2. ⚫Physiology of sexual response
⚫Psychosexual disorder
⚫ Sexual dysfunction
⚫ Abnormalities of sexual preference/paraphilias
⚫ Disorders of gender identity/transsexualism
⚫ Psychological problems in homosexual
⚫Management
4. ⚫Interest in sexual activity
⚫In woman :
⚫ Desire changes during menstrual period, near the time
of ovulation
⚫ a/w high levels of oestrogen secretion during
preovulatory period
5. Begins with either mental (fantasy/thought) or physical contact
Body prepares for sexual intercourse
Vasocongestion of the skin
Myotonia
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Increased heart rate, respiratory rate and blood pressure
Nipples erection
Man Woman
Erection of penis
Thickening of scrotal skin
Testes rise toward the
perineum
Breasts enlargement
Clitoris head swells
Lubrication/expansion/diste
nsion of inner 2/3 of vagina
Uterus body and cervix
raised
6. ⚫Excitement remains high but stable
⚫Increasing in circulation, HR, BP
⚫Further increased in muscle tension
Man Woman
Erection maintained
Testes raised further
Urethral sphincter contract
(prevent urine from mixing
with semen and against
retrograde ejaculation)
Labia engorgement
Clitoris head withdraws
Further lubrication
Further distention of inner 2/3
of vagina, outer 1/3 swells
Further elevation of uterus
7. • Peak of sexual pleasure
• Further increased in HR, RR, BP
• Quick cycles of muscle contraction
Man Woman
Contraction of prostate &
seminal vesicles
Emission of seminal fluid to
urethra
Ejaculation of semen
Contractions of outer 1/3 of
vagina
8. ⚫Muscles relaxation
⚫Returning to normal physiology
⚫ As we grow older, desire for sexual activity does not
change
⚫BUT,
⚫man will require more direct stimulation of genitals &
more time to achieve orgasm, intensity of ejaculation
decreases, length of refractory period increases
⚫After menopause woman(decreased estrogen levels):
vaginal dryness & thinning
9. The sexual response cycle
Phase Male response Female response Example of
dysfunction
Desire
mental/physical
stimulation
Hypoactive sexual
desire disorder
Sexual aversion
disorder
Excitement
Increasing sexual
pleasure with pre-
orgasm plateau
Penile erection
Retraction of testes
Cowper’s gland
secretion
Clitoral enlargement
Vaginal lubrication
Breast engorgement
Male erectile disorder
Female sexual arousal
disorder
Orgasm
Peaking of sexual
pleasure
Ejaculatory spurt
Rhythmic
contractions of
seminal system
Skin flushing
Rhythmic vaginal and
uterine contraction
Skin flushing
Delayed ejaculation
Premature
ejaculation
Female preorgasmia
Resolutions
Relaxation, reversal
of physiologic
changes
Refractory to orgasm
for a period of time
which increases with
age
No refractory period Postcoital dysphoria
Postcoital headache
10. ⚫Psychosexual disorder
⚫ Sexual dysfunction
⚫ Abnormalities of sexual preference/paraphilias
⚫ Disorders of gender identity/transsexualism
⚫ Psychological problems in homosexual
⚫Management
11.
