10- Sexual Dysfunctions, Paraphilic Disorders, and Gender Dysphoria

sexual dysfunction

Individuals find it difficult to function adequately while having sex; for example, they may not become aroused or achieve orgasm.

paraphilic disorders

the relatively new term for sexual deviation, sexual arousal occurs primarily in the context of inappropriate objects or individuals.

gender dysphoria

there is incongruence and psychological distress and dissatisfaction with the gender one has been assigned at birth

heterosexual behavior

sex with the opposite sex

homosexual behavior

sex with the same sex

1. Desire phase

2. Arousal stage

3. Plateu phase

4. Orgasm phase

5. Resolution phase

The human sexual response cycle

Desire phase

Sexual urges occur in response to sexual cues or fantasies.

Arousal stage

A subjective sense of sexual pleasure and physiological signs of sexual arousal: in males, penile tumescence (increased flow of blood into the penis); in females, vasocongestion (blood pools in the pelvic area) leading to vaginal lubrication and breast tumescence (erect nipples).

Plateu phase

Brief period occurs before orgasm.

Orgasm phase

In males, feelings of the inevitability of ejaculation, followed by ejaculation; in females, contractions of the walls of the lower third of the vagina.

Resolution phase

Decrease in arousal occurs after orgasm (particularly in men).

lifelong

refers to a chronic condition that is present during a person’s entire sexual life;

acquired

refers to a disorder that begins after sexual activity has been relatively normal.

generalized

occurring every time the individual attempts sex,

situational

occurring with some partners or at certain times but not with other partners or at other times.

1. lifelong

2. acquired

3. generalized

4. situational

specifiers for sexual dysfunction

• sexual desire disorders

• sexual arousal disorders

• orgasm disorders

• sexual pain disorder

types of sexual dysfunction

male hypoactive sexual desire disorder

Persistently or recurrently deficient (or absent) sexual/ erotic thoughts or fantasies and desire for sexual activity.

female sexual interest/arousal disorder

in females low sexual interest is almost always accompanied by a diminished ability to become excited or aroused by erotic cues or sexual activity.; deficits in interest or the ability to become aroused in women is combined in a disorder

erectile disorder

Many males with _____ have frequent sexual urges and fantasies and a strong desire to have sex. Their problem is in becoming physically aroused

delayed ejaculation

Males who achieve orgasm only with great difficulty or not at all meet criteria for a condition

female orgasmic disorder

Presence of either of the following symptoms and experienced on almost all or all (approximately 75%-100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):

1. Marked delay in, marked infrequency of, or absence of orgasm.

2. Markedly reduced intensity of orgasmic sensations.

premature ejaculation

ejaculation that occurs well before the man and his partner wish it to

premature ejaculation

A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the person wishes it

genito-pelvic pain/penetration disorder

A sexual dysfunction specific to women refers to difficulties with penetration during attempted intercourse or significant pain during intercourse

vaginismus

the most usual presentation of this penetration disorder is referred to as ____, in which the pelvic muscles in the outer third of the vagina undergo involuntary spasms when intercourse is attempted

1. interviews

2. thorough medical evaluation

3. psychophysiological assessment

three major aspects to the assessment of sexual behavior

penile strain gauge

penile erection is measured directly, As the penis expands, the ___ picks up the changes and records them on a polygraph.

vaginal photoplethysmograph

This device, which is smaller than a tampon, is inserted by the woman into her vagina. A light source at the tip of the instrument and two light-sensitive photoreceptors on the sides of the instrument measure the amount of light reflected back from the vaginal wall

model of sexual dysfunction

helps explain why some individuals may be dysfunctional at the present time but not how they became that way.

ertophobia

Although it is not known for sure why some people develop problems, many people learn early that sexuality can be negative and somewhat threatening, and the responses they develop reflect this belief. Donn Byrne and his colleagues call this negative cognitive set

script theory of sexual functioning

according to which we all operate by following “scripts” that reflect social and cultural expectations and guide our behavior

Human Sexual Inadequacy

The procedures outlined in this book literally revolutionized sex therapy by providing a brief, direct, and reasonably successful therapeutic program for sexual dysfunctions.

squeeze technique

to treat premature ejaculation, most sex therapists use a procedure developed by Semans (1956), sometimes called the _____, in which the penis is stimulated, usually by the partner, to nearly full erection.

