This document discusses human sexuality, sexual problems, and their treatment. It describes norms of healthy sexuality and defines two categories of sexual problems: sexual dysfunctions involving difficulties with sexual desire, arousal, orgasm or pain; and paraphilias, which are recurrent abnormal sexual interests involving non-consenting partners or humiliation. Potential biological, psychological and social factors contributing to sexual problems are explored, as well as various treatment approaches including psychotherapy, medication, and conditioning techniques.

2. One of the most personal area of
life. Each of us is sexual being with
preferences and fantasies that may
surprise or even shock us from time
to time. Usually these are part of
normal sexual functioning. But when
our fantasies or desire begin to affect
or other in unwanted or harmful
ways, they begin to qualify as
abnormal.

3. For perspective, we begin by briefly
describing norms and healthy sexual
behavior. Then we consider two forms
of sexual problems: sexual
dysfunctioning and paraphilias.

4. • Consider contemporary Western worldviews that
inhibition of sexual expression causes problems.
Contrast this with nineteenth-and-early-twentieth-
century views that excess was culprit; in particular
excessive masturbation in childhood was widely
believe to lead to sexual problems in adulthood. Von
Krafft-Ebing (1902) postulated that early
masturbation damage the sexual organs and
exhausted a finite reservoir of sexual energy, resulting
in diminishing ability to function sexually in
adulthood. Even in adulthood, excessive sexual
activity was thought to underlie problems such us
erectile failure. The general Victorian view was that
sexual appetite was dangerous and therefore had to be

5. • Other changes over time have influence people
attitudes and experiences of sexuality.
• Aside from changes over time and across generation,
culture influences attitudes and beliefs about
sexuality. In some culture, sexuality is viewed as an
important part of well-being and pleasure, wheras in
others, sexuality is viewed as relevant only for
procreation (Bhurga, Popelyuk & McMullen, 2010).
Cultures also vary in their acceptance of variation in
sexual behavior.
• In other culture it is common to stigmatize same-
gender sexual behavior. Clearly, we must keep
varying cultural norms in mind as we study human

6. • Across wide range of indices, men reported more
engagement in sexual thought and behavior that
do women.
• Compared to women, men report thinking about
sex, masturbation, and desiring sex more often,
as well as desiring more sexual partner and
having more partners.
• Beyond these differences in sex drive Peplau
(2003) has described several other ways in which
the genders tend to differ in sexuality. Women
tend to be more ashamed of any flaws in their
appearance than the men, and this shame can
interfere with sexual satisfaction (Sanchez &
Kiefer, 2007)

7. • For women, sexual appears more
closely tied to relationship status and
social norms that for men (Baumeister,
200).
• Among women with sexual symptoms,
more than half believe their symptoms
are caused by relationship problems
(Nicholls, 2008).
• Men are more likely to think about
their sexuality in terms of power than
are women (Andersen, et al. 1999).

8. • There are many parallels in men’s and
women’s sexuality. For example, in a
survey more than 1,000 women reported
that their primary motivation for having
sex was sexual attraction and physical
gratification (Meston & Buss, 2009) It
would be exaggeration to claim that the
sole reason women are having sex is to
promote relationship closeness. It is
important to acknowledge commonalities
as well as differences across genders.

9. Many researchers have focused on
understanding the sexual response
cycle. Kinsey group made
breakthroughs in the 1940’s by
interviewing people about sexuality.
Masters and Johnson created another
revolution in research on human
sexuality 50 years ago when they
began to gather direct observations
and physiological measurements of
people masturbating and having
sexual intercourse.

10. • Kaplan identified four phases in the human
sexual response cycle.
1. Desire phase. This stage refers to sexual
interest or desire, often associated with
sexually arousing fantasies or thoughts.
2. Excitement phase. During this phase, men
and women experience pleasure and increased
blood flow to the genitalia.
3. Orgasm Phase. Sexual pleasure peaks in
ways that have fantasies poets and rest of us
ordinary people for thousand years.
4. Resolution phase. This last stage refers to the
relaxation and sense of well-being that usually
follow an orgasm.

