CHAPTER 10: Sexual Dysfunctions (copy)

sexual dysfunction

individuals with _ find it difficult to function adequately while having sex; they may not become aroused or achieve orgasm.

paraphilic disorders

relatively new term for sexual deviation

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

Philia

it refers to a strong attraction or liking

para

it indicate that the attraction is abnormal.

Paraphilic arousal patterns

tend to be focused rather narrowly, often precluding mutually consenting adult partners, even if desired

paraphilic disorders

this disorder have little to do with sexual dysfunctions except for the fact that they both involve sexual behavior.

gender dysphoria

in _ there is incongruence and psychological distress and dissatisfaction with the gender one has been assigned at birth (boy or girl).

gender dysphoria

the disorder is not sexual but rather a disturbance in the person’s sense of being a male or female.

genito-pelvic pain/penetration disorder

this includes difficulties with penetration during intercourse due in many cases to painful contractions or spasms of the vagina—appears only in females

Sexual dysfunctions

_ can be either lifelong or acquired.

Lifelong

it refers to a chronic condition that is present during a person’s entire sexual life

acquired

it refers to a disorder that begins after sexual activity has been relatively normal.

generalized

disorders can be _, occurring every time the individual attempts sex.

situational

disorders can be _, occurring with some partners or at certain times but not with other partners or at other times.

male hypoactive sexual desire disorder

little or no interest in sex that is causing significant distress in the individual or couple. In males, this disorder is called _.

female sexual interest/arousal disorder

deficits in interest or the ability to become aroused in women is combined in a disorder called _

little or no interest

Males with hypoactive sexual desire disorder and females with sexual interest/arousal disorder have _ in any type of sexual activity

Erectile disorder

_ is a specific disorder of arousal. The problem here is not desire. Males with this disorder have frequent sexual urges and fantasies and a strong desire to have sex.

impotence and frigidity

old and somewhat derogatory terms for male erectile disorder and female interest and arousal difficulties are _.

• these are imprecise labels that do not identify the specific phase of the sexual response in which the problems are localized

women

inability to achieve an orgasm despite adequate sexual desire and arousal is commonly seen in _

delayed ejaculation

Males who achieve orgasm only with great difficulty or not at all meet criteria for a condition called _

female orgasmic disorder

female version of delayed ejaculation

never or almost never

In diagnosing this problem (female orgasmic disorder), it is necessary to determine that the women _ reach orgasm.

retrograde ejaculation

_, in which ejaculatory fluids travel backward into the bladder rather than forward.

• almost always caused by the effects of certain drugs/coexisting medical condition

• should not be confused with delayed ejaculation.

premature ejaculation

far more common male orgasmic disorder is _, ejaculation that occurs well before the man and his partner wish it to

Female Orgasmic Disorder

Disorder Criteria:

Presence of either of the following symptoms and experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):

1. Marked delay in, marked infrequency of, or absence of orgasm.

2. Markedly reduced intensity of orgasmic sensations.

• persisted for a minimum duration of approximately 6 months.

• cause clinically significant distress in the individual.

Premature Ejaculation

Disorder Criteria:

A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the person wishes it.

Note: Although the diagnosis of premature (early) ejaculation may be applied to individuals engaged in nonvaginal sexual activities, specific duration criteria have not been established for these activities.

• must have been present for at least 6 months and must be experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts).

• cause clinically significant distress in the individual.

genito-pelvic pain/penetration disorder

A sexual dysfunction specific to women refers to difficulties with penetration during attempted intercourse or significant pain during intercourse. This disorder is called _

vaginismus

the most usual presentation of this genito-pelvic pain/penetration disorder is referred to as _, in which the pelvic muscles in the outer third of the vagina undergo involuntary spasms when intercourse is attempted

vaginismus

The spasm reaction of _ may occur during any attempted penetration, including a gynecological exam or insertion of a tampon. Women report sensations of “ripping, burning, or tearing during attempted intercourse”

assessment of sexual behavior

three major aspects to the _:

1. Interviews, usually supported by numerous questionnaires because patients may provide more information on paper than in a verbal interview

2. A thorough medical evaluation, to rule out the variety of medical conditions that can contribute to sexual problems

3. A psychophysiological assessment, to directly measure the physiological aspects of sexual arousal

Penile Erection Measurement

In men, it is measured directly using a penile strain gauge, which detects changes as the penis expands and records them on a polygraph. Participants are often unaware of these objective measures, and their self-reported arousal may differ from the recorded data. This discrepancy varies depending on the type of sexual problem they have.

vaginal photoplethysmograph

The comparable device of penile strain gauge for women is a _, developed by James Geer and his associates

vaginal photoplethysmograph

device that is smaller than a tampon inserted by the woman into her vagina. A light source at the tip of the instrument and two light-sensitive photoreceptors on the sides of the instrument measure the amount of light reflected back from the vaginal walls.

