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Exam 2: Sexual Differentiation

Sex

• Biology: sex is determined by gamete size. Individuals who produce large gametes (eggs) are female; those who produce small gametes (sperm) are male

• APA guidelines: Sex refers to a person’s biological status and is typically categorized as male, female, or intersex (i.e., atypical combinations of features that usually distinguish male from female). There are a number of indicators of biological sex, including sex chromosomes, gonads, internal reproductive organs, and external genitalia

Gender

• A psychosocial term that encompasses the psychological, cultural, and social characteristics we ascribe to men and 

• APA Guidelines: Gender refers to the attitudes, feelings, and behaviors that a given culture associates with a person’s biological sex. Behavior that is compatible with cultural expectations is referred to as gendernormative; behaviors that are viewed as incompatible with these expectations constitute gender non-conformity.

Chromosomes

• Long tightly packed DNA sequences 

• Almost every cell in human body has 23 pairs of chromosomes 

• One chromosome of each pair inherited from mother; one from father

Sex Chromosomes

• 22 pairs are identical

• 23rd set sex chromosomes differs for males and females

• One of sex chromosomes inherited from mother via ovum 

  • Always an X 

• One of sex chromosomes inherited from father via sperm 

  • X or Y because semen contains ~ same number of x-carrying and y-carrying sperm

  • Father’s genetic contribution determines sex of child

• X chromosome larger than Y chromosome 

  • X chromosome ~ 900-1400 genes 

  • Y chromosome ~ 70-400 genes 

• Many of the genes on Y are involved in male sexual differentiation

  • Y sperms swim faster bc its lighter

• X carying sperm and Y carrying sperm produced in roughly same quantity

  • 160:100 male to female ratio of fertilized eggs

  • 105:100 male to female live births

    • Where did the males go?

      • There are many more steps to develop a male in the womb. Females develop as a default

    • If a male has a recessive gene in the X, then it will likely be expressed, whereas in women, if one X carries a recessive gene and the other doesn’t, it likely isn’t expressed

      • This explains more male stillborn and miscarriages

  • 100:100 male to female teenagers

Role of Chromosomes in Sexual Development

• At conception, humans consist of one cell, the fertilized egg 

• Whether cell develops into male or female embryo determined by presence or absence of a Y chromosome 

• A sex-determining gene called SRY located on Y chromosome (XY embryos) is initial switch that causes differentiation in male direction 

  • Absence of SRY (XX embryos) development in female direction

The Development of Internal & External Sex Organs

Undifferentiated Male and Female Internal Sex Organs (~ 5 wks)

• Both XX and XY embryos have: 

  • A pair of undifferentiated gonads 

  • Two sets of ducts: 

    • Müllerian ducts 

    • Wolffian ducts

• Both have basic external genitals: 

  • 1) genital tubercle 

  • 2) genital folds

  • 3) genital swelling

• ~wk 7 if no Y chromosome, undifferentiated gonads develop into ovaries 

  • if Y chromosome present, it expresses the sex determining region Y (SRY) gene 

  • expression of SRY gene results in production of testis-determining factor, which induces differentiation of gonads into testes 

  • Ovaries and testes begin to produce sex hormones → development of remaining internal and external genitals

Female-typical Development of Internal Sex Organs

• Wolffian ducts degenerate 

• Müllerian ducts → fallopian tubes, uterus, upper (innermost) part of vagina

Male-typical Development of Internal Sex Organs

•  Wolffian ducts → vas deferens, seminal vesicle, epididymis 

• Testes secrete anti-Müllerian hormone (AMH) → Müllerian ducts degenerate

Female-typical Development of External Sex Organs

•  Genital tubercle → clitoris 

• Genital folds → inner labia 

• Genital swelling → outer labia

Male-typical Development of External Sex Organs

• Genital tubercle → glans penis 

• Genital folds → shaft of penis 

• Genital swelling → scrotum

Further Development of External Genitalia

• Ovaries and testes change in shape and position 

• ~10 wks moved down to upper pelvis 

• In females the ovaries remain in this position until birth then gradually descend in the pelvis and remain on either side of uterus

