:
+Marked delay, infrequency or absence of orgasm
+Markedly reduced intensity of orgasmic sensation
+Causes marked distress or interpersonal problems
+Not due to a medical illness, another psychological disorder (except another sexual dysfunction) or the effects of a drug

Question 10

Criteria for delayed Ejaculation

Answer 10

+ Marked delay, infrequency or absence of orgasm on at least 75% of sexual occasions.
+Causes marked distress or interpersonal problems
+Not due to a medical illness, another psychological disorder (except another sexual dysfunction) or the effects of a drug

Question 11

What are the main sexual pain disorders?

Answer 11

1. Genitopelvic pain / penetration disorder

2. Vaginismus and Dyspareunia

Question 12

Criteria for Genitopelvic pain/ penetration disorder

Answer 12

+ Persistent or recurrent pain during intercourse
+Diagnosable in both men and women (rare in men)
+ R/O Medical cause (e.g. infection), lack of vaginal lubrication or menopausal problems.
+Most women experience sexual arousal and orgasms from manual or oral stimulation that does not involve penetration.
+ 10-30% prevalence rates

Question 13

Criteria for Genitopelvic pain / penetration disorder

Answer 13

+ Inability to have vaginal intercourse/penetration
+Marked vulvar, vaginal or pelvic pain during vaginal penetration or intercourse attempts.
+Marked fear or anxiety about pain or penetration
+ Marked tensing of the pelvic floor muscles during attempted vaginal penetration
+Causes clinically significant distress or interpersonal problems
+ Not due to another psychological disorder, a medical condition, or the effects of a drug.

Question 14

Etiology of sexual dysfunction

Answer 14

Masters & Johnson (1970) two-tier model:

1. Immediate causes
   +Performance fears
   +Adoption of spectator role

2. Distal (historical) causes
\+Sociocultural
\+Biological causes
\+Sexual traumas
\+Homosexual inclinations

Question 15

Distal and Immediate Causes of Human Sexual inadequacies

Answer 15

Distal
\+Guilt about sexuality from religious and other cultural influences
\+ Rape or sexual abuse
\+ Homosexual preferences
\+Lack of knowledge about sexuality
\+Excessive alcohol intake
\+Physiological problems
\+Sociocultural factors

Immediate
+Spectators role and fears about performance

Question 16

Predictors of successful sexual functioning

Answer 16

Psychological factors
\+Good emotional health
\+Attraction toward partner
\+Positive attitude towards partner
\+Positive sexual attitude

Physical factors
+Good physical health
+Regular appropriate exercise
+Good nutrition

Social and Sexual history factors
+Positive sexual experiences in past
+Good relationship with partner
+Sexual knowledge and skills

Question 17

Predictors of poor sexual functioning

Answer 17

Psychological factors
\+Depression or anxiety disorders
\+Focus on performance
\+Too much routine
\+Poor self-esteem
\+Uncomfortable environment for sex
\+Rigid, narrow attitude toward sex
\+Negative thoughts about sex

Physical factors
\+Heavy drinking
\+Cardiovascular problems
\+Diabetes
\+Neurological diseases
\+Low physiological arousal
\+SSRI medications
\+ Antihypertensive medication
\+Other drugs

Social and Sexual history factors
\+ Rape or sexual abuse
\+Relationship problems such as anger or poor communication
\+Long periods of abstinence
\+History of hurried sex

Question 18

Biological factors of sexual dysfunctions

Answer 18

\+Diseases of vascular system
\+Diseases of the nervous system
\+Low levels of testosterone or estrogen
\+Heavy alcohol consumption before sex
\+History of chronic alcoholism
\+Heavy cigarette smoking
\+Medications - Antihypertensives and SSRIs

Question 19

Psychosocial factors of sexual dysfunctions

Answer 19

+Rape
+Early childhood sexual abuse
+ Relationship problems - anger, hostility, poor communication, underlying anxiety about relationship security
+Psychological disorders - Major depression, anxiety, or panic disorder
+ Low physiological arousal
+Stress and exhaustion
+Negative cognitions

Question 20

Treatments of sexual dysfunction

Answer 20

+Anxiety reduction
+directed masturbation
+Procedures to change thoughts and attitudes - sensory awareness procedures and rational emotive therapy
+Sexual skills and communication training
+Couples therapy
+Medications and physical treatments - Squeeze technique for early ejaculation - PDE-5 inhibitors for erectile dysfunction (Viagra, Cialis and Levitra)

Question 21

What are Paraphilias?

Answer 21

Recurrent sexual attraction to unusual objects or sexual activities

+For at least 6 months
+ Deviation (para) in what the person is attracted to (Philia)
+ Should only be diagnosed when they cause marked distress or are done with nonconsenting persons.

Question 22

What are the categories of Paraphilias?

Answer 22

1. Sexual attraction to an inanimate objects

2. Sexual attractions based on children

Question 23

What are the different types of Paraphilias?