12. Hypoactive sexual desire
disorder
Sexual aversion disorder
- Deficiency/absence of
sexual fantasies and desire
for sexual activity
- An aversion/avoidance of
genital sexual contact with a
sexual partner or by
masturbation
More common Less common
Causes :
- Chronic stress/anxiety/depression
- Abstinence from sex for prolonged period of time
- Must rule out chronic disease, endocrine disorder
13. Female Male erectiledisorder
Persistent/recurrent/complete
failure to attain/maintain
lubrication-swelling response
Recurrent and persistent
partial/complete failure to attain/
maintain an erection
Must rule out medications (antihypertensives, antihistamine), medical
conditions (vascular, neurological, endocrine)
Causes marked distress/interpersonal difficulty
14. Female orgasmic
disorder (preorgasmia)
Male orgasmic disorder
(delayed ejaculation)
Prematureejaculation
-Inability to achieve
orgasm by
masturbation/coitus
- psychological factors :
- fears of impregnation
-Rejection by sex partner
-Damage to vagina
-physical factor :
denervation of
lumbosacral spine
Difficulty in achieving
ejaculation during coitus
Causes :
Primary organic :
congenital, neurological,
endocrine
Secondary organic :
trauma, cord lesion,
medication
(sympatholytic)
Psychological : poor
partnership factors,
repressed homosexuality
Ejaculation occurs before
or immediately after
entering the vagina
Psychological : usually
due to anxiety caused by
interrupted sexual
experiences, intimacy
fears
15. Dyspareunia Vaginismus
-Recurrent/persistent
genital pain occuring in
man/woman before, during
or after intercourse
-More common in woman
-Not caused by lack of
lubrication, vaginismus or
organic causes
-Involuntary muscle
constriction of the outer
third of the vagina that
interferes with penile
insertion and intercourse
-Can be due to response
during insertion of
speculum into vagina, sexual
trauma (rape)
16. ⚫ “para” = aside, being altered / modified
⚫ “philia” = love
⚫ Sexual arousal, fantasies, sexual urges or behaviour
involving non-human objects, suffering or humiliation of
oneself or one’s partner, children or other non-consenting
person
⚫ At least 6 months & cause impairment in daily functioning
⚫ Begins in childhood/early adolescent
⚫ Chronic, increases with age and stressors
⚫ More common in man
17. ⚫Subtypes :
Abnormalities of the sexual
object
Abnormalitiesof the sexual act
Sexual fetishism Exhibitionism
Transvertism Voyeurism
Paedophilia Sexual sadism
Necrophilia Sexual masochism
Frotteurism
18. ⚫Sexual focus is on objects (shoes, gloves, underwears)
⚫Sexual activity either directed :
⚫Towards the fetish itself (masturbation with/into a
shoe) OR
⚫The fetish may be incorporated into sexual
intercourse (demand that high-heeled shoes be worn)
19. ⚫repeatedly wears clothes of opposite sex as means of
sexual arousal
⚫Typically begins in childhood, as grow older
permanently dressed as woman
⚫Single garment complete set of clothing
⚫Wear in private some go on to wear in public
(hidden under male outer garments)
⚫vs transsexualism no sexual arousal
20. ⚫Repeated sexual activity or fantasy of such activity
with prepubertal children
⚫Preferred children : 9 year old pubertal
⚫Person is at least 16 year old OR 5 years older than the
victims
⚫Molestations involve genital fondling or oral sex
22. ⚫
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Exposure of genitalia to a stranger
Nearly all are male, to surprise a female
2 groups:
⚫
1. Inhibited temperaments expose flaccid penis much guilt
2. Aggressive personality traitsexpose erectile penis while
masturbatinglittle guilt
Begins in middle or late life suspect organic brain disorder,
depressive disorder or alcoholism
24. ⚫Preference for sexual activity that involves bondage or
infliting pain on another person
⚫Masochism: prefers to receive such stimulation
⚫Sadism: prefers to administer such stimulation
⚫Beating, whipping, tying symbolic, cause little
actual injury, may die
⚫Mild sadomasochism is normal
⚫The most important source of stimulationabnormal
25. ⚫sexual pleasure in men from rubbing their genitals
against unsuspecting women, usually in crowded area
26. ⚫ Has conviction of being of the sex opposite to that indicated by the
external genitalia
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Wish to alter external genitalia and live as a member of the opposite
sex
Most are men (women who cross-dress or imitate men are
homosexual)
Diagnosis :
Strong and persistent cross-gender identification
Manifested by repeated stated desire/insistence that one is of the
opposite sex
Children believe they will grow up to be the opposite sex (cross
dressing, cross-sex roles in play)
Significant distress/impairment in functioning
28. BIO PSYCHOSOCIAL
Sildenafil (viagra ) for sexual Psychotherapy for
dysfunction individual, couple
Prostaglandin injections Sex education
Lubricating creams Behaviour modification
Anti-androgen medication
(tamoxifen)
Sexual reassignment surgery
for transsexualism
