Sexual Disorders Flashcards
(36 cards)
1
Q
sexual orientation vs identity
A
orientation: preference to have sex with one partner or another, one gender of another, one way or another
identity: the gender to which one identifies
2
Q
gender dysphoria
A
- places emphasis on sense of “gender incongruence
- can take many forms and differences in presentation depend on age
- diagnosis requires clinically significant distress or impairment
- prevalence is v low (estimated to be under 0.014% in amabs and 0.003% in afabs), but likely underestimates since not all adults seeking hormone treatment and surgical reassignment attend specialty clinics
- evidence indicates gender identity is influence by physical disturbances such as hormones
3
Q
hormones in gender dysphoria
A
- humans + other primate offspring of mothers who took sex hormones during pregnancy frequently behave like members of the opposite sex and have anatomical abnormalities
- girls whose mother took synthetic progestins (male sex hormone precursors) to prevent uterine bleeding during pregnancy were more tomboyish in preschool
- young boys whose mothers ingested female hormones when pregnant were less athletic and engaged in less rough-and-tumble play than male peers
- the children weren’t necessarily abnormal in gender identity, but the mothers’ ingestion of prenatal sex hormones seems to have led to higher than usual lvls of cross-gender interests and behaviour
4
Q
body alterations
A
- a person who enters a program that entails alteration of the body is generally required to undergo 6-12 months of psychotherapy (which typically focuses on anxiety, depression and available options for altering the body)
- some have only cosmetic surgery (ex mtf may have electrolysis to remove facial hair and surgery to to reduce size of chin and adam’s apple)
- many take hormones to bring bodies phys closer to beliefs abt their gender (mtf may take female hormones to promote breast growth and soften the skin)
- some may also undergo sex-reassignment surgery
5
Q
sex-reassignment or gender-affirming surgery
A
- the first operation took place in 1930 europe, on an ex-soldier (now christine)
- more frequently exercised by men that by women
- controversy over how beneficial it truly is
- one study that “found no advantage to the individual ‘in terms of social rehabilitation’” led to the termination of the John Hopkins Uni school of medicine sex-reassignment program, which was the largest one in the US
- another study found that 97% of ftm and 87% of mtf surgeries were judged satisfactory (tho that doesn’t necessarily mean they were beneficial)
- preoperative factors that predict favourable post-surgery adjustment: reasonable emotional stability, successful adaptation in the new role for at least one year pre-surgery, adequate understanding of limitations and consequences of the operation, and psychotherapy in the context of an established gender identity program
6
Q
paraphilias
A
- disorders involving sexual attraction to unusual objects or sexual activities unusual in nature (there is a deviation (para) in what the person is attracted to (philia); literally unusual love)
- fantasies, urges or behaviours last at least six month and (for the most part) cause significant distress or impairment
- smn can have the behav, fantasies and urges w/o being diagnosed with a paraphilia if they aren’t recurrent/if they aren’t distressed by them
- most ppl with paraphilias are overwhelmingly male, regardless of sexual orientation (the highest rates of females are in paedophilia and masochism, but still sig more men)
7
Q
DSM-V criteria for paedophilia
A
- over a period of min 6 mo, recurrent, intense sexually arousing fantasies, sexual urges, or behav involving sexual activity with a prepubescent child (gen 13 or younger)
- the indv has acted on these sexual urges OR the urges/fantasies cause marked distress or interpersonal difficulty
- the indv is at least 16 and at least five years older than the child/children in Criterion A
8
Q
fetishism
A
- reliance on an inanimate object for sexual arousal
- recurrent and intense sexual urges toward non-living objects, called fetishes (most common are feet, shoes, stockings/sheers, rubber products (raincoats, gloves, etc), toileting articles, fur garments, underpants)
- presence of the fetish is strongly preferred or even necessary for sexual arousal
- almost always impacts males
- attraction felt by fetishist towards the object has compulsive quality (experienced as involuntary and irresistible)
9
Q
transvestic disorder
A
- over a period of at least 6 mo, recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges or behaviours; these cause clinically significant distress or impairment in social, occupational, or other areas of functioning