Answer 23

1. Fetishistic disorder
2. Transvestic disorder
3. Pedohebephilic disorder
4. Voyeuristic disorder
5. Exhibitionistic disorder
6. Frotteuristic disorder
7. Sexual sadism disorder
8. Sexual masochism disorder

Question 24

What is a Fetishistic disorder?

Answer 24

+For at least 6 months, recurrent and intense sexually arousing fantasies, urges or behaviors involving the use of nonliving objects or nongenital body parts.

+The sexually arousing objects are not limited to articles used in cross-dressing or to devies designed to provide tactile genital stimulations, such as a vibrator.

Question 25

Prevalence of Fetishistic disorder

Answer 25

+Occurs most often in men +Object often necessary for sexual arousal +Attraction to object irresistible and involuntary +Fetishes often co-occur with other paraphilias.

Question 26

Pedohebephilic Disorder

Answer 26

Pedos = child hebe= pubscence philia=attraction +Sexually arousing urges, fantasies or behaviours involving sexual contact with a prepubertal or pubescent child +Ofender at least 16 years old and 5 years older than victim +child pornography is widely used +Person has acted on urges or the urges and fantasies cause marked distress or interpersonal problems. +Victims usually known to pedophile +Most pedophilia does not involve violence other than the sexual activity

Question 27

What is incest?

Answer 27

+Subtype of pedohebephilic disorder +Most common brother and sister + Less common but more pathological - father and daughter +Incest taboo almost culturally universal +genetically adaptive +Offspring of father-daughter or brother and sister have a greater likelihood of inheriting pairs of recessive genes with possible negative biological effects.

Question 28

What is Voyeuristic disorder?

Answer 28

+Sexually arousing fantasies, urges, or behaviors while observing other who are unclothed or engaging in sexual activity +Almost always men +Excitement comes from knowing the victim is unaware of the voyeur; element of risk important +Seldom results in physical contact +Orgasm achieved by masturbation +Victims unaware that they are being watched

Question 29

Diagnostic criteria of voyeuristic disorder?

Answer 29

+For at least 6 months, recurrent and intense sexually arousing fantasies, urges, or behaviors involving the observation of unsuspecting others who are naked, disrobing, or engaged in sexual activity +Person has acted on these urges with a nonconsenting person, or the urges and fantasies cause marked distress or interpersonal problems

Question 30

What is Exhibitionistic disorder?

Answer 30

+Intense desire to obtain sexual gratification by exposing one’s genitals to unwilling strangers +Victims can be children +Seldom results in physical contact +Usually involves desire to shock or alarm victim + Often comorbid with voyeuristic and frotteuristic disorders

Question 31

Diagnostic criteria for Exhibitionistic disorder?

Answer 31

+For at least 6 months, recurrent, intense, and sexually arousing fantasies, urges, or behaviors involving showing one’s genitals to an unsuspecting person +Person has acted on these urges to a nonconsenting person, or the urges and fantasies cause clinically significant distress or interpersonal problems

Question 32

What is Frotteuristic disorder?

Answer 32

+Sexually oriented touching of a nonconsenting person +The individual rubs his genitals against a women’s body or fondles her breast or genitals +Often occurs in crowded subway or other public place

Question 33

What is sexual sadism and sexual masochism disorders?

Answer 33

• Intense and recurrent desire to obtain or increase sexual gratification by inflicting pain or psychological suffering on another person • Must cause clinically significant distress or the person has acted on these urges with a nonconsenting person. • Intense and recurrent desire to obtain or increase sexual gratification through receiving pain or humiliation • Must cause marked distress or impairment in functioning

Question 34

What is Asphyxiophilia?

Answer 34

+Sexual arousal by oxygen deprivation | +Can result in death or serious brain damage

Question 35

What is the Etiology of the Paraphilias?

Answer 35

Neurobiological factors • Male hormones or androgens +Almost all individuals with paraphilias are men +Do not have unusual levels of testosterone Clasical conditioning +Research has not supported orgasm conditioning hypothesis Operant conditioning +Poor social skills or reinforcement of unconventionally +History of childhood physical and sexual abuse +Alcohol and negative affect are common triggers +Cognitive distortions

Question 36

Treatment for Paraphilias

Answer 36

+ Incarceration and ordered treatment are common +Often difficult to interpret outcome from treatment studies Studies vary greatly Many lack control groups Dropout rates high

Question 37

Treatment of Paraphilias

Answer 37

``` Enhance motivation • Denial and minimization of problem often present • Some blame the victim +Lack of motivation for treatment +Drop out of treatment ``` ``` Cognitive behavioral treatment • Aversion therapy • Covert sensitization • Counter distorted thinking • Often combined with social skills and empathy training ``` ``` Biological treatments • Castration used in past • Medications Hormonal agents to reduce androgens Depo SSRIs ```