integ: abpsych (sexual dysfunctions and gender dysphoria)

Sexual Dysfunctions

• when you have a problem that prevents you from wanting or enjoying sexual activity

• characterized by a clinically significant disturbance in a person's ability to respond sexually or to experience sexual pleasure

• May occur in both heterosexual and homosexual relationships

• It can happen anytime. People of all ages experience sexual dysfunction, although the chances increase as you age.

Lifelong

• chronic condition that is present during a person’s entire sexual life

• has been present since the individual first became sexually active and persists throughout life.

Acquired

disorder that begins after sexual activity has been relatively normal

Generalized

• occurring every time the individual attempts sex

• Not limited to certain types of stimulation, situations, or partners.

situational

occurring with some partners or at certain times but not with other partners or at other times

desire phase

sexual urges occur in response to sexual cues or fantasies

arousal stage

a subjective sense of sexual pleasure and physiological signs of sexual arousal: in males, penile tumescence (increased flow of blood into the penis); in females, vasocongestion (blood pools in the pelvic area) leading to vaginal lubrication and breast tumescence (erect nipples)

plateau phase

brief period occurs before orgasm

orgasm phase

in males, feelings of the inevitability of ejaculation, followed by ejaculation

in females, contractions of the walls of the lower third of the vagina

resolution phase

decrease in arousal occurs after orgasm (particularly in men)

Delayed Ejaculation Disorder

• inability to achieve an orgasm despite adequate sexual desire and arousal

• They achieve orgasm only with great difficulty or not at all

• male orgasmic disorder

• it is believed to be impacted by individual, biological, psychological, and relationship factors.

• Specifically, unique masturbation habits and age can be influencers.

Retrograde Ejaculation

ejaculatory fluids travel backward into the bladder rather than forward

Delayed Ejaculation

A. Either of the following symptoms must be experienced on almost all or all occasions (approximately 75%-100%) of partnered sexual activity (in identified situational contexts or, if generalized, in all contexts), and without the individual desiring delay:

1. Marked delay in ejaculation.

2. Marked infrequency or absence of ejaculation.

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

TREATMENT OF DELAYED EJACULATION

• Treatment often includes an integration of medication, psychotherapy, and behavioral masturbatory retraining

• The clinician should also assess for and address any performance anxiety and self-criticism.

erectile disorder

• repeated failure to obtain or maintain erections during partnered sexual activities

• Many males with what have frequent sexual urges and fantasies and a strong desire to have sex at any time

• causes: vascular disorders, medication, performance anxiety, negative thoughts, and relationship issues

erectile dysfunction

A. At least one of the three following symptoms 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):

1. Marked difficulty in obtaining an erection during sexual activity.

2. Marked difficulty in maintaining an erection until the completion of sexual activity.

3. Marked decrease in erectile rigidity.

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

erectile failure

has been found to be related to having sex with a previously unknown partner, concomitant use of drugs or alcohol, not wanting to have sex, and peer pressure.

TREATMENT OF ERECTILE DISORDER

• Medication may be one of the most well-known treatment methods

• Psychological treatment approaches include the use of CBT to decrease negative thought patterns and reduce performance anxiety

• Other behavioral interventions such as sensate focus and sexual stimulation techniques have been used

• A physical examination by a physician or urologist to rule out physiological problems might also be recommended.

Alexithymia

deficits in cognitive processing of emotions

Female Orgasmic Disorder

• inability to achieve an orgasm despite adequate sexual desire and arousal in women

• Most common complaint among women who seek therapy for sexual problems

Female Orgasmic Disorder

A. 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.

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

CAUSES OF FEMALE ORGASMIC DISORDER

• can be caused by individual variables, such as levels of sexual anxiety, stress, or fatigue.

• Relationship factors, like the quality of partner interaction and communication, can impact a woman’s ability to orgasm

• In some cases, physical illness, neurological or gynecological issues, diabetes, spinal cord injury, and medication can create problems

• has a high comorbidity rate with other sexual concerns regarding arousal, sexual desire, and lack of vaginal lubrication

TREATMENT OF FEMALE ORGASMIC DISORDER

• can practice stimulation techniques, sensate focus, and receive psychological CBT interventions that decrease performance anxiety and encourage erotic fantasy

• Other treatments include medication and/or hormone treatment.

clitoral stimulation

Many women require what to reach orgasm,

female orgasmic disorder

a woman's experiencing orgasm through clitoral stimulation but not during intercourse does not meet criteria for a clinical diagnosis of