11. • Sexual dysfunctions are disorders in
which people cannot respond
normally in key areas of sexual
functioning
• Sexual dysfunctions are typically
very distressing, and often lead to
sexual frustration, guilt, loss of self-
esteem, and interpersonal problems

12. The proposed DSM-5 divide
sexual dysfunctions into three
categories: those involving (1) sexual
desire, arousal, and interest; (2)
orgasmic disorder; and (3) sexual
pain disorders. The diagnostic criteria
for all sexual dysfunctions specify that
dysfunction should be persistent and
recurrent and should cause clinically
significant distress or problems
functioning.

13. Sexual Interest, Desire and Arousal
• Sexual interest/arousal disorder in
women. Refers to persistent deficits
in sexual interest (sexual fantasies or
urges), biological arousal or
subjective arousal.
• Hypoactive sexual desire disorder
in men. Refers to deficient or absent
sexual fantasies and urges, and
erectile disorder refers to failure to
attain or maintain an erection through
completion of the sexual activity.

14. Proposed DSM-5 Criteria for sexual
Interest/Arousal Disorder in Women
Diminish, absent, or reduced frequency of at
least three of the following for 6 months or
more.
• Interest in sexual activity
• Sexual thoughts or fantasies
• Initiation of sexual activity and
responsiveness to partner’s attempts to
initiate
• Sexual excitement/pleasure during75 percent
of sexual encounters
• Sexual interest/arousal elicited by any
internal or external erotic cues
• Genital or nongenital sensation during 75

15. Orgasmic Disorders
• Female orgasmic disorder. Refers to
the persistent absence of orgasm after
sexual excitement.
Two orgasmic disorder for men:
• Early ejaculation disorder. Defined
by ejaculation that occurs too quickly.
• Delayed ejaculation disorder.
Define by persistent difficulty in
ejaculating.

16. Sexual Pain Disorder
• Genito-pelvic pain/penetration
disorder. Defined by persistent or
recurrent pain during intercourse.
• DSM-IV-TR distinguished two pain
disorders:
 Dyspareunia is define by persistent
or recurrent pain during sexual
intercourse.
 Vaginismus is define by involuntary
muscle spasms of outer third of the
vagina to a degree that make intercourse
impossible.

17. • In the widely acclaimed book Human Sexual
Inadequacy, Masters and Johnson (1970) drew on
their case studies to publish a theory of why
sexual dysfunction develop. Two-tier model of
immediate and distal causes to conceptualize the
etiology of sexual dysfunction inadequacy:
 Fears about performance. Involve concerns with
how one is “performing” during sex.
 Spectator role. Refers to being an observer rather
than a participant in sexual experience.
 These immediate causes of sexual dysfunctions
were hypostasized to have one or more historical
antecedent, such as socio-cultural influences,
biological causes, sexual traumas, or homosexual
preference.

18. Biological Factor
• Biological causes of sexual dysfunction can include
diseases such as atherosclerosis, multiple sclerosis,
and spinal cord injury; low level of testosterone or
estrogen; heavy alcohol use before sex; chronic
alcohol dependence; and heavy cigarette smoking
(Bach et al. 2001). Certain medication, such as
antihypertensive drugs and especially selective
serotonin reuptake inhibitor (SSRI) antidepressant
drugs like Prozac and Zoloft, have effect on sexual
function, including delayed orgasm, decreased libido,
and diminished lubrication (Segraves, 2003). Among
older men who develop erectile dysfunction,
vascular conditions often involved.

19. Psychological Factors
• Some sexual dysfunction can be traces to rape,
childhood sexual abuse, or other degrading encounters.
• Depression and anxiety increase the risk the sexual
dysfunctions (Hayes, Dennerstein, Bennett, et al., 2008)
• Negative cognitions, such as worries about pregnancy
or AIDS, negative attitudes about sex, or concerns
about the partner, interfere with sexual functioning
• Variability in sexual performance is common; a
stressful day, a distracting context, a relationship
concern, or any number of other issues may diminish
sexual response when it happens.

