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Print human sexuality


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Print human sexuality

  1. 3. Human sexuality in perspective <ul><li>An optimal survey of sexual deviations or sexual disorders must take into account the broader expanse of human sexuality… </li></ul><ul><li>What is human sexuality? </li></ul>
  2. 4. Sexuality <ul><li>The sum of a person’s sexual behaviors and tendencies, and the strength of such tendencies (Stedman’s Medical Dictionary) </li></ul>
  3. 5. Factors affecting sexuality <ul><li>Genotype – the genes of an individual provide the biologic basis of sexuality </li></ul><ul><li>Socio-cultural heritage – influence and modify the effects of genetic endowment </li></ul><ul><li>Physical environment – also modify the effects of the genetic make-up and the socio-cultural heritage </li></ul>
  4. 6. Expressions of sexuality <ul><li>Appearance </li></ul><ul><li>Attitudes </li></ul><ul><li>Behaviors </li></ul><ul><li>Relationships </li></ul><ul><li>Influenced by ongoing biophysical and psychosocial factors, sexuality starts to take shape during early childhood and is reshaped throughout life </li></ul>
  5. 7. Components of sexual identity <ul><li>Biosexual identity – from genetic and hormonal influences (XX, XY, etc) </li></ul><ul><li>Gender role – outward expression of gender – the behaviors, feelings, and attitudes appropriate for either a male or a female </li></ul><ul><li>Gender identity – a person’s private experience of gender – the sense of oneself as being male, female, or ambivalent </li></ul>
  6. 8. Components of sexual identity 2 <ul><li>Sexual orientation or preference – refers to a person’s about his or her sexual attraction and erotic potential </li></ul><ul><li>Heterosexuality </li></ul><ul><li>Homosexuality </li></ul><ul><li>Bisexuality </li></ul>
  7. 9. Sexual orientation <ul><li>Heterosexuality - sexual arousal from or sexual activity with people of the opposite gender </li></ul><ul><li>Homosexuality – sexual arousal from or activity with people of the opposite gender </li></ul><ul><li>Bisexuality - sexual arousal from or sexual activity with both males and females </li></ul>
  8. 11. “ Abnormal” sexual behavior <ul><li>Definition depends largely on cultural and historical context </li></ul><ul><li>Accepted norms of sexual behaviors and attitudes vary greatly within and among different cultures </li></ul><ul><li>In the past sexual intercourse for procreation was considered as the only “normal” sexual behavior </li></ul>
  9. 12. Other opinions… <ul><li>Sexual behavior is abnormal if it causes personal distress </li></ul><ul><li>Sexuality is a continuum from adaptive to maladaptive: normal sexuality is adaptive; abnormal sexuality is maladaptive – the behavior is maladaptive if it impairs individual goals and disrupts social group functioning </li></ul>
  10. 13. Stages of sexual development <ul><li>Infancy to age 5 </li></ul><ul><li>Ages 5 to 10 </li></ul><ul><li>Ages 10 to 14 </li></ul><ul><li>Ages 14 and older </li></ul><ul><li>Adulthood </li></ul>
  11. 15. Taking the stigma off homosexuality and masturbation <ul><li>Homosexuality is now widely considered as a normal variant of sexuality ( Until the 70’s psychiatrists officially described homosexuality as abnormal ) </li></ul><ul><li>Masturbation was once widely seen as a perversion and a potential cause of mental disorders </li></ul>
  12. 16. Sexual disorders <ul><li>Sexual disorders described in DSM-IV-TR include: </li></ul><ul><li>Paraphilias </li></ul><ul><li>Sexual dysfunctions </li></ul><ul><li>Sexual pain disorders </li></ul><ul><li>Gender identity disorder </li></ul>
