Sexual and relationship problems/Gender dysphoria

Question 1

What are the two main theories of sexual functioning?

Answer 1

Linear model: sequence of stages from desire to arousal to orgasm

A circular model (Basson, 2000) –desire may not be the first phase –Better model of sexual dysfunction in women

Question 2

What are the different Sexual Dysfunctions?

Answer 2

Desire Stage: Male hypoactive sexual desire disorder, female sexual interest/arousal disorder

Arousal stage: Male erectile disorder

Orgasm stage: Male Delayed ejaculation or premature ejaculation, Female orgasmic disorder

Pain: Female genito-pelvic pain/penetration disorder

Question 3

What are Sexual Desire Disorders?

Answer 3

Sexual desire: interest in engaging in sexual activity either alone or with a partner

DSM-5hypoactive sexual desire disorder: individual’s desire for sex is severely diminished and associated with great distress

Question 4

What are Sexual Arousal Disorders and what is their prevalence for both men and women?

Answer 4

For men: inability to attain or maintain an erection sufficient for intercourse –Lifetime prevalence of up to 50% –Higher risk for men who smoke or who have a range of medical conditions

For women: difficulty in attaining or maintaining adequate lubrication until the completion of the sexual act
–Lifetime prevalence of up to 52%

Question 5

What are Orgasmic Disorders?

Answer 5

Men: DSM-5: two types of orgasmic disorders: –Delayed ejaculation (4% in Aus)–Premature ejaculation (8% in Aus)

Women: marked delay or absence or reduced intensity of orgasmic sensations, accompanied by significant distress–51% (Aus)
Genito-pelvic pain/penetration disorder: pain or discomfort during intercourse–4% (Aus)

Question 6

What are key aetiological findings of sexual dysfunction?

Answer 6

Biological Factors: Increasing problems with age, Comorbid medical conditions, Medications

Psychosocial Factors: Emotions, Development, Relationship

Question 7

How is Sexual Dysfunction treated?

Answer 7

CBT: challenge unrealistic beliefs associated with sexual dysfunction

Behaviour therapy: combination of –Education–Communication skills training–Sensate focus exercises

Internet-based treatment promising

Medication: some efficacy

Question 8

What is Paraphilic Sexual Activity?

Answer 8

Atypical sexual activities that involve one of the following: –Non-human objects–Non-consenting adults–The suffering or humiliation of oneself or one’s partner–Children

Question 9

What are the different Paraphilic Disorders?

Answer 9

Exhibitionistic—exposing genitals to an involuntary observer

Fetishistic—use of nonliving object for sexual gratification

Frotteuristic—touching or rubbing against a non-consenting person for sexual gratification

Paedophilic—sexual activity with children

Sexual masochistic and sexual sadism—experience of sexual stimulation through the infliction of pain or humiliation on another person

Transvestic—cross-dressing

Voyeuristic—looking at unsuspecting individuals as they undress

Question 10

What are key aetiological findings of Paraphilic Disorders?

Answer 10

Little data but probably originate in childhood or adolescence

Question 11

How are Paraphilic Disorders treated?

Answer 11

Behaviour therapies: aversion therapy and exposure therapy

Social skills training: some support but findings are generally mixed

For some disorders, chemical or surgical castration, in conjunction with other therapies

Question 12

What are key relationship problems?

Answer 12

Personality characteristics (1940s)

Interactional styles between couples (1950s)

Power and power imbalances / family dynamics (1960s and 1970s)

Interaction patterns and predictors of divorce (1980s and 1990s)

Complex processes and relationships between different variables (more recently)

Question 13

What are key patterns of interaction within relationships?

Answer 13

Good communication and self-disclosure

Conflict
–Lower levels of conflict
–Lack of extreme levels of conflict
–Satisfactory resolution of conflict

Association between sexual satisfaction and relationship satisfaction

Question 14

What are contextual factors of relationship problems?

Answer 14

Becoming a parent

Negotiations of balance between work and family

Same-sex relationships: negative social attitudes towards homosexual couples

Question 15

How are Relationship Problems treated?

Answer 15

Behavioural and cognitive-behavioural couple therapy–Behavioural training, communication training, problem solving and challenging dysfunctional cognitions

Question 16

How is Trans and Gender Diverse defined?

Answer 16

Trans and gender diverse (TGD): those whose gender expression or identity varies from that generally expected for someone assigned to their sex at birth

The DSM-5: ‘gender identity disorder’ replaced by with ‘gender dysphoria’ to decrease stigma

Shift from ‘male’ and ‘female’ to fluidity in gender experiences

Question 17

How is Gender Dysphoria diagnosed?

Answer 17

Experience of gender incongruence with associated distress or impairment in life functioning can occur with the following:

Desire to be another gender
Desire for cross gender pay
Preference for toys and clothing typically associated with preferred gender
Resistance or rejection to toys and clothing typically associated with assigned gender
Preference for playmates of the preferred gender
Dislike of primary and/or secondary sex characteristics
Desire for primary and/or secondary sex characteristics of preferred gender

Question 18

What are the differential diagnosis’ for Gender Dysphoria?

Answer 18

–Transvestic disorder
–Schizophrenia and other psychotic disorders
–Body dysmorphic disorder
–Personality disorder
–Dissociative identity disorder
–Autism spectrum disorder

Question 19

What are key epidemiological of gender dysphoria?

Answer 19

1 in 22,145 Australian passport holders has modified the gender marker on their passport

Age of onset varies with developmental changes–Early onset –commences in childhood and persists–Late onset –commences in puberty or later in life

Poorer mental health common in TGD individuals linked with stigma, violence and social rejection

Question 20

What are key aetiological findings of gender dysphoria?

Answer 20

Interactions between biological, psychological and social forces •Gender identity may be formed in utero–Possibly due hormones •Potential neuroanatomical differences •Possible genetic influences

Sociocultural influences on gender variance vary greatly across cultures–Gender expression are typical–Gender variance is sharply repressed

Question 21

What are the guiding principles of Gender Dysphoria treatment?

Answer 21

Individualise treatment 
Avoid harm 
Use appropriate language 
Be respectful 
Consider sociocultural factors

Question 22

What are common interventions for Gender Dysphoria?

Answer 22

Pharmacological: Hormonal therapy E.g. Testosterone and Oestrogen

Removal of undesired genitalia/Modification of existing structures and creation of new tissues: Most individuals have favourable outcomes. However, 2–3 per cent choose to revert to their birth-assigned gender

Voice and communication therapy

Question 23

What is the prevalence of Sexual Desire Disorders?

Answer 23

8 per cent of men & 55 per cent of women