Sexual disorders and Gender variations

Sexual dysfunctions

Have a persistent inability to function normally in some areas of the sexual response cycle

Paraphilic disorders

Repeated and intense sexual urges, fantasies, or behaviors involving objects, situations, or individuals society deems inappropriate, causing significant distress or impairment.

• Para → ‘faulty’ or abnormal

• Philia→ attraction

Gender Dysphoria

Persistent feeling of being born in the wrong sex, identifying with the other gender, and experiencing significant distress or impairment because of these feelings.

Sexual Dysfunctions

Set of disorders in which people have difficulty responding sexually or experiencing sexual pleasure

To be diagnosed with Sexual Dysfunctions must

• Occur most of the time for at least 6 months

• Cause significant distress or impairment

• Not be due to another nonsexual psychiatric problem

The Sexual Response Cycle

• Desire phase

• Arousal phase

• Plateale Phase

• Orgasm Phase

• Resolution Phase

Desire phase _ The Sexual Response Cycle.

Urges in response to sexual cues, involving interest in or desire for sexual activity.

Arousal Phase - The Sexual Response Cycle.

Psychological experience of sexual arousal

• Vasocongestion (Increased blood flow to penis in males and pelvic area in females)

• Myotonia (muscular tension)

Plateau Phase - The Sexual Response Cycle.

High but stable level of excitement before orgasm

Orgasm Phase - The Sexual Response Cycle.

In males, sense of inevitability of ejaculation, followed by ejaculation ;

In females, rhythmic contractions of the vagina and more irregular contractions of the uterus

Resolution Phase - The Sexual Response Cycle.

Decrease in arousal and deep relaxation following orgasm, includes the refractory period in men.

4 terminology of Sexual dysfunctions

• Lifelong (levenslang)

• Acquired (verworven)

• Global (gegeneraliseerd)

• Situational (situatief)

Lifelong (levenslang)

some people struggle with sexual dysfunction their whole lives

Acquired (verworven)

For others, normal sexual functioning preceded the disorder

Global (gegeneraliseerd)

In some cases, the dysfunction is present during all sexual situations

Situational (situatief)

In others, it is tied to certain sexual stimulation, particular situations, or partners

Sexual desire disorders (DSM-IV TR)

- Hypoactive sexual desire disorder

- Sexual aversion disorder

Sexual arousal disorders (DSM-IV TR)

• Female sexual arousal disorder

• Male erectile disorder

Orgasmic disorders (DSM-IV TR)

- Female orgasmic disorder

- Male orgasmic disorder

- Premature orgasmic disorder

Sexual pain disorders (DSM-IV TR)

- Dyspareunia

- Vaginismus

Sexual desire disorders (DSM-5)

- Male hypoactive sexual desire disorder

- Female sexual interest/arousal disorder

Male Hypoactive Sexual Desire Disorder

Lack or reduced interest in sex, occurring most of the time for at least 6 months and causing significant distress.

Female Sexual Interest/Arousal Disorder

Lack of sexual interest and rarely initiated intimacy, often associated with hormonal, emotional, or situational factors.

Sexual arousal disorder (DSM-5)

• Female sexual interest/arousal disorder

• Erectile disorder

Erectile Disorder

Difficulty achieving or maintaining an erection during sexual activity, possibly related to hormonal, vascular, psychological, or situational causes.

Orgasmic disorders (DSM-5)

- Female orgasmic disorder

- Premature ejaculation

- Delayed ejaculation

Premature (Early) Ejaculation

Persistent ejaculation within 1 minute of penetration, occurring on most sexual occasions over at least 6 months.

Delayed Ejaculation

Marked delay or inability to achieve ejaculation despite adequate stimulation, potentially linked to psychological or physiological causes.

Female Orgasmic Disorder

• Individual usually displays a significant delay, infrequency, or absence of orgasm, and/or is unable to achieve past orgasmic intensity

• Individual experiences significant distress

• Present for at least 6 months

Biological factors in Sexuality

Genetic sex, hormonal functioning, diseases affecting sexual arousal and functioning, effects of drugs

Psychological factors in Sexuality

attitudes and expectations toward sex and one’s body, classical and operant conditioning of arousal patterns, anxiety, depression, other mental health problems

Social Factors

Relationships with sexual partners, reinforcements and punishments for sexual behaviour, cultural norms for sexual behaviours, gender role, traumas and more chronic stressors

Sexual pain disorder (DSM-5)

Genito-pelvic pain/penetration disorder

Genito-pelvic pain/penetration disorder

Difficulty with vaginal penetration, significant pain during intercourse, fear of pain, or tightening of pelvic floor muscles during attempts at penetration.

Sexual problems in age

• 18-24: Male 10% ; Female 21%

• 25-29: Male: 8% ; Female 16%

• 40-54: Male 8% ; Female 10%

• 55-69: Male 11% ; Female 19%

• 70-80: Male 21% ; Female 12%

Paraphilia 性慾倒錯

Behaviours in which an individual has recurrent, intense sexually arousing fantasies, sexual urges or behaviour involving:

1. Nonhuman objects

2. Children or other nonconsenting person

3. The suffering or humiliation of self or partner

Paraphilia Disorder

• May involve multiple paraphilia displays

• Relatively few people receive a formal diagnosis

• In general, a diagnosis is applied when paraphilias cause a person significant distress or impairment or when the satisfaction of the paraphilias places the person or their people at risk of harm

ICD-11 view on Paraphilias

ICD-11 limits paraphilia disorders to those that involve sexual arousal patterns focused on nonconsenting others or associated with substantial distress or direct risk of injury or death.

