Sexual Myths and Realities Pre1966 Masters amp Johnsons Human Sexual Response The Science of Sexuality Accepted beliefs about Human Sexuality Masturbation is rare and causes disease in men ID: 751159
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Human Sexuality
Sexual Disorders: Dysfunction, Dysphoria, and ParaphiliaSlide2
Sexual Myths and RealitiesPre-1966/ Masters & Johnson’s “Human Sexual Response”; The Science of SexualityAccepted beliefs about Human Sexuality:Masturbation is rare and causes disease in men
Women never masturbateHomosexuality is abnormalMost couples have exclusively missionary sexWomen are not sexual and rarely have orgasmsPremarital sex is rare; so is extramarital sexSlide3
What is “Normal” Sexual Behavior?Normal Sexual Behavior: Wide range; research is recent and evolving
Difficult to determine what is normalExample: people report tremendous variation in frequency of sexual outlet or releaseInfluenced by cultural norms and valuesKinsey: “The only unnatural sex act is that which you cannot perform”
Definitions of sexual disorders are inexactSlide4
Defining Sexual Behavior as a Mental Disorder
Controversy surrounding definition of deviant sexual behavior
Current Def: Only deviant if it threatens society, causes distress to participants, or impairs social or occupational functioning
Is gender dysphoria a psychiatric disorder?
Is Sex Addiction a disorder?
Is hyposexuality a disorder if there is no distress?Slide5
The Sexual Response CycleAppetitive/Excitement phase Characterized by person’s interest in sexual activity
Arousal/Plateau phaseMay follow or precede the appetitive phaseHeightened when specific, direct sexual stimulation occursVarious physical changes occurExample: increased blood flow to penis in malesSlide6
The Sexual Response Cycle (cont’d.)Orgasm phase Characterized by involuntary muscular contractions throughout the body and eventual release of sexual tension
Resolution phase Characterized by relaxation of the body after orgasmHeart rate, blood pressure, and respiration return to normalSlide7
Human Sexual Response CycleSlide8
Sexual DysfunctionsRecurrent and persistent disruption of any part of the normal sexual response cycleDSM-5 requires that symptoms be present for at
least six months and be accompanied by significant distressTypes of dysfunctionsLifelong – onset since beginning of sexual behaviorAcquired – after a period of normal sexual behaviorGeneralized – across situations, partners, all stimulationSituational – specific to certain situations, partners, stimSlide9
Sexual Dysfunction DxDSM-5 diagnosis for sexual dysfunction not made if better explained by another disorder (i.e., depr)Sexual Dysfunction can be comorbid with relational difficulties and psychological disorders
Example: Loss of Sexual Arousal Drive subsequent to relationship conflict; poor body image; griefSlide10
Lifetime Prevalence of Sexual Disorders in the United States (40–80 Age Range) Slide11
Sexual Interest/Arousal DisordersProblems with initial phase of sex: little interest in sex but capable of orgasmWhat is normal frequency? 2-3x
wk? year? Male hypoactive sexual desire disorderLittle or no interest in sexual activitiesFemale sexual interest/arousal disorderLittle or no interest, or diminished arousal to sexual cuesMost common in women –
33%40-50% of all sexual difficulties involve deficits in interestSlide12
Orgasmic DisordersFemale orgasmic disorder (prevalence 10-40%)Persistent delay or inability to achieve orgasm
despite receiving adequate sexual stimulationMarked reduced intensity of orgasmic sensationNot dx if orgasm is possible with stimulationDelayed ejaculation – (worsens with age)Persistent delay or absence of ejaculation after excitement phase is reached
Lifelong type can occurRule out Medical Cause: surgical injury to lumbar nerves; nerve supply to genitalsSlide13
Orgasmic DisordersPremature EjaculationRecurrent pattern of having an orgasm with minimal sexual stimulation before, during, or after vaginal penetrationMust occur within one minute of penetrationMost common sexual dysfunction for young menAffects 21-33 percent of menSlide14
Orgasmic DisordersPain Penetration Disorders: Involves physical pain or discomfort associated with intercourse/penetrationDyspareunia
Pain in the pelvic region during intercourseVaginismusInvoluntary spasm of the outer third of the vaginal wall Prevents or interferes with sexual intercourseSlide15
Arousal Disorders: AgingSexual Changes across Lifespan:Female drop in estrogen: Interest drop; Thinning of vaginal walls; lower lubrication
Male drop in Testosterone – drop in arousal & EDDelayed Ejaculation/AbsenceErectile Dysfunction: inability to form penile erection Psychological cause: may experience Nocturnal erectionsMedical Cause: Poor circulation/heart diseaseProstate DiscomfortsSlide16
Etiology of Sexual DysfunctionsSlide17
Etiology of Sexual DysfunctionsBiological dimensionLevels of
testosterone (low) or estrogens (low) linked to lower sexual interest in men and women, and erectile difficulties in menMedications used to treat medical conditions affect sex driveMany antidepressant and antihypertensive medications
