Mental health is not just about overt behaviours---exposed socially, but there are more volatile intimate emotions that could devastate any human relations forever-though not overtly observed as abnormal--! We will discuss about such emotions which are banned in social discussions and stigmatized. "Sexual disorders and dysfunctions" could be present in any socioeconomic classes--not age, education, gender, culture specific. Understanding these critical emotions on time and accepting it would save human relationships--avoiding suffering, inferiority complex, gender harassment and abuse. Educate yourself and save relationships!!! Mental health subject is originally stigmatized, moreover talking to someone about sexual disorders is as critical as finding a pearl into a deep ocean.........

1. Sexual Disorders
&
Gender Identity Disorders
Presented by : Mangal Kardile
Mental Health Aims
www.mentalhealthaims.com

2. Gender identity disorders
• Distinguished by gender role- maleness or
femaleness (masculinity or femininity of overt
behaviour)- Ex.- GID transsexual
• Acc to DSM-IV-TR
1) cross gender identification(desire to change in
opposite sex)
2) gender dysphoria (feel discomfort &
unhappiness of one’s biological sex)
* Occur in childhood, adolescence (male or female)

3. Gender identity disorders
• GID in childhood- males-marked preoccupation with traditionally
feminine activities (ostracized as “sissies”)
• females- balk at parent’s attempts to dress them in traditional
female clothing (tomboys)
• GID ratio male to female 1:5
• Female GIDs more tolerated than males
• Male adult outcome – homosexuality
• Richard Green’s – only 1 out of 44 feminine boys had sex surgery
• 10 – 20% GID Children found to be transsexual at the age of 16-18
• 40-60% - identified themselves as homosexual or bisexual
• no much prospective studies have found on female GID (35 to 45%
show GID, interested for sex reassignment)
• Have mixed expressions about whether this is a disorder?

4. Gender identity disorders-treatment
• GID in childhood- brought by parents for
psychotherapy
Works on child’s unhappiness and parent’s relations
• Children behavioural problems - anxiety and mood
disorders (need therapeutic attention)
• Help in improving interpersonal relations & cross
gender behaviour
• Typically treated psychodynamically-examining inner
conflicts ?

5. Transsexualism - adults
• GID in adults- Comparatively a rare disorder
(found to have child GID)
• intend & desire to change their sex
• Surgical facilities have made it feasible (1 male in 30,000 & 1 female in 1 lac)
• Two types of male to female transsexuals-
1) Homosexual
2) Autogynephilic transsexual – have autogynephilia- a paraphilia (attraction of
thoughts, images, fantasies of themselves as women- diagnosis not been made in
DSM-IV-TR)
Causes- hypotheses - prenatal hormonal influences
research – female fetus exposed to androgens in utero develop as masculine type
Autogynephilic – occurs with history of transvestic fetishism
Can lead to acute gender dysphoria (fantasize of female genitalia)
Not typically feminine in childhood, motivated to seek reassignment surgery

6. Transsexualism - adult treatment
• Psychotherapy not useful for gender dysphoria
• Effective treatment- surgical reassignment
• hormone treatment (1 year) those awaiting surgery
• Biological Men – estrogens
• Biological female – testosterone
• After surgery- continue with hormones
• Surgery of genitals for males, extensive electrolysis, raise pitch
• Surgery for females- mastectomy & hysterectomy, plastic surgery
(artificial penis? Cannot create desired emotions in brain)
• 87% of 220 (male to female) 97% of 130 (female to male) have
satisfaction by surgery
• ….difficult to treat the psychological disorders with drastic
anatomical changes

7. Sexual disorders

8. Sexual desire – a biological need
in all animal kingdoms….

9. ….including human beings!