  13. 17. Paraphilias <ul><li>Complex psychosexual disorders marked by sexual urges, fantasies, or behaviors that center on: </li></ul><ul><li>inanimate objects such as clothing </li></ul><ul><li>suffering or humiliation </li></ul><ul><li>children or other non-consenting persons </li></ul><ul><li>All paraphilias involve an attraction to a non-sanctioned source of sexual satisfaction </li></ul>
  14. 18. Paraphilias 2 <ul><li>Source of satisfaction may be a behavior as with exhibitionism or sadism , or a forbidden object of attraction as with pedophilia or fetishism </li></ul><ul><li>Paraphilias commonly involve sexual arousal and orgasm, usually achieved through masturbation and fantasy </li></ul><ul><li>Usually a paraphilia is chronic and lifelong </li></ul><ul><li>The paraphiliac urge, fantasy, or behavior is always present </li></ul>
  15. 19. streaking
  16. 20. Paraphilias 3 <ul><li>Rarely diagnosed in clinical settings because people with paraphilias are secretive about them </li></ul><ul><li>In paraphilia clinics, the most common disorders seen include pedophilia, voyeurism, and exhibitionism. Sadomasochism is much less common </li></ul>
  17. 21. Paraphilias 4 <ul><li>Majority of paraphiliacs are males except for masochism where females outnumber males by 20 to 1 </li></ul><ul><li>Some paraphilias are crimes in many jurisdictions (those that involve or harm another person) are considered criminal acts: pedophilia, exhibitionism, voyeurism, frotteurism, and sexual sadism </li></ul>
  18. 22. Paraphilias 5 <ul><li>Exhibitionists, pedophiles, and voyeurs make up the majority of apprehended sex offenders </li></ul><ul><li>Sex offenses against children as in pedophilia, constitute a significant portion of reported criminal sex acts </li></ul>
  19. 23. Exhibitionism <ul><li>One of the most common paraphilias </li></ul><ul><li>Marked by sexual fantasies, urges, or behaviors involving surprise exposure of the male genitals to strangers , primarily female passersby (female exhibitionists are rare) in public places </li></ul><ul><li>It is meant to be shocking otherwise it loses it power to sexually arouse the paraphiliac </li></ul>
  20. 24. Exhibitionism 2 <ul><li>The most prominent sexual offense leading to arrest </li></ul><ul><li>Usually begins during adolescence and continues into adulthood </li></ul><ul><li>It may become lifelong if untreated </li></ul><ul><li>It commonly becomes less severe by age 40 </li></ul>
  21. 25. Fetishism <ul><li>Characterized by sexual fantasies, urges, or behaviors that involve the use of a fetish – a non-human object or a non-sexual part of the body to produce or enhance sexual arousal </li></ul><ul><li>Fetishism may involve a partner. Sometimes focusing on certain parts of the body like the feet, hair, or ears can become a fetish </li></ul><ul><li>Some people achieve sexual gratification only when using a fetish </li></ul>
  22. 26. Forms of fetishism <ul><li>Involves a partner and associates sexual activity with some object as women’s panties or body part. The foot is the most commonly used body in fetishism. </li></ul><ul><li>In the extreme form of fetishism, a non-living object completely replaces a human partner : underwear, boots, velvet, silk, etc. Fondling the object when alone results in orgasm. </li></ul>
  23. 27. Transvestic fetishism <ul><li>A heterosexual male partially (usually hidden under male clothing) or fully dresses in female clothes ( cross-dressing ) to produce or enhance sexual arousal </li></ul><ul><li>Transvestites believe they have both male and female personalities . Cross-dressing allows them to display their feminine side. </li></ul><ul><li>Commonly involves masturbation and metal images of men attracted to the patient as a “woman” </li></ul>