Descent of the Testicles

• ~6-7 months testicles descend into pelvis and shortly before birth move down into scrotum 

• As each testicle enters scrotum it brings with it the vas deferens, blood vessels and nerves 

• ~2% newborn boys one or both testes don’t descend

  • It’s important they descend because sperm in the body is too hot for sperm production

Hormonal Influences on Sexual Development

• Presence/absence of T also acts on brain during “critical period” to masculinize/demasculinize brain 

• Hormonal influences during “critical periods” are referred to as “organizational effects” as they cause permanent changes 

• In adulthood, same hormones cause behavioral responses (e.g., trigger reproduction) but referred to as “activational effects” as they are reversible

  • Ex: hormone blockers

• Male rat sexual behavior

  • T restores sex behavior

Brain Differentiation

• Presence/absence of T also acts on brain during “critical period” to masculinize/demasculinize brain 

• Differentiation causes cells and neural circuits of hypothalamus (H) to differ between males and females. 

  • At puberty, female H directs a cyclic secretion of sex hormones – menstrual cycle 

  • Male H directs relatively constant production of sex hormones

Sex Differences in Brain Structures

• Male and female brains very similar but early hormonal influences produce some differences in brain organization 

• ~10 brain regions > women vs men; ~14 brain regions > men vs women

• Looking at cerebral cortex, can identify sex of individual with 93% accuracy 

• Also sex differences in connections within brain and in metabolism of neurotransmitters (dopamine, serotonin) – may explain sex differences in certain mental disorders (e.g, depression, anxiety, autism)

Exam 2: Non-binary Sex Transgender 

Terminology

• Sex: Biological characteristics of male/female (e.g., internal/external genitalia, chromosomes) 

• Gender: Cultural/social factors ascribed to person’s biological sex 

• Gender Identity: One’s core sense of being male/female, both or neither

Sex Characteristics

Sex Chromosome Anomalies

• Turner Syndrome (X-) (X0) 

• Klinefelter Syndrome (XXY) 

• Triple X (XXX) 

• XYY Syndrome

Turner Syndrome (X0)

• 45 chromosome; only one sex chromosome 

• Some ”mosaics” – bodies have both XX and X0 

• ~1/5,000 conceptions; 1/3,000 live births 

• Usually infertile: no functional ovaries 

• Physical Characteristics: short, broad chest, webbed neck, widely spaced nipples 

• Mental ability: IQ not affected; may have some cognitive deficits

Klinefelter Syndrome (XXY, XXXY)

• ~1/600 live births 

• More severe variants include >1 extra X chromosome (XXXY, XXXXY) 

• Usually sterile: puberty delayed or absent, low T, small testicles 

• Physical appearance: have Y chromosome which masculinizes body but sometimes feminized appearance (e.g., breast development)

• Physical appearance: have Y chromosome which masculinizes body but sometimes feminized appearance (e.g., breast development)

XYY Syndrome

• ~1/1000 live births 

• Sexual development typical; lower sperm quality but usually still fertile 

• Physical Characteristics: typical male; some tall (~6’5”) 

• Mental Ability: low IQ, autism-related symptoms common

Triple X Syndrome (XXX)

• 1/1000 live births 

• Usually fertile  

• Physical Characteristics: taller than average, wide-set eyes, dental problems 

• Mental Ability: may have learning disabilities (delayed speech, lower IQ) • Incidence: ~1 in 1000 live female births

Intersex Conditions Disorders of Sexual Development

• Ovotesticular Disorder 

• Androgen Insensitivity Syndrome (AIS)

• Congenital Adrenal Hyperplasia (CAH) 

• 5-alpha-reductase Deficiency

Ovotesticular Disorder

• Extremely rare 

• Person has both ovarian and testicular tissue – either on different sides of body or in gonads that contain mixtures 

• Appearance of genitals varies 

• Usually infertile

Congenital Adrenal Hyperplasia (CAH)