20. • Anxiety Reduction. Systematic
desensitization and vivo (real-life)
desensitization, combine with skills
training. Psycho education about her body.
• Direct Masturbation. Was devised by
LoPiccolo and Lobitz (1972) to enhance
women’s comport with and enjoyment of
their sexuality.
Treatment for Sexual Dysfunctions

21. • Procedures to Change Attitudes and Thoughts.
Clients are encourage to focus on the pleasant
sensations that accompany even incipient sexual
arousal. The sensate-focus exercises are way of
helping the person be more aware and comfortable
with sexual feelings.
• Skills and Communication Training. To improve
sexual and communication, therapist assign written
materials and show clients explicit videos
demonstrating sexual techniques (McMullen &
Rosen, 1979)
Treatment for Sexual Dysfunctions

22. • Couples therapy. Sexual dysfunctions are often
embedded in a distressed relationship . Sex
therapists often work from a system perspective in
which a sexual problem is viewed as one aspect of
complex network of relationship factors (Wylie,
1997).
• Medication and Physical Treatment.
Antidepressant drugs have been found to be
helpful when depression appears to contribute to
diminished sex drive.
Treatment for Sexual Dysfunctions

23. • Early Ejaculation. For the treatment of early
ejaculation, the squeeze technique is often used,
in which a partner is trained to squeeze the penis
in the area where the head and the shaft meet to
rapidly reduce arousal.
• Erectile Disorder. The most common intervention
for erectile disorder is a phosphodiesterase type
5 (PDE-5) inhibitor, such as sildenafil (Viagra),
tadafil (Cialis), or vardenafil (Levitra), inhibitors
relax smooth muscles and thereby allow blood to
flow into penis, creating an erection during sexual
stimulation but not in its absence.

24. • Para meaning “Faulty or Abnormal”
and Philia meaning “attraction”,
literally, “Abnormal Attraction”
• These are disorder in which arousing
has recurrent intense sexually
involving, non human object, children
or other non-consenting person and
suffering or humiliation of one’s self or
partner.

25. The principal paraphilias in the proposed DSM-5
are:
 Fetishism Disorder
 Pedohebephilic Disorder
Voyeuristic Disorder
 Exhibitionistic Disorder
 Frotteutistic Disorder
Sexual Sadism and Masochism Disorder

26. Fetishistic Disorder
• Fetishism are recurrent intense
sexual urges, sexually arousing
fantasies, or behaviors that involve
the use of a nonliving object, often
to the exclusion of all other stimuli
– The disorder is far more common in
men than women and usually begins
in adolescence
– Almost anything can be a fetish
• Women’s underwear, shoes, and boots
are especially common

27. Pedohebephilic Disorder
• Pedes is Greek for “child”, hebe
for “pubescence,” and philia
“attraction.”
• When adults derive sexual
gratification through sexual
contact with pubescent children or
when they experience recurrent,
intense and distressing desire for
sexual contact with pubescent
children.
• Offender be atleast 18 years old
and least 5 years older than the

28. Pedohebephilic Disorder
Criteria for Pedohephilic
Disorder
• Fantasies, urges, or
behaviors relating to the
recurrent and intense
sexual arousal from
prepubescent or pubescent
children.
• Equal or greater arousal
from such children than
from physically mature
individuals, over a period
of at least six months.
Effect on the Child
• More disturbed behavior
• Lower self-esteem
• Increased tendency for
depression
• Increased tendency for
anxiety

29. Pedohebephilic Disorder
Prevention
• Common element include teaching children to
recognize inappropriate adult behavior, resist
inducement, leave the situation quickly, and
report the incident to an appropriate adult (Wolfe,
1990).
• Children are taught to say “no” in a firm, assertive
way when an adult talks to or touches them in
manner that makes them feel uncomfortable.