• oral medication

• injection of vasoactive substances directly into the penis

• surgery

• vacuum device therapy

four most popular procedures to treat sexual dysfunction

sildenafil (Viagra)

medicine introduced for erectile dysfunction

vasodilating drugs

some urologists teach patients to inject ____ such as papaverine or prostaglandin directly into the penis when they want to have sexual intercourse.

vacuum device therapy

works by creating a vacuum in a cylinder placed over the penis.

paraphilic disorder

these disorders of sexual arousal, if they cause distress or impairment to the individual, or cause personal harm, or the risk of harm to others are called

frotteuristic disorder

Over a period of at least 6 months, recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors.

fetishistic disorder

a person is sexually attracted to nonliving objects.

1. inanimate object

2. source of specific tactile stimulation

Fetishistic arousal is associated with two classes of objects or activities:

partialism

A third source of attraction is a part of the body, such as the foot, buttocks, or hair.

voyeuristic disorder

is the practice of observing, to become aroused, an unsuspecting individual undressing or naked

exhibitionistic disorder

is achieving sexual arousal and gratification by exposing genitals to unsuspecting strangers

transvestic disorder

sexual arousal is strongly associated with the act of (or fantasies of) dressing in clothes of the opposite sex, or cross-dressing

with fetishism

If sexual arousal is primarily focused on the clothing itself the diagnostic criteria require a specification

autogynephilia

Another specifier for transvestism describes a pattern of sexual arousal associated not with clothing itself but rather with thoughts or images of oneself as a female

sexual sadism disorder

Over a period of at least 6 months, recurrent and intense sexual arousal from the psychological or physical suffering of another person, as manifested by fantasies, urges, or behaviors.

sexual masochism disorder

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.

pedophilia

Perhaps the most tragic sexual deviance is sexual attraction to children (or young adolescents generally aged 13 years or younger),

incest

If the children are the person’s relatives, the pedophilia takes the form of

pedophilic disorder

Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving sexual activity with a prepubescent child or children (generally age 13 years or younger).

specified paraphilic disorder

This category applies to presentations in which symptoms characteristic of a paraphilic disorder that cause clinically significant distress or impairment in social, occupational, or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the paraphilic disorders diagnostic class

telephone scatologia

attraction to obscene phone calls

necrophilia

attraction to corpses

zoophilia

attraction to animals

coprophilia

attraction to feces

klismaphilia

attraction to enemas

urophilia

attraction to urine

covert sensitization

in this treatment, patients associate sexually arousing images in their imagination with some reasons why the behavior is harmful or dangerous. Before treatment, the patient knows about these reasons, but the immediate pleasure and strong reinforcement the sexual activity provides is enough to overcome any thoughts of possible harm or danger that might arise in the future

orgasmic reconditioning

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

relapse prevention treatment

Patients are taught to recognize the early signs of temptation and to institute a variety of self-control procedures before their urges become too strong.

cypoterone acetate

The most popular drug used to treat individuals with paraphilic disorders is an antiandrogen called

cypoterone acetate

This “chemical castration” drug eliminates sexual desire and fantasy by reducing testosterone levels dramatically, but fantasies and arousal return as soon as the drug is removed

medroxyprogesterone

a hormonal agent that reduces testosterone; may be useful for dangerous sexual offenders who do not respond to alternative treatments or to temporarily suppress sexual arousal in patients who require it, but it is not always successfu

gender dysphoria

is present if a person’s physical sex is not consistent with the person’s sense of who he or she really is or with his or her experienced gender

Disorders of Sex Development (DSD)

Gender dysphoria can also occur among individuals with ___

intersexuality or hermaphroditism

DSD is formerly known as

autogynephilia

in which gender dysphoria begins with a strong and specific sexual attraction to a fantasy of oneself as a female

gender nonconformity

boys who behave in feminine ways and girls who behave in masculine ways

sex reassignment surgery

The final nonreversible step is to alter anatomy physically to be consistent with gender identity through

1 to 2 years

To qualify for surgery at a reputable clinic, individuals must live in the desired gender for ____ years so that they can be sure they want to change sex

gynecomastia

In transwomen, hormones are administered to promote ____(the growth of breasts) and the development of other secondary sex characteristics