Female Sexual Interest/Arousal Disorder

• absence or reduced frequency or intensity in sex

• There may be absent or reduced frequency or intensity of interest in sexual activity

• Suggests that the lack of sexual interest or arousal has been present for the woman's entire sexual life

• Frequently associated with problems in experiencing orgasm, pain experienced during sexual activity, infrequent sexual activity, and couple-level discrepancies in desire

• No sexual thoughts or fantasies, no initiation, no sexual excitement or pleasure during sex

Female Sexual Interest/Arousal Disorder

A. Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:

1. Absent/reduced interest in sexual activity.

2. Absent/reduced sexual/erotic thoughts or fantasies.

3. No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate.

4. Absent/reduced sexual excitement/pleasure during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).

5. Absent/reduced sexual interest/arousal in response to any internal or external sexual/erotic cues (e.g., written, verbal, visual).

6. Absent/reduced genital or nongenital sensations during sexual activity in almost all or all (approximately 75%-100%) sexual encounters (in identified situational contexts or, if generalized, in all contexts).

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexuai mental disorder or as a consequence of severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

TREATMENT OF FEMALE SEXUAL INTEREST/AROUSAL DISORDER

treatment typically includes a mixture of pharmacological and psychological interventions, including hormone treatment, cognitive behavioral therapy (CBT), and mindfulness-based interventions

desire discrepancy

a woman has lower desire for sexual activity than her partner, is not sufficient to diagnose female sexual interest/arousal disorder.

hypoactive sexual desire disorder

absent or reduced frequency or intensity of interest in sexual activity

vaginal dryness

this in older women is related to age and menopausal status.

Genito-Pelvic Pain/Penetration Disorder

• difficulties in vaginal penetration during intercourse

• Vaginal pain during attempted intercourse is so severe that sexual behavior is disrupted

• Also called vaginismus

  • Pelvic muscles in the outer third of the vagina undergo involuntary spasms when intercourse is attempted

  • May occur during any attempted penetration

Genlto-Pelvic Pain/Penetration Disorder

A. 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.

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of a severe relationship distress (e.g., partner violence) or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

Genito-pelvic pain

can also be usefully characterized qualitatively (e.g., "burning," "cutting," "shooting," "throbbing").

Male Hypoactive Sexual Desire Disorder

• persistently deficient or absent sexual/erotic thoughts or fantasies and desire for sexual activity

• Sometimes associated with erectile and/or ejaculatory concerns

• Rarely the sole sexual diagnosis in men

Male Hypoactive Sexual Desire Disorder

A. Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and socio-cultural contexts of the individual’s life.

B. The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.

C. The symptoms in Criterion A cause clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to thes effects of a substance/medication or another medical condition.

CAUSES OF MHSDD

Risk factors for developing this can include

problems in the relationship, sociocultural messages

about masculinity, early negative messages about

sex, and biomedical factors such as age, hormone

production, illness, and side effects from medication.

Hormone replacement therapy

can assist those with low testosterone, and medications may be prescribed or current medications adjusted

Premature Ejaculation Disorder

• ejaculation that occurs well before the man and his partner wish it to

• Occurs approximately 1 minute after penetration

• A common male orgasmic disorder

• Complain a sense of lack of control over ejaculation and report apprehension about their anticipated inability to delay ejaculation on future sexual encounters

• Associated with erectile problems

Premature (Early) Ejaculation

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

B. The symptom in Criterion A 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).

C. The symptom in Criterion A causes clinically significant distress in the individual.

D. The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.

acquired premature (early) ejaculation.

some men develop the disorder after a period of having a normal ejaculatory latency,

CAUSES OF PE

• can be due to medical conditions, such as neurological disorders, urological problems, or physical injury

• Psychological factors include performance anxiety, stress, poor confidence or body image, and negative early learned experiences

TREATMENT OF PREMATURE EJACULATION

Pharmacological treatments include topical creams or medication such as SSRIs, Penile exercises, CBT, and individual or conjoint therapy are other treatment options.

Cialis

injection of vasodilating drugs such as papaverine or prostaglandin directly into the penis

Vacuum Device Therapy

works by creating a vacuum in a cylinder placed over the penis

Gender Dysphoria

• present if a person’s physical sex is not consistent with the person’s sense of who he or she really is or with his or her experienced gender

• People with this disorder often feel trapped in a body of the wrong sex

gender dysphoria

• Can also occur among individuals with disorders of sex development (DSD)

  • Formerly known as intersexuality or hermaphroditism

• If this occurs in the context of a DSD, this should be specified

Gender Nonconformity

boys who behave in feminine ways and girls who behave in masculine ways

sex and sexual

refer to the biological indicators of male and female (understood in the context of reproductive capacity), such as in sex chromosomes, gonads, sex hormones, and nonambiguous internal and external genitalia.