• ~1/13,000 

• Gene mutation leads to impaired steroid metabolism 

• Adrenal glands secrete insufficient amount of steroids that control salt and water balance (fatal if untreated) 

• Adrenals also secrete high levels T 

• In XX high T causes partial masculinization of genitals

Androgen Insensitivity Syndrome

• ~1/13,000 

• XY individual 

• X-linked recessive gene results in malfunctioning T receptor 

• Male internal tract fails to develop because Wolffian ducts need T to develop; female tract fails to develop because testes secret anti-Müllerian hormone (lack reproductive tract of either male or female therefore infertile) 

• External genitalia look typically female at birth

• Vagina may be present but is shallow 

• Testes remain inside body 

• Vulva develop normally; breasts and feminine body type develop at puberty because of adrenal estrogen 

• Usually identify as female

5-Alpha Reductase Deficiency

• XY genotype 

• Rare deficiency of enzyme 5-alpha reductase, which converts T to dihydrotestosterone 

• The fetus is exposed to T produced by the testes, but not dihydrotestosterone →  incomplete masculinization

• In womb, T acts on Wolffian ducts to cause differentiation of internal genitalia 

  • BUT - dihydrotestosterone is necessary for differentiation of external genitalia 

  • Thus, at birth, there are internal male genitalia but external female genitalia

• At puberty, T increases muscle mass, growth of penis & scrotum, testes descend, voice deepens, onset of sperm & ejaculation 

• At puberty, dihydroT mediates changes that are scant or absent in this population: 

  • Prostate growth

  • Facial hair growth 

  • Recession of hairline 

  • Acne

Transgender

• Transgender (or trans): Those who identify with gender different from assigned gender 

• Cisgender: Those who identify with their assigned gender 

• Gender Dysphoria: DSM-5 diagnostic term to refer to individuals who experience distress from the incongruence between their experienced/expressed gender and their assigned gender

Gender Dysphoria DSM-5 Diagnosis

• In children, manifested by 4+ of: 

  • Strong desire to be, or insistence that s/he is some alternative gender 

  • Wearing or simulating some alternative gender typical clothing 

  • Preferences for cross-sex roles in fantasies 

  • Desire to participate in stereotypical games and pastimes of some alternative gender 

  • Strong preference for some alternative gender playmates 

• In boys: assertion male genitals disgusting, desire not to have a penis, aversion towards gender-stereotypical play 

• In girls: rejection of urinating in sitting position, desire to grow a penis, wish not to grow breasts or menstruate, aversion towards feminine clothing

• In adolescents and adults, manifested by: 

  • Stated desire to be some alternative gender 

  • Frequent passing as some alternative gender 

  • Desire to live or be treated as some alternative gender 

  • Conviction that s/he/they have typical feelings of some alternative gender 

    • Manifested by: 

      • Preoccupation with getting rid of primary and secondary sex characteristics, or belief that he/she was born the wrong sex

Treatment for Gender Dysphoria

• Not evidence that therapy aimed at “adjusting the mind to the body” is effective

• No successful “conversion” of transsexual persons via psychotherapy

• Most professionals agree that “adjusting the body to the mind” is best practice for those clinically diagnosed who desire the procedure(s)

Transitioning

• Not all individuals who identify as trans seek to transition medically to the other sex. 

• They may not transition because they don’t need to do so in order to express their identity, or they may reject a simple male/female dichotomy. 

