Sexual disorders that affect men and women

1. Sexual Disorders
and Gender
Dysphoria

2. Learning Objectives
Treatments for Sexual
Dysfunctions
Sexual Dysfunctions Paraphilias
Gender Identity
Disorder
01
02
03
04

3. Sexual
Dysfunctions
01

4. What is it?
● Refers to an impairment either in the desire for
sexual gratification or in the ability to achieve it
● Human sexual response can be described as a cycle
with four phases: desire, excitement, orgasm and
resolution

5. How common are they?
1. 43% Women; 31% Men
2. Women complaints were lack of desire and sexual arousal problems
3. Men complaints were climaxing too early, erectile dysfunction and
lack of sexual interest

6. Disorder of Desire
● Urge to have sex, sexual fantasies, and sexual
attraction to others
● Hypoactive sexual desire is a lack of interest in
sex, and in turn, a low level of sexual activity
● Sexual Aversion- persistent and recurrent aversion
to, and avoidance of, almost all genital contact with
a sexual partner

7. Causes
Biological
High Prolactin,
low
testosterone
and high/low
estrogen
Long-term
physical illness-
stress,
depression
Psychological
Increase in
anxiety or
anger
Attitudes,
fears or
memories
Mild level of
depression
OCD
Sociocultural
Situational
pressures
Issues in
relationship
Cultural
standards
Trauma of
sexual
molestation or
assault

8. Disorders of Excitement
● Characterized both by a subjective sense of sexual
pleasure & by physiological changes that accompany this
subjective pleasure, such as penile erection & vaginal
lubrication &clitoral enlargement
● Female sexual arousal disorder- repeatedly unable to
attain or maintain proper lubrication or genital swelling
during sexual activity
● Male erectile disorder- persistently fail to attain or
maintain an adequate erection during sexual activity

9. Causes
Biological
Problems with
blood vessels
Damage to
Nervous
System
Use of
medications &
substance
abuse
Psychological
Performance anxiety- the
fear of performing
inadequately & a related
tension experienced during
sex
Spectator role- state of
mind that some people
experience during sex,
focusing on their sexual
performance to such an
extent that their
performance & their
enjoyment are reduced
Sociocultural
Loss of job &
financial
stress
Marital
stress

10. Disorders of Orgasm
● An individual’s sexual pleasure peaks and sexual tension is released
as muscles in the pelvic region contract rhythmically
● Premature ejaculation- persistently reaches orgasm and ejaculates
with very little sexual stimulation before, on, or shortly after
penetration & before he wishes to
● Male orgasmic disorder- repeatedly cannot reach orgasm or is very
delayed in reaching orgasm after normal sexual excitement
● Female orgasmic disorder- rarely reach orgasm or generally
experience a very delayed one

11. Explanation for Premature
Ejaculation
● The young man is inexperienced and hasn’t learned to slow
down nor control his arousal
● Common in first sexual encounter
● Men of any age who only have sex occassionally are also
prone to it
● May also be related to anxiety, hurried masturbation (fear of
being “caught” by parents)

12. Explanation for Male
Orgasmic Disorder
● A low testosterone level
● Some head or spinal cord injuries can interfere
● Drugs that slow down the sympathetic nervous system such as
alcohol, high blood pressure meds, certain antidepressants such
as prozac
● Psychological cause seems to be performance anxiety and
spectator role
● Engaging the act because of pressure instead of pleasure

13. Causes for Female Orgasmic
Disorder
Biological
Diabetes,
multiple
sclerosis,
postmenopausal
changes
Psychological
Memories of
childhood
traumas and
relationships
Sociocultural
Cultural
messages-
strict religious
upbringing
about female
sexuality

14. Disorders of Sexual Pain
● The person has a sense of relaxation and well-being
● Vaginismus- involuntary contractions of the muscles around
the outer third of the vagina prevent entry of the penis
● Learned fear response that sex will be painful
● Infections of vagina or UTI
● Dyspareunia (painful mating)- experiences of severe pain in
the genitals during sexual activity
● Physical cause- injury to the vagina, pubic hairs that rub
against the labia, pelvic diseases, cysts, allergy to condoms

