Sexual Dysfunctions, Paraphilias, and Gender Dysphoria

sexual dysfunctions

difficulties functioning adequately during sex that causes significant distress or impairment

paraphilic disorders

sexual arousal in the context of inappropriate objects or individuals

sexual response cycle

desire → arousal → plateau → orgasm → resolution

sexual desire disorders

little or no desire to have sex

• male hypoactive sexual desire disorder

• female sexual desire/arousal disorder

clinical description of male hypoactive sexual desire disorder

little or no interest in any type of sexual activity, including masturbation and fantasies

clinical description of female sexual desire/arousal disorder

reduced sexual interest, activity, thoughts, arousal to sexual cues, or pleasure during almost all sexual encounters

clinical description of erectile disorder

sexual arousal disorder

difficulty achieving or maintaining an erection

• though sexual desire usually remains in tact

clinical description of premature/delayed ejaculation

in males, ejaculation in the first minute after penetration before it is desired (premature)

• most prevalent sexual dysfunction in males, usually young and experienced

clinical description of female orgasmic disorder

marked delay, absence, or decreased intensity of orgasm in almost all sexual encounters

• not explained by relationship distress

clinical description of genito-pelvic pain/penetration disorder

difficulty with vaginal penetration associated with at least one;

• pain

• fear or anxiety of pain

• tensing in anticipation

biological causes of sexual dysfunctions

medical conditions that lower sensitivity in genital areas

chronic illnesses → fear of exercise in sex

certain medications (SSRIs, antidepressants)

drugs or alcohol

psychological causes of sexual dysfunctions

anxiety and negative thoughts about sexual encounters

traumatic experiences

avoiding awareness of sexual cues

sociocultural influences of sexual dysfunctions

learning as a child that sexuality can be negative and possibly threatening

traumatic sexual experiences

lack of communication about sexual needs

poor interpersonal relationships, losing feelings for your partner, not attracted to your partner, doubting your own attractiveness

treatments of sexual dysfunctions

meds: viagra

education about the sexual response cycle

Masters and Johnson Intervention- sex therapy

clinical description of frotteuristic disorder

persistent patterns of seeking sexual gratification from rubbing up against unwilling others

clinical description of fetishistic disorder

sexual arousal to nonhuman objects (inanimate objects or sources of specific sensations)

• ex. rubber (clothes)

clinical description of voyeuristic disorder

observing an unexpecting individual undressing, naked, or engaged in sexual activity to receive sexual gratification

clinical description of exhibitionist disorder

exposure of genital to unexpecting strangers for sexual gratification

clinical description of transvestic disorder

sexual arousal related to the act of wearing clothes of the opposite sex

clinical description of sexual sadism disorder

inflicting pain or humiliation to attain sexual gratification

clinical description of sexual masochism disorder

suffering pain or humiliation to attain sexual gratification

causes of paraphilic disorders

early inappropriate sexual associations or experiences (vicariously and/or accidently)

psychosocial treatments of paraphilic disorders

orgasmic reconditioning: masturbating to appropriate stimuli

covert sensitization: imagining averse consequences to formnegative associations with unacceptable behavior

medical treatments for paraphilic disorders

possibly some meds to reduce testosterone in certain groups such as sex offenders

gender identity

an essence of feeling towards being a man, woman, gender fluid, nonbinary, or having other experiences

clinical description of gender dysphoria

a marked incongruence between one’s experienced/expressed gender identity and their gender assigned at birth

other symptoms of gender dysphoria

have to have at least 6:

• desire/insistence for cross dressing (assigned males) or masculine clothing and rejecting feminine ones (assigned females)

• desire for playmates of the opposite gender

• dislike of sexual anatomy

• desire for secondary sex characteristics of opposite gender

• preference for opposite toys, games, etc.

treatments for gender dysphoria in children

“waiting it out”/rejecting/supporting gender identity

puberty blockers

psychoeducation and therapy to help navigate social issues and clarify gender identity

treatments for gender dysphoria in adults

gender-affirming surgery

full psych eval and education

hormonal treatments to bring desired sex characteristics