10. But there can be difficulties ……in
natural course
• Call as sexual disorders –
• Impairment –
desire of sexual gratification
Ability to achieve it, varies in degrees
• Occurs in homosexual & heterosexual couples
• Why?- psychological, interpersonal &
biological disturbances
• Sexual partners affects one another

11. Four phases of sexual responses
( Masters & Johnson 1966-75)
1) Desire phase – fantasies, sexual activity
2) Excitement phase –
subjective sense - pleasure
physical change – male & female organs
3) Orgasm –
release of sexual tension
peak of sexual pleasure
4) Resolution –
sense of relaxation & well being

12. What does the research say?
• Very little research done – sensitive issue, less
funding
• National Health and Social Life Survey (USA,
1999)- Followed DSM-IV-TR criteria
• 3159 – random selection of Americans
• past 12 months sexual problems
• 43% women and 31% men- had sexual problems
• Decreased by age - Women
• Increased by age - Men

13. How & why the sexual disorders?
• Sexual desire disorders- male and female
1) Hypoactive sexual desire disorder – psychological
& biological factors
*Insufficient sexual interaction
*usually reported by sexual partner
2) Sexual aversion disorder – psychologically
aversive
*decline of testosterone in male
*removal of ovaries in women
More problems with women than men

14. Sexual arousal disorders- nature &
reasons
1) Sexual arousal disorders-
1) Male erectile disorder – (erectile insufficiency) - formerly called
impotency
*Anxiety about sexual performance
*Medical conditions, drug abuse, alcohol
*Other diseases as “priapism” in young males (lasting erection)
2) Female sexual arousal disorder (absence of feelings of sexual
arousal, unresponsiveness of swelling and lubrication of vulva and
vaginal tissues), have lower tactile sensitivity
subtypes- genital and subjective
*sexual traumatization
*distorted socialization about “evils” of sex
*disgust with or dislike of current partner

15. Sexual arousal disorders- treatments
1) Male erectile disorder – medical treatment (yohimbine)
*injections of smooth-muscle relaxing drugs into erection
chambers(corpora cavernosa)
*a vacuum pump
*extreme cases- penile implants (inflated when erection demanded)
(clinically successful but some have side effects)
*Viagra, Levitra and Cialis oral drug – clinically successful (makes
nitric oxide)
*some couples receive - cognitive behavioral therapy
2) Female sexual arousal disorder- psychotherapy and sex therapy
*vaginal lubricants
*Viagra, Levitra and Cialis – more useful for women with
antidepressant treatment

16. 2) Orgasmic disorders- Male
1) Male Premature ejaculation- common before 59 years age
persistent and recurrent onset of orgasm and ejaculation with
minimal sexual stimulation
*failure to achieve satisfaction
*acute embarrassment – leads to anxiety of recurrence
causes - increased penile sensations or anxiety or inflammation of
prostate gland (not enough empirical research)
2) Male orgasmic disorder- retarded ejaculation or inhibited male
orgasm (persistent inability to ejaculate during intercourse)
*achieve orgasm - solitary masturbation
causes- multiple sclerosis, certain medication
*SSRI or use of antidepressants delay or prevent ejaculation

17. 2) Orgasmic disorders- Female
1) Female orgasmic disorder - (10 %-15% never achieve
orgasm)
some readily sexually excitable but show persistent or
recurrent delay or absence in orgasm following a normal
sexual excitement phase
*most do not routinely experience orgasm, some use
mechanical device
causes - *fearful and inadequate sexual relations
*uncertain about partner’s desires
*some pretend to have orgasm to satisfy their partners
*partner being insensitive to her feelings

18. 3) Dysfunction involving sexual pain- Female
1) Vaginismus – involves involuntary spasm of the muscles at entrance to or
outer third of the vagina, (not due to physical disorder) that prevents
penetration and sexual intercourse
*doubts about involuntary muscle spasm
*Binik- found that one fourth women experienced spasm and pain during
attempted intercourse and during gynecological exam
Causes- also have sexual arousal disorder due to fear of earlier experience
2) Dyspareunia- ( painful coitus) persistent or recurrent genital pain due to
sexual intercourse
*common in young women than men having obvious physical causes
Causes - acute or chronic infections or inflammations of vagina or internal
productive organs, vaginal atrophy occurs with aging, scars of vaginal
tearing or insufficiency of sexual arousal
*Often associated with Vaginismus

19. Dysfunction involving sexual pain- treatments
1) Vaginismus –
* basically banning intercourse
* training of vaginal muscles
* graduated self-insertion of vaginal dilators of
increasing size
2) Dyspareunia-
* addressing the physical problem
* need psychological intervention
* acc to Binik – Pelvic pain disorder

20. Fact remains.....
• Intensive research required……….....

21. Love, respect and faith…can win over
sexual difficulties!

22. Thank you