30. Pedohebephilic Disorder
Dealing with the Problem
• When they suspect that something is awry, parents must raise
the issue with their children.
• Many children need treatment (Litrownik &Castillo-Canez,
2000).
• Used intervention similar to those used for traumatic stress
disorder in adult; the emphasis is on exposure to memories of
the trauma through discussion in a safe and supportive
therapeutic atmosphere (Johnson, 1987).
• It is also important for children to learn that healthy human
sexuality is not power and fear (McCarthy, 1986).
• As with rape, it is important to change the person’s attribution
of responsibility from “I was bad” to “He/she was bad.”

31. Voyeuristic Disorder
• Voyeurism is the practice of
observing someone else nude or
engaging in intimate behaviors
without that person's awareness of
what is going on.
• Voyeurism typically begin in
adolescence.
– The person may masturbate during the
act of observing or while remembering
it later
– The risk of discovery often adds to the
excitement

32. Exhibitionistic Disorder
• Exhibitionism is a recurrent,
intense desire to obtain sexual
gratification by exposing one’s
genitalia to an unwilling
stranger, sometimes a child.
• The urge to expose seems
overwhelming and virtually
uncontrollable to the
exhibitionist and is apparently
trigger by anxiety and
restlessness as well as by sexual
arousal.

33. Frotteuristic Disorder
• Frotteurism involves
the sexually oriented
touching of an
unsuspected person.
• Almost always male, the
person fantasizes during
the act that he is having a
caring relationship with
the victim

34. Sexual Sadism and Masochism Disorder
• Sexual sadism is define by an
intense and recurrent desire
to obtain or increase sexual
gratification by inflicting pain
or psychological suffering on
another.
• Sexual masochism is define
by an intense and recurrent
desire to obtain or intense
sexual gratification through
being subjected to pain or
humiliation.

35. Etiology of the Paraphilias
• Neurobiological Factors there
has been speculation that
androgens(hormones like
testosterone) play a role.
Androgens regulate sexual
desire, and sexual desire
appears to be typically high
among people with paraphilias
(Kafka, 1997). Nonetheless,
men with paraphilias do not
appear to have high levels of
testosterone or other
androgens (Thilabaut, et al.,
2010).
• Psychological Factor
emphasizing classical
conditioning as well as
deficiencies in social skills that
make it difficult for the person
to interact normally with other
adults. there is limited support
for behavioral risk factors.
Exposure to childhood sexual
abuse may be a risk factor.
Alcohol use may increase the
odds acting on sexual urges.
Cognitive distortions appears to
be involved.

36. Treatment for the Paraphilias
• The most promising treatment for the paraphilias are
cognitive behavioral. One conditioning procedure is to pair
inappropriate sexual object with aversive stimuli. Cognitive
methods focus on the cognitive distortions of the person with
a paraphilias. Approaches to improve social skills, empathy
and impulse control and to avoid relapse triggers, are
common. Studies suggest that psychological treatments do
reduce rates of legal offenses.
• Drugs that reduce testosterone levels have been found to
reduce both sex drive and deviant sexual behaviors, but
because of the side effects, there are ethical issues involved in
the long-term use of these drugs. SSRI antidepressants are
commonly prescribe to reduce sexual drive of men with
paraphilias, but the quality of the research evidence is poor.

37. Strategies to Enhance Motivation
1. Empathize with the offender’s reluctance to
admit that he is an offender and to seek
treatment, thereby reducing defensiveness and
hostility.
2. Point out that treatment might help him control
his behavior better.
3. Emphasize that negative consequences of
refusing treatment (e.g. Transfer to less attractive
incarceration setting if the person is already in
custody) and offending again (e.g., stiffer legal
penalties.)

38. Is a type of sexual assault usually
involving sexual intercourse, which
is initiated by one or more persons
against another person without that
person's consent. The act may be
carried out by physical force,
coercion, abuse of authority or
against a person who is incapable of
valid consent, such as one who is
unconscious, incapacitated, or below
the legal age of consent.

39. Reforming the Legal System
Estimate are that less than half of rapes are reported
(National Center of Victims and Violent Crime,
2004). Interview with half a million women
indicated three reason for reluctance to report:
1. Consider the rape a private matter
2. Fearing reprisal from rapist or his family or
friends
3. Believing that police would ineffective or
insensitive (Wright, 1991)