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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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
