9. Sexual Dysfunctions, Paraphilic Disorders, Gender Dysphoria

desire, arousal, orgasm, pain

4 domains of sexual dysfunctions

Desire - Arousal - Plateau - Orgasm - Resolution

Phases of the Human Sexual Response Cycle

Lifelong

A specifier describing the disturbance has been present since the individual became sexually active

Acquired

A specifier describing the disturbance began after a period of relatively normal sexual function

Male hypoactive sexual desire disorder

Males that have little or no interest in type of sexual activity

Female sexual interest/arousal disorder

Low sexual interest is almost always accompanied by a diminished ability to become excited or aroused by erotic cues or sexual activity in females.

Erectile Disorder

a specific disorder of arousal. The problem here is not the desire. Many males with this disorder have frequent sexual urges and fantasies and a strong desire to have sex but experience difficulties in erection

Female Orgasmic Disorder

marked delay, or absence, or reduced intensity of orgasm

Premature (Early) Ejaculation

a persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approx. 1 min following vaginal penetration and before the individual wishes it

Delayed Ejaculation

Marked delay/infrequency/absence in ejaculation

Genito-Pelvic Pain/Penetration Disorder

This disorder refers to difficulties with penetration during attempted intercourse or significant pain during intercourse.

Vaginismus

Involuntary pelvic muscle spasms during attempted intercourse, potentially occurring during gynecological exams or tampon insertion.

Psychophysiological assessment

directly measures physiological responses to sexual stimulation, providing valuable insights into arousal patterns and potential dysfunctions

Penile Strain Gauge

Measures penile erection in males

Vaginal Photoplethysmograph

Measures vaginal blood flow in females

Diabetes & Kidney Disease

Can reduce sensitivity in the genital area, leading to erectile dysfunction

Vascular Disease

Affects blood flow to the genitals, crucial for arousal and performance

antihypertensive, antidepressants & antianxiety drugs

drugs that can interfere with sexual functioning/dampen sexual desire and arousal

Performance Anxiety

Worries about performance can negatively impact arousal.

Erotophobia

Learned negative attitudes toward sexuality.

Semans squeeze technique

for premature ejaculation, where the partner stimulates the penis to nearly full erection and then squeezes the penis near the top, quickly reducing arousal

Viagra

drug for male erectile disorder

Paraphilic disorders

are characterized by unusual sexual interests that can cause distress or impairment to the individual, or harm, or the risk of harm to others.

Paraphilic disorders

involve sexual arousal primarily in the context of inappropriate objects or individuals, often precluding mutually consenting adult partners.

Fetishistic Disorder

recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s), as manifested by fantasies, urges, or behaviors

Body part(s), Nonliving object(s), other

Specifiers of Fetishistic Disorder

Frotteuristic Disorder

recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors

In a a controlled environment and In full remission

Specifiers of Frotteuristic Disorder

Voyeuristic Disorder

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

18 y.o.

the individual diagnosed with Voyeuristic Disorder must be at least _ y.o.

Exhibitionistic Disorder

recurrent and intense sexual arousal from exposure of one’s genitals to an unsuspecting person, as manifested by fantasies, urges, or behaviors

Sexually aroused by exposing genitals to prepubertal children/to physically mature individuals/ both

Exhibitionistic Disorder specify whether

Transvestic Disorder

recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or behaviors

With fetishism, with autogynephilia

specifiers of Transvestic Disorder

Transvestic Disorder With Fetishism

if sexually aroused from cross-dressing by fabrics, materials, or garments

Transvestic Disorder With Autogynephilia

if sexually aroused from cross-dressing by thoughts or images of self as a woman

Sexual Sadism

Involves inflicting pain or humiliation on others to achieve sexual arousal. This disorder can escalate to dangerous behaviors

Sexual Masochism

Gaining sexual arousal from suffering pain or humiliation.

With asphyxiophilia

Specifier of Sexual Masochism Disorder if the individual engages in achieving sexual arousal related to restriction of breathing

5-10%

percentage of women of all sexual offenders

Pedophilic Disorder

Sexual attraction to children or young adolescents.

Incest

Pedophilia involving a relative.

Child Pornography

A strong diagnostic indicator of pedophilic disorder

specify whether: exclusive/nonexclusive type

specify if sexually attracted to males/females/both

specify if limited to incest

Specifiers of Pedophilic Disorder

16 y.o. (at least 5 yrs older than the child)

Minimum age of individual to be diagnosed with Pedophilic Disorder

Comprehensive Evaluation

Assessing patients involves evaluating paraphilic arousal, desired arousal to adults, social skills, and relationship formation. This multifaceted approach provides a clearer picture of the individual's needs and challenge

Covert Sensitization

This technique involves associating arousing images with negative consequences in the patient's imagination. This aims to weaken the positive association between the behavior and pleasure, making it less appealing

Orgasmic Reconditioning

Patients are encouraged to substitute more desirable fantasies just before ejaculation during masturbation. With repeated practice, the desired fantasy can be introduced earlier in the process, leading to a shift in arousal patterns.

Relapse Prevention

Patients are taught to recognize early signs of temptation and to employ self-control strategies to prevent relapse. This helps build coping skills for managing urges and maintaining progress

Antiandrogens

drugs that reduce testosterone levels, decreasing sexual desire and fantasy. While effective in reducing arousal, these "chemical castration" drugs are not a long- term solution.

Triptorelin

another antiandrogen, shows promise in reducing sexual arousal with fewer side effects. However, its effectiveness relies on consistent use and motivation

Gender Dysphoria

stems from the desire to live openly as the other gender

Disorders of Sex Development (DSD)

formerly known as intersexuality

with a disorder/difference of sex development

posttransition (in adolescence and adult)

specifier for Gender Dysphoria

psychotherapy, hormone therapy, sex reassignment surgery

treatment options for gender dysphoria

Psychotherapy

plays a crucial role in helping individuals clarify their gender identity, address any underlying mental health concerns, and develop coping mechanisms.

hormone therapy

used to promote secondary sex characteristics consistent with the individual's gender identity.

Sex reassignment surgery

a final and irreversible step to physically align the body with gender identity

Puberty Blocking Medication

In pre-pubescent children who identify as transsexual, this medication may be considered to allow time for gender identity exploration