15. Treatments for
Sexual
Dysfunction

16. Sex Therapy
Modern sex therapy is short-term and instructive, typically lasting 15-
20 sessions
1. Assessment & conceptualization of the problem
2. Mutual responsibility
3. Education about sexuality
4. Attitude change
5. Elimination of performance anxiety & the spectator role
6. Increasing sexual communication skills
7. Changing destructive lifestyles & marital interactions
8. Addressing physical and medical factors

17. Hypoactive Sexual Desire and Sexual Aversion
● Affectual awareness
● Self-instruction training
● Behavioral approaches- “desire diary”

18. Erectile Disorder
● Tease technique
● Manual or oral sex
● Gel suppositories,
injections of drugs to the
penis, and a vacuum
erection device

19. Premature Ejaculation
● Stop-start or pause- manually stimulated until aroused
● Fluoxetine (prozac) and other serotonin-enhancing
antidepressant drugs

20. Male Orgasmic Disorder
● Reduction of performance anxiety and increase stimulation
● Masturbation

21. Female Arousal/Orgasmic Disorders
● Self-exploration, enhancement of body awareness, and
directed masturbation training
● Directed masturbation training- woman is taught step-
by-step how to masturbate effectively and eventually
reach orgasm during sexual interactions

22. Vaginismus & Dyspareunia
● V- 1st- woman may practice tightening and relaxing her vaginal
muscles until she gains more voluntary control over them
● V-2nd- may receive gradual behavioral exposure treatment to
overcome fear
● D- learn different sexual positions
● D- medical intervention with sex theraoy

23. Paraphilias

24. https://www.osmosis.org/learn/Paraphilic_disord
ers:_Clinical_practice

25. Disorders characterized by recurrent and
intense sexual urges, fantasies, or behaviors
involving nonhuman objects, children,
nonconsenting adults or experiences of
suffering and humiliation

26. ● Must last at least 6 months
● Great distress or interference with one’s
social life or job performance (for some)

27. Fetishism
● Recurrent intense sexual urges, sexually aroused
fantasies, or behaviors that involve the use of a
nonliving object, often to the exclusion of all other
stimuli
● Examples: women’s underwear, shoes, sadism, foot
● Psychodynamic- defense mechanism
● Behavioral- classical conditioning
○ Masturbatory satiation
○ Orgasmic reorientation

28. Transvestic Fetishism aka Cross-dressing
● Repeated and intense sexual urges, fantasies, or behaviors that
involve dressing in clothes of the opposite sex
● May be as a result of operant conditioning- parents may openly
encourage the individuals to cross-dress as children or reward
them for the behavior

29. Exhibitionism
● Repeated sexually arousing urges or fantasies about
exposing their genitals to another person, and may act
upon those urges
● Begins before 18
● Immature in dealings with the opposite sex
● Difficulties in interpersonal relationships
● Therapy- aversion therapy, masturbatory satiation and
others

30. Voyeurism
● Repeated and intense sexual desires to observe unsuspecting
people in secret as they undress or to spy on couples having
intercourse, and may act upon those desires
● May masturbate during the act of observing
● Causes:
○ Psychodynamic- gain power over others
○ To reduce fears of castration
○ Behavioral- learned behavior

31. Frotteurism
● Repeated and intense sexual urges, fantasies or behaviors that
involve the touching and rubbing against a non consenting
person

32. Pedophilia
● Repeated and intense sexual urges or fantasies about
watching, touching or engaging in sexual acts with
prepubescent children, and may carry out those urges or
fantasies
● Develops during adolescence & may have beens sexually
abused
● Think “it is alright to have sex with children as long as they
agree”
● Treatment: same as others

33. Sexual Masochism
● Repeated and intense sexual urges, fantasies, or behaviors that involve
being humiliated, beaten, bound or otherwise made to suffer
● Hypoxphilia- people stangle or smother themselves (or ask their
partners) in order to enhance their sexual pleasure
● May have developed through classical conditioning

34. Sexual Sadism
● Repeated and intense sexual urges, fantasies, or behaviors that involve
inflicting suffering on others
● A number of rapists display sexual sadism
● Classical conditioning as well
● Modeling
● Psychodymanic & Cognitive- underlying feelings of sexual inadequacy

35. Gender Identity
Disorder