Types of Paraphilias

• The consent of others

• Nonconsenting others

• Contact with others

• Those that do not necessarily require contact with others

Paraphilia Disorder checklist

For at least 6 months, the individual experiences recurrent and intense sexually arousing fantasies, urges, or behaviours involving objects or situations outside the usual sexual norms (nonhuman objects; nongenital body parts; the suffering or humiliation of oneself or one’s partner; or children or other nonconsenting persons).

Paraphilic Disorder — Distress or Impairment Requirement

The individual experiences significant distress or impairment over the fantasies, urges, or behaviors.

Paraphilic Disorders Without Need for Distress Criterion

• Pedophilic disorder

• Exhibitionistic disorder

• Voyeuristic disorder

• Frotteuristic disorder

• Sexual saisom disorder

The performance of the paraphilia behaviours indicates a disorder, even in the absence of distress or impairment

Paraphilic disorders

• Fetishistic disorder 戀物癖

• Transvestic disorder (transvestism, cross-dressing) 異裝癖（異裝癖、變裝）

• Exhibitionistic disorder 露陰障礙

• Voyeuristic disorder 偷窺癖

• Frotteuristic disorder 摩擦性障礙

• Pedophilic disorder 戀童癖

• Sexual masochism disorder 性受虐狂障礙

• Sexual sadism disorder 性虐待障礙

DSM-5TR Update on Pedophilic Disorder (Fantasies and Pornography)

Fantasizing or watching pornographic material is no longer considered to be a pedophilic disorder under DSM-5TR.

If someone is diagnosed with pedophilic disorder, the option ‘in remission’ is no longer possible; a diagnosis is for life.

Pedophilic Disorder

Recurrent sexual attraction to prepubescent children, often associated with early life trauma, abuse or neglect

Fetishistic Disorder

Intense sexual arousal from nonliving objects or specific nongenital body parts, causing distress or impairment.

Transvestic Disorder

Intense sexual arousal derived from cross-dressing, typically in heterosexual males.

Exhibitionistic Disorder

Sexual arousal from exposing one's genitals to unsuspecting individuals, often accompanied by immaturity and masculinity doubts.

Frotteuristic Disorder

Sexual arousal from touching or rubbing against a non-consenting person, often occurring in crowded public places.

Sexual Masochism Disorder

Sexual arousal from being humiliated, beaten, bound, or otherwise made to suffer.

Sexual Sadism Disorder

Sexual arousal from the physical or psychological suffering of another person.

Explanations and Social Influence on Paraphilias

Although theorists have proposed various explanations for paraphilias, there is little formal evidence to support them.

→ Definitions of these disorders are strongly influenced by the norms of the society in which they occur.

Treatments for paraphilic disorders

• No treatments have received much research or been proven effective

• Psychological and sociocultural treatments have been available for the longest period of time, but today's professionals are also using biological interventions.

Gender Variations and Identity

People differ in terms of gender identity, biological sex, and gender expression. Most people have an identity consistent with their assigned gender (birth anatomy); cisgender.

Traditional and Current Views of Gender

Traditional view sees gender as binary (male or female). Current view sees gender as a continuous spectrum, but this view is still in development.

Non-Binary and Gender Fluidity

• Non-binary individuals do not choose between male or female gender identity.

• They may feel partly boy/man and girl/woman, neither, nor experience gender fluidity.

• Others may feel genderless or a gender.

• Another term for non-binary is genderqueer or gender-neutral.

Transgender individuals

• Gender identity differs from their assigned (based on external genitals) gender

• Affects 25 million people worldwide (0.6% of the adult population)

• Estimations in the Netherlands based on self-identification, between 0.15-0.58%

DSM-5TR Checklist for Gender Dysphoria — Core Criteria

For 6 months or more, an individual’s gender-related feelings and/or behaviors are at odds with those of his or her assigned gender

Symptoms of gender dysphoria

indicated by two or more of the following symptoms:

• Gender-related feelings and/or behaviours clearly contradict the individual’s primary or secondary sex characteristics

• Powerful wish to eliminate one’s sex characteristics

• Yearning for the sex characteristics of another gender

• Powerful wish to be a member of another gender

• Yearning to be treated as a member of another gender

• Firm belief that one’s feelings and reactions are those that characterize another gender

Transgender functioning

• Transgender women outnumber transgender men by 2 to 1

• i.e., transgender women = persons who identify as female but were assigned male at birth

• Publications between 1968-2008 showed that feelings may emerge in childhood and this pattern may disappear later

• Newer publications (2022  ) may show different results…

Treatment aspects in gender variations

• Psychological:

  • Build awareness of needs and feelings

  • reduce anxiety

  • depression and anger

  • improve self-image

  • develop coping skills

• Biological:

  • Gender-change procedures

  • gender reassignment surgery

  • gender confirmation surgery

  • gender-affirming surgery, hormone therapy (estrogen/testosterone)

• Cognitive-behavioural: Transgender education programs, support programs