Ab Psych Chapter 10: Disorders Involving Gender & Sexuality

• Sexual dysfunctions: Persistent problems with sexual interest, arousal, or response

  • When someone does not respond normally in areas of sexual functioning

• Two classifications:

  • Lifelong dysfunction: has been occurring since the beginning

  • Acquired dysfunction: having normal functioning but then changes to abnormal

  • Situational: only occurs in certain situations

  • Generalized: Dysfunction occurs across all situations

• Three categories of sexual dysfunction:

  • Disorders involving problems with sexual interest, desire, or arousal.

  • Disorders involving problems with orgasmic response

  • Problems involving pain during sexual intercourse or penetration (in women)

• Male hypoactive sexual desire disorder: little, if any, desire for sexual activity or may lack sexual or erotic thoughts or fantasies (8-25% across ages, most common among older males)

• Female sexual interest/arousal disorder: lack of or greatly reduced level of sexual interest, drive, or arousal (10-55% across age ranges, most common in older females)

• 3 groups of disorders involving problems achieving orgasm:

  • Female orgasmic disorder

  • Delayed ejaculation

  • Premature ejaculation

Female orgasmic disorder/ delayed ejaculation: significant delay in reaching orgasm (women) or ejaculation (men), or an infrequency or absence of orgasm or ejaculation

• Must be present 6 months or longer

• Must cause distress

• Symptoms must occur on all or almost all occasions of sexual activity

Premature ejaculation: recurrent pattern of ejaculation occurring within about one minute of penetration and before the man desires it (30%+ across studies)

Genito-Pelvic Pain / Penetration Disorder: applies to women who experience sexual pain and/or difficulty engaging in vaginal intercourse or penetration.

Vaginismus: a condition in which the muscles surrounding the vagina involuntarily contract whenever vaginal penetration is attempted, making sexual intercourse painful or impossible

• Prevalence rate 5-17%

Causes of Sexual Dysfunction:

• Psychological perspectives: Sexual trauma, fear, memories related to sex - Anxiety, depression, & anger

  • Performance anxiety: excessive concern about the ability to perform sexually. Hyper-vigilance to bodily performance

• Biological perspectives: Abnormalities in prolactin, testosterone, and estrogen. Cardiovascular problems, Obesity, diabetes, certain medications like anti-depressants, alcohol consumptions, drug use, physical inactivity, and vascular/nervous disorders

Treatment for Sexual and Gender Disorder:

• Sex Therapy: cognitive-behavioral techniques to help individuals enhance their sexual competencies (sexual knowledge and skills) and relieve performance anxiety

• Medications: viagra, gel suppositories, penile injections, vacuum erection device (VED), penile implant

• Dilators

Paraphilic Disorders: Paraphilias → People with paraphilias have unusual or atypical patterns of sexual attraction that involve sexual arousal in response to an atypical stimuli

• The paraphilic behavior must either cause personal distress or impairment in important areas of daily functioning, or involve behaviors in which satisfaction of the sexual urge involved harm or risk of harm to other people. Diagnosed only when the urges, fantasies, or behaviors last at least 6 months

• Having a paraphilia is not the same as having a paraphilic disorder → you can have a paraphilia but it does not cause you personal distress, so it does not count as a disorder

More Paraphilic Disorders:

• Exhibitionistic Disorder: Strong and recurrent sexual urges, fantasies, or behaviors of exposing of one’s genitals to unsuspecting individuals for the purpose of sexual arousal

• Voyeurism: Strong and recurrent sexual urges, fantasies, or behaviors in which a person becomes sexually aroused by watching unsuspecting people, generally strangers, who are naked, disrobing, or engaging in sexual activity

• Frotteurism: Recurrent, powerful, sexual urges, fantasies, or behaviors in which a person becomes sexually roused by rubbing against or touching a nonconsenting person

• Fetishism: Recurrent, powerful sexual urges, fantasies, or behaviors involving inanimate objects, such as an article of clothing or non-genital body parts

• Transvestism: recurrent and powerful urges, fantasies, or behaviors in which they become sexually aroused by cross-dressing

• Others: Necrophilia, partialism, zoophilia, coprophilia, urophilia

Sexual Masochism and Sadism Disorders:

• Sexual Masochism: Sexual arousal via humiliation, bounding, flogging, or suffering

  • Hypoxyphilia: sexual arousal by being deprived of oxygen

• Sexual Sadism: Sexual arousal through inflicting physical or psychological suffering or humiliation on another person

  • Can be with either consenting or non-consenting partners

Theoretical Perspectives on Paraphilic Disorders:

• Learning models: Paraphilias are the result of

  conditioning and observational learning.

