Sexual Disorder + Gender Diversity

Sexual functioning

what happens in body during sexual activity

Gender identity

individual’s perception of themselves as male, female, other gender, or no gender

gender roles

societal expectations of how males and females should behave

refractory stage

post orgasm, not sexually responsive

sexual desire

urge/inclination to engage in sexual activity

Excitement phase

psychological arousal experience/pleasure and physiological changes

plateau phase

period in between arousal and orgasm

excitement high but stable

resolution

deep relaxation following orgasm

man loses erection, woman’s orgasmic platform subsides

Sexual dysfunction

problems experiencing sexual arousal

must occur the majority of the time for at least 6mo

sexual dysfunction

causes significant distress/impairment

not due to another issue

substance/medication induced sexual dysfunction

caused by substance/medication

Male hypoactive sexual desire disorder

little desire for sex, absent sexual thoughts

common in older men, causes poor wellbeing

lifelong MHSDD

disturbance has always been present

acquired MHSDD

used to enjoy sex but has lost interest

Female sexual interest/arousal disorder

recurrent inability to maintain/attain swelling-lubrication response of sexual excitement

absent/reduced interest in sexual thoughts

women with FSIAD

have decreased initiation/receptiveness, decreased excitement/pleasure

no genital/non-gential response

Erectile Dysfunciton

recurrent inability to attain/maintain erection until completion of sexual activity

common, has significant impact on quality of life

Lifetime ED

never able to acquire erection

Acquired ED

can’t sustain erection anymore

risk factors for ED

age, smoker, obesity, prostate surgery, penile trauma

Female orgasmic disorder

marked decrease intensity/absence of orgasm

may be due to anatomy

more common in postmenopausal women

Early/Premature ejaculation

recurrent ejaculation within 1 minute of initiated, partnered activity when not desired

minimal sexual stimulation causes ejaculation

early/premature ejaculation is associated with

distress, negative health outcomes

inability to delay ejaculation on all/nearly all vaginal penetrations

Delayed ejacultion

marked delay, infrequency, absence of ejaculation during sexual encounters

most common cases cannot ejaculate during intercourse but can with oral and manual stimulation

Genito Pelvic Pain/Penetration disorder

marked difficulty during vaginal penetrations OR tightening of pelvic floor muscles during penetration

leads to frustration, depression, pain

Causes of genito pelvic pain/penetration disorder

anxiety, physical condition, lack of knowledge, issues in relationship

Biological causes of sexual dysfunctions

vasocongestion + muscle tension related

diseases = diabetes, CV, high bp, surgery, spinal cord injuries

Hormonal causes of sexual dysfunctions

in men - low androgen/ high estrogen/prolactin

in women - endocrine levels associated with lower sexual interest

Substance induced sexual dysfunction

problems with functioning due to meds, birth controls etc.

Age Related changes

lower testosterone and estrogen levels in men/women 

medical conditions, loss of loved one 

Psychological causes of sexual dysfunctioning

symptoms and side effects of mental disorders

Attitudes/Cognitions about Sex

teaching that impacts/restricts thoughts on sex

sex negative upbringing

performance anxiety

worrying about arousal/orgasm to the extent that it interferes with sexual functioning 

spectatoring

anxiously attending to reactions/performance during sex

trauma

like sexual assault can decrease desire/functioning

Sociocultural causes

some cultures don’t value female desire, have negative attitudes towards sex 

lack of knowledge, increase stress, poor physical health

Biological treatments for Sexual dysfunction

treat underlying conditions, Viagra for ED, antidepressants, hormone therapy, mechanical interventions

Psychotherapy

cognitive treatments to address maladaptive attitudes

focus on conflicts, then dysfuntions

Sex therapy to improve skills + comfort

sensate focused therapy to alternate giving/receiving stimulation in relaxed, communicative atmosphere

Treating Early Ejaculation

stop/start = alternate stimulation to avoid early eja

squeeze technique = press penis to cause partial loss of erection

Treating pelvic muscle tightness

decondition automatic tightness of vaginal muscles

focus on weakness, joint dysfunction, pain, massage

LGBTQI face additional stressors due to stigma about sexuality

higher risk of sexual violence/transphobia (limiting access to treatment)

Gender dysphoria

psychological distress due to incongruence between biological sex and gender identity

Paraphillic disorder

atypical sexual perfrences cause distress, can harm/risk harm to others

Paraphilic disorders can involve

nonhuman objects, non-consenting partners, humilation/suffering

Fetishistic disorder

uses inanimate objects as perferred/exclusive source of sexual arousal, more common in men

Transvestic disorder

heterosexual men dress in clothes of opposite sex to become aroused

sexual sadism disorder

fantasies, urges, behaviors that involve inflicting pain/humilation on sex partner

sexual masochism disorder

fantasies, urges, behaviors that involve enduring pain/humiliation during sex

sadomasochism

pattern of sexual rituals between sadistic givers and masochistic receivers

acted upon non-consentual person

Voyeurism 

watching unsuspectitng person undress/engage in sexual activities 

Voyeuristic disorder

obtaining sexual arousal by secretly/compulsively watching another person do activities while naked

Exhibitionistic disorder

obtaining gratification by exposing genitals to involuntary observer, often causes legal problems

Frotteurism

gain sexual gratification from rubbing against/fondling body parts of non-consenting person

frequently co-occurs with voyeurism + exhibitionism 

Pedophilic disorder

adult obtains sexual gratification by engaging in sexual activities with young children

pedophilic disorder may be

exclusive or nonexclusive, may be limited to incest

many use child pornography to become aroused

some are threatening/violent to victims, others are loving/gentle = grooming

Behavioral causes of paraphilia

classical pairing of early/intense arousal with stimulation

Cognitive causes of paraphilia

distortions/assumptions about behaviors of victims

feelings of entitlement, guilt/shame

Biological causes of paraphilia

frontal lobe abnormalities, lower IQ, head injuries before age 11

Treating pedophilia

often forced after arrest, decrease sex drive via meds + castration

behavioral modification treatments

aversion therapy to extinguish response to objects that person finds arousing

cognitive treatments

learn socially acceptable ways to approach interesting people

gender dysphoria

child persistently rejects their anatomic sex and desires/insists they are members of opposite sex

resulting stress leads to depression, substance abuse, suicide, risky sex

Cisgender

individual whose gender aligns with natal sex

Transgender

broad spectrum of individuals who persistently identify with a gender different from that of their natal gender

Prenatal hormones effect brain development

female-to-male = high levels of androgen exposure

male-to-female = low levels of androgen exposure

Treating gender dysphoria

living authentically while prioritizing emotional wellbeing

therapy to clarify gender identity/desire for treatment and address secondary interpersonal/psychological issues

social transition before

hormone therapy and gender affirming surgery