Sexual Dysfunction, Paraphilic Disorders and Gender Dysphoria Flashcards Preview

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Flashcards in Sexual Dysfunction, Paraphilic Disorders and Gender Dysphoria Deck (67)
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1

Milestones in Sexual Science History

  • “Sexual science” coined in 1906
  • Krafft-Ebing and “Psychopathia Sexualis”
  • Freud and the libido
  • Havelock Ellis and sexual variation
  • Alfred Kinsey and data
  • Masters and Johnson and sexual arousal

2

Why Do We Mate?

  • Parental Investment and Sexual Strategies Theory
  • Assumptions about evolution and behaviour
  • Short-term vs. long-term strategies for males and females
  • What maximizes our reproductive potential?

3

Why Do We Have Sex?

  • 237 reasons broken down into 4 main factors
    • Physical reasons
    • Goal attainment
    • Emotional reasons
    • Insecurity
  • Significant sex differences (and similarities)
  • Infidelity?
    • “A man is basically as faithful as his options”       

    –Chris Rock

4

Sexual Orientation

Men and Women

  • At least for men, sexuality appears to be very biologically based
  • Bisexuality in men and women
    • Does it exist in men? Long-standing debate
    • Current research on bisexuality in men suggests men are either homosexual or heterosexual
      • Are we looking at a paraphilic explanation? (Men who are straight may engage in homosexual actions as part of a paraphilia in order to be embarrassed)
  • Women’s sexuality occurs more on a continuum from heterosexual, bisexual and homosexual

5

Sexual Desire and Sexual Arousal Patterns

  • Men tend to have more category specific arousal patterns consistent with their self-identified sexual orientation, women show arousal to many different types of stimuli
  • Based on recent research on naked people exercising and engorged genitals

6

Sex Differences in Sexual Desire/Drive

Female erotic plasticity

Strength of sex drive

  • Female erotic plasticity
    • Individual women will exhibit more variation across time than men in sexual behaviour
    • Female sexuality will exhibit larger effects than male in response to most specific sociocultural variables
    • Sexual attitude-behaviour consistency will be lower for women than men
  • Strength of sex drive
    • Men have more frequent and more intense sexual desires than women

7

Human Sexual Response Cycle (4)

Masters & Johnson:

  • Masters & Johnson:
    • Excitement Phase (Initial Arousal)
    • Plateau Phase (at full arousal but not yet at orgasm stage)
    • Orgasm
    • Resolution Phase (after orgasm)
  • No difference between clitoral and vaginal orgasm (Freud)

8

Sexual Dysfunction: 

people who find it difficult to function adequately during sex

9

Dysfunction

Dysfunction

  • Refers to normal sexuality as opposed to paraphilias
  • Impairments or disturbances in:
    • Desire
    • Arousal
    • Orgasm
    • The presence of pain

10

Paraphilic disorders

sexual deviation where sexual arousal occurs primarily in the context of inappropriate objects or individuals

11

Philia:

Para: 

Philia: refers to strong attraction or liking

Para: indicates the attraction is abnormal

12

Gender dysphoria: 

incongruence and psychological distress and dissatisfaction with the gender one has been assigned at birth

13

largest discrepancy in gender difference in sexuality

The frequency of masturbation (men over women) 

14

Fraternal birth order hypothesis: 

that males are more likely to be gay if they have older brothers (the odds increase by one third for each older brother)

15

Biological limits 

Almost certainly, biology sets certain limits within which social and psychological factors affect development

16

DSM-5 Classifications of sexual dysfunctions

17

Female Sexual Interest/Arousal Disorder Diagnostic Criteria (sexual desire disorder)

  • A. Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:
    • Absent/reduced interest in sexual activity
    • Absent/reduced sexual/erotic thoughts or fantasies
    • No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate
    • Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75% - 100%) sexual encounters
    • Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual)
    • Absent/reduced genital or nongenital sensations during sexual activity in almost all or all sexual encounters
  • B. Symptoms in Criterion A have persisted for at least 6 months
  • C. Symptoms in Criterion A cause clinically significant distress in the individual
  • D. Sexual dysfunction not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors, not attributable to effects of substance/medication or other medical condition

18

Male Hypoactive Sexual Desire Disorder Diagnostic Criteria (sexual desire disorder)

  • A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individuals’ life
  • B. Symptoms in Criterion A have persistent for a minimum duration of approximately 6 months
  • C. Symptoms cause clinically significant distress in the individual
  • D. Sexual dysfunction not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors, not attributable to effects of substance/medication or other medical condition

19

Erectile Disorder Diagnostic Criteria (sexual arousal disorder)

  • A. At least one of the three following symptoms must be experienced on almost all or all occasions of sexual activity:
    • Marked difficulty in obtaining an erection during sexual activity
    • Marked difficulty in maintaining an erection until the completion of sexual activity
    • Marked decrease in erectile rigidity
  • B. Symptoms have persisted for at least 6 months
  • C. Symptoms cause clinically significant distress in the individual
  • D. Sexual dysfunction not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors, not attributable to effects of substance/medication or other medical condition