- may have something to do with autogynephilia
- usually begins with partial crossdressing in childhood/adol, in indv that are almost always males and typically hets, most of whom are married; they tend to cross-dress episodically (as opposed to regularly), and the indv tend to be masculine in appearance, demeanor and sexual preference
- the crossdressing usually takes place in private/secret, and is known to few members of the family
10
Q
autogynephilia
A
- a man’s tendency to become sexually aroused at the thought of himself as a woman
- thought to have some association with crossdressing, but not necessarily true
11
Q
voyeurism
A
- involves marked preference for obtaining sexual gratification by watching others in a state of undress or having sexual relations; called electric voyeurism if it occurs by videotaping another person
- a true voyeur, usually a man, doesn’t find it exciting to watch a woman undress for his special benefit; element of risk seems important (they’re excited by the anticipation of how the woman would react if she found out)
- frequency difficult to assess since maj of all illegal activities go unnoticed by police; voyeurs more likely to be charged with loitering rather than peeping
- typ begins in adolescence
- thought that voyeurs are fearful of more direct sexual encounters with others, perhaps bc they lack social skills
- voyeurs often have other paraphilias but don’t seem to be otherwise disturbed
12
Q
exhibitionism
A
- recurrent, marked preference for obtaining sexual gratification by exposing one’s genitals to an unwilling stranger, sometimes a child
- typ begins in adolescence
- as with voyeurism, seldom an attempt to have actual sexual contact with the stranger
- arousal come both from actual exposure as well as simply imagining it
- the exhibitionist masturbates wither while fantasizing or during the actual exposure
- in most cases, desire to shock or embarrass the observer
13
Q
frotteurism
A
- seuxally oriented touching of an unsuspecting person (often rubbing the penis against smn’s thights/buttocks, or fondling of breasts/genitals), with the attacks typically occurring in places that provide easy means of escape, such as crowded buses or sidewalks
- hasn’t been studied extensively, but appears to begin in adolescence and typically occurs along with other paraphilias
14
Q
sadism
A
key characteristic: marked preference for obtaining/increasing sexual gratification by inflicting pain or psychological suffering (ex humiliation) on another
- found in both het and homo relation, and both men and women
- disorder seems to begin in early adulthood
- most sadists are relatively comfortable with their unconventional sexual practices and lead otherwise conventional lives
- often seen as being motivated by control over another and overcoming resistance/non-consent, new research suggests the the overriding motivation is actually the violence/aggression
15
Q
masochism
A
key characteristic: marked preference for obtaining/increasing sexual gratification through subjection oneself to pain/humiliation
- found in both het and homo relationships
- some masochists are women
- disorder seems to begin in early adulthood
- most are rel comfortable with their unconventional sexual practices and lead otherwise conventional lives
- masochists outnumber sadists
16
Q
other specified paraphilic disorders
A
necrophilia: sexual desire for deceased ppl
zoophilia: bestiality
telephone scatologia: routine urge to make obscene phone calls
coprophilia: use of feces for sexual excitement
klismaphilia: use of enemas
urophilia: use of urine
17
Q
sexual dysfunctions
A
several categories (sexual desire, arousal, orgasmic, and pain disorders)
- persistent and recurrent difficulty, causing marked distress or interpersonal problems
- diagnosis of sexual dysfunction not made if disorder believed to be due entirely to a medical illness (ex advanced diabetes can cause erectile issues) or another disorder (ex maj depression)
18
Q
human sexual response cycle
A
appetitive: stage involving sexual interest or desire, often as’d with arousing fantasies
excitement: subjective experience of sexual pleasure, as’d with phyisological changes in the body (ex increased blow flow to genitals)
orgasm: sexual pleasure peaks (ejaculation or contracting of outer 3rd of vaginal walls), muscle tension, pelvic thrusting
resolution: feelings of relaxation that generally follow orgasm
19
Q
sexual desire disorders
A
- hypoactive sexual desire disorder involved deficient/absent sexual fantasies
- sexual aversion disorder, a more extreme form removed from the DSM5 due to rarity, involved the indv actively avoiding nearly all genital contact with another
- problematic, bc how do we empirically determine how frequently someone should want sex, and with what intensity/urgency?
