50K - views

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.

Download Presentation

Human Sexuality Sexual Disorders: Dysfunction, Dysphoria, and Paraphilia




Download Presentation - The PPT/PDF document "Human Sexuality Sexual Disorders: Dysfun..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.



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

Slide1

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