Psychosexual disorders

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  • In the U.S. homosexuality is not considered a paraphilia and is not listed in DSM.
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Psychosexual disorders

  1. 1. Psychiatry department Beni Suef University
  2. 2. Normal sexual behavior  It achieves three major functions for human beings. They are:  1. Procreation (reproduction)  2. Pastime, pleasure  3. Object relation, it is an expression of relatedness, and preserves bonds between human beings (families). This is the most important function.
  3. 3. Brain and Sexual Behavior  The limbic system is directly involved with elements of sexual functioning. In all mammals the limbic system is involved in behavior required for self-preservation and the preservation of the species.
  4. 4. Brain and Sexual Behavior  Brain neurotransmitters are related to sexual function.  For example, an increase in dopamine is presumed to increase libido.  Serotonin (upper pons and midbrain) is presumed to have an inhibitory effect on sexual function.  Erection is mediated by cholinergic innervation.  Ejaculation is mediated by alpha-1 adrenergic fibers.  The uterus receives both adrenergic and cholinergic fibers.
  5. 5. Factors in Normal or abnormal sexuality  There are three interrelated factors: 1. Sexual identity 2. Gender identity  It is formed by the age of 2-3 years, and may be earlier.  It is usually congruent with the sexual identity.  Abnormality in this domain causes Transsexualism. 3. Sexual behavior: It is a series of psychological and physiological responses that represent the sexual cycle. Abnormalities in this domain cause Sexual Dysfunctions.
  6. 6. The Sexual Cycle  The sexual cycle (response) is a true psychophysiological experience.  Four phases are recognized in the human sexual cycle.  Phase I: Desire  Phase II: Excitement  Phase Ill; Orgasm  Phase IV: Resolution
  7. 7. Sexual Dysfunctions  They include:  1. Lack or loss of sexual desire.  2. Disorders in sexual arousal that include impotence in males and failure of genital response in females.  3. Orgasm disorders (inhibited male or female orgasm).  4. Sexual pain disorders in which pain occurs before, during or after intercourse recurrently or persistently in either the man or the woman.
  8. 8. Erectile dysfunction (impotence)  It is the persistent inability to obtain an erection sufficient for vaginal insertion, or to maintain it until completion of the sexual activity.  It may be due to organic or psychological causes or a combination of both.  A good history is of primary importance in determining the cause of the dysfunction.
  9. 9. Erectile dysfunction (impotence)  If a man reports having spontaneous erections at times when he does not plan to have intercourse, having morning erections, etc..., the organic causes of his impotence can be considered negligible, and costly diagnostic procedures can be avoided.  The condition may accompany some other psychiatric disorders e.g. depression and schizophrenia or may occur due to a pharmacological substance or psychoactive substance abuse.
  10. 10. Female orgasmic disorder  Inhibited female orgasm or anorgasmia is manifested by the recurrent delay in, or absence of, orgasm after a normal sexual excitement phase judged to be adequate in focus, intensity, and duration.  Numerous psychological factors arc associated with female orgasmic disorder.  They include fear or guilt concerning sexual impulses, fear of rejection by a sex partner, or hostility toward men.
  11. 11. Premature Ejaculation  The man recurrently achieves orgasm and ejaculates before he wishes to do so.  There is no definite time frame within which to define the dysfunction.  The diagnosis is made when the man regularly ejaculates before or immediately after entering the vagina or following minimal sexual stimulation.  That definition assumes that the female partner is capable of an orgasmic response.
  12. 12. Dyspareunia  It refers to recurrent and persistent pain related to intercourse. It is usually a disorder of women. The dysfunction is usually related to vaginismus. Vaginismus is an involuntary and persistent constriction of the outer one third of the vagina that prevents penile insertion and intercourse. The complaint is more common in women who have anxiety about sexual intercourse, and in those with a history of rape or childhood sexual abuse.
  13. 13. Abnormal sexuality  It is defined as: "sexual behavior that is destructive to self or to others; that is not directed towards a partner; or that excludes stimulation of the genitalia.
  14. 14. Paraphilias  Paraphilias are diagnosed if the deviant behavior replaces normal sexual behavior or becomes an integral part of a normal sexual behavior, without it, sexual behavior is not performed.  This a group of sexual deviations in which sexual urges and sexually arousing fantasies involve: 1. nonhuman objects; or 2. children or other non-consenting persons; or 3. suffering or humiliation of oneself or one's partner
  15. 15. Paraphilias  They include the following examples:  1. Fetishism  2. Exhibitionism  3. Voyeurism  4. Frotteurism  5. Sexual Sadism  6. Sexual Masochism  7. Pedophilia  Other sexual disorder: Homosexuality (disorder in sexual orientation)
  16. 16. Management of Psychosexual Disorders  1. Proper diagnosis:  2. Psychotherapy:  Different psychotherapeutic methods are used.  Behavioral and cognitive behavioral psychotherapies are the most widely used techniques.  3. Pharmacological treatment:
  17. 17. 3. Pharmacological treatment:  • Sildenafil (Viagra) for erectile dysfunction  • Local anesthetic sprays for premature ejaculation  • SSRIs are used for premature ejaculations, no controlled studies are available  • Pharmacological treatment of any underlying psychiatric disorders: depression, generalized anxiety, phobia
  18. 18. Thank You

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