• Four major elements (World Professional Association for Transgender Health): 

  • Assessment, education, and psychotherapy 

  • Hormonal treatment 

  • Experience in the desired gender role 

  • Gender confirmation surgery

Hormone Treatment: Natal male to female

• testosterone (T) blockers, estrogen 

  • ↑ Skin softness 

  • ↑ Breast development 

  • ↓ Facial and body hair 

  • ↓ Muscle strength 

  • ↓ Sex drive 

  • ↓ Penile erections, prostate size, sperm count/quality

Hormone Treatment: Natal female to male

• T, progesterone (to stop menstruation) 

  • ↑ Facial and body hair 

  • ↑ Muscle mass 

  • ↓ Breast size (does not eliminate breasts) 

  • ↑ Clitoris size 

    • Vaginal atrophy 

    • Suppresses menstruation 

    • Deepens voice

Gender Confirmation Surgery: Natal Males

• Key procedures: 

  • Removal of penis and testicles 

  • Construction of vagina (vaginoplasty), labia, clitoris 

  • Augmentation of breasts 

• Vaginoplasty 

  • Creation of cavity in space between rectum and prostate 

  • Tissue from the penis and scrotum (or other skin grafts) used to line the cavity

Gender Confirmation Surgery: Natal Males

• Other procedures: 

  • Surgery to vocal cords (to raise pitch) 

  • Liposuction to waist 

  • Hair graft 

  • Reduction of Adam’s apple 

  • Procedures to feminize facial appearance

Gender Confirmation Surgery: Natal females

• Key procedures: 

  • Removal of breasts, ovaries, uterus, vagina 

  • Construction of penis (with functioning urethra, and capable of erection with implant) 

  • Construction of scrotum

    • From labial skin; saline-filled testicle implants

Exam 2: Sexual Orientation

Terminology

• Sexual Orientation: Sexual attraction toward persons of the other sex (heterosexual), same sex (homosexual), both sexes (bisexual), or neither sex (asexual) 

• Heterosexual: Sexually oriented toward primarily opposite sex (“straight”) 

• Homosexual: Sexually oriented toward primarily same-sex 

  • Lesbian – female attracted to females 

  • Gay – male attracted to males 

• Bisexual: Sexually oriented toward both sexes approximately equally 

• Pansexual: Sexually oriented toward people regardless of sex, gender identity, or expression 

• Queer: Often a non-specific term referring to not primarily heterosexual 

• Demisexual: Sexual attraction only experienced after strong emotional connection with someone 

• Asexual: A sexual orientation involving a lack of sexual attraction to others (“Aces”)

Asexuality

• Approximately ~1% of the population 

• A sexual orientation involving a lack of sexual attraction to others (a.k.a “Aces”) 

• Many still want intimacy and relationships, some enjoy sexual stimulation (e.g., masturbation), some have sexual fantasies 

• Not experiencing distress related to this, except perhaps stigma related distress 

• Not a paraphilia, sexual desire disorder, or psychiatric condition

Measuring Sexual Orientation

• Kinsey (1940s & 1950s): Homosexuality as a normal variant of human sexuality. 

• “Males do not represent two discrete populations, heterosexual and homosexual. The world is not to be divided into sheep and goats. It is a fundamental of taxonomy that nature rarely deals with discrete categories... The living world is a continuum in each and every one of its aspects.”

Kinsey Sexual Orientation Rating Scale

Sexual Orientation Prevalence

• In addition to generational differences, sig differences based on gender and political ideology: 

• Women > men to identify as LGBT (6.4% vs. 4.9%, respectively). 

• Women > men more likely to identify as bisexual (4.3% vs 1.8%). 

• 13.0% of political liberals, 4.4% of moderates and 2.3% of conservatives say they are lesbian, gay, bisexual or transgender. 

• Differences less pronounced by party identification, with 8.8% of Democrats, 6.5% of independents and 1.7% of Republicans identifying as LGBT. 

• There are no meaningful educational differences -- 5.6% of college graduates and 5.7% of college non graduates are LGBT.

History of Homosexuality as a Disorder in the DSM

• DSM I (1952): Homosexuality

  • Considered a mental disorder 

  • “sociopathic personality disturbance” 

• DSM-II (1968): Sexual Orientation Disturbance 

  • considered sexual deviation 

  • only diagnosed if “in conflict with” sexual orientation 

• DSM-III (1980): Ego-dystonic Homosexuality 

• DSM-III-R (1987): Ego-dystonic Homosexuality removed

The Declassification of Homosexuality as a Mental Illness

• Kinsey (1940s & 1950s): Homosexuality as a normal variant of human sexuality. 

