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Human Sexuality Sexual Disorders: Dysfunction, Dysphoria, and Paraphilia

Sexual Myths and Realities. Pre-1966/ Masters & Johnson’s “Human Sexual Response”; The Science of Sexuality. Accepted beliefs about Human Sexuality:. Masturbation is rare and causes disease in men.

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Human Sexuality Sexual Disorders: Dysfunction, Dysphoria, and Paraphilia






Presentation on theme: "Human Sexuality Sexual Disorders: Dysfunction, Dysphoria, and Paraphilia"— Presentation transcript:

Slide1

Human Sexuality

Sexual Disorders: Dysfunction, Dysphoria, and Paraphilia

Slide2

Sexual Myths and Realities

Pre-1966/ Masters & Johnson’s “Human Sexual Response”; The Science of Sexuality

Accepted beliefs about Human Sexuality:

Masturbation is rare and causes disease in men

Women never masturbate

Homosexuality is abnormal

Most couples have exclusively missionary sex

Women are not sexual and rarely have orgasms

Premarital sex is rare; so is extramarital sex

Slide3

What is “Normal” Sexual Behavior?

Normal Sexual Behavior: Wide range; research is recent and evolvingDifficult 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 inexact

Slide4

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 Cycle

Appetitive/Excitement phase Characterized by person’s interest in sexual activityArousal/Plateau phaseMay follow or precede the appetitive phaseHeightened when specific, direct sexual stimulation occursVarious physical changes occurExample: increased blood flow to penis in males

Slide6

The Sexual Response Cycle (cont’d.)

Orgasm phase Characterized by involuntary muscular contractions throughout the body and eventual release of sexual tensionResolution phase Characterized by relaxation of the body after orgasmHeart rate, blood pressure, and respiration return to normal

Slide7

Human Sexual Response Cycle

Slide8

Sexual Dysfunctions

Recurrent and persistent disruption of any part of the normal sexual response cycle

DSM-5 requires that symptoms be present for at

least six months and be accompanied by significant distress

Types of dysfunctions

Lifelong – onset since beginning of sexual behavior

Acquired – after a period of normal sexual behavior

Generalized – across situations, partners, all stimulation

Situational – specific to certain situations, partners, stim

Slide9

Sexual Dysfunction Dx

DSM-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; grief

Slide10

Lifetime Prevalence of Sexual Disorders in the United States (40–80 Age Range)

Slide11

Sexual Interest/Arousal Disorders

Problems with initial phase of sex: little interest in sex but capable of orgasm

What is normal frequency? 2-3x

wk

? year?

Male hypoactive sexual desire disorder

Little or no interest in sexual activities

Female sexual interest/arousal disorder

Little or no interest, or diminished arousal to sexual cues

Most common in women –

33%

40-50% of all sexual difficulties involve deficits in interest

Slide12

Orgasmic Disorders

Female 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 reachedLifelong type can occurRule out Medical Cause: surgical injury to lumbar nerves; nerve supply to genitals

Slide13

Orgasmic Disorders

Premature Ejaculation

Recurrent pattern of having an orgasm with minimal sexual stimulation before, during, or after vaginal penetration

Must occur within one minute of penetration

Most common sexual dysfunction for young men

Affects 21-33 percent of men

Slide14

Orgasmic Disorders

Pain Penetration Disorders: Involves physical pain or discomfort associated with intercourse/penetrationDyspareuniaPain in the pelvic region during intercourseVaginismusInvoluntary spasm of the outer third of the vaginal wall Prevents or interferes with sexual intercourse

Slide15

Arousal Disorders: Aging

Sexual Changes across Lifespan

:

Female drop in estrogen: Interest drop; Thinning of vaginal walls; lower lubrication

Male drop in Testosterone –

drop in arousal

& ED

Delayed Ejaculation/Absence

Erectile Dysfunction

: inability to form penile erection

Psychological cause: may experience Nocturnal erections

Medical Cause: Poor circulation/heart disease

Prostate Discomforts

Slide16

Etiology of Sexual Dysfunctions

Slide17

Etiology of Sexual Dysfunctions

Biological 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 medicationsAlcohol 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 AbuseIncrease 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 beliefs

Slide19

Etiology of Sexual Dysfunctions (cont’d.)

