Loving relationships contribute greatly to happiness, and sexuality influences who we fall in love with and mate with. The document discusses three categories of sexual disorders - paraphilias, gender dysphoria, and sexual dysfunctions. Paraphilias involve recurrent sexual fantasies or behaviors involving nonconsenting persons or harm. Gender dysphoria involves discomfort with one's sex. Sexual dysfunctions involve impaired sexual desire, arousal, orgasm or pain. Causes may be biological or psychological and treatments involve counseling, medication or therapy.

2. Loving, sexually satisfying relationships
contribute a great deal to our happiness, and
if we are not in a relationships, we are apt to
spend a great deal of time, effort, and
emotional energy looking for them. Sexuality
is a central concern of our lives, influencing
with whom we fall in love and mate and how
happy we are with our partner and with
ourselves.

3. SEXUAL
DISORDER
3 CATEGORIES:
1.PARAPHILIAS
2. . GENDER DYSPHORIA
3.SEXUAL DYSFUNCTION

4.  Paraphilia means ”love” (philia) “beyond the
usual” (para).
Have recurrent, intense sexually arousing
fantasies, sexual urges, or behaviors that
generally involve (1)nonhuman objects (2) the
suffering or humiliation of oneself or one’s
partner, or (3) children or other
nonconsenting persons.

5. 1. Fetishistic Disorder
 Fetishism refers to the association of sexual
arousal with nonliving objects.
 The range of objects that can become associated
with sexual arousal is virtually unlimited, but
fetishism most often involves women’s underwear,
shoes and boots, or products made up of rubber or
leather.
 People who fit the description of fetishism
typically masturbate while holding, rubbing, or
smelling the fetish object

7. 2. Transvestic Fetishism
Accdg.To DSM-5, heterosexual men who experience
recurrent, intense sexually arousing fantasies, urges, or
behaviors that involve cross-dressing as a female may be
diagnosed with transvestic disorder, if they experience
significant distress or impairment due to the condition.
Typically, the onset of transvestisism is during adolescence
and involves masturbation while wearing female clothing
or undergarments.
Blanchard(1989,2010) has hypothesized that the
psychological motivation of most heterosexual
transvestites includes autogynephilia: paraphilic sexual
arousal by the thought or fantasy of being a woman.

8.  The great sexologist Magnus Hirschfeld first
identified a class of cross dressing men who
are sexually aroused by the image of
themselves as women: “they feel attracted
not by the woman outside them, but by the
woman inside them.
 Not all men with transvestic fetishism show
clear evidence of autogynephilia.

10. 3.Voyeuristic Disorder
A person is diagnosed with voyeurism according
to DSM-5 if he has recurrent, intense sexually
arousing fantasies, urges or behaviors involving
the observation of unsuspecting females who are
undressing or of couples engaging in sexual
activity.
Frequently, such individuals masturbate during
their peeping activity.

11.  PEEPINGTOMS, as they are commonly
called, commit these offenses primarily as
young men.
PEEPINGTOM-a person who gets pleasure,
especially sexual pleasure from secretly watching
others; a voyeur.
 Voyeurism is probably the most common
illegal sexual activity.

13. 4. Exhibitionistic Disorder (indecent exposure in
legal terms)
Is diagnosed in a person with recurrent, intense urges,
fantasies, or behaviors that involve exposing his genitals
to others (usually strangers) in appropriate
circumstances and without their consent.
Frequently the element of shock in the victim is highly
arousing to these individuals.
In some instances, exposure of the genitals is
accompanied by suggestive gestures or masturbation,
but more often there is only exposure.

15. 5. Frotteuristic Disorder
Frotteurism is sexual excitement at rubbing one’s
genitals against, or touching the body of a
nonconsenting person.
Being the victim of frotteuristic act is fairly
common among regular riders of crowded buses
or subway trains.

18. 6. Sexual Sadism Disorder
The term sadism is derived from the name Marquis de
Sade(1740-1814), who for sexual purposes, inflicted such
cruelty on his victims that he was eventually committed
as insane.
In DSM-5, for diagnosis of sadism, a person must have
recurrent, intense sexually arousing fantasies, urges, or
behaviors that involve inflicting psychological or
physical pain or another individual.
Sadistic fantasies often include themes of dominance,
control and humiliation.

20. 7. Sexual Masochism Disorder
The term masochism is derived from the name of
Austrian novelist LeopoldV. Sacher-Masoch (1836-1895)
who fictional characters dwelt lovingly on the sexual
pleasure of pain.
In sexual masochism, a person experiences sexual
stimulation and gratification from the experience of pain
and degradation in relating to a lover.
Accdg.To DSM-5 the person must have experienced
recurrent, intense sexually arousing fantasies, urges or
behaviors involving the act of being humiliated, beaten,
bound or otherwise made to suffer.

24. 8. Pedophilic Disorder
Is diagnosed when an adult has recurrent, intense sexual
urges or fantasies about sexual activity with a
prepubertal child.
Pedophiles’ sexual interaction with children involves
manual or oral contact with a child’s genitals;
penetrative anal or vaginal sex is much rarer.
Nearly all individuals with pedophilia are male, and
about 2/3 of pedophilic offenders victims are girls
typically between the ages of 8 & 11.

