Sexual Dysfunction and Gender Dysphoria

How is sexual dysfunction categorized

- Characterized by a clinically significant disturbance in a person's ability to respond sexually or to experience sexual pleasure

-

Subtype of sexual dysfunction

- Subtypes specify onset of dysfunction and whether generalized vs. situational

Factors that should be considered in sexual dysfunction (3)

1) Partner & Relationship factors – poor communication, discrepancy in desire

2) Vulnerability factors

3) Cultural or religious factors – inhibitions or attitudes toward sexuality

What causes distress in the person dx with sexual dysfunction?

- Symptom experienced on almost all or all occasions (>75% of partnered sexual activity) for 6 months are associated with individual distress

** many disorders cause distress in partners as well (↓ arousal, avoidance)

Delayed ejuculation

- Marked delay (no specific time), infrequency or absence of desired ejaculation

- age-related after 50

DDX for delayed ejaculation (4)

1. Paraphilia

2. Psychological (situational)

3. Medical issue,

4. Medications (SSRI, anti-HTN)

Erectile disorder

- Difficulty obtaining or maintaining erection during sexual activity

- Marked decrease in erectile rigidity

- Age-related (>40-50% males >50)

* about 20% males fear erectile problems on first sexual experience (8% experience... sex with previously unknown partner, use of drugs/ETOH, not wanting to have sex, peer pressure)

What does erectile disorder lead to (4)

1. Decrease self-esteem

2. Decrease self-confidence

3. Decrease sense of masculinity

4. Fear or avoid future encounters

Female orgasmic disorder

- Delay in, marked infrequency or absence of orgasm

- Marked reduced intensity of orgasm

*********!!!!!!!! Many women require clitoral stimulation

-prevalence of orgasm dysfunction is 10-15%

-MC in inexperienced women

T/F- If a women can orgasm through clitoral stimulation but not intercourse she can still get dx with Female organsmic disorder

FALSE

Primary anorgasmia

-Condition where one has never experienced an orgasm

- Strongly associated with relationship problems

Most effective tx for female orgasmic disorder

1. Directed masturbation

2. Sensate focus (touching and being touched)

3. Psychotherapy

Sexual Interest/Arousal disorder definition

- Lack of, or significantly reduced sexual interest/arousal

Sexual interest/Arousal disorder Criteria (5)

- Manifested by 3 or more of the following absent or reduced:

1. Interest in sexual activity

2. Erotic thoughts/fantasy

3. Response to erotic cues,

4. Initiation of sex or being receptive to partner’s initiation

5. Reduced excitement/pleasure sensation during sex

Genito-Pelvic Pain/Penetration disorder

- Difficulties and pain, fear or anxiety anticipated about, tensing or tightening of pelvic floor with vaginal penetration

DDX for Genito-Pelvic Pain/Penetration disorder (6)

1. Friction

2. Vaginismus

3. Infection

4. Estrogen deficiency

5. Endometriosis,

6. Pelvic mass

Premature/Early Ejaculation

-Pattern of ejaculation within about 1 minute following penetration and before the individual wishes it to

- Most common sexual disorder in men less than 40 years

How long should sex last

- Survey of sex therapists states 13 minutes

Treatment for premature/early ejaculation (5)

1. Sex therapy

ASK KRUGER for below

2. Local anaesthetics

3. TCAs

4. SSRIs

5. Selective phosphodiesterase inhibitors.

**Most treatments are either experimental or used off-label

LGBTQ stats

- 7.2 % report being LGBTQ

-62% identify as bisexual

-Bisexuals are the largest % that are not out

-1.6% identify as trans or non binary

Gender Dysphoria in Children Criteria

A. Marked conflict between one’s experienced/expressed gender and assigned gender for 6 months,

B. Manifested by 6 or more (#1 must be one of them) causing clinically significant distress or impairment:

1. Strong desire to be of the other gender or insistence that one is the other gender

2. Strong preference to wear opposite gender clothing

3. Strong preference for cross-gender roles in make-believe or fantasy play

4.Strong preference using toy or doing activities of the opposite gender

5. Strong preference for playmates of the other gender

6. Strong rejection of typically gender-stereotypical toys and activities (i.e. rough and tumble play in boys)

7. Strong dislike of own's anatomy

8. Strong desire for primary and/or secondary sexual characteristics that match one’s expressed gender

Onset of gender dysphoria in children

2-4 yrs old

*age when gender is recognized

T/F most gender dysphoria in children HAS persisted in studies

FALSE

-Most does not persist

T/F children who experience gender dysphoria become homosexual or bisexual vs. transgender

TRUE

Gender dysphoria in adolescents and adults Criteria (6)

A. Marked conflict between one’s experienced/expressed gender and assigned gender x 6 months

B. Manifested by 2 or more causing clinically significant distress or impairment:

1. Marked conflict between one’s experienced/expressed gender and primary/secondary sexual characteristics

2. Strong desire to be rid of or prevent the development of primary/secondary sexual characteristics due to conflict

3. Strong desire for primary/secondary sexual characteristics of the other gender

4. Strong desire to be the other gender

5. Strong desire to be treated as the other gender

6. Strong conviction once has the typical feelings and reactions of the other gender

What mental health problems for gender dysphoria increase (5)

1. MDD

2. Suicidality

3. Substance abuse

4. Bullying/discrimination

5. School drop out

Biological or genetic sex

- Objective gender determination

Gender identity

- How a person thinks about their gender regardless of biological sex

Social learning theory

- According tog the social learning theory, we form our gender identity as a result of sociocultural models and influences that we’re exposed to during early development

Gender roles

- Behaviors, attitudes, values, beliefs and responsibilities that a particular cultural group considers appropriate for males and females based on biological sex

- Assigned by society

-Gender based stereotypes

Sexual identity

- Who a person is sexually and romantically attracted to

* Bem merges biologic-social views and states that the “best predictor of sexual orientation is the degree to which a child is gender-conforming or not”

Androgynous

- Both masculine and feminine

Bisexual

- Has sexual and romantic attractions to same and opposite sex

Butch

- Sub identity go lesbian or gay

- Based on masculine dress and behavior

Cross Dresser

- Wears clothes, makeup, etc. which are considered (by culture) appropriate for the other sex

Fem

- Sub identity of lesbian or gay

- Based on feminine dress and behavior

Drag vs. Drag queen

- Drag - clothes, often unusual or dramatic, especially those considered appropriate to other sex

- Drag Queen - M->F transvestite who employs dramatic clothes, makeup, and mannerisms, often for other people's

appreciation

Gay/Homosexual

- Has sexual and romantic attractions to members of the same sex

Heterosexual

- Has sexual and romantic attractions to members of the opposite sex

Sexual orientation

- Person's preference for the same or opposite sex partners

o Sexual orientation emerges for most in early adolescence without any prior sexual experience.

-Psychologists do not consider sexual orientation to be a conscious choice that can be voluntarily changed.

Transgender

- One who switches gender roles, inclusive term for transsexuals and transvestites

Transexual vs Transvestite

- Transsexual - switches physical sexes (Surgery + hormonal therapy)

- Transvestite - one who cross dresses for pleasure in the appearance and sensation; may experience gender dysphoria

Sexual reassignment surgery

- Surgical procedure which changes one's primary sexual organs from one sex to another