  24. 28. Truth about transvestites <ul><li>Myth – transvestites are homosexuals </li></ul><ul><li>Truth – 90% of transvestites are heterosexual </li></ul><ul><li>Myth - transvestites act like women even when wearing men’s clothes </li></ul><ul><li>Truth – for fear of being discovered, they try to act as traditionally masculine as possible </li></ul>
  25. 29. Truth about transvestites 2 <ul><li>Myth – transvestites are effeminate </li></ul><ul><li>Truth – transvestites are no more effeminate than other males </li></ul><ul><li>Myth – transvestites want to become women </li></ul><ul><li>Truth – few transvestites wish to change sexes </li></ul>
  26. 30. Truth about transvestites 3 <ul><li>Myth - Transvestites cross-dress because they were dressed as girls when they were children </li></ul><ul><li>Truth – Although many transvestites first experienced cross-dressing in childhood, in many cases they initiated these experiences themselves to play out fantasies about gender role </li></ul>
  27. 31. Pedophilia <ul><li>Marked by sexual fantasies, urges, or activity involving a child, usually age 13 or younger </li></ul><ul><li>In adolescent pedophilia the child is 5 years younger than the adolescent </li></ul><ul><li>The </li></ul>
  28. 32. Pedophile activity <ul><li>During the act the pedophile may – </li></ul><ul><li>Undress the child </li></ul><ul><li>Encourage the child to watch him masturbate </li></ul><ul><li>Touch or fondle the child’s genitals </li></ul><ul><li>Forcefully perform sexual acts on the child </li></ul><ul><li>Pre-pubertal children are the most common targets </li></ul>
  29. 33. Causes of paraphilias <ul><li>Behavioral theory – child who was the victim or observer of inappropriate sexual behaviors learns to imitate such behavior and gets reinforcement for it </li></ul><ul><li>Biological theory – hormonal, behavioral, and CNS interaction – especially the role of aggression and male sex hormones </li></ul>
  30. 34. Factors that contribute to paraphilias <ul><li>Dysfunctional families marked by isolation, sexual, emotional, and physical abuse </li></ul><ul><li>Psychoactive substance use </li></ul><ul><li>Concurrent mental or personality disorders </li></ul><ul><li>Closed head injury </li></ul><ul><li>CNS tumors </li></ul>
  31. 35. Factors… <ul><li>History of emotional or sexual trauma </li></ul><ul><li>Lack of knowledge about sex </li></ul><ul><li>Neuroendocrine disorders </li></ul><ul><li>Psychosocial stressors </li></ul>
  32. 36. Signs and symptoms <ul><li>Anxiety </li></ul><ul><li>Depression </li></ul><ul><li>Hobby or occupation change that makes the paraphilia more accessible </li></ul><ul><li>Disturbance in body image </li></ul><ul><li>Guilt or shame </li></ul><ul><li>Ineffective coping </li></ul><ul><li>Multiple paraphilias at the same time </li></ul>
  33. 37. Signs and symptoms 2 <ul><li>Purchase of books, videos, or magazines related to the paraphilia or frequent visits to paraphilia-related websites </li></ul><ul><li>Recurrent fantasies involving a paraphilia </li></ul><ul><li>Sexual dysfunction </li></ul><ul><li>Social isolation </li></ul><ul><li>Troubled sexual or social relationships </li></ul>
  34. 38. Diagnosis <ul><li>Penile pletysmography – measurement of patient’s sexual arousal in response to visual imagery </li></ul><ul><li>DSM-IV-TR criteria </li></ul>
  35. 39. Treatment <ul><li>Paraphiliacs seldom seek treatment because of their guilt, shame, and fear of social ostracism and legal problems </li></ul><ul><li>Depending on the specific paraphilia, treatment may involve a combination of psychotherapy, cognitive therapy, behavioral therapy, pharmacotherapy, and surgery </li></ul>
  36. 40. Paraphilia-related disorders <ul><li>Compulsive masturbation </li></ul><ul><li>Protracted promiscuity – cannot maintain a monogamous relationship </li></ul><ul><li>Pornography dependency </li></ul><ul><li>Telephone sex </li></ul><ul><li>Severe sexual desire </li></ul><ul><li>Repetitive use of sexual toys </li></ul>