Vascular disease

_ is a major cause of sexual dysfunction, because erections in men and vaginal engorgement in women depend on adequate blood flow.

arterial insufficiency; venous leakage

The two relevant vascular problems in men are _ (constricted arteries), which makes it difficult for blood to reach the penis, and _ (blood flows out too quickly for an erection to be maintained

Chronic illness

_ can also indirectly affect sexual functioning.

For example, it is not uncommon for individuals who have had heart attacks to be wary of the physical exercise involved in sexual activity to the point of preoccupation.

prescription medication

A major physical cause of sexual dysfunction is _.

anti-hypertensive medications

Drug treatments for high blood pressure, called _, in the class known as beta-blockers, including propranolol, may contribute to sexual dysfunction.

alcohol

Physically, _ is a central nervous system suppressant, and for men to achieve erection and women to achieve lubrication is more difficult when the central nervous system is suppressed

Chronic alcoholism

this can also cause fertility problems in both men and women

erotophobia

Some people learn early that sexuality is negative or threatening, leading to responses that reflect this belief. Donn Byrne and colleagues call this negative cognitive set “_”, which is learned in childhood from family, religious influences, or others. Research suggests that _ predicts sexual difficulties later in life.

penile prostheses

Insertion of _ or implants has been a surgical option for almost 100 years; only recently have they become good enough to approximate normal sexual functioning.

semirigid silicone rod

One treatment for erectile dysfunction involves implanting a _ in the penis. This rod can be bent into position for intercourse and moved out of the way when not in use.

Vacuum device therapy

it creates a vacuum in a cylinder placed over the penis, drawing blood into the penis. A special ring at the base then traps the blood, helping maintain an erection.

fetishistic disorder

in this disorder, a person is sexually attracted to nonliving objects.

Fetishistic arousal

_ involves sexual attraction to:

1. Inanimate objects

2. Specific tactile stimulation, such as rubber or shiny black plastic (e.g., rubber clothing)

3. Body parts (partialism), such as feet, buttocks, or hair

Most sexual fantasies, urges, and desires focus on these objects or body part.

Paraphilic disorders

_ occur when sexual urges, fantasies, or behaviors cause distress or impairment to the individual or harm/risk of harm to others.

Frotteuristic disorder

this disorder involves sexual arousal from rubbing against a non-consenting person, often in crowded places like subways or buses. Victims, usually women, may feel trapped and unable to escape, while the perpetrator becomes aroused and may even reach ejaculation.

Genito-Pelvic Pain/Penetration Disorder

Disorder Criteria:

Persistent or recurrent difficulties with one (or more) of the following:

1. Vaginal penetration during intercourse.

2. Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.

3. Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration.

4. Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.

• have persisted for a minimum duration of approximately 6 months.

• clinically significant distress in the individual.

Voyeuristic disorder

this disorder is the practice of observing, to become aroused, an unsuspecting individual undressing or naked.

Exhibitionistic disorder

this disorder, by contrast, is achieving sexual arousal and gratification by exposing genitals to unsuspecting strangers

transvestic disorder

in _, sexual arousal is strongly associated with the act of (or fantasies of) dressing in clothes of the opposite sex, or cross-dressing

Frotteuristic Disorder

Disorder Criteria:

• Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors.

• the person has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Fetishistic Disorder

Disorder Criteria:

• Over a period of at least 6 months, recurrent and intense sexual arousal from the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors.

• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The fetish objects are not limited to articles of clothing used in cross-dressing (as in transvestic disorder) or devices specifically designed for the purpose of tactile genital stimulation (e.g., a vibrator)

Voyeuristic Disorder

Disorder Criteria:

• Over a period of at least 6 months, recurrent and intense sexual arousal from observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity, as manifested by fantasies, urges, or behaviors.

• The person has acted on these sexual urges with a noncon senting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

• The individual experiencing the arousal and/or acting on the urges is at least 18 years of age

Exhibitionistic Disorder

Disorder Criteria:

• Over a period of at least 6 months, recurrent and intense sexual arousal from the exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors.

• The person has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning

sadism and sexual masochism

Both sexual _ are associated with either inflicting pain or humiliation (sadism) or suffering pain or humiliation (masochism)

hypoxiphilia

_ which involves self-strangulation to reduce the flow of oxygen to the brain and enhance the sensation of orgasm.

antisocial personality disorder

many rapists meet criteria for _ and may engage in a variety of antisocial and aggressive acts.

pedophilia

the most tragic sexual deviance is sexual attraction to children (or young adolescents generally aged 13 years or younger), called _

incest

If the children are the person’s relatives, the pedophilia takes the form of _

Pedophilic Disorder

Disorder Criteria:

• Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).

