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    Sexual disorders Sexual disorders Presentation Transcript

    • SexualSexual DisordersDisorders
    • Human Sexual Response CycleHuman Sexual Response Cycle Appetitive or Desire.Appetitive or Desire. Arousal.Arousal. Orgasm.Orgasm. Resolution.Resolution.
    • HomosexualityHomosexuality No longer considered a disorder (sinceNo longer considered a disorder (since DSM-IIIR)DSM-IIIR) – No physiological differences in arousal.No physiological differences in arousal. – No difference in psychological disturbance.No difference in psychological disturbance. – No gender identity confusion.No gender identity confusion. – Similar concerns regarding life issues.Similar concerns regarding life issues.
    • Dysfunction vs. DisorderDysfunction vs. Disorder Dysfunction:Dysfunction: – Disruption of any part of the normalDisruption of any part of the normal response cycle.response cycle. Sexual desire.Sexual desire. Psycho-physiological changes.Psycho-physiological changes. Response cycle.Response cycle. Causes distress for the person.Causes distress for the person. Disorder:Disorder: – Recurrent, intense sexual urges, fantasiesRecurrent, intense sexual urges, fantasies or behavior that involves unusual objects,or behavior that involves unusual objects, activities or situations.activities or situations. – Causes distress or impairment.Causes distress or impairment.
    • DSM-IV GroupingsDSM-IV Groupings Sexual Dysfunctions.Sexual Dysfunctions. Gender Identity Disorders.Gender Identity Disorders. Paraphilias.Paraphilias.
    • Sexual DysfunctionsSexual Dysfunctions Sexual Desire Disorders.Sexual Desire Disorders. Sexual Arousal Disorders.Sexual Arousal Disorders. Orgasmic Disorders.Orgasmic Disorders. Sexual Pain Disorders.Sexual Pain Disorders. Prevalence:Prevalence: – Ranges from 5 to 35 percent of the generalRanges from 5 to 35 percent of the general population.population.
    • Sexual Desire DisordersSexual Desire Disorders Disorders related to theDisorders related to the appetitiveappetitive phasephase.. 40 to 50% of all sexual dysfunctions are40 to 50% of all sexual dysfunctions are desire (Spector & Carey, 1990).desire (Spector & Carey, 1990). Hypoactive sexual desire disorder:Hypoactive sexual desire disorder: – Absent or low sexual interest or desire.Absent or low sexual interest or desire. – 20% of adults.20% of adults. – Can be lifelong.Can be lifelong. Sexual Aversion disorder:Sexual Aversion disorder: – Avoidance of and aversion to sexualAvoidance of and aversion to sexual intercourse.intercourse.
    • Sexual Arousal DisordersSexual Arousal Disorders Relate to the excitement phase.Relate to the excitement phase. Problems involving feelings of sexualProblems involving feelings of sexual pleasure.pleasure. Kaplan estimates that approximatelyKaplan estimates that approximately 50% of men have experienced transient50% of men have experienced transient impotence.impotence.
    • Sexual Arousal DisordersSexual Arousal Disorders Female SexualFemale Sexual Arousal Disorder:Arousal Disorder: – Inability to attain orInability to attain or maintainmaintain physiologicalphysiological response duringresponse during sexual activity.sexual activity. Male ErectileMale Erectile Disorder:Disorder: – Inability to attain orInability to attain or maintain an erection.maintain an erection. – Primary.Primary. – Secondary.Secondary.
    • Orgasmic DisordersOrgasmic Disorders Female Orgasmic Disorder:Female Orgasmic Disorder: – Persistent delay or inability to achieve orgasm.Persistent delay or inability to achieve orgasm. Male Orgasmic Disorder:Male Orgasmic Disorder: – Persistent delay or inability to achieve anPersistent delay or inability to achieve an orgasm.orgasm. Premature Ejaculation:Premature Ejaculation: – Ejaculation with minimal sexual stimulation.Ejaculation with minimal sexual stimulation.
    • Orgasmic DisordersOrgasmic Disorders Female Orgasmic Disorder:Female Orgasmic Disorder: – Actually rare.Actually rare. – Less than 1% of women.Less than 1% of women. Male Orgasmic Disorder:Male Orgasmic Disorder: – Rare.Rare. – Often associated with trauma.Often associated with trauma. Premature Ejaculation:Premature Ejaculation: – 38% of men experience this disorder.38% of men experience this disorder.
    • Sexual Pain DisordersSexual Pain Disorders Dyspareunia:Dyspareunia: – Genital pain in a man or womenGenital pain in a man or women notnot due todue to lack of lubrication in her vagina.lack of lubrication in her vagina. Vaginismus:Vaginismus: – Involuntary spasm of the vagina preventingInvoluntary spasm of the vagina preventing or interfering with sexual intercourse.or interfering with sexual intercourse. Possible causes (Masters & Johnson):Possible causes (Masters & Johnson): – Important partner.Important partner. – Rigid religious beliefs about sex.Rigid religious beliefs about sex. – Sexual trauma.Sexual trauma.
