Gender and Sexual Disorders Chapter 8 Psyc 303 Spring 2013 Reviewing Learning Objectives Normal sexual behavior is quite difficult to define, and depends on biological and cultural factors, as well as sexual practices. Understand how GID relates to transsexualism, but that it differs from transvestic fetishism. Both men and women can experience sexual dysfunction, and differences exist between performance and desire. Sexual dysfunction may be biologically or psychosocially based for men and women; however, it is best to take an individualized approach to treatment. No one profile exists for those who engage in paraphilias; be able to list the three types and examples of each. It is important to incorporate both a biological and psychosocial approach to the treatment of paraphilias; however, note ethical issues when conducting research.

Kinsley – interviewed 18,000 Americans Who is the person who engaged in one of the first formal attempts to study human sexuality using interviews of thousands of Americans? Kinsley – interviewed 18,000 Americans Masters and Johnson’s work – recorded physical responses during sexual intercourse Alfred Kinsley

Sexual Functioning Human sexual response cycle: Four phases of sexual response 1) Desire phase (response to external and internal cues) 2) Arousal phase (physical and psychological signs of sexual arousal) 3) Orgasm phase (ejaculation of seminal fluids and contractions in the outer third of the vagina) 4) Resolution phase (decrease in arousal followed by refractory “resting” period)

Men vs. women when it comes to sexual response Sex drive – physical and/or psychological craving for sexual activity and pleasure Exists equally for men and women Men engage in more frequent sexual activity and tend to think about sex more often than women Women have a greater capacity for sex (longer duration of sexual activity, no refractory period, multiple orgasms)

Men vs. women when it comes to sexual response Women define sexual desire in a broader way: Equate desire with a need for emotional intimacy Effects of age for men observed in genital response, for women in declining sexual desire Adults of all ages are sexually active – albeit to a different degree

Understanding Sexual Behavior Heterosexuality, bisexuality, and homosexuality Appears as though 2 to 5% of men & 1 to 2% of women are exclusively same sex attracted Men are more likely to be exclusively attracted to the same sex, whereas women are more likely to describe themselves as attracted to both sexes – more fluidity in sexual orientation among women…. The need for attachment or pair-bonding could lead to romatic attraction to either sex There seems to be a greater erotic plasticity among women (more women are identified as bisexual than males). How do you explain that?

The development of sexual orientation is biologically based: Genetic influence Heritability estimates between 50-60 % for women, 30% for men Sex hormones: Androgens during the fetal development Not clear Gay men had a greater number of older brothers compared to heterosexual men There seems to be a greater erotic plasticity among women (more women are identified as bisexual than males). How do you explain that?

“Jack” wants to be called “Jill” and “Jill” wants to be called “Jack”: Gender Identity Disorder (GID) Sex – genes, hormones, genetalia Gender – defined by culture, developed by ages 3-4 GID inconsistency between biological sex and gender identity Strong desire to participate in games of opposite sex, cross-gender roles in pretend plays; persistent fantasies of being the opposite sex; repeated expressions of wanting to be the opposite sex

GID, also called Transsexualism Transgender behavior – attempts to behave in ways representative of the opposite sex Transsexualism different from transvestic fetishism (the desire to dress in the clothes of the opposite sex)

Functional Impairment of GID Peer rejection Social isolation Negative moods Distress in parents Distress in children for being prevented from engaging in the desired behaviors

Sex, Race, and Ethnicity Factors Related to GID Detected between the ages of 2 to 4 Early signs (e.g., persistent cross dressing & play) Verbal wishes to be of the opposite sex Prevalence rates prepubescent vs. adolescence Cultural considerations

Etiology of GID A number of theories exist for the origin of GID, but no empirical data has supported any of these. Biological -Brains of transsexual males similar to heterosexual females -Prenatal hormone imbalances -Hormonal condition (congenital adrenal hyperplasia, CAH) -Androgen production Psychosocial -Parental rejection (parent-child relationship)

Treatment options for GID are: 1 Treatment options for GID are: 1. The most effective treatment for individual’s with GID is sex reassignment surgery (SRS) or commonly referred to as gender reassignment surgery (GRS). A few steps one must accomplish before surgery is an option living as the preferred gender for at least two years, hormone therapy where testosterone is given to biological females and estrogen is given to biological males. SRS or GRS

Treatment options for GID are… 2. Psychological -Attention and reinforcement of same-sex activities -Behavioral approach with rewards and punishment

Sexual Dysfunction Absence or impairment of some aspect of sexual response that causes distress or impairment Factors that contribute to sexual performance (age, sex, culture, life circumstances, illness, or separation from sexual partner) Classification (disorders of sexual desire, sexual arousal, orgasm, and pain)

To Desire or Not: Sexual Desire Disorders Sexual desire – interest in sexual activity or objects, or wishes to engage in sexual activity Diminished or absent interest in sexual activity Two subtypes: -Hypoactive sexual desire disorder -Sexual aversion disorder Factors associated with decreased sexual desire