  37. 41. Rare paraphilias <ul><li>Coprophilia - feces </li></ul><ul><li>Emetophilia - vomit </li></ul><ul><li>Hybristophilia – crimes </li></ul><ul><li>Klismaphilia - enemas </li></ul><ul><li>Necrophilia - corpses </li></ul><ul><li>Plushophilia – stuffed toys </li></ul><ul><li>Uroglagnia - urine </li></ul><ul><li>Zoophilia - animals </li></ul>
  38. 42. Sexual dysfunctions <ul><li>Characterized by pain during sex or by a disturbance in one of the phases of the sexual response cycle </li></ul><ul><li>May cause marked distress and interpersonal problems </li></ul><ul><li>Can impair intimate relationships by reducing the enjoyment of normal sex or preventing the normal changes of the sexual response cycle </li></ul>
  39. 43. Sexual dysfunctions <ul><li>Sexual arousal disorders </li></ul><ul><li>Sexual desire disorders </li></ul><ul><li>Orgasmic disorders </li></ul><ul><li>Sexual dysfunction caused by a medical condition </li></ul><ul><li>Sexual pain disorders </li></ul><ul><li>Commonly linked to psychological factors, medical conditions, substance use, etc. </li></ul>
  40. 44. Female sexual arousal disorder <ul><li>Inability to achieve or maintain an adequate lubrication-swelling response </li></ul><ul><li>One of the most severe sexual dysfunctions in women </li></ul><ul><li>Usually reports limited or absent sexual desire and little or no pleasure from sexual stimulation </li></ul>
  41. 45. Female orgasmic disorder <ul><li>Defined as the inability to achieve an orgasm </li></ul><ul><li>The most common sexual dysfunction in women </li></ul><ul><li>Unlike a woman with a sexual arousal disorder, one with orgasmic disorder may desire sexual activity and become aroused, but feels inhibited as she approaches orgasm </li></ul>
  42. 46. Causes of sexual arousal and orgasmic disorders <ul><li>Depression </li></ul><ul><li>Drug use – CNS depressants, antidepressants, hormonal contraceptives, alcohol, or street drugs </li></ul><ul><li>Discordant relationships </li></ul><ul><li>Diseases </li></ul><ul><li>Fatigue </li></ul><ul><li>Gynecologic factors </li></ul>
  43. 47. Causes of sexual arousal and orgasmic disorders 2 <ul><li>Inadequate or ineffective sexual stimulation </li></ul><ul><li>Lifestyle disruptions </li></ul><ul><li>Psychological factors – stress, anxiety, anger, hostility, boredom with sex, guilt, depression, etc </li></ul><ul><li>Pregnancy </li></ul><ul><li>Religious or cultural taboos that reinforce guilt about sex </li></ul>
  44. 48. Manifestations <ul><li>Female arousal disorder – </li></ul><ul><li>Decreased sexual desire </li></ul><ul><li>Individual or family stress or fatigue </li></ul><ul><li>Poor self esteem or body image </li></ul><ul><li>Persistent or recurrent, partial or complete failure to attain or maintain the lubrication-swelling response </li></ul><ul><li>Marked distress or interpersonal difficulty </li></ul>
  45. 49. Manifestations <ul><li>Female orgasmic disorder – </li></ul><ul><li>Persistent or recurrent delay in or the absence of orgasm after a normal sexual excitement phase during sexual activity deemed to be adequate </li></ul><ul><li>Patient suffers marked distress </li></ul>
  46. 50. Treatment of sexual arousal disorder <ul><li>Help patient relax, become aware of feelings regarding sex, eliminate guilt and fear of rejection </li></ul><ul><li>Reassurance </li></ul><ul><li>Psychotherapy / behavioral therapy </li></ul><ul><li>Sensate focus exercises - </li></ul>
  47. 51. Treatment of orgasmic disorder <ul><li>Decrease or eliminate involuntary inhibition of the orgasmic reflex </li></ul><ul><li>Treatment may include experiential therapy, psychoanalysis, or behavior modification </li></ul><ul><li>Individual therapy, marital or couples therapy, or sex therapy may be indicated </li></ul><ul><li>Medications to decrease symptoms </li></ul><ul><li>Treatment of underlying physical disorder </li></ul>