    • TreatmentTreatment Education.Education. Physical Examination:Physical Examination: – Possible Biological Causes.Possible Biological Causes. – Possible Medication Conflict.Possible Medication Conflict. Therapy:Therapy: Psychological:Psychological: – Sensate Focus.Sensate Focus. – Marital Counseling.Marital Counseling. – Communication Training.Communication Training. Medical: - Viagra. - Physical Implants.
    • Gender Identity DisorderGender Identity Disorder Strong and persistent cross-genderStrong and persistent cross-gender identification.identification. – Desire to be the other gender.Desire to be the other gender. Persistent discomfort with one’sPersistent discomfort with one’s anatomical sex.anatomical sex. Causes distress or impairment.Causes distress or impairment. Trans-Sexualism.Trans-Sexualism.
    • Gender Identity DisorderGender Identity Disorder Onset tends to be in childhood.Onset tends to be in childhood. Boys:Boys: – Tend to be called as girls.Tend to be called as girls. – Tend to play more with “girl” toys.Tend to play more with “girl” toys. – Often show personality problems in addition.Often show personality problems in addition. Girls:Girls: – May insist she has a penis.May insist she has a penis. – Interest in “boy” play.Interest in “boy” play. – Often labeled as boys.Often labeled as boys.
    • TreatmentTreatment Usually involves both parent & child.Usually involves both parent & child. Education.Education. Behavioral Modification.Behavioral Modification. Sex Change Operations:Sex Change Operations: – Female to male: some positive results.Female to male: some positive results. – Male to female: fewer positive results.Male to female: fewer positive results. – Often remain depressed.Often remain depressed.
    • ParaphiliasParaphilias Sexual disorders of at least 6 months.Sexual disorders of at least 6 months. Person has acted or is distressed byPerson has acted or is distressed by recurrent urges or fantasies.recurrent urges or fantasies. Often co-morbid with more than oneOften co-morbid with more than one sexual disorder.sexual disorder. Nearly 50% had engaged in a variety ofNearly 50% had engaged in a variety of sexually deviant behaviors.sexually deviant behaviors. Much more prevalence in males thanMuch more prevalence in males than females.females.
    • Paraphilia CategoriesParaphilia Categories Non-Human Objects.Non-Human Objects. Non-Consenting Persons.Non-Consenting Persons. Suffering or Humiliation.Suffering or Humiliation.
    • Non-Human ObjectsNon-Human Objects Fetishism:Fetishism: – Sexual attraction involving nonliving objects.Sexual attraction involving nonliving objects. – Most common: female underwear.Most common: female underwear. – Often used during masturbation or intercourse.Often used during masturbation or intercourse. – Rare among women.Rare among women. – As a group, these people are not usuallyAs a group, these people are not usually dangerous nor do they tend to commit seriousdangerous nor do they tend to commit serious crimes.crimes. Transvestic Fetishism:Transvestic Fetishism: – Sexual arousal by cross-dressing.Sexual arousal by cross-dressing. – Not trans-sexualism.Not trans-sexualism. – Majority are heterosexual, married & haveMajority are heterosexual, married & have children.children.
    • Non-Consenting PersonsNon-Consenting Persons Exhibitionism:Exhibitionism: – Urges, acts or fantasies involvingUrges, acts or fantasies involving exposure of genitals to strangers.exposure of genitals to strangers. – Relatively common.Relatively common. – Most often males in their 20s.Most often males in their 20s. – No contact desired.No contact desired. Frotteurism:Frotteurism: – Involving touching or rubbing against aInvolving touching or rubbing against a non-consenting person.non-consenting person. – Contact is the motive.Contact is the motive. – Often occurs in crowded public places.Often occurs in crowded public places.
    • Non-Consenting PersonsNon-Consenting Persons Voyeurism:Voyeurism: – Involves observing unsuspecting personInvolves observing unsuspecting person disrobing or engaging in sexual behavior.disrobing or engaging in sexual behavior. – 95% involve strangers.95% involve strangers. – No contact is desired.No contact is desired. – Arrest is predictable.Arrest is predictable. Pedophilia:Pedophilia: – Involving sexual contact with aInvolving sexual contact with a prepubescent child Pedophilia.prepubescent child Pedophilia. – The person must be at least 16 years old toThe person must be at least 16 years old to receive the diagnosis.receive the diagnosis. – The victim must be at least 5 years younger.The victim must be at least 5 years younger.
    • Suffering or HumiliationSuffering or Humiliation Sadism:Sadism: – Sexually arousing urges associated withSexually arousing urges associated with inflicting suffering on another.inflicting suffering on another. – Range from pretended infliction of pain toRange from pretended infliction of pain to extremely dangerous pathological form ofextremely dangerous pathological form of sadism involving murder.sadism involving murder. Masochism:Masochism: – Sexual urges associated with beingSexual urges associated with being humiliated, bound or made to suffer.humiliated, bound or made to suffer. – Passive role.Passive role. – Not dangerous.Not dangerous.