Social dimensionSocial relationships: positive sexual experiencesCurrent sexual relationship: communication/sexual compatibility; partner violence/abuseEarly sexual experiencesTraumatic sexual experiencesRelationship dynamics predictive of sexual disordersMarital satisfaction associated with greater sexual frequency

Slide20

Etiology of Sexual Dysfunctions (cont’d.)

Sociocultural dimension: Rigid Scriptscultural scripts: defines roles, allowable behaviors, pleasures, sexual play scriptExamples 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 gays

Slide21

Treatment of Sexual Dysfunctions

Biological 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 pleasure

Slide22

Psychological Treatment Approaches

Education Replace myths and misconceptions with factsAnxiety reductionDesensitization or graded approachesChanging negative thoughts and beliefs about sexStructured behavioral exercisesTasks that gradually increase amount of sexual interactionSexual Communication training – relationship focused

Slide23

Gender Dysphoria

Previously called gender identity disorder (GID) or transsexualism Marked incongruence (mismatch) between one’s experienced or expressed gender and biologically assigned genderNot 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 Dysphoria

Etiology is unclearResearch has focused on other sexual disordersLikely an interaction of multiple variablesMost transgender children have normal hormone levelsNo specific neurological explanationBrain alterations associated with psychosocial distress and social exclusion

Slide25

Psychological and Social Influences

Explanations 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 dysphoria

Slide26

Treatment of Gender Dysphoria

Gender reassignment therapiesChanging physical characteristics through hormone therapy or surgeryMany involve reconstructing genital organsSome insurance beginning to include coverage for transgender individualsStudies show positive outcomes

Slide27

Paraphilic Disorders

DSM-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 functioning

Slide28

Paraphilic Disorders

Slide29

Paraphilic Disorders Involving Nonhuman Objects

Fetishistic disorder – predominantly menExtremely strong sexual attraction and fantasies involving inanimate objectsExamples: 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 others

Slide30

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 female

Slide31

Paraphilic Disorders Involving Nonconsenting Persons

Exhibitionistic disorder Urges, acts, or fantasies of exposing one’s genitals to strangers, intent to shockVoyeuristic 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 Disorder

Recurrent/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 accidental

Slide33

Pedophilic Disorder

Adult 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 lifelong

Slide34

Paraphilic Disorders Involving Pain or Humiliation

Sexual masochism disorder Sexual urges, fantasies, or acts that involve being humiliated, bound, or made to sufferIndividual does not seek harm or injuryFinds sensation of helplessness appealingSexual sadism disorderSexual urges, fantasies, or acts that involve inflicting physical or psychological suffering on others

Slide35

Etiology and Treatment of Paraphilic Disorders

We still have much to learnSome research findings conflict with each otherSome men may be biologically predisposed to pedophilic disorderPsychological factors also contributeParaphilias may result from accidental associations between certain situations and sexual arousal

Slide36

Behavioral Approaches to Treatment

Extinction or aversive conditioning: punishment or elimination of behavior

Acquiring or strengthening sexually appropriate behaviors: learning healthy sexuality

Developing appropriate social skills

Legal Consequences

to inappropriate sexual interest

Slide37

Rape

Sexual aggression that involves sexual activity performed against a person’s will through the use of force, argument, pressure, alcohol or drugs, or consentNot considered a psychological disorderNumber of rapes in the U.S. has risen dramaticallyOne in five adult women has been rapedOne in 71 men

Slide38

Characteristics of Male Rapists

Create 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 woman

Slide39

More Characteristics of Male Rapists

Come from environments of parental neglect or physical or sexual abuseExperience Sex earlier in life than men who are not sexually aggressiveHave more sexual partners than non-sexually aggressive men

Slide40

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 rape

Slide41

Effects of Rape

Rape 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 lives

Slide42

Etiology of rape

Power 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 victims

Slide43

Etiology of Rape (cont’d.)

Rape has more to do with power, aggression, and violence than sexSexual motivation also plays a role in rapeMost 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 statistics

Slide45

Treatment for Rapists

Many believe sex offenders are not good candidates for treatmentMost common penalty is imprisonmentHigh recidivism ratesWhen intervention occurs, it usually incorporates behavioral techniquesSome treatment techniques show success with exhibitionistsOutcomes tend to be poor for rapists

Slide46

Contemporary Trends and Future Directions

Trends 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 diagnosis

Sweden has removed transvestism, fetishism, and sadomasochism from list of mental illnesses

Slide47

Review

What 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 disorders

Class Discussion

Please turn in group work at end of class