Cross-sex hormone treatment

denotes the use of feminizing hormones in an individual assigned male at birth based on traditional biological indicators or the use of masculinizing hormones in an individual assigned female at birth.

gender

used to denote the public (and usually legally recognized) lived role as boy or girl, man or woman,

Gender assignment

the initial assignment as male or female.

Gender-atypical

somatic features or behaviors that are not typical (in a statistical sense) of individuals with the same assigned gender in a given society and historical era

gender-nonconforming

for behavior, alternative descriptive term of gender-atypical is?

Gender reassignment

denotes an official (and usually legal) change of gender.

Gender identity

a category of social identity and refers to an individual's identification as male, female, or, occasionally, some category other than male or female.

Gender Dysphoria in Children

A. 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.

B. The condition is associated with clinically significant distress or impairment in social, school, or other important areas of functioning.

Gender Dysphoria in Adolescents and Adults

A. 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 second- ary 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

B. The condition is associated with clinically significant distress or impairment in social, occupationali^or other important areas of functioning.

Sex Reassignment Surgery

• Alter anatomy physically to be consistent with gender identity

• Must live in the desired gender for 1-2 years

• Must be stable psychologically, financially, and socially

Gynecomastia

growth of breasts for transwomen

paraphilia

• any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners

• focus predominantly on a person’s sexual behaviors, while others center on their sexual preferences. For instance, the former may involve strong and enduring fascinations with activities like spanking, whipping, cutting, bondage, or strangulation of another person, surpassing or equaling their interest in sexual intercourse or similar interactions with others.

• VOYEURISTIC DISORDER

• EXHIBITIONISTIC DISORDER

• FROTTEURISITIC DISORDER

• ALGOLAGNIC DISORDERS, WHICH INVOLVE PAIN AND SUFFERING (SEXUAL MASOCHISM DISORDER AND SEXUAL SADISM DISORDER

• based on anomalous activity preferences.

• These disorders are subdivided into courtship disorders, which resemble distorted components of human courtship behavior:

PEDOPHILIC DISORDER

FETISHISTIC DISORDER

TRANSVESTIC DISORDER

The second group of disorders is based on anomalous target preferences. These disorders include one directed at other humans:

VOYEURISTIC DISORDER

A. 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.

B. The individual 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.

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

In a controlled environment

This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in such behaviors are restricted.

In full remission

• The individual has not acted on the urges and there has been no distress or impairment in social, occupational, or other areas of functioning, for at least 5 years while in an uncontrolled environment.

EXHIBITIONISTIC DISORDER

A. 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.

B. The individual 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.

Sexually aroused by exposing genitals to prepubertal children

Sexually aroused by exposing genitals to physically mature individuals

Sexually aroused by exposing genitals to prepubertal children and to physically mature individuals

SPECIFIERS FOR EXHIBITIONISTIC DISORDER

FROTTEURISTIC DISORDER

A. 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.

B. The individual 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

A. 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.

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

With Asphyxiophilia:

in sexual masochism disorder: If the individual engages in the practice of achieving sexual arousal related to restriction of breathing.

SEXUAL SADISM DISORDER

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

urges, or behaviors.

B. The individual 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.

PEDOPHILIC DISORDER

A. 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).

B. The individual has acted on these sexual urges, or the sexual urges or fantasies

cause marked distress or interpersonal difficulty.

C. 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.

Exclusive type (attracted only to children)

Nonexclusive type

Sexually attracted to males

Sexually attracted to females

Sexually attracted to both

Limited to incest

SPECIFIERS FOR PEDOPHILIC DISORDER

FETISHISTIC DISORDER

A. Over a period of at least 6 months, 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.

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

C. 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., vibrator).

Body part(s)

Nonliving object(s)

other

SPECIFIERS FOR FETISHISTIC DISORDER

TRANSVESTIC DISORDER

A. Over a period of at least 6 months, recurrent and intense sexual arousal from cross-dressing, as manifested by fantasies, urges, or behaviors.

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

With fetishism:

in transvestic disorder: If sexually aroused by fabrics, materials, or garments.

With autogynephilia

in transvestic disorder: If sexually aroused by thoughts or images of self as a woman.