- causes of low sex drive: religious orthodoxy, trying to have sex with a partner of the non-preferred sex, fearing loss of control, fearing pregnancy, depression, side effects from meds (antihypertensives, tranquilizers), lack of attraction
- may also be related to relationship factors (communication with and conflict resolution btw partners), history or sexual trauma, fear of contracting STDs, anger (reduces desire), high lvls of daily stress and low lvls of testosterone
20
Q
sexual arousal disorders
A
- subcats are female sexual interest/arousla disorder (prev frigidity) and male erectile disorder (prev impotence)
- female diagnosis made when there’s consistently inadequate vaginal lubrication for comfortable completion of intercourse, and has a prevalence rate ~20%
- male diagnosis made when there’s persistent failure to attain/maintain an erection though completion of the sexual activity; prevalence is 3-9% and increases greatly with age
- arousal problems account for ~50% of complains from ppl seeking help w sexual dysfunctions
- as many as 2/3 of erectile problems have some biol basis, usually in combo w psych factors (in theory, any drug, disease or hormone imbalance that causes issues with nerves/blood supply can impact erection)
- anxiety and depression are common among men with erectile issues, suggesting somatic and psychological factors interact to produce and maintain the difficulties
21
Q
female orgasmic disorder
A
- formerly inhibited female orgasm
- absence of orgasm after period of normal sexual excitement
- second most common problem among women (after hypoactive sexual desire disorder) and the problem that most often brings women into therapy
theories: women may have to learn to become orgasmic (the capacity to orgasm is less innate in females than males), lack of sexual knowledge, chronic use of alcohol - women also have different thresholds for orgasm
- may relate to fear of losing control; screaming uncontrollably, making fools of themselves, fainting
- may also believe that letting the body take over from the conscious controlling mind is somehow unseemly, leading to inhibition
22
Q
delayed ejaculation
A
- relatively rare, occurring only in 3-8% of clients receiving treatment for sexual dysfunction
- hypothesized causes include fear of impregnating partner, withholding love, expressing hostility, and fear of letting go; alcohol may also contribute
- may be traced to a physical source (ex spinal injury, tranquilizer)
23
Q
premature ejaculation
A
- most prevalent sexual dysfunction in men, affecting 16-27% in canada (and similar rates elsewhere); most common in BC and the atlantic
- may occur even before penetration, but usually within a few seconds of intromission
- associated with considerable anxiety
- has negative impact on overall quality of life and sexual quality of life for both the men and their partners
- relationship problems and sexually dysfunctional partners can play roles
- these men are more sexually responsive to tactile stimulation, have longer periods of abstinence than climactic sex
- learning proposed as a factor (exposure to sitches that promote and reinforce short ejaculation latency (ex teenage masturbation)
24
Q
sexual pain disorders
A
- now called genito-pelvic pain/penetration disorder (prev subtypes are v difficult to differentiate)
- diagnosis given when any of four symptoms are linked to significant distress/impairment
- persistent/recurrent difficulties with vaginal penetration during intercourse
- persistent/recurrent pain during sexual intercourse or penetration attempts (dyspareunia, which is also linked to lower sexual desire and arousal, greater dissatisfaction, and strained interpersonal relationships)
- marked fear/anxiety abt vulvovaginal or pelvic pain
- involuntary spasm of the outer 3rd of the vagina, making intercourse impossible (vaginismus) ((not no change to arousal, nor ability to orgasm from manual/oral (non-penetrative) stimulation)
25
causes of sexual dysfunction
- once viewed as a result of moral degeneracy, or excessive masturbation in childhood; Ebing and Ellis said early masturbation damaged the sexual organs and exhausted a finite reservoir of sexual energy
- metal mittens were promoted to discourage kids from handling genitals, and adults were encouraged to exercise and eat a bland diet to distract from too much sex (this is why corn flakes and graham crackers were invented)
- psychoanalysis views them as symptoms of underlying repressed conflicts, and considers the symbolic meaning of the symptom to understand etiology and guide treatment ; themes of repressed and and aggression competing with gratification of sexual needs pervades the lit
26
current etiology of sexual dysfunctions
- current/proximal cause distill down to fear about performance (being overly concerned with how one is performing during sex) and adoption of a spectator role (an observer as opposed to a true participant in the experience)
- both involve patterns of behaviour in which the individual's focus on/concern for sexual performance impedes their natural sexual response
- we have no conclusive evidence on causality though, and one could easily see how the dysfunction could lead to these patterns