Sexual Arousal Disorders Female sexual arousal disorder -Psychological reasons vs. Physiological reasons or both -75% of women report sexual arousal disorder to their gynecologist Male erectile disorder -Persistent and recurrent inability to maintain an adequate erection until completion of sexual activity -Significant distress and/or interpersonal difficulty

Orgasmic Disorders Female orgasmic disorder Male orgasmic disorder -Persistent and recurrent delay or absence of orgasm following the normal excitement phase -Important to consider age, adequacy of sexual stimulation, and sexual experience Male orgasmic disorder -Delayed ejaculation or the delay of or inability to achieve orgasm, not as common as “premature ejaculation” Premature ejaculation -Consistent ejaculation with minimal sexual stimulation, 30% of men, also known as rapid ejaculation

Sexual Pain Disorders Dyspareunia (consistent genital pain associated with sexual intercourse) 3 to 5% of men report this 14% of gay men report this Vaginismus (unwanted involuntary spasms of the vaginal muscles that interfere with intercourse or any attempt at vaginal insertion) 72% of women report pain with sex

How do sexual disorders impact individuals? Both individuals sexual well-being is affected Sexual functioning vs. overall functioning Sexual difficulties are common Impacts self-esteem, sexual relationship, but not always “overall relationship” Only less than 19% of people seek treatment

Sex, Race, and Ethnicity Occurs across all race and ethnicities Developmental factors – premature ejaculation African American women reported lower levels of sexual desire and pleasure White women are more likely to have pain Both African American and white women reported more difficulties than Hispanic women

Etiology of sexual disorders Biological -Hormonal imbalances (hypothyroidism or hypogonadism) -Menopause (decreased levels of estrogen) -Decrease in testosterone levels (beginning in the 30 to 40s) -Physical disorders (cardiovascular disease, hypertension, diabetes, kidney failure, & cancer) -Androgens -Alcohol and drugs -Antidepressants (SSRIs)

Etiology of sexual disorders Psychosocial -Depression -Anxiety -Stress -“Performance anxiety” -Classical conditioning (repeated experiences involving the need to ejaculate quickly) -Couple distress and negative life events -Environmental factors -Aging

Treatment of sexual disorders Biological -Testosterone replacement therapy (injection, patch, or gel) -SSRIs (increase sexual desire but impair sexual performance) -Media and advertisements (Viagra, Levitra, and Cialis) -Penile implants -Vacuum devices

Treatment of sexual disorders Psychosocial -Sex therapy (4 steps) -“Stop-Squeeze” technique -Directed masturbation -Systematic desensitization (with the use of different-sized vaginal dilators) -CBT to challenge irrational beliefs

Paraphilias Intense, persistent, and frequently occurring sexual urges, fantasies, or behaviors that involve unusual situations, objects, or activities Association with criminal activity Considered unusual or “out of the norm” Three categories (sexual arousal: toward nonhuman objects, children and nonconsenting individuals, and involving suffering or humiliation of oneself or others)

Sexual Arousal toward Nonhuman Objects Fetishism (fantasies, urges, or behaviors, that involve nonliving objects, not limited to female clothing used in cross- dressing) Most common (female underwear, stockings, footwear, or other apparel) Transvestic Fetishism (sexual arousal in men that results from wearing women’s clothing and is accompanied by distress and impairment) Occurs only among heterosexual men

Sexual Arousal toward Children and Nonconsenting Individuals Exhibitionism (exposure of one’s genitals to unsuspecting viewers) Frotteurism (rubbing against a nonconsenting person) Sexual Arousal toward Children and Nonconsenting Individuals Pedophilia (sexual urges, fantasies, or actual behavior directed toward a prepubescent child) Voyeurism (seeing an unsuspecting person naked, undressing, or engaging in sexual activity)

Sexual Arousal Involving Suffering or Humiliation of Oneself or Others Sexual Sadism (infliction of pain or humiliation, but in this case the physical or psychological suffering is inflicted on another person Found primarily in males 20 males to 1 female Sexual masochism (sexual arousal as a result of being humiliated, beaten, bound, or otherwise made to suffer pain)

Paraphilias and the facts… People usually have more than one There is no cookie-cutter profile They are described as well-adjusted, successful, and above the norm on assessments of mental health Men with transvestic fetishism are happy with their biological sex Erotica asphyxiation occurs at the same rate

The facts about sex, ethnicity, and development… Most people with paraphilias are male Sexual masochism is found in women, but males attribute to 20 to 1 ratio Women prefer less pain during sexually masochistic activities Onset begins from age 7 to 38 with 16 being the average age for paraphilias Cultural implications

The Causes of Paraphilias Unknown Behavioral component with conditioning (one engages in a paraphilia and achieves sexual release; therefore, the behavior is likely to be reinforced due to experience of pleasure) Lack of data to support biological or psychosocial reasons

Biological treatment options to consider… Past treatment of surgical castration, although is no longer used Medications (SSRIs and antiandrogens) Examples of testosterone-lowering medications (Depo-Provera & Depo-Lupron)

Psychosocial treatment options to consider… Behavioral and cognitive-behavioral treatments Satiation Covert sensitization Olfactory aversion Social skills training (SST) Couples therapy Sex education