Sexual Disorders - Midterm 3

What are the two key categories for sexual disorders

• Sexual dysfunction — persistent disruption in the ability to experience sexual arousal, desire, or orgasm, or pain during intercourse

• Paraphilic disorder — persistent or troubling attractions to unusual sexual activities or objects

How have norms shifted over time

• Too much = the problem (before) → diets and foods were even developed to reduce sexual functioning

• Too little = the problem (now)

What are some historical factors that may have contributed to the shift in norms

• Birth control pills

• AIDS

• Access to pornography

What is Gender Dysphoria

Diagnostic criteria — a desire to be a member of the opposite sex that causes marked distress or functional impairment

What is gender identity

a person's inherent sense of being male or female (not the same as sexual orientation)

Why should gender dysphoria not be considered a disorder

• Cross-gender behaviour is universal

• The diagnosis can foster stigma rather than promote mental health

• Treatment for a "disorder" doesn't align with sex-reassignment surgery — treatment would aim to reverse the desire, not provide surgery

What are the three categories that sexual dysfunction is divided into?

• Sexual Interest, Desire & Arousal

• Orgasmic Disorders

• Sexual Pain Disorders

What what be present for all sexual dysfunction disorders?

dysfunction must be persistent, recurrent, and cause clinically significant distress

• Symptoms must be present for ≥ 6 months

• Must not result from relationship distress (e.g., partner abuse)

what is Female Sexual Interest/Arousal Disorder

Reduced interest/arousal

How do women with Female Sexual Interest/Arousal Disorder in biological response vs desire

Women with this disorder show normal levels of biological response to erotic stimuli but lack desire. They report previously exciting stimuli are no longer exciting.

What is Male Hypoactive Sexual Desire Disorder (DSM Criteria)

Persistently or recurrent deficient (or absent) sexual fantasies and desire for sexual activity, as judged by the clinician

What is Erectile Disorder

Failure to attain or maintain an erection through completion of sexual activity

State the DSM-5 Criteria for Erectile Disorder

• Inability to attain or maintain an erection.

• Marked decrease in erectile rigidity interfering with penetration or pleasure

How does Erectile disorder differ from low sex drive

Many men with this disorder want to have sex; the problem is physical arousal. Increases sharply with age.

What are Orgasmic Disorders

Problems in achieving orgasm for men and women

What is Female Orgasmic Disorder

Absence/diminished or delayed orgasms

DSM-5 Criteria: Female Orgasmic Disorder

• Marked delay, infrequency, or absence of orgasm, OR

• Markedly reduced intensity of orgasmic sensation

DSM Criteria for Premature (Early) Ejaculation Disorder

Tendency to ejaculate within 1 minute of penile insertion, AND before the person wishes it

DSM-5 Criteria for Delayed Ejaculation Disorder

Marked delay, infrequency, or absence of orgasm

What is Genito-Pelvic Pain/Penetration Disorder

persistent or recurrent pain during intercourse

DSM Criteria for Genito-Pelvic Pain/Penetration Disorder

DSM-5 Criteria — persistent or recurrent difficulties with at least one of the following:

• Inability to have vaginal penetration during intercourse

• Marked vulvar, vaginal, or pelvic pain during vaginal penetration or intercourse attempts

• Marked fear or anxiety about pain or penetration

• Marked tensing of the pelvic floor muscles during attempted vaginal penetration

State the four phases of sexual response cycle

1. Desire

2. Excitement (Erection of the penis, Enlargement of breasts & changes in the vagina)

3. Orgasm

4. Resolution

What were the two core immediate causes of sexual dysfunction

• Fear about performance — Concerns with how one is performing during sex

• Adoption of a spectator role — Observing oneself rather than fully participating in the sexual experience

What are some biological factors in sexual disorders?

• Low testosterone → reduced sexual desire in men

• Low estradiol + low testosterone → low sexual desire in women

What is a biological cause for Genito-Pelvic Pain / Penetration Disorder

Some women have a neurologically based supersensitivity to pain

What is a biological cause for premature Ejaculation?

Abnormal serotonin receptors are a major explanation

What can childhood sexual abuse cause?

• diminished arousal & desire, higher rates of genital pain

• Men experience double the rate of premature ejaculation

State the Psychological & Cognitive Factors for sexual disorders

• Depression and anxiety increase the risk of sexual dysfunctions

• Low general physiological arousal can interfere with specific sexual arousal

• Negative cognitions (fear of pregnancy, AIDS, negative attitudes) → interfere with sexual functioning

• Thoughts about sexual performance are significant problems for both men and women

Where do negative sexual cognitions often come from?

social and cultural surroundings

What is the first step of treatment for sexual disorder?

Psycho-education: Provide good information about how common sexual dysfunction is

What can Psycho-education help with

• Normalize concern, reduce anxiety, and eliminate blame

• Men with premature ejaculation may blame themselves → understanding the biological component brings relief

How can couple therapy for sexual disorder help?

