[ABPSY] Sexual Deviations and Dysfunctions

sexual dysfunctions

• persistent or recurrent problems with sexual interest, arousal, or response that causes or impairment

• sex is human nature: biological thing

• central to people’s functioning in most individuals

4 sexual response phases

• Desire -> Orgasm -> Excitement -> Resolution

types of sexual dysfunctions

1. disorders of interest/arousal

2. orgasmic disorders

3. genito-pelvic pain/penetration disorders

disorders of interest/arousal

1. male hypoactive sexual desire disorder

2. female sexual desire/arousal disorder

3. male erectile disorder

[IA] male hypoactive sexual desire disorder

• at least 6 months 

• acknowledging asexuality 

• little desire for sexual activity or may lack sexual or erotic thoughts of fantasies

• impotence 

[IA] female sexual desire/arousal disorder

• at least 6 months 

• frigidity: failure to respond to sexual stimuli

• lack of, or greatly reduced level of sexual interest, drive or arousal 

[IA] male erectile disorder

• decrease in erectile rigidity

• little desire = affects relationships 

• difficulty in maintaining erection during sexual activity

types of orgasmic disorders

1. female orgasmic disorder

2. delayed ejaculation

3. premature ejaculation

[OD] female orgasmic disorder

• specifiy if never experienced an orgasm in any situation

• persistent or recurrent delay or absence of organs following normal sex excitement phase

[OD] delayed ejaculation

• In men, persistent, delay, infrequency, or absence of ejaculation

• delay in 75-100% of partnered sexual activity

[OD] premature ejaculation

• Ejaculation occurring within about one minute of vaginal penetration before it is desired

• Duration is not specified for non vaginal sexual activities

types of genito-pelvic pain / penetration disorders

• genital pain during intercourse with muscle tension, fear, and anxiety related to genitalpain or penetrative sexual activity

• vaginismus:

• rare in men 

• male dyspareunia:

• rule out medical conditions and effects of substances

  • antidepressants have regulated and lead to problems with sex

• note that significant distress is experienced by the individual 

[GPP] vaginismus

• muscles surrounding the vagina involuntarily contract whenever penetration is attempted, making sexual intercourse painful or impossible

male dyspareunia

• recurrent/persistent genital or pelvic pain with sexual activity or sexual dysfunction 

specifiers

1. lifelong

2. acquired

3. generalized

4. situational

5. severity

[specifiers] lifelong

• onset as soon as the individual became sexually active 

• can have normal or healthy functioning before they start to experience problems 

[specifiers] acquired

disturbance started after a period of relative normal sexual function

[specifiers] generalized

• applies to most type of stimulations, situations or partners

[specifiers] situational

• the disturbance is limited to certain types of stimulation, situations or partners

• ex. Blondes

[specifiers] severity

mild, moderate, severe

etiology and treatment for SD

1. biological

2. socio-cultural

3. psychological

4. biological treatments

5. psychosocial therapy

[etio] biological

• hormonal imbalances

  • Hypothyroidism: impact of low production of thyroid hormone

  • Hypogonadism: low production of sex glands, decline in the sex glands produced by the gonads and can lead to low sex hormones

• menopause (lower estrogen)

• low in testosterone (30-40s)

• physical disorders

  • diabetes

  • cardiovascular disease

  • hypertension 

  • obesity 

  • kidney failure 

  • cancer

• alcohol and drugs

• antidepressants (SSRI impair sexual performance) 

• work with psychologist, psychiatrist, and physician -> involves biological/physiological responses

[etio] socio-cultural

• women may harbor stereotypical attitudes towards female sexuality

• sexual dysfunction too may be linked to extremely strict sociocultural beliefs and sexual taboos

• rigid standards about women -> affect sexual functioning

• expectations for women in terms of sexual activities

  • men should "initiate" vs. women

  • heteronormative and patriarchal standards

  • expectations for men in relationships also -> paying for the first date

• role of culture and religion 

• could limit women’s expression of their sexuality

• expectations for men in sex

• lack of sex education in the PH

• ex. bong suntay 

[etio] psychological

1. severe mental disorders

• depression, anxiety 

2. traumatic sexual experience 

• childhood sexual abuse 

• stress and psychological exhaustion 

3. negative cognitions

• performance anxiety 

• worry about pregnancy, AIDS

• negative towards sex

• concerns about the partner

4. classical conditioning 

• repeated experiences involving the need to ejaculate quickly 

5. interpersonal 

• couple distress and negative life events 

• poor communication and unresolved differences 

6. irrational beliefs

[etio] other psychological factors

• performance anxiety and sexual activity

• negative attitudes toward sex

• religious beliefs

• body dissatisfaction and sexual dissatisfaction 

• self-perception

  • ex. had to look at it a certain way

• expectations about sex

• interpersonal concerns and sex 

  • addressed in psychotherapy

  • need to normalize

[treatment] biological

• testosterone replacement therapy (injection, patch, gel) 