• "Males do not represent two discrete populations, heterosexual and homosexual. The world is not to be divided into sheep and goats. It is a fundamental of taxonomy that nature rarely deals with discrete categories... The living world is a continuum in each and every one of its aspects.“ 

• Evelyn Hooker (1957): Homosexuality is not a mental disorder. 

  • Ground-breaking study compared projective tests on 30 homosexual men with 30 heterosexual men 

  • Experienced psychologists could not distinguish between the two groups.

Genetic Studies of Homosexuality

• Homosexual males: 52% of identical twins, 22% fraternal twins, 11% adoptive brothers also gay (Bailey & Pillard, 1995) 

• Homosexual females: 48% identical twins, 16% fraternal twins, 6% adoptive siblings also lesbian (Bailey et al., 1995)

• Conclusion: Some heritability but if homosexuality were solely genetic, it should have disappeared long ago (less likely to reproduce).

Birth Order Effects on Homosexuality

• Gay men have more older brothers (but not older sisters) than heterosexual men (Blanchard, 2008). 

• Later born brothers from same mother more likely to be homosexual (Blanchard, 2004). 

• Each older brother increases likelihood of being gay by ~33% (Blanchard, 2008).

• Maternal Immune Hypothesis: Progressive immunization to male-specific antigens after the birth of successive sons in some mothers – possibly effects male differentiation of brain in fetus.

Hormone Studies of Homosexuality

• Studies focused on deficiencies in certain hormones or excess hormonal exposure during prenatal development 

  • supported by animal research

Finger Length Studies of Homosexuality

• 2D:4D ratio (McFadden et al., 2005). 

• Typical male-type pattern is a longer ring than index finger 

• Typical female pattern is similar ring and index fingers 

• Lesbian women often have typical male-type finger pattern 

• Likely exposure to androgen prenatally  

• Evidence for gay men less clear

Exam 2: Atypical Sexuality

DSM-5 Criteria for Paraphilic Disorder  

• DSM differentiates between atypical human behavior and behavior that causes mental distress to a person or makes the person a serious threat to the psychological and/or physical well-being of others.  

• To be classified as a Paraphilic Disorder individuals must:  

  • Feel personal distress about their interest and/or  

  • Have a sexual desire or behavior that involves another person’s psychological distress, injury, or death, or a desire for sexual behavior that involves unwilling persons or persons unable to give legal consent.

Frotteuristic Disorder (mashing) 

• Sexual arousal from touching or rubbing against a non-consenting person 

• Part of the excitement is in the risk of getting caught in a public place. 

• Common locations for frotteurism are subways, buses, elevators, sporting events, and other crowded public events.

• Most cases occur with males touching females, although there have been cases of persons of any sex touching another person of any sex. 

• In cases of adults of any sex touching children of any sex considered a criminal offense because it is a form of nonconsensual sex. 

• College survey: 24% women, 7% men reported being victim of frotteurism 

• In a study of young female on public trains in Tokyo, over 66% reported that they had been subject to acts of frotteurism (rubbing, touching, groping).

Sexual Sadism Disorder

• Sexual arousal from the physical or psychological suffering of another person (real not simulated) 

• Named after the Marquis do Sade, 19th century French nobleman/writer whose many novels (e.g., Justine, Juliette) equate cruelty, pain, humiliation with erotic pleasure

Sexual Sadism Disorder: DSM-5 Criteria

• Patients derive recurrent and intense sexual arousal from the physical or psychological suffering of another person; arousal is expressed in fantasies, intense urges, or behaviors.  

• Patients have acted on their urges with a nonconsenting person, or these fantasies or urges cause clinically significant distress or impair functioning at work, in social situations, or other important areas of their lives.  

• The condition has been present for ≥ 6 months.