26. NAME FOCUS OF SEXUAL URGES OR FANTASIES
1.Telephone Scatologia Obscene phone calls
2. Necrophilia Corpses
3. Partialism One specific part of the body
4. Zoophilia Animals
5. Coprophilia Feces
6. Klismaphilia Enemas
7. Urophilia Urine
8. Stigmatophilia Piercing; marking body;
tattoos

27. It is not known for certain what causes paraphilia.
Some experts believe it is caused by a childhood trauma,
such as sexual abuse. Others suggest that objects or
situations can become sexually arousing if they are
frequently and repeatedly associated with a pleasurable
sexual activity. In most cases, the individual with a
paraphilia has difficulty developing personal and sexual
relationships with others.
Many paraphilias begin during adolescence and
continue into adulthood.The intensity and occurrence of
the fantasies associated with paraphilia vary with the
individual, but usually decrease as the person ages.

28. Most cases of paraphilia are treated with
counseling and therapy to help these people
modify their behavior. Medications may help to
decrease the compulsiveness associated with
paraphilia and reduce the number of deviant
sexual fantasies and behaviors. In some cases,
hormones are prescribed for individuals who
experience frequent occurrences of abnormal or
dangerous sexual behavior. Many of these
medications work by reducing the individual's
sex drive.

29. In DSM-5 Gender Dysphoria has replaced
Gender Identity Disorder.
Gender Dysphoria is discomfort with one’s
sex-relevant physical characteristics or with
one’s assigned gender.
Gender Dysphoria can be diagnosed at two
different life stages, either during childhood
and adolescence or adulthood.

32.  Psychiatric and biological causes
It was traditionally thought to be a
psychiatric condition meaning a mental ailment.
Now there is evidence that the disease may not
have origins in the brain alone.
Studies suggest that gender dysphoria may
have biological causes associated with the
development of gender identity before birth.
More research is needed before the causes of
gender dysphoria can be fully understood.

33. Genetic causes of biological sex
Research suggests that development that
determines biological sex happens in the
mother’s womb.
Anatomical sex is determined by
chromosomes that contain the genes and DNA.
Each individual has two sex chromosomes. One
of the chromosomes is from the father and the
other from the mother.
A normal man has an X and a Y sex
chromosome and a normal woman has two X
chromosomes.

34. Treatment for Children:
 family therapy
 individual child psychotherapy
 parental support or counselling
 group work for young people and their parents
Treatment for Adults:
 mental health support, such as counselling
 speech and language therapy – to help alter your
voice, to sound more typical of your gender identity
 peer support groups, to meet other people with
gender dysphoria
 relatives' support groups, for your family

35. • According to DSM-5 sexual dysfunctions refers to
impairment either in the desire for sexual
gratification or in the ability to achieve it.
• Today researchers, and clinicians typically identify
four different phases of human sexual response as
originally proposed by Masters and Johnson(1996,
1970, 1975) and Kaplan (1979). According to DSM-
5, disorders can occur in any of the first three
phases:

36. 1. The first phase is the DESIRE PHASE, w/c consist
of fantasies about sexual activity or sense of
desire to have sexual activity.
2. The second phase is the EXCITEMENT(or
arousal) PHASE, characterized both by a
subjective sense of sexual pleasure and by
physiological changes that accompany this
subjective pleasure, including penile erection in
the male and vaginal lubrication and clitoral
enlargement in the female.

37. 3.The third phase is the ORGASM, during which
there is a release of sexual tension and a peaking
of sexual pleasure.
4.The final phase is the RESOLUTION, during which
the person has a sense of relaxation and well-
being.

38. 1. Male Hypoactive Sexual Desire Disorder
 Is defined in terms of subjective experiences, such
as lack of sexual fantasies and lack of interest in
sexual experiences.
 Is diagnosed in men who have for at least 6 months
distressed or impaired due to low levels of sexual
thoughts, desires, or fantasies.
CAUSAL FACTORS:
• problem emanating from partners.
• cultural beliefs or attitudes.
• Personal vulnerabilities. (e.g. poor body image)

40. 2. Male Erectile Disorder
Persistent or recurrent inability to attain, or to
maintain until completion of the sexual activity.
CAUSAL FACTORS:
 Anxiety about sexual performance.
 Cognitive distractions
 Decreased blood flow to the penis or in diminished
ability of the penis to hold blood to maintain an
erection.(only for older men)
 Lifestyle factors(e.g. smoking, obesity, alcohol abuse)

42. TREATMENTS:
 Medications that promote erections like
Viagra, Levitra, and Cialis.

43. 3. Premature(Early) Ejaculation
In DSM-5 “premature ejaculation”is called early
ejaculation disorder.
The persistent and recurrent onset of orgasm and
ejaculation with minimal sexual stimulation.
It may occur before, on, or shortly after penetration
and before the man wants it to.
The average duration of time to ejaculate in men with
this problem is 15 seconds or 15 thrusts of intercourse.