  48. 52. Premature ejaculation <ul><li>Male’s inability to control the ejaculatory reflex during sexual activity </li></ul><ul><li>Ejaculation occurs before or immediately after penetration or before the wishes of both partners </li></ul><ul><li>Affects men of all ages </li></ul><ul><li>Doesn’t affect the ability to have an erection </li></ul><ul><li>Can seriously disrupt intimate relationships </li></ul>
  49. 53. Causes of premature ejaculation <ul><li>Psychological factors – stress, performance anxiety, or limited sexual experiences </li></ul><ul><li>Ambivalence or unconscious hatred towards women </li></ul><ul><li>Negative sexual relationships – unconsciously denying the partner sexual fulfillment </li></ul><ul><li>Guilt feelings about sex </li></ul>
  50. 54. Signs and symptoms <ul><li>Cannot prolong foreplay </li></ul><ul><li>Ejaculates as soon as vagina is entered </li></ul><ul><li>Partner seeks psychiatric treatment… </li></ul><ul><li>Anxiety, depression, disturbance of body image </li></ul><ul><li>Frustration, feelings of being unattractive </li></ul><ul><li>Ineffective coping </li></ul><ul><li>Dyspareunia, </li></ul><ul><li>Poor self-concept, social isolation </li></ul>
  51. 55. Sexual pain disorders: Dyspareunia <ul><li>Unexplained genital pain occurs before, during, or after intercourse </li></ul><ul><li>May be mild or severe enough to restrict the enjoyment of sex </li></ul><ul><li>Causes: GU infections, allergy to condoms, diaphragms; tumors, PID, endometriosis, scars, insufficient lubrication, intact hymen, local trauma, etc </li></ul>
  52. 56. Dyspareunia, cont. <ul><li>Treatment : lubricants, treatment of infections, hymenal scar removal, gentle stretching of scars in vaginal opening, change in coital position </li></ul><ul><li>Psychotherapy may be included if the condition has a psychological cause </li></ul>
  53. 57. Vaginismus <ul><li>Involuntary spasmodic muscle contractions occur at the entrance to the vagina when the male tries to insert his penis </li></ul><ul><li>Pain occurs if intercourse is attempted despite these contractions, making intercourse extremely painful or impossible </li></ul><ul><li>Possibly a learned response secondary to previous experience of dyspareunia </li></ul>
  54. 58. Gender identity disorder <ul><li>Marked by discomfort with one’s apparent or assigned gender and a strong, persistent, identification with the opposite sex </li></ul><ul><li>3 components of gender identity: self-concept, perception of an ideal partner, and external presentation of gender through behavior, dress, or mannerisms </li></ul>
  55. 59. Causes of gender identity disorder <ul><li>Chromosomal anomalies </li></ul><ul><li>Hormonal imbalances </li></ul><ul><li>Pathologic defects in early parent-child bonding (dressing up a child as a member of the opposite sex) </li></ul><ul><li>Paraphilias </li></ul><ul><li>Feelings of sexual inadequacy </li></ul><ul><li>Generalized anxiety disorder </li></ul><ul><li>Personality disorders </li></ul>
  56. 60. Treatment, gender identity disorder <ul><li>Individual and couple therapy </li></ul><ul><li>Psychiatric management </li></ul><ul><li>Hospitalization </li></ul><ul><li>Group or individual psychotherapy </li></ul><ul><li>For a child, individual and family therapy </li></ul>
  57. 61. Sadism <ul><li>A person achieves sexual gratification by inflicting pain, cruelty, or emotional abuse on others </li></ul><ul><li>The sexual sadist may verbally humiliate his partner and abuse her physically through torture, whipping, cutting, binding, beating, burning, stabbing, or rape </li></ul>