Sadistic Serial Killers

• Derive sexual pleasure from their crimes, but not necessarily through rape/sexual assault of victims 

• Often just the sight of pain and suffering is enough for them to satisfy their sexual urges; for some the act of killing is what leads to sexual climax 

• Many notorious sadistic serial killers: Jack the Ripper, Jeffrey Dalmer, ”Son of Sam,” “Butcher Baker,” Dennis Rader “BTK”

Prevalence of Sexual Sadism Disorder

• Rates vary from < 10% of convicted sexual offenders in the US, to 37-75% of individuals who have committed sexually motivated homicide.  

• Results from phallometric testing show that individuals diagnosed with sexual sadism disorder or who demonstrate preference for sadism (without meeting diagnostic criteria) demonstrate sexual arousal to violence or injury in a sexual context, while those with other disorders or no diagnoses that commit sexual crimes respond to resistance or nonconsent (Seto et al., 2012).

Sexual Masochism Disorder: Common Acts Alone

• For people who engage in masochistic activities, these may be the preferred or exclusive mode of producing sexual excitement.  Common masochistic fantasies/behaviors conducted alone: 

  • Binding themselves 

  • Piercing their skin 

  • Applying electrical shocks 

  • Burning themselves 

  • Self-suffocation during masturbation (asphyxiophilia/ autoerotic asphyxia)

Sexual Masochism Disorder: Common Acts with Partner

• Common masochistic behaviors conducted with a partner: 

  • Bound 

  • Blindfolded 

  • Spanked 

  • Flagellated (whipped) 

  • Humiliated by being urinated or defecated on 

  • Forced to cross-dress

  • Coerced into a sexual act 

  • Partially asphyxiated, usually at the time of orgasm

Prevalence of Sexual Masochism Disorder

• True prevalence unknown (most don’t want to be treated).  

• Research indicates fantasies related to sexual masochism fairly common.  

• ~12% females and ~25% men respond sexually to erotic stories with masochistic themes.  

• ~5% of women and ~12% of men engage in fantasy with masochistic themes (e.g., being beaten, whipped, spanked or tied up)  

• As many as 50% of sexually active adults enjoy being bitten or scratched during consensual sexual activity. 

Sexual Masochism Disorder: Autoerotic Asphyxia

• A specific type of sexual masochism that involves oxygen deprivation by means of neck compression during sexual activity (hanging, ligature, plastic bags).  

• Conducted with a partner or during masturbation.  

• Leading cause of death directly related to sexual masochistic disorder. Due to the self-inflicted nature or such deaths, it is something difficult to determine whether death was accidental or the result of suicide.  

• Estimated ~500-1000 young men die via autoerotic asphyxia in US each year; 30% adolescent hanging deaths attributed to practice.

Psychological Factors Relevant to Masochism

• The mental framing of pain as pleasurable can alter the perception of the sensation. Those who enjoy pain might experience a different emotional response to painful stimuli, potentially linking it to feelings of intimacy, trust, love.  

• The way individuals cognitively frame experiences of pain can also influence brain activity. For masochists, the prospect of pain is often anticipated with excitement = positive association (e.g., sexual arousal) => release of endorphins and “feel good” hormones.  

• Negative emotions (depressed mood, anxiety) have been shown to augment pain. 

• Women with genital tend to negatively anticipate the experience of genital pain, which has been shown to exacerbate pain; mindfulness-based treatments that emphasize noticing the physical qualities of pain instead of the anxious anticipation of pain lead to decreased levels of self reported genital pain. 

Biological Factors Relevant to Masochism

• Endorphin Release: Both pain and pleasurable stimuli can trigger the release of endorphins, which are neurotransmitters that can create feelings of euphoria and act as natural painkillers. Masochists may experience a stronger endorphin release in response to pain, contributing to a pleasurable experience.  

• Neurological Aspects: Some research suggests that the way pain signals are processed in the brain can differ between those who enjoy pain and those who do not. For some individuals, the neural pathways associated with pleasure and pain may overlap.  

• Pain Tolerance and Sensitivity: There may be differences in the way pain thresholds are set or how sensitive individuals are to pain. Masochists may have a higher pain tolerance or a different pain experience, which could be associated with how their brains interpret and process pain signals.