  • Object / activity becomes inadvertently associated with sexual arousal

• Escapism: Paraphilias represent temporary escape from ordinary life

• Biological: Increased sex drive in men

  • Increased sexual fantasies

  • Shorter refractory period

  • Disturbances in brain networks

Pedophilic Disorder: Recurrent and powerful sexual urges, fantasies, or behaviors involving sexual activity with children

• Must be at least 16 years of age and at least 5 years older than child/children toward whom the person is sexually attracted to / victimized

• Can present as looking at or undressing children, exhibitionism, kissing, fondling, oral sex, anal intercourse, vaginal intercourse

• Origins of pedophilia are complex, and not completely understood.

• Shy, passive, social inept, isolated. Threatened by relationships with adult women

• Connected to childhood neglect / abuse

• Severe consequences to victims

• Although most cases involve men, both men and women can have pedophilia

Treatment for Paraphilic Disorder:

• Cognitive Behavioral Therapy: Focus on changing problem behavior

  • Aversive conditioning: Induce a negative emotional response to unacceptable stimuli

  • Covert sensitization: Paraphilic fantasies are paired with aversive stimuli in imagination

  • Social skills training: Improve ability to develop and maintain relationships with adult partners

• Biomedical Therapy:

  • Selective serotonin reuptake inhibitors (SSRIs)

  • Synthetic steroidal analogs

  • Anti-androgens

  • Efficacy is in question

    • May be only suitable for the short term

    • Significant side effects

Disorders Involving Gender:

• Sex: Biological differences between males and females (e.g. genitalia, genetic)

• Gender: Socially constructed roles, behaviors, expressions, and identifies of girls, women, boys, men, non-binary, gender-queer, and gender diverse people

• Gender identity: The psychological sense of being male or female, a blend of both, or neither

• Transgender identity: The psychological sense of belonging to one gender while possessing the sexual organs of another.

Gender Dysphoria: Marked incongruence between one’s experienced/expressed gender and assigned gender.

• Can occur in both children and adults

• Causes clinically significant distress or impairment in social, occupational, or other important areas of functioning

DSM Criteria for Gender Dysphoric Disorder:

• A marked incongruence between one’s experienced/ expressed gender and assigned gender, as manifested by at least 2 of the following:

  • Marked incongruence between one’s experienced/expressed gender and primary and/or secondary sex characteristics

  • Strong desire to be rid of one’s primary and/or secondary sex characteristics because of a marked incongruence with one’s experienced/expressed gender

  • A strong desire for the primary and/or secondary sex characteristics of the other gender

  • A strong desire to be of the other gender

  • A strong desire to be treated as the other gender

  • A strong conviction that one has the typical feelings and reactions of the other gender

Transgender & Gender Diverse Community: Encompasses a range of identities

• Constitutes any individual who identifies as transgender, gender non-conforming, nonbinary, or any gender identity that does not align with cisgender and/or the gender binary

• Not all people who identify as transgender or gender diverse have gender dysphoria (or any other disorder)

• DSM-5 post-transition specifier: The individual has transitioned to full-time living in the desired gender and has undergone at least 1 cross-sex medical procedure or treatment

Prevalence of Gender Dysphoria:

• Variations in measurement has resulted in varied estimates of prevalence.

• DSM-5: 0.005-0.014% for birth assigned males; 0.002-0.003% for birth assigned females

  • But rates may be higher

• Causes are still being explored

  • Gender development

  • Hormones

  • Rare conditions

  • Commandeered by non-professionals

    • Be aware of false information