• The person has acted on these sexual urges, or the sexual urges or fantasies cause marked distress or interpersonal difficulty.

• The individual is at least age 16 years and at least 5 years older than the child or children in Criterion A.

  
  

  Note: Do not include an individual in late adolescence involved in an ongoing sexual relationship with a 12- or 13-year-old

Sexual Sadism Disorder

Disorder Criteria:

• Over a period of at least 6 months, recurrent and intense sexual arousal from the psychological or physical suffering of another person, as manifested by fantasies, urges, or behaviors.

• The person has acted on these sexual urges with a nonconsenting person, or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Sexual Masochism Disorder

Disorder Criteria:

• Over a period of at least 6 months, recurrent and intense sexual arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer, as manifested by fantasies, urges, or behaviors.

• The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

paraphilic disorders

It is not unusual for individuals with _ to rationalize their behavior by engaging in some other practices that they consider to be morally correct or uplifting at the same time, a practice sometimes referred to as “moral cleansing.”

Covert sensitization

repeated mental reviewing of aversive consequences to establish negative associations with behavior

orgasmic reconditioning

In _, patients are instructed to masturbate to their usual fantasies but to substitute more desirable ones just before ejaculation.

Gender dysphoria

it is present if a person’s physical sex (male or female anatomy, also called “natal” sex) is not consistent with the person’s sense of who they really are or with their experienced gender.

posttransition

If the individual has made the transition to full-time living in their experienced gender (by interacting with people in their daily lives in a consistent manner in their desired gender) and they are preparing for, or have undergone sex reassignment surgery, then they are referred to as “_,” and this is specified in the diagnostic criteria for gender dysphoria

Gender Dysphoria in Children

Disorder Criteria:

A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least six of the following (one of which must be Criterion A1)

1. A strong desire to be of the other gender or an insistence that one is the other gender (or some alternative gender different from one’s assigned gender).

2. In boys (assigned gender), a strong preference for cross-dressing or simulating female attire; or in girls (assigned gender), a strong preference for wearing only typical masculine clothing and a strong resistance to the wearing of typical feminine clothing.

3. A strong preference for cross-gender roles in make-believe play or fantasy play.

4. A strong preference for the toys, games, or activities stereotypically used or engaged in by the other gender.

5. A strong preference for playmates of the other gender.

6. In boys (assigned gender), a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play or in girls (assigned gender), a strong rejection of typically feminine toys, games, and activities.

7. A strong dislike of one’s sexual anatomy.

8. A strong desire for the primary and/or secondary sex characteristics that match one’s experienced gender

Gender Dysphoria in Adolescents and Adults

Disorder Criteria:

A marked incongruence between one’s experienced/expressed gender and assigned gender, of at least 6 months’ duration, as manifested by at least two of the following:

1. A marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics (or in young adolescents, the anticipated secondary sex characteristics).

2. A strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender (or in young adolescents, a desire to prevent the development of the anticipated secondary sex characteristics).

3. A strong desire for the primary and/or secondary sex characteristics of the other gender.

4. A strong desire to be of the other gender (or some alternative gender different from one’s assigned gender).

5. A strong desire to be treated as the other gender (or some alternative gender different from one’s assigned gender).

6. A strong conviction that one has the typical feelings and reactions of the other gender (or some alternative gender different from one’s assigned gender).

intersexuality or hermaphroditism

Gender dysphoria can also occur among individuals with disorders of sex development (DSD), formerly known as _ , who are born with ambiguous genitalia associated with documented hormonal or other physical abnormalities.

Gender Nonconformity

it refers to behaviors and attitudes where boys exhibit feminine traits and girls exhibit masculine traits.

sex reassignment surgery

the final nonreversible step is to alter anatomy physically to be consistent with gender identity through _

Sexual dysfunction

it is associated with socially transmitted negative attitudes about sex, current relationship difficulties, and anxiety focused on sexual activity.

significant distress or impairment to the individual or causes harm or the risk of harm to others.

Paraphilia becomes a paraphilic disorder when the sexual attraction causes _

sexual sadism disorder

_, in which sexual arousal is associated with inflicting pain or humiliation

sexual masochism disorder

sexual arousal is associated with experiencing pain or humiliation

sexual arousal patterns

as the DSM-5 criteria do, that gender identity is independent of __

(ex. transwoman (a biological [natal] male with a strongly experienced feminine gender identity) may be sexually attracted to females.)

child pornography offense

an important study indicates that being charged with a _ is one of the best diagnostic indications of pedophilic disorder

with fetishism

If sexual arousal is primarily focused on the clothing itself, the diagnostic criteria require a specification “_”

distress and impairment or harm or the threat of harm to others.

DSM-5 does not consider a paraphilia a disorder unless it is associated with __