- most sex therapists assume sexually dysfunctional couples have both sexual and interpersonal problems
- most ppl with these issues lack knowledge and skill
- sometimes partners have deficiencies (ex husbands of non-orgasmic women often reported as awkward lovers)
- poor communication btw partners
27
therapies for sexual dysfunctions
- 75% of ppl with a sexual dysfunction don't seek medical assistance
- treatment was pioneered by masters and johnson, and aimed to reduce or eliminate fears of performance, and to take the participants out of the maladaptive spectator role, enabling the couple to enjoy sex freely and spontaneously
- places considerable focus on the sexual value system (the ideas that each partner has abt what's acceptable or needed in a sexual relationship)
- therapists offer interpretations about why problems arise and continue; the couple is encouraged to see it as their mutual responsibility
- sensate focus
28
sensate focus
- treatment for sexual dysfunction (masters and johnson)
- couple is instructed to choose a time when both felt a natural sense of warmth, unit compatibility, or even shared sense of gamesmanship
- they then undress and pleasure each other by touching their partner's body
- the getter was simply allowd to enjoy being touched without being required to feel a sexual response, and was to immediately tell the partner if something became distracting or uncomfortable
- the roles were then switched
- attempts at intercourse forbidden throughout
29
anxiety reduction
- treatment for sexual dysfunction (wolpe)
- systematic desensitization and in vivo desensitization combined with skills training
- specific interventions may include relaxation training or in vivo desensitization
30
directed masturbation
- multi-step treatment for sexual dysfunction devised by LoPiccolo and Lobitz to complement the masters and johnson program
- the woman must carefully examine her nude body and identify various areas with the aid of diagrams; use of mirrors encouraged to see areas/crevices that had gone unnoticed
- she should touch her genitals and locate areas that produce pleasure; if orgasm not successful, she may be instructed to use a vibrator
- her partner comes in, first watching, then doing what she had been doing for herself, finally having intercourse while stimulating her genitals (manually or with vibrator)
- ample empirical evidence to support improvement in the treatment of orgasmic disorders
31
sensory-awareness procedures
- treatment of sexual dysfunction
- clients encouraged to tune into pleasant sensations that accompany even incipient sexual arousal
- includes sensate-focus, rational-emotive behaviour therapy (which tires to sub less self-demanding thoughts for musturbation)
- Kaplan also recommends procedures to try to increase the attractiveness or sex (having clients engage in erotic fantasies, giving courtship and dating assignments)
32
skills and communication training
- a subset often found in treatments for sexual dysfunction
- to improve sexual skills and communication, therapists assign written material, show videotapes and films demoing explicit sexual techniques, and discuss
- particularly important for a range or sexual disorders that partners learn to communicate likes and dislikes
- training also exposes clients to anxiety provoking material (ex seeing one's partner naked), allowing for desensitization
33
couples therapy
- sexual dysfunctions are often embedded in a distressed marital or close relationship, and troubled couples need special training in non-sexual communication skills and other ways of relating to each other
- writings on sex therapy emphasize the need for a systems persepective and for the therapist to appreciated that a sexual problem is embedded in a complex network of relationship factors
34
surgery for sexual dysfunctions
- semi-rigid silicone rod can be implanted in a chronically flaccid penis, or a device can be implanted that can be stiffened with fluid from a reservoir and a small pump implanted in the scrotum; LT follow ups suggest poor sex functioning actually continues after such surgeries tho
- vascular surgery (correction to any problem of bloodflow via arteries or outflow to veins; results are mixed at best, but here the erection could potentially be recoupled with arousal)
35
non-surgical interventions for erectile dysfunciton
- the penis is placed in a cylinder attached to a vacuum pump and the air is removed; this draws blood towards the penis to produce an erection
- once erect, the penis is removed, and an elastic band is wrapped around the base to trap the blood
- device has been recommended as effective by the american urological association
36
drugs for sexual dysfunction (basically viagra the slide)
- Viagra (sildenafil) relaxes smooth muscles, allowing blood flow to the penis during sexual stimulation to cause an erection; it's taken an hour before sex and effects last ~4hrs; generally produces modest side effects such as headaches, flushing in the body, and visual disturbance
- research indicated 70% of men who take report improvement regardless of whether the dysfunction is of biol or psych cause
- viagra may be dangerous for men with CV disease, as the condition often co-exists in men with erectile dysfunction