• Some sexual dysfunctions are embedded in a distressed relationship— and sexual difficulties can also create problems between partners

• Increase communication

How do Cognitive Interventions for sexual disorder work?

Challenge self-demanding, perfectionistic thoughts that may cause or worsen sexual dysfunction.

What is Sensate Focus?

A technique to refocus on the sensual pleasure of intimacy — countering the destructive tendency to evaluate performance or attractiveness during sex

State Treatments for Female Orgasmic Disorder.

• Directed masturbation is the primary technique

State treatment for Genito-Pelvic Pain / Penetration Disorder

relaxation techniques

State treatment for Premature Ejaculation

• SSRI antidepressants have been found to help reduce premature ejaculation — and are more effective than behavioral techniques.

• Behavioural — The Squeeze Technique

Antidepressants >> Behavioral techniques

State treatments for Erectile Disorder

PDE-5 Inhibitors (e.g., Viagra) — relax smooth muscles, allowing blood flow into the penis and creating an erection

What are Paraphilic Disorders?

DSM-5 defines paraphilic disorders as recurrent sexual attraction to unusual objects or sexual activities for ≥ 6 months

Onset for Paraphilic Disorders

• some disorder have onset during adolescence, others onset during early adulthood

State DSM-Criteria for Fetishistic Disorder

• sexually arousing fantasies, urges, or behaviors involving the use of nonliving objects or non-genital body parts

• The sexually arousing objects are not limited to articles of clothing used in cross-dressing or to devices designed to provide tactile genital stimulation, such as a vibrator

State DSM criteria for Pedophilic Disorder

• Sexually arousing urges, fantasies or behaviours involving sexual contact with a prepubescent child

• Person has acted on these urges, or the urges and fantasies cause marked distress or interpersonal problems

• Person is at least 16 years old and 5 years older than the child

What is incest

• Incest is a subtype of pedophilic

• Incest → sexual relations between close relatives for whom marriage is forbidden

DSM-5 Criteria: Voyeuristic Disorder

• Sexually arousing fantasies, urges, or behaviors involving observing other who are unclothed or engaging in sexual activity

• Person has acted on these urges with a nonconsenting person, or the urges and fantasies cause marked distress or interpersonal problems

What is an element that must be present for a diagnosis of Voyeuristic Disorder

Fantasies alone do not warrant a diagnosis. The element of risk and threat of discovery is important

DSM-5 Criteria: Exhibitionistic Disorder

• Intense desire to obtain sexual gratification by exposing one’s genitals to unwilling stranger

  • Seldom results in physical contact with victim

  • Usually involves desire to shock or alarm victim

DSM-5 Criteria: Frotteuristic Disorder

• Sexually oriented touching of a nonconsenting person

  • The individual with frotteurism rubs his genitals against a women’s body or fondles her breast or genitals

DSM-5 Criteria — Sexual Sadism Disorder

• sexually arousing fantasies, urges, or behaviours involving the physical or psychological suffering of another person

• Causes clinically significant distress or impairment in functioning, or the person has acted on these urges with a nonconsenting person

DSM-5 Criteria — Sexual Masochism Disorder

• sexually arousing fantasies, urges, or behaviors involving the act of being humiliated, beaten, bound, or made to suffer

• Causes marked distress or impairment in functioning

What is Transvestic Disorder

• Recurrent and intense sexual arousal from cross-dressing

• No desire to be of the opposite gender

What are Neurobiological Factors of Paraphilias

Since men are overwhelmingly overrepresented in paraphilic disorders, androgens were believed to be the cause

However, more recent research has not substantiated this

Psychological factors of Paraphilias

• Conditioning

• History of childhood physical and sexual abuse

• Cognitive distortions

  • “Because the child doesn’t run away, she must want me to fondle her”

• Alcohol & negative affect are common triggers

Cognitive Treatment for Paraphilias

• Strategies to Enhance Motivation

• Cognitive behavioral treatment:

  • Counter distorted thinking

  • Empathy training and/or social skills training

Biological Treatment for Paraphilias

Biological treatment

• Medications

  • Hormonal agents to reduce androgens

• SSRIs

list three personality traits commonly seen in people with paraphilic disorders

Heightened impulsivity

Poor emotion regulation

Hostile attitudes + lack of empathy toward their sexual targets

List the cognitive features that may lead to pedophile disorder

• Slightly lower IQ + higher rates of neurocognitive problems

• More minor physical anomalies related to atypical prenatal development

How does relapse prevention for paraphilic disorder work?

identify the situations and emotions that trigger the symptomatic behavior

What are modern CBT treatments for paraphilic disorder

Social skills training

Sexual impulse control strategies

Focus on early abuse experiences

Empathy training

What is the key intervention described for helping abused children recover

Change the child's attribution of responsibility — shifting blame from themselves → onto the abuser