BDSM vs Paraphilic Disorder

BDSM vs Paraphilic Disorder

• CONSENT. With all aspects of BDSM, consent is fundamental. All parties involved in sadistic play must clearly understand what activities they're about to engage in and agree to them enthusiastically. Boundaries and safe words should be discussed beforehand to allow anyone to withdraw consent easily at any point.  

• COMMUNICATION. Established understanding of desires and limits.  

• SAFE, SANE, AND CONSENSUAL (SSD) or RISK AWARE CONSENSUAL KINK (RACK) are words people in the BDSM community live by. These principles emphasize the importance of knowing and understanding the risks of BDSM activities and only agreeing to what is safe and sane.

Prevalence of BDSM

• Meta analyses indicates BDSM-related fantasies common in both males and females, with 40- 70% population engaging in fantasies about the acts and ~ 20% engaging in BDSM.  Most common in the West, though less studied outside of Western countries. Practitioners mostly white, well educated, young.  

• Women report fantasizing about being dominated sig more than men (65% women vs. 54% men), while men reported fantasizing about dominating someone sig more than women (60% men vs. 47% women).  

• Women desired to engage in masochism significantly more than men (28% women vs. 19% men).

Intrinsic Origins of BDSM

• Intrinsic Origins (78% of practitioners)  

  • Most described their interest in BDSM starting at young age, without necessarily having a sexualized component (e.g., some described liking to be tied up or blindfolded during various make-believe games, such as "cops and robbers." These participants often said they were "born" liking BDSM or "wired" that way.  

  • ~ 7% indicated had an "a-ha" moment later in life, realizing they had always been interested in BDSM practices but hadn't put the pieces together until adulthood.  

  • About 10% engaged in BDSM to help cope with inner psychological distress or suffering (e.g., one participant said they used BDSM to "heal" themselves from their "issues").

Extrinsic Origins of BDSM

• Extrinsic Origins (22% of participants)  

  • Became interested in practicing BDSM as result of someone else introducing them to the concepts, either directly or indirectly.  

  • Within this group, 11% reported it being connected to a history of childhood sexual abuse, 9% due to parental discipline (e.g., spanking with an object). Another 9% introduced it through play as a child (i.e., like "cops and robbers" example but was a friend who introduced the idea of restraints) and 9% reported being introduced to BDSM as an adult by a recent sexual partner

Reasons Given for Practicing BDSM

• Power Exchange. Most frequent reason for engaging in BDSM (46% of participants). This was described as occurring through role play and/or being physically restrained.  

• Receiving Pain. The second most common reason for engaging in BDSM (37% of respondents). These practitioners were clear that there was a difference between good pain and bad pain.  

• Altered State of Consciousness. 28% of practitioners said practicing BDSM allowed them to access an altered mental space that could lead to a somewhat meditative and relaxed state.

Consensual Non-Consent

• A set of practices in which the submissive partner agrees to a sexual situation where their ability to withdraw consent will be limited or fully eliminated 

• Not Wanting to Ruin Your Own Fun  

  • Daniel, 21 a heterosexual middle-aged man with a strong preference towards assuming the submissive role refused to use safewords, or any other safety tools that could allow him to interrupt a scene too early. This was especially important since his main partner was a selfdescribed sadist who enjoyed administering heavy flogging. Daniel himself identified as a submissive, but not a masochist and participated in those gladly. However, he specifically denied himself an ‘out’, as he believed that given a chance to interrupt a whipping before it was finished, he would probably take it due to the unpleasantness of momentary pain – and, in doing so, ruin the fun for both himself and his partner. 