45. What are the consequences if a man has this kind of
sexual dysfunction?
Include failure of the partner to achieve satisfaction.
Often acute embarrassment for the early ejaculating
man, with disruptive anxiety about recurrence on future
occasions.

46. TREATMENTS:
 Behavioral therapy
Pause-and-squeeze technique
-developed by Masters and Johnson(1970).
-this technique requires the man to monitor his
sexual arousal during sexual activity.
-when arousal is intense enough that the man feels
that ejaculation might occur soon, he pauses, and he or his
partner squeezes the head of the penis for a few moments
until the feeling of pending ejaculation passes, repeating the
stopping of intercourse as many times as needed to delay
ejaculation.
-initial reports suggested that this technique was
approximately 60 to 90 percent effective.

47. Pharmacological Intervention
Anti-depressant such as:
oParoxetine(Pexil)
oSetraline(Zoloft)
oFluoxetine(Prozac)
oDapoxetine(Priligy)

48. 4. Delayed Ejaculation Disorder
 Sometimes called “retarded ejaculation” .
 Refers to the persistent inability to ejaculate during
intercourse.
 It occurs in only about 3 to 10 percent of men. Men
who are completely unable to ejaculate are rare.
TREATMENTS:
o Psychological treatments include couples
therapy in which a man tries to get used to
having orgasms through intercourse with a
partner rather than via masturbation.

50. 1. Female Sexual Interest/Arousal Disorder
 is a combination of two previous disorders, Sexual
Aversion Disorders and Sexual Arousal Disorders.
 SEXUAL AVERSION DISORDER-persistent or
recurrent extreme aversion to, and avoidance of, all
(or almost all) genital sexual contact.
 FEMALE SEXUAL AROUSAL DISORDER-
persistent or recurrent inability to attain, or to
maintain until completion of the sexual activity, an
adequate lubrication-swelling response of sexual
excitement. It is the female counterpart of erectile
disorder for men. It was formerly known as
“frigidity”.

51. ***Note: another interesting change from DSM-IV-
TR to DSM-5 is the elimination of sexual aversion
disorder. A leading researcher on sexual
dysfunction has recently argued that sexual
aversion disorder should be considered as an
anxiety disorder akin to simple phobias rather
than as a sexual dysfunction.

53. CAUSAL FACTORS:
1. Biological Factors –basis remains
controversial.
2. Psychological Factors
3. Prior or current depression or anxiety
disorders may contribute to many cases of
sexual desire disorders.
4. Physical Factors-(e.g. Age of a person)

54. TREATMENTS:
 Pharmacological Intervention
▪ Bupropion-(an atypical antidepressant) to improve sexual
arousability.
▪ flibanserin
 Psychotherapy
▪ Focus on education
▪ Communication training
▪ Cognitive restructuring of dysfunctional beliefs about sexuality
▪ Sexual fantasy training.
▪ Sensual focus training-they involve teaching couples to focus on
the pleasurable sensation brought about by touching without the
goal of actually having intercourse or orgasm.

55. 2. Genito-Pelvic Pain/Penetration Disorder
 Genito-Pelvic Pain/Penetration Disorder, was
previously called in DSM-IV-TR Sexual Pain
Disorders: 1.)Dyspareunia and 2.)Vaginismus.
Dyspareunia- recurrent or persistent genital pain
associated with sexual intercourse in either a male or
female. Although it is considered to be much more
common in women.
Vaginismus- recurrent or persistent involuntary
spasm of the outer third of the vagina that interferes
with sexual intercourse.

56. ***Note: The disorders have been combined in DSM-5
because scientific research did not support their
distinction. In particular, vaginismus has been
believed to be an involuntary spasm of the muscles
near the entrance of the vagina, preventing
penetration and sexual intercourse. However no
scientific evidence exists that women with vaginismus
have vaginal spasm or that vaginismus could reliably
diagnosed. In contrast women diagnosed with
vaginismus commonly complained of pain during
penetration and anxiety before and during sexual
encounters.

58. CAUSAL FACTORS:
 Physical Causes-include acute or chronic infections or
inflammations of the vagina, vaginal atrophy that occurs
with aging, scars from vaginal tearing or insufficiency of
sexual arousal.
 Psychological Factors-(e.g. fear and anxiety.)

59. TREATMENTS:
1. Cognitive-Behavioral Interventions-include
education about sexuality, identifying and correcting
maladaptive cognition, graduated vaginal dilation
exercises to facilitate vaginal penetration, and
progressive muscle relaxation.
2. MedicalTreatments- such as surgical removal of the
vulvar vestibule can be very successful.

60. 3. FemaleOrgasmic Disorder
Can be diagnosed in women who are readily
sexually excitable and who otherwise enjoy sexual
activity but who show persistent or recurrent
delay in or absence of orgasm following a normal
sexual excitement phase and who are distressed
by this.

62. CAUSAL FACTORS:
 Some women feel fearful and inadequate in
sexual relations.
TREATMENTS:
 Cognitive-BehavioralTreatments-usually
involves education about female sexuality
and female sexual anatomy.