Sexual Dysfunctions, Gender Dysphoria, and Paraphilic DisordersL

March 27, 2025

What is sex as an act?

Encompasses multiple forms of intimacy

What are sexual interests?

Thoughts, ideas, or beavhiors one finds arousing that do NOT harm or violate the consent or boundaries of others. Preferences, kinks, factasies, and experimentation.

Genderfluid

a term someone might use for a gender identity which varies over time

gender non-conforming

a term one might use for appearance and behavior that does not reflect the gender roles expected of them

non-binary

a term that might be used for a spectrum of gender identities that are not exclusively masculine or feminine‍

trans

an umbrella term for those whose gender is not reflected by assigned sex

gender dysphoria

distress stemming from an incongruence between a person's felt/known gender and assigned sex/gender

What is the DSM-5 Criteria for Gender Dysphoria in Childern?

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.

1. A strong desire to be of the other gender or an insistence that one is the other gender

2. In boys, a strong preference for cross-dressing or situmlating female attire; or in girls, 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/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, a strong rejection of typically masculine toys, games, and activities and a strong avoidance of rough-and-tumble play; or in girls, 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 characterisitics 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.

What is the DSM-5 Criteria for Gender Dysphoria in Adoescents/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 2 of the following.

1. A marked incongruence between one’s experienced/expressed gender and primary and/or 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 secondary sex characteristics)

3. A strong desire for the other 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 reations of the other gender (or some alternative gender different from one’s assigned gender.)

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

posttransition

The individual has transitioned to full-time living in the experienced gender (with ot without legalization of gender change) and has undergone (or is preparing to have) at least one gender-affirming medical procedure or treatment regimen — namely, regular gender-affirming hormone treatment or gender reassignment surgery confirming the experienced gender. (e.g., breast augmentation surgery and/or vulvovaginoplasty in an individual assigned male at birth; transmasculine chest surgery and/or phalloplasty or metoidoplasty in an individual assigned female at birth.)

transgender embodiment services

the various medical treatment and procedures that alter an individuals primary and/or secondary sexual characterisitics

gender affirming surgery

any form of surgical procedure performed in order to better reflect and embody gender identity and expression

homo-

relating to the same gender identity

-romantic

one’s romantic orientation and one’s sexual orientation can be different

-gamous/gamy

marriage or uniting sexually

-amorous/amory

sexual and/or love/romantic relationships not necessarily pertaining to marriage

-sexual

used to describe a person’s sexual orientation idenification, or preferences

poly-

multiple (usually partners) concurrently

What does fluidity refer to in sexual orientation?

sexuality can change over the course of someone’s life and in different situations

What is the DMS-5 Criteria of Female Orgasmic Disorder?

A. Presence of either of the following symptoms and experinced on almost all of all occasions of sexual activity

1. marked delay, 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 have caused significant distress in the individual.

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

Specify whether:

• Lifelong: The disturbance has been present since the individual became sexually active.

• Acquired: The disturbance began after a period of relatively normal sexual function.

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

• Situational: Only Occurs with certain types of stimulation, situations, or partners

• Never experienced an orgasm under any situation.

What is the DMS-5 Criteria of Delayed Ejeculation?

A. Either of the following symptoms must be experienced on almost all or all occasions 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/absence of ejaculation

B. The symptoms in Criterion A have persisted for a miniumum 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.

Specify whether:

• Lifelong: The disturbance has been present since the individual became sexually active.

• Acquired: The disturbance began after a period of relatively normal sexual function.

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

• Situational: Only Occurs with certain types of stimulation, situations, or partners

statistics for female/men orgasms

• On average, men orgasm 85% of the time during sex

• On average, women orgasm 46% of the time during sex

• Some studies suggest that 1 in 5 women have never orgasmed in their life.

• On average 20 min for women vs. 5 min for men

statistics vaginal orgasms

• 18% orgasm from penetrative, vaginal intercourse

• 36% orgasm from clitoral stimulation 

• 53% orgasm from cunnilingus

What are kinks?

a term commonly associated with types of sexual activity that involve consensual role adoption, allowing participants to explore facets of their inter and intra-personal sources of gratification.

What are paraphilic disorders?

an atypical sexual interest causes distress or impairment to the individual or harm to others.

features of conset

Requires a continued & ongoing enthusiastic yes – not the absence of no:

Clearly & freely communicated

Cannot be given by individuals who are: Underage; Intoxicated; Incapacitated by drug or alcohol; Asleep; Unconscious

If someone agrees to an activity under pressure of intimidation or threat, that is not considered consent because it was not given freely.

Unequal power dynamics also prevent consent from being given freely.

What is sexual assault?

Engaging in any sexual behavior without consent. This ranges from flashing, public masturbation, touching, kissing, forcing acts, to non-consensual penetration of any kind (known as rape: includes penetration of any body part: oral, vaginal, anal, etc.)

What are examples of nonconsent?

Silent/ Saying nothing

Switching to another sexual activity without consent just because someone agreed to first sexual activity

Turning their head or body away from you

Pushing you away

Lying still, not participating

Avoiding touch/not touching you

What are Paraphilic Disorders?

Any sexual-arousal-related behavior or thought pattern that causes dysfunction (impairment), distress, deviance, and/or danger (AKA: acts of violence, for example: engaging in any activity where involved parties do not consent).

What is the DSM-5 of 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.

specify if:

• In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in voyeuristic behavior are restricted.

• In full remission: The individual has not acted on the urges with a nonconsenting person, 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.

What is the DSM-5 of 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.

Specify whether:

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

Specify if:

• In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to expose one’s genitals are restricted.

• In full remission: The individual has not acted on the urges with a nonconsenting person, 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.

What is the DSM-5 of 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.

Specify if:

• With asphyxiophilia: If the individual engages in the practice of achieving sexual arousal related to restriction of breathing.

• In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in masochistic sexual behaviors are restricted.

• In full remission: 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

What is the DSM-5 of 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.

specify if:

• In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in sadistic sexual behaviors are restricted.

• In full remission: The individual has not acted on the urges with a nonconsenting person, 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. 

What is the DSM-5 of Pedophilic 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.

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.

Specify whether:

• Exclusive type (attracted only to children) Nonexclusive type

Specify if:

• Sexually attracted to males, females, or both

• Limited to incest 

What is the DSM-5 of 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).

Specify:

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

Specify if:

• In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to engage in fetishistic behaviors are restricted.

• In full remission: 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. 

What is the DSM-5 of 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***.

Specify if:

• With fetishism: If sexually aroused by fabrics, materials, or garments.

• With autogynephilia: If sexually aroused by thoughts or images of self as a woman.

Specifiy if:

• In a controlled environment: This specifier is primarily applicable to individuals living in institutional or other settings where opportunities to cross-dress are restricted.

• In full remission: 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.