Alcohol as leading cause of disorders – ejaculation/ed issuesIllnesses and other physiological factors (heart disease; diabetes; )Slide18
Etiology of Sexual Dysfunctions (cont’d.)Psychological dimension History of Sexual Trauma; Emotional Abuse
Increase of Stress; Poor CopingAnxiety disorder: poor performanceDepression: anhedoniaPerformance anxiety and spectator roleCultural/Religious beliefs about sexuality/body (prohibitions)
Poor Self-Image: Negative thoughts and dysfunctional beliefsSlide19
Etiology of Sexual Dysfunctions (cont’d.)Social dimensionSocial relationships: positive sexual experiences
Current sexual relationship: communication/sexual compatibility; partner violence/abuseEarly sexual experiencesTraumatic sexual experiencesRelationship dynamics predictive of sexual disordersMarital satisfaction associated with greater sexual frequencySlide20
Etiology of Sexual Dysfunctions (cont’d.)Sociocultural dimension: Rigid Scriptscultural scripts: defines roles, allowable behaviors, pleasures, sexual play script
Examples of sociocultural aspectsPeople in Asian countries consistently report lowest frequency of sexual intercourseCultural scripts for men in the United StatesSexual potency as a sign of masculinityHomophobia toward lesbians or gaysSlide21
Treatment of Sexual DysfunctionsBiological interventionsHormone replacement – testosterone, estrogen, etc.
Mechanical means to improve functioningVacuum pumps, suppositories, penile implantsFor ED, injecting medication into penisOral medications (Viagra, Levitra, Cialis)Psychological boost may lead to feelings of enhanced pleasureSlide22
Psychological Treatment ApproachesEducation Replace myths and misconceptions with facts
Anxiety reductionDesensitization or graded approachesChanging negative thoughts and beliefs about sexStructured behavioral exercisesTasks that gradually increase amount of sexual interaction
Sexual Communication training – relationship focusedSlide23
Gender DysphoriaPreviously called gender identity disorder (GID) or transsexualism Marked incongruence (mismatch) between one’s experienced or expressed gender and biologically assigned gender
Not the same as sexual orientationDiagnosed when there is significant distress or impairment – High Suicidality RiskChildhood – some don’t persist into adulthoodAdolescent/Adult onset - many persist into adulthood Slide24
Etiology of Gender DysphoriaEtiology is unclearResearch has focused on other sexual disorders
Likely an interaction of multiple variablesMost transgender children have normal hormone levelsNo specific neurological explanationBrain alterations associated with psychosocial distress and social exclusionSlide25
Psychological and Social InfluencesExplanations must be viewed with cautionHypothesis –
Do Childhood experiences influence development of gender dysphoria? Mediating role?Parent encouragement of feminine behavior, overprotection, lack of male role models, etc.Psychosocial stressorsStigma and lack of societal acceptance play a role in distress and impairment associated with gender dysphoriaSlide26
Treatment of Gender DysphoriaGender reassignment therapiesChanging physical characteristics through hormone therapy or surgery
Many involve reconstructing genital organsSome insurance beginning to include coverage for transgender individualsStudies show positive outcomesSlide27
Paraphilic DisordersDSM-V definitionSexual arousal in objects, body parts, or abnormal targets (feet, lingerie, hair, voyeurism, porn, etc.)May involve unusual erotic behavior
Diagnosed only when paraphilia harms, or risks harming others and is acted onOr causes the individual to experience distress or impairment in social functioningSlide28
Paraphilic DisordersSlide29
Paraphilic Disorders Involving Nonhuman ObjectsFetishistic disorder – predominantly menExtremely strong sexual attraction and fantasies involving inanimate objects
Examples: shoes or undergarmentsPerson is often sexually aroused to the point of erection in the presence of the fetish itemPerson may choose sexual partners on the basis of having that item (e.g., bound feet)
Must cause significant distress or harm to othersSlide30
Transvestic Disorder Intense sexual arousal associated with cross-dressing (wearing clothes appropriate to the opposite gender)
Do not confuse with gender dysphoriaMost people who cross-dress are exclusively heterosexualIncidence higher among men than womenMen may become sexually aroused by thoughts of themselves as femaleSlide31
Paraphilic Disorders Involving Nonconsenting PersonsExhibitionistic disorder Urges, acts, or fantasies of exposing one’s genitals to strangers, intent to shock
Voyeuristic disorder Urges, acts, or fantasies involving observation of an unsuspecting person disrobing or engaging in sex activityDiagnosed only in those age 18 or olderIndividual must be distressed by or have acted on the voyeuristic urges Slide32
