Transcript Sexual and Gender Identity Disorders

Main Classes of Disorders
• Paraphilias
• Gender Identity Disorders
• Sexual Dysfunctions
An Overview
• Para
– “Beyond”
– Philia
– “Love”
Sexual Stimulation Requiring Bizarre or
Unusual Acts, Imagery, or Objects
Fetishism
• Sexual Attraction to Nonliving Objects
– Inanimate Objects
– Tactile Stimulation
– Parts of the Body
Exhibitionism
• “The Flasher”
– Expose Genitals to Unsuspecting
Strangers
– Element of Risk is Important
– Not Harmless (Many Rape / Molest)
Voyeurism
• “The Peeping Tom”
– Watching Unsuspecting Strangers
Naked or Undressing
Transvestic Fetishism
• “Cross Dresser”
– Sexual Arousal by Dressing in Clothes
of the Opposite Sex
– Most are Male Heterosexuals
Sexual Sadism and Masochism
•
The “Sadist”
– Sexual Arousal by
Inflicting Pain / Humiliation
Domination, Beatings
•
The “Masochist”
– Suffers the Pain / Humiliation
– Helps the Sadist
Pedophilia and Incest
• Pedophilia
•
– Sexual Attraction to Children
– More Aroused to Young Children
Incest
– Children Related to Perpetrator
– May be Aroused to Adults
Psychosocial Contributions
• Inability to Develop Adequate
•
•
•
•
Relationships
Early “Unusual” Sexual Experiences
Person’s Early Sexual Fantasies
Excessive Sex Drive
Specific Causes are Still Unclear
Psychosocial Treatments
•
•
•
•
Covert Sensitization
Orgasmic Reconditioning
Relapse Prevention
Victim Empathy Training
Drug Treatments
•
•
•
Anti-Androgen
– Cyproterone Acetate
– Reduces Testosterone Levels
Eliminates Sexual Desire / Fantasy
Use for Sex Offenders
• Rare
• Trapped in the Body of the
•
Wrong Sex
Transexualism (former
name)
•
•
•
No Physical Abnormalities
Independent of Sexual Arousal
Patterns
May be Attracted to People With
Desired Identity
•
•
No specific biological link has
been discovered to this point
(but probably a major factor)
Gender identity is usually
established between 18 mos. and
3 years of age
• Sex Reassignment Surgery
• High cost ($$)
• Female-to-Male Adjust Better
•
(most are happy)
Psychosocial Treatment (an
attempt to change the gender
identity)
Desire Phase
• Sexual Desire Disorders
• Sexual Arousal Disorders
• Orgasm Disorders
• Sexual Pain Disorders
Resolution
Arousal - Excitement
Plateau
Orgasm
Hypoactive Sexual Desire Disorder
• No Interest in Any Sex Activity
• Common Presenting Problem
• How Much Sex Is Enough?
Hypoactive Sexual Desire Disorder
Sexual Aversion Disorder
• Anything Sexual Evokes Fear,
Disgust, or Panic
Male Erectile Disorder
Female Sexual Arousal Disorder
• Problem is NOT Desire, but Arousal
• Males: “Impotence”
•
Maintaining /Achieving Erection
Females: “Frigidity”
Maintain / Achieve Lubrication
Inhibited Orgasm
• Adequate Arousal and Desire
• BUT Unable to Achieve Orgasm
• Common in Females; Rare in Males
Only 50% Women Experience Regular Orgasms
During Intercourse
Premature Ejaculation
• Ejaculation Occurs Too Quickly
• Define “Too Quickly / Premature”
• Problem Occurs in About 37%
• Perception of Lack of Control Over
Orgasm in the Chief Complaint
Dyspareunia
• Intercourse Associated With Pain
• Rule out Medical Causes of Pain
• Rare Condition in Males
• More Common in Women
Vaginismus
Interviews
Thorough Medical Evaluation
Psychophysiological Assessment
• Listen to Audiovisual Erotic Material
• Measure Arousal Directly
• Penile Strain Gauge
• Vaginal Plethysmograph
Biological Contributions
• Diabetes and Kidney Disease
• Cardiovascular Diseases
• Chronic Illness
• Prescription Medications
• Using Alcohol and Other Drugs
Biological Contributions
Psychological Contributions
• Couple problems
• Performance Anxiety Involves
•
•
Arousal, Cognition, and Negative Affect
The Role of Distraction
Arousal Level is Underestimated
Biological Contributions
Psychological Contributions
Social and Cultural Contributions
• Learn That Sexuality is Negative
• Traumatic Sexual Experiences
• Poor Interpersonal Relationship
• Inaccurate Beliefs and Myths
Providing Education About Sex
Psychosocial Treatments
• Reconditioning
• Eliminate Performance Anxiety
Sensate Focus / Nondemand Pleasuring
• Gradual Process of Building Intimacy
Providing Education About Sex
Psychosocial Treatments
Medical Treatments
• Medications
Vasodilating Drugs (Viagra)
• Surgery and Implants
• Vacuum Device Therapy