20

Premature (Early) Ejaculation Diagnostic Criteria (orgasm disorder)

  • A. A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it
    • Specific duration criteria have not been established for nonvaginal sexual activities
  • B. The symptom in Criterion A must have been present for at least 6 months and must be experienced on almost all or all occasions of sexual activity
  • C. Symptom causes clinically significant distress
  • D. Sexual dysfunction not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors, not attributable to effects of substance/medication or other medical condition

21

Female Orgasmic Disorder Diagnostic Criteria

  • A. Presence of either of the following symptoms and experienced on almost all or all occasions of sexual activity
    • Marked delay in, marked infrequency of, or absence of orgasm
    • Markedly reduced intensity of orgasmic sensations
  • B. Minimum duration of approximately 6 months
  • C. Symptoms cause clinically significant distress
  • D. Sexual dysfunction not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors, not attributable to effects of substance/medication or other medical condition

22

Delayed Ejaculation Diagnostic Criteria (orgasm disorder)

  • A. Either of the following symptoms must be experienced on almost all or all occasions of partnered sexual activity, and without the individual desiring delay:
    • Marked delay in ejaculation
    • Marked infrequency or absence of ejaculation
  • B. Symptoms have persisted for minimum of 6 months
  • C. Symptoms cause clinically significant distress
  • D. Sexual dysfunction not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors, not attributable to effects of substance/medication or other medical condition

23

Genito-Pelvic Pain/Penetration Disorder Diagnostic Criteria (sexual pain disorder)

  • A. Persistent or recurrent difficulties with one or more of the following:
    • Vaginal penetration during intercourse
    • Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts
    • Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration
    • Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
  • B. Symptoms have persisted for a minimum of 6 months
  • C. Symptoms cause clinically significant distress
  • D. Sexual dysfunction not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors, not attributable to effects of substance/medication or other medical condition

24

Vaginismus:

pelvic muscles in the outer third of the vagina undergo involuntary spasms when intercourse is attempted

25

Potential Causes of Sexual Dysfunction

Biological risk factors

Psychosocial risk factors

  • Individual
  • Relationship

  • Biological risk factors
    • Vascular disease
    • Diabetes, CNS diseases
    • Hormone levels
    • Alcohol use
    • Medications
    • Damage/injury to vagina
    • Age
    • Cigarette smoking
    • Chronic pain
  • Psychosocial risk factors
    • Individual
      • Psych disorders
      • Emotional issues
      • Maladaptive cognitions
      • Cultural factors
      • Lack of education
      • Sexual trauma
    • Relationship
      • Couple distress
      • Poor communication
      • Lack of physical attraction
      • Restricted sexual repertoire

26

Assessing sexual behaviour (3) components

  1. Interviews, usually supported by numerous questionnaires because patients may provide more information on paper than a verbal interview
  2. Thorough medical evaluation, to rule out the variety of medical conditions that can attribute to sexual problems
  3. Psychophysiological assessment, to directly measure the physiological aspects of sexual arousal

27

Medical/physical causes needed to rule out when diagnosing sexual dysfunctions

  • Alcoholism
  • Diabetes
  • Ageing
  • Neurological disorders
  • Illicit drugs
  • Medication side effects
  • Infections
  • Past operations
  • Past traumas

28

Treatment Overview of sexual dyfunctions

  • Goals should not be performance-oriented
    • Primary goal should be to help couple develop more satisfying sexual relationship
  • Challenges to therapy
    • Preference for a simple pill
    • Rigid, faulty attribution for sexual difficulties
    • Noncompliance with work assignments
    • Extramarital affairs
    • Cultural or religious opposition to treatment methods
  • Methods:
    • Psychoeducation
    • Stimulus control
    • Cognitive restructuring
    • Return attention to erotic cues

29

Arousal during performance demand for normal individuals and those with sexual dysfunctions

  • Normal functioning individuals show increased sexual arousal during “performance demand” conditions, experience positive affect, are not distracted by nonsexual stimuli and have a good idea about how aroused they are.
  • Individuals with sexual problems show decreased arousal during performance demand, experience negative affect, are distracted by non-sexual stimuli and do not have an accurate sense of how aroused they are.

                                                 These finding are particularly applicable to arousal disorders

  • Most sexual dysfunctions tend to occur together

30

Psychological Treatment of Female Sexual Dysfunctions

  • Primary anorgasmia (never had an orgasm)
    • Sensate focus
    • Directed masturbation
  • Secondary anorgasmia (can have orgasms in some situations but not others)
    • Psychoeducation, sexual skills training, body image, communication training
  • GPPPD treatments (Genito-Pelvic Pain/Penetration Disorder)
    • Insertion training/dilation
    • Relaxation and Kegel exercises
    • Surgery