Frotteuristic DisorderRecurrent/intense sexual urges, acts, or fantasies of touching or rubbing against a nonconsenting personFor diagnosis, person must be markedly distressed by urges or have acted on themPrevalence is difficult to determineBehavior may go unnoticed or presumed to be accidentalSlide33
Pedophilic DisorderAdult relates to children as erotic objectsSexual abuse of children is commonEstimated 1/4 of girls and 1/5 of boysMost people who act on pedophilic urges are friends, relatives, or acquaintances of their victimsEffects of sexual abuse can be lifelongSlide34
Paraphilic Disorders Involving Pain or HumiliationSexual masochism disorder Sexual urges, fantasies, or acts that involve being humiliated, bound, or made to suffer
Individual does not seek harm or injuryFinds sensation of helplessness appealingSexual sadism disorderSexual urges, fantasies, or acts that involve inflicting physical or psychological suffering on othersSlide35
Etiology and Treatment of Paraphilic DisordersWe still have much to learnSome research findings conflict with each other
Some men may be biologically predisposed to pedophilic disorderPsychological factors also contributeParaphilias may result from accidental associations between certain situations and sexual arousalSlide36
Behavioral Approaches to TreatmentExtinction or aversive conditioning: punishment or elimination of behaviorAcquiring or strengthening sexually appropriate behaviors: learning healthy sexualityDeveloping appropriate social skillsLegal Consequences to inappropriate sexual interestSlide37
RapeSexual aggression that involves sexual activity performed against a person’s will through the use of force, argument, pressure, alcohol or drugs, or consent
Not considered a psychological disorderNumber of rapes in the U.S. has risen dramaticallyOne in five adult women has been rapedOne in 71 menSlide38
Characteristics of Male RapistsCreate situations in which sexual encounters may occurMisinterpret
friendliness as provocation and protests as insincerityManipulate women into sexual encounters with alcohol (70%) or other drugsAttribute failed attempts at sexual encounters to perceived negative features of the womanSlide39
More Characteristics of Male RapistsCome from environments of parental neglect or physical or sexual abuse
Experience Sex earlier in life than men who are not sexually aggressiveHave more sexual partners than non-sexually aggressive menSlide40
Date Rape
Many Reluctant to ReportBetween eight and 25 percent of female college students report having “unwanted sexual intercourse”Many universities conducting workshops to encourage understanding that
intercourse without consent is rapeSlide41
Effects of RapeRape trauma syndrome symptomsInclude psychological distress, phobic reactions, post-traumatic stress symptoms, and sexual dysfunction
Phases in rape trauma syndromeAcute phase: disorganization; PTSD SxFeelings of self-blame, fear, or depressionLong-term phase: reorganizationSurvivors deal directly with feelings and attempt to reorganize their livesSlide42
Etiology of rapePower rapist: 55 percent of rapistsCompensate for feelings of personal/sexual inadequacy by trying to intimidate victims
Anger rapist: 40 percent of rapistsAngry at women in generalSadistic rapist: 5 percent of rapistsDerives satisfaction from inflicting painMay torture or mutilate victimsSlide43
Etiology of Rape (cont’d.)Rape has more to do with power, aggression, and violence than sexSexual motivation also plays a role in rape
Most rape survivors are in their teens or 20sVulnerable age groupMost rapists name sexual motivation as primary reason for actionsMany rapists have
multiple paraphilias (immature sexuality)Slide44
Etiology of Rape (cont’d.)Why is the rate of rape increasing in US?
Effects of pornography and media portrayals of violent sex may affect rape prevalence“Cultural spillover” theoryRape is high in environments that encourage violenceUnited States has highest rape rate among countries reporting rape statisticsSlide45
Treatment for RapistsMany believe sex offenders are not good candidates for treatmentMost common penalty is imprisonment
High recidivism ratesWhen intervention occurs, it usually incorporates behavioral techniquesSome treatment techniques show success with exhibitionistsOutcomes tend to be poor for rapistsSlide46
Contemporary Trends and Future DirectionsTrends in Defining Abnormality:New Def: “Normal” if no harm to self or others? Exp: Is a fetish normal if not harmful??Gender dysphoria may eventually be removed as a psychiatric diagnosisSweden has removed transvestism, fetishism, and sadomasochism from list of mental illnessesSlide47
ReviewWhat are normal sexual behaviors?What do we know about normal sexual responses and sexual dysfunction?What causes gender dysphoria, and how is it treated?What are paraphilic disorders, what causes them, and how are they treated?Is rape an act of sex or aggression?Slide48
Group Work: Case Analysis Each group will work together on each case, evaluate each case, form a diagnosis and develop a rationale for the decision.Total of 4 cases representing different sexual disordersClass Discussion Please turn in group work at end of class