SEXUAL DYSFUNCTIONS, PARAPHILIC DISORDERS, AND GENDER DYSPHORIA

abnormal psychology

NORMAL SEXUALITY

Current views tend to be quite tolerant of a variety of sexual expressions, even if they are unusual

/unless the behavior is associated with impairment or involves nonconsenting individuals such as children.

SEXUAL DYSFUNCTIONS

disorders in which individuals find it difficult to function adequately while having sex or experience problems with desire, arousal, or orgasm.

sexual dysfunctions categories

lifelong or acquired,

generalized or situational,

and must cause clinically significant distress

Hypoactive Sexual Desire Disorder

refers to low or no interest in any type of sexual activity. Men with this condition diminished ability to become excited or aroused by erotic cues or sexual activity.

Female Sexual Interest/Arousal Disorder

involves an absence or reduced sexual interest or arousal in women, including reduced erotic thoughts or fantasies and lack of pleasure during sexual activity.

Male Erectile Disorder

A repeated failure to attain or maintain an erection during sexual activity, causing significant distress.

Female sexual interest/arousal disorder

inability to achieve or maintain adequate lubrication or arousal.

Prevalence of erectile dysfunction by age

40% of men in their 40s;

70% of men in their 70s experience erectile difficulties.

Delayed Ejaculation

A condition in which men have difficulty or are unable to achieve orgasm despite adequate sexual stimulation and desire.

Female Orgasmic Disorder

Marked delay, infrequency, or absence of orgasm in women, or reduced intensity of orgasmic sensations.

Premature (Early) Ejaculation

Occurs when ejaculation happens within approximately one minute of vaginal penetration and before the individual wishes it.

Affects 21% of men

Genito-Pelvic Pain/Penetration Disorder

Vaginismus

Persistent or recurrent difficulties with pain during intercourse.

fear or anxiety

Vaginismus

Involuntary spasms of the pelvic muscles outer vagina that interfere with intercourse.

Assessment of sexual behavior

(1) Clinical Interview,

(2) Medical Evaluation,

(3) Psychophysiological Assessment.

measurement of male arousal

Using a penile strain gauge to measure changes in penile circumference.

measurement of female arousal

Using a vaginal photoplethysmograph, which measures increased blood flow in the vaginal walls.

Masters and Johnson program

revolutionized sex therapy by providing a successful therapeutic program.

sensate focus and nondemand pleasuring.

eliminate psychologically based performance anxiety

Squeeze Technique

treatment for premature ejaculation (60–90% success).

Masturbatory Training

treatment for female orgasmic disorder (70–90% success).

Vaginal Dilators

Sildenafil, Levitra, Cialis

facilitate erection by increasing blood flow (50-80% benefits)

-addition of CBT higher results

flibanserin

treatment for hypoactive sexual desire in women / low desire disorder (modest benefits).

penile prostheses or implants

a surgical option, generally used only if other approaches don't work

Vacuum device therapy

a vacuum in a cylinder placed over the penis (70-100% satisfactory)

Paraphilic Disorders

Disorders in which sexual attraction occurs to inappropriate objects or individuals, causing distress or impairment.

-children

-clothing

-articles

Philia

refers to a strong attraction or liking

para

a indicates the attraction is abnormal.

Fetishistic Disorder

Sexual attraction to nonliving objects (e.g., shoes, undergarments) or specific body parts (partialism).

Voyeuristic Disorder

Observing unsuspecting individuals who are naked or undressing for sexual arousal.

Exhibitionistic Disorder

Exposure of one’s genitals to strangers; shock of the victim is arousing.

Frotteuristic Disorder

Recurrent and intense sexual arousal from touching or rubbing against nonconsenting persons, often in crowded places.

Transvestic Disorder

Cross-dressing for sexual arousal;
Specifier: “with fetishism” (arousal from garments) or “with autogynephilia” (arousal from thoughts of being female).

Sexual Sadism Disorder

Inflicting inflicting pain or humiliation for sexual arousal.

Sexual Masochism Disorder

Sexual arousal from the act of being humiliated, beaten, bound, or made to suffer by fantasies, urges, or behaviors

Pedophilic Disorder

Sexual attraction to children (age 13 or younger).

• 90% of offenders are male; 10% are female.

• > 5 years older than the child (>16yrs old)

• If within the family, it is called incest.

• Some offenders are exclusively attracted to children, others to both adults and children.

Covert Sensitization

IMAGINATION—

patients associate sexually arousing images with some reasons why the behavior is harmful or dangerous.

Orgasmic reconditioning

Patients are instructed to masturbate to their usual fantasies but to substitute more desirable ones just before ejaculation.

Relapse Prevention

teach patients to recognize the early signs of temptation and to institute a variety of self-control procedures.

CBT

Most effective treatment in reducing reoffending

Cyproterone Acetate (Chemical Castration)

eliminates sexual desire and fantasy by reducing testosterone levels dramatically.

Medroxyprogesterone (Depo-Provera)

hormonal agent that decreases sex testosterone; injectible.

Gender Dysphoria

Individuals feel trapped in a body of the wrong sex and wish to live as the opposite gender.

incongruence and psychological distress and dissatisfaction with the gender one has been assigned at birth (boy or girl)

not sexual; about identity and self-perception

gender identity

A person’s deeply felt sense of being male or female.

masculinity or femininity

firms up between 18 months and 3 years of age

Gonadal Hormone Therapy

treatment estrogen for trans women, testosterone for trans men to induce secondary sex characteristics.

gynecomastia - growth of breasts

electrolysis - removal of facial hair

Sex Reassignment Surgery (SRS)

nonreversible step; alter anatomy physically

must live in the desired gender for 1 to 2 years

must be stable psychologically, financially, and socially.

Treatment for Youth

Pre-pubescent - psychoeducation and therapy

Adolescents - puberty blockers to delay development until decision-making maturity.

Three approaches:

1. Reduce dysphoria and align identity with assigned sex.

2. “Watchful waiting” until adolescence.

3. Affirm cross-gender identity early.

Treatment for Disorders of Sex Development (DSDs)

intersexuality or hermaphroditism;

individuals born with ambiguous genitalia,