Rough Sex

• Survey, n=1,795 sexually active university students (Herbenick et al. 2021) 

• Rates of engaging in rough sex: 

  •  ~21% never  

  • ~29% rarely 

  •  ~40% sometimes  

  • ~13% often 

• Most frequent rough sex behaviors:  

  • choking (77%)  

  • hair pulling (75%)  

  • spanking (69%) 

• Gender differences in initiation:  

  • 57% of men  

  • 39% of women  

  • 48% of TGNB

• Sig increase in rough sex among teenagers and young adults  

• Young people often describe worrying they will be “vanilla shamed” — written off as boring — if they’re not into rough sex  

• Some young men worry they won’t be viewed as masculine if they don’t choke or slap their partner  

• Exposure to rough sex in sexually explicit material sig predictor of desire to engage in rough sex & actual participation  

• Average young person first sees pornography (on purpose or by accident) is 12 years old  

• Young men often describe learning about rough sex from pornography; young women often describe learning about rough sex from social media memes, TikTok and fan fiction.  

• These repeated exposures can create a sense of how sex is “supposed” to play out. 

Choking During Sex

• Recent U.S. survey of 4,989 college students, 58% of women reported having been choked during sex, and one-quarter of these first experienced being choked during sex between the ages 12 and 17 (Herbenick et al., 2021).  

• Women who had been choked more than five times in their lifetime were twice as likely to report current symptoms related to depression, anxiety, sadness, and loneliness compared to their choking naïve counterparts (Herbenick et al., 2021).  

• Being choked during sex can induce hypoxic/ischemic stress by restricting the blood flow and air to the brain. When choking ends, the blood flow rushes back to the brain and the return of the oxygen is thought to trigger pleasant or euphoric feelings.  

• Ischemia is like a 'fake stroke' and presents similarly to a real stroke. The reduction or restriction of blood flow to the tissues causes symptoms similar to a real stroke, such as confusion, weakness, or loss of consciousness.

The Effects of Choking During Sex on Brain Function

• Hou et al. (2023) examined differences in brain structures (MRI) between women (18-30 years) who had never engaged in choking during sex (n=21) vs women who had engaged in choking during sex ≥4 times in the past 30 days (n = 20)  Increased cortical thickness, reduced gyrification, and alterations in fractal dimensionality  Provide the first evidence that frequently being choked/strangled during sex is associated with structural changes in the brain and could possibly alter cortical maturation in young adult women.

Anomalous Target Preferences

Transvestic Disorder

• Persistent, intense sexual arousal from fantasizing about or acting on urges to dress as opposite gender • Primarily heterosexual males • Not to be confused with transsexualism – do not seek sex reassignment surgery and do not cross dress to be consistent with gender identity • Autogynephilia – sexually aroused by imagining self as woman

Fetishistic Disorder

•  Sexual arousal from either the use of nonliving objects or a highly specific focus on nongenital body part(s) • Most fetishes related to body (e.g., buttocks, legs, feet, hair, body fluid) • Partialism – focus on specific body part • “Devotees” – arousal to amputation stump • “Wannabes” – arousal to thought of having an amputation • Media fetishism – desire directed toward materials (e.g., leather, silk, fur)

• Only diagnosed if causes distress or impairments in functioning • 25% of pornographic industry profits  The data for actual prevalence is limited. Most of the published data are case reports or small case series.  Vast majority of the cases are male.  Weinberg et al. found that 88% of 262 men with a footwear fetish were homosexual; 12% bisexual.  Often patients will present to the clinical settings only if either there is a problem in their relationship or the individual has been reported to the police and has been forced to seek clinical treatment.  Thus, the motivation for seeking treatment is variable, which influences therapeutic alliance and adherence. 

Prevalence of Different Fetishes

• Used data from 381 online sexuality-related discussion groups (~5,000 individuals)  Relative frequency of each preference category was estimated considering  (a) the number of groups devoted to the category  (b) the number of individuals participating in the groups  (c) the number of messages exchanged. 

Fetishistic Disorder: Conditioned Sexual Arousal in Rats

• Male rats given first sexually experiences either wearing or not wearing jackets  

• Tested later with jacket on/off

Fetishistic Disorder: Conditioned Boot Fetish in Men

• First and only study to test classical conditioning of a fetish in human males 

• Repeated presentation of slide of woman’s boot (CS) followed immediately by slide of nude woman (UCS)