chapter 13: sexual dysfunctions, gender dysphoria, and paraphilic disorders

sexual dysfunction

clinically significant impairment in one’s ability to respond sexually or to experience sexual pleasure

paraphilias

intense and persistent atypical sexual interests; can’t be diagnosed as a disorder unless the individual experiences distress/impairment or harms others

sexual response cycle

the sequence of changes that occur in the body with increased sexual arousal, orgasm, and the return to the unaroused stage, noted by William Masters and Virginia Johnson

excitement stage

genital tissues swell as they fill with blood (vasocongestion), causing penile erection, engorgement of clitoris, and vaginal lubrication

plateau stage

additional swelling of penis and vulvar/vaginal tissues; testes become elevated and may reach 1.5x unaroused size; clitoris retracts under clitoral hood and inner part of vagina expands

orgasm stage

rhythmic, muscular contractions in genital region occur in 8 second intervals

penile orgasm

seminal fluid collects in urethral bulb at base of penis, and within 2-3 seconds, contractions lead to expulsion of ejaculate

resolution

following orgasm, body gradually returns to its pre-aroused state

refractory period

people are unresponsive to further sexual stimulation

lifelong sexual dysfunction

any sexual dysfunction that the person has always experienced

generalized sexual dysfunctions

any sexual dysfunction that is apparent in all sexual situations, including with the person’s sexual partners and during solitary sexual activity

situational sexual dysfunctions

any sexual dysfunction that is apparent only in a specific sexual situation, for example with a certain sexual partner

hypoactive sexual desire disorder

a sexual dysfunction characterized by persistent/recurrent deficiency of sexual fantasies and desire for sex, causing marked distress or interpersonal difficulty

sexual interest/arousal disorder

a sexual dysfunction characterized by a lack of, or significantly reduced sexual arousal/interest (eg reduced sexual thoughts and sexual pleasure) for a minimum of 6 months in 75%-100% of sexual occasions, and the presence of marked distress

erectile disorder

difficulties with obtaining an erection during sexual activity, maintaining an erection u ntil completion of sexual activity, and/or marked decrease in erectile rigidity in 75%-100% of sexual occasions

female orgasmic disorder

a sexual dysfunction characterized by a delay in, infrequency of, or absence of orgasm and/or a reduction in the intensity of orgasmic sensations in all or almost all (75%-100%) occasions of sexual activity for a minimum of six months, causing marked distress or interpersonal difficulty

orgasm gap

notable difference in orgasm frequency between women and men during penetrative sexual activity, such that women report lower orgasm frequency than do men

delayed ejaculation

a marked delay in ejaculation or a marked infrequency or absence of ejaculation that is present in about 75%-100% of sexual occasions and for a minimum duration of six months, leading to distress

premature (early) ejaculation

a sexual dysfunction characterized by ejaculation within ~1 minute of vaginal penetration during 75%-100% of occasions of sexual activity for a minimum of 6 months, with marked distress

intravaginal ejaculatory latency time (IELT)

time interval between penetration and ejaculation; typically 5-6 min

dyspareunia

painful sexual intercourse; replaced by GPPPD

vaginismus

difficulty with vaginal penetrative sexual activity due to anxiety/fear of pain; replaced by GPPPD

genito-pelvic pain/penetration disorder (GPPPD)

a sexual dysfunction characterized by persistent or recurrent difficulties with one or more of the following: vaginal penetration during intercourse; marked vulvovaginal or pelvic pain during vaginal intercourse/penetration attempts; marked fear/anxiety about vulvaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration; marked tension/tightening of the pelvic floor muscles during attempted vaginal penetration on 75%-100% of sexual occasions for at least 6 months, resulting in distress

hypersexuality

excessive interest/involvement in sexual activity at levels high enough to become clinically significant

performance anxiety

a state of nervousness that can occur when people perform sexually that can negatively affect their performance because they’re too busy worrying about and monitoring their own performance and their partners’ responses

sexual conditioning

developing a habit of masturbating quickly and efficiently can over time generalize to other sexual situations

sensate focus

in sex therapy, a technique used to improve intimacy, communication, and pleasure as well as decrease performance anxiety; a form of desensitization applied to sexual fears

communication and exploration

sexual health education specific to presenting issue, enhancing communication between partners, exploration of self

stop-start and squeeze techniques

behavioural approaches used to treat premature (early) ejaculation

stop-start technique

manual stimulation of penis occurs until earliest signs of approaching orgasm are perceived, at which point stimulation is stopped; after 40 seconds to 1 min, stimulation recommences; repeated until entire process lasts ~15 min

squeeze technique

squeezing around coronal ridge of penis to diminish arousal and prevents ejaculation

vaginal dilation

use of dilators to aid in relaxing the vaginal opening; recommended for those with GPPPD

paraphilias

a redirection of sexual desires toward what is generally considered to be an inappropriate or atypical object, person, or behaviour; there is no clinically significant impairment

paraphilic disorder

a paraphilia that is currently causing distress or impairment to the individual, a paraphilia that causes personal harm, or risk of harm, to others when acted upon

fetishistic disorder

a form of paraphilic disorders paraphilias in which the presence of nonliving objects or excessive focus on non-genital body parts is required or strongly preferred for sexual excitement, and which leads to distress or impairment

tranvestic disorder

when articles worn by the person with the fetish are clothings of the other sex and this behaviour is considered distressing

fetishism

sexual behaviours/fantasies in which the presence of nonliving objects/excessive focus on non-genital body parts is usually required or strongly preferred for sexual excitement

sexual sadism

a sexual preference that involves sexual arousal from inflicting pain or humiliation on others

sexual masochism

a sexual preference that involves sexual arousal from experiencing pain or humiliation inflicted by others

BDSM

bondage and discipline, domination and submission, and sadism and masochism

sexual sadism disorder

when a person experiences sexual pleasure from inflicting physical pain/psychological suffering on another person, often to gain power/to humiliate the other person

sexual masochism disorder

can include behaviours that range from harmless (likely not meeting definition of a disorder) (eg being restrained) to potentially dangerous and meeting criteria for a sexual masochism disorder (eg hypoxyphilia)

hypoxyphilia

the practice of heightening the sexual experience by deliberately inducing unconsciousness in oneself by oxygen deprivation, produced by chest compression, strangulation, enclosing the head in a plastic bag, or various other techniques

exhibitionistic disorder

a type of paraphilic disorder that is also a criminal offence, in which a person exposes their genitals to an unsuspecting stranger

voyeuristic disorder

a form of paraphilic disorder that is also a criminal offence, in which a person is sexually aroused from watching unsuspecting individuals who are naked, disrobing, or engaged in sexual activity

frotteuristic disorder

a form of paraphilic disorder that is also a criminal offence, in which a person touches or rubs against a non-consenting person for the purpose of sexual pleasure

pedophilic disorder

a form of paraphilia that is also a criminal offence, in which a person has recurrent fantasies or behaviours involving sexual activity with children; most often in males and describes individuals who exhibit a predominant sexual interest in, or preference toward, prepubescent children

exhibitionism

exposing one’s genitals to an unsuspecting and nonconsenting individual/individuals

voyeurs

individuals who experience recurrent and intense sexually arousing urges/fantasies or behaviours involving the observation of unsuspecting individuals who are naked, disrobing, or engaged in sexual activity

frotteurism

touching/rubbing up against a noncompliant person so that the frotteur can become sexually aroused and, in many cases, reach orgasm

child molester

an individual who sexually abuses a pre-pubescent child (or children) but does not necessarily have a sexual preference for children

pedophile

an adult who is sexually attracted to children