chapter 9 paraphilias and sexual dysfunctions

Sexual Dysfunction

Problems with desire, arousal, orgasm, or pain during sex, requiring distress or impairment for diagnosis

Paraphilias

Intense sexual urges or fantasies involving abnormal targets, behaviors, or pain/suffering, lasting 6+ months, often causing distress or involving non-consenting individuals

Gender Dysphoria

Involves a strong desire to be treated as a different gender or to remove one’s sex characteristics

Sexual Response Cycle Components

desire/excitement, arousal, plateau, orgasm, and resolution

Male Hypoactive Sexual Desire Disorder

• little or not interest in any type of sexual activity

• masturbation, sexual fantasies, and intercourse are rare

Female Sexual Interest/Arousal Disorder

• absence or significantly reduced sexual interest/arousal

Female Orgasmic Disorder

Delayed, absent, or reduced orgasm intensity

Genito-Pelvic Pain/Penetration Disorder

Pain, fear, or muscle tension during vaginal penetration

Premature Ejaculation

Ejaculation occurs earlier than desired

Erectile Disorder

Difficulty achieving/maintaining an erection

treatment for Male Hypoactive Sexual Desire Disorder

Psychoeducation, addressing medical or psychological causes

treatment for Female Sexual Interest/Arousal Disorder

Sensate focus, addressing contributing psychological or relational factors

treatment for Female Orgasmic Disorder

Psychoeducation, focusing on decreasing anxiety and increasing communication

treatment for Genito-Pelvic Pain/Penetration Disorder

Relaxation techniques, education, and gradual desensitization

treatment for Premature Ejaculation

Behavioral techniques, medications

treatment for Erectile Disorder

Medications, psychosexual therapy, addressing medical causes

biological causes of sexual dysfunction

• physical disease, prescription medications

• alcohol and other drugs

• anti-hypertensive medication

psychological causes of sexual dysfunction

• anxiety? distractions? negative associations with sex → worries about own performance

• erotophobia - learned negative attitudes about sexuality → from family or cultures

• negative sexual experiences

• deterioration of interpersonal relationships

Courtship Disorders - Voyeuristic Disorder

Watching unsuspecting individuals undressing or having sex

Courtship disorder - Exhibitionistic Disorder

Exposing genitals to non-consenting persons

Courtship disorder - Frotteuristic Disorder

Touching or rubbing against non-consenting individuals

Algolagnic Disorders - Sexual Sadism

Inflicting pain, suffering, or humiliation

Algolagnic Disorders - Sexual Masochism

Experiencing pain or humiliation

Anomalous Target Preferences - Pedophilic Disorder

Attraction to prepubescent children

Anomalous Target Preferences - Fetishistic Disorder

Sexual arousal from non-living objects or body parts

Anomalous Target Preferences - Transvestic Disorder

Sexual arousal from cross-dressing

etiology of paraphilias

• Early conditioning experiences linking abnormal targets with arousal.

• High sex drive combined with stress or negative emotions.

covert sensitization

Associating arousal with negative consequences in imagination

orgasmic reconditioning

Replacing inappropriate fantasies with appropriate ones during arousal

Coping and Relapse Prevention

Risk management and self-control strategies