• SSRIs (increase sexual desire but impair sexual performance)

• in media and advertisements 

  • viagra, levitra, cialis 

• penile implants 

[treatment] psychosocial therapy

1. couples therapy 

• skills and communication training 

2. sex therapy steps

• stop-squeeze technique: males who have problems with premature ejaculation

• directed masturbation: for women with orgasmic problems 

• after addressing, SD

3. systematic desensitization 

• with the use of different-sized vaginal dilators for women who experience pain during sex

• CBT to challenge irrational beliefs and attitudes

• communicating sexual needs 

• pakiramdaman in the philippines -> main way of communicating 

paraphillic disorders

• Group of persistent sexual behavior pattern in which unusual objects, rituals, or situations are required to fulfill sexual satisfaction

• para; beside; philla; love

[paraphillic] specifiers

• 6 months, distress, impairment 

• Coercive, vs non-coercive

• Atypical vs clinical

types of paraphilic disorders

1. towards nonhuman objects

2. towards children and non-consenting individuals

3. involving suffering or humiliation

disorders towards nonhuman objects

1. fetishistic disorder

2. transvestic disorder

[nonhuman] fetishistic disorder

• fantasies, urges, or behaviors that involves nonliving objects , not limited to female clothing used in cross-dressing

  • most common: lingerie, stockings, footwear

  • actirasty: sun light 

• xylophilia; exposed to wood

• specifier: body parts, nonliving objects, others

[nonhuman] transvestic disorder

• sexual arousal in men from wearing women’s clothing

• With distress and impairment

• only in cisgender heterosexual men 

• Specifier:

  • With fetishism - aroused by garments, fabrics or materials

  • With autogynephilia - aroused by thoughts or images of self as female

disorders towards children and nonconsenting individuals

1. exhibitionistic disorder

2. voyeuristic disorder

3. frottereustic disorder

4. pedophilic disorder

[children] exhibitionistic disorder

• exposure of one's genitalia to unsuspecting viewers

• specify if sexually aroused by exposing genitals to prepuberal children, physically mature individuals or both

• nonconsenting

[children] voyeuristic disorder

• watching an unsuspecting person naked, undressing, or engaging in sexual activity

• the individual acting on the urges must be 18 yo

  • kids don't experience it: can be curiosity

• with a nonconsenting person

[children] frottereustic disorder

• rubbing against a nonconsenting person

• willing to take risk even though they know its against the law/illegal 

• with intense arousal

[children] pedophilic disorder

• sexual urges, fantasies, or actual behavior directed towards prepubescent child

• usually with children 13yo or younger

• 16 yo can be diagnosed if a criterion is met

  • if 16 and above, and 5 years younger

  • can be considered it even if minor

  • age gap: more than 5 years

• grooming: below 18, minor

  • groomer; legal age

disorders involving suffering or humilation

1. sexual masochism disorder

2. sexual sadism disorder

[suffering] sexual masochism disorder

• strong and recurrent sexual urges, fantasies, or behaviors in which one becomes sexually aroused by being humiliated, bound, flogged, or made to suffer in other ways

• hypoxyphillia: involving arousal obtained by reduction of oxygen flow to the brain

• specify with asphyxiophilia; sexual arousal through restriction of breathing

• sexual preference vs. disorder

  • BDSM: maintain healthy relationships and functioning, family relationships

• presence distress in person: puts life in danger

• obvious lack of control despite consequences 

[suffering] sexual sadism disorder

• Recurrent powerful sexual urges, fantasies, or behaviors in which one becomes sexually aroused by inflicting physical or psychological suffering or humiliation on another 

sadomasochism

•  practicing both sadism and masochism

etiology and treatment of PD

1. biological view

2. psychodynamic influences

3. psychological perspectives

4. incarceration and court-ordered treatment

5. cognitive behavioral tx

6. biological tx

[etio] biological view

• Male hormones or androgens as almost all are more common in men

[etio] psychodynamic influences

• Defense against leftover castration anxiety from the phallic period of psychosexual development

• History of childhood physical and sexual abuse

[etio] psychological perspectives

• Cognitive distortions 

  • Since the child does not run away, she must want me to touch her

• Learning 

  • Conditioning and observational learning 

  • An object or activity becomes inadvertently associated with sexual arousal

• Poor social skills

[treatment] incarceration and court-ordered tx

• Used to enhance motivation 

• Often: denial and minimization of problem 

• Some: blame victim

• Lack of motivation for treatment 

• Drop out of treatment 

[treatment] cognitive behavioral tx

• Cognitive conditioning 

  • Aversive therapy

  • Covert sensitization (with imagery)

• Counter distorted thinking

• Often combined with social skills and empathy training

[treatment] biological tx

• Castration used in past

• Medications: hormonal agents to reduce androgens 

  • Depo-provera

  • SSRIs