Sexual Disorders Dr. Vidumini De Silva

Basic need 10 – 12 yrs – preoccupied with sexual changes & beginning of interest towards the opposite gender

Disorders Paraphilia Sexual dysfunctions Other

1. Paraphilia Repetitive sexual fantasies involving non human objects OR repetitive sexual activity with humans involving humiliation, suffering with non consenting partners.

Males – commoner Sub types – Exhibitionism : recurrent intense sexual urges, behaviours, or sexually arousing fantasies involving the exposure of genitals to a stranger Fetishism : involves using nonliving objects frotteurism : touching or rubbing against a non consenting person

Paedophilia : sexual activity with a prepubescent child Masochism : made to suffer, humiliation, beaten, and bound Voyeurism : observing people who are either naked, disrobing or engage in sexual activity Sadism : psychological / physical suffering is sexually exciting for the patient

Aetiology of Paraphilia Biological – abnormalities in limbic and temporal lobe Behavioural theory : environmental influence Other – due to multiple factors

Rx Biological : block/decrease level of androgens Psychoanalytical therapy : assisting to identify childhood trauma/conflict that prevents the patient having normal sexual relationship Behavioural therapy : aversioning ( eg: use of electrical shock when exposure to undesired behaviour

Exercise 01 What’s your role?

2. Sexual dysfunction Phases of sexual response cycle Desire Excitement Orgasm Resolution

Sexual Desire Disorders Hypoactive Sexual Desire Disorder Testosterone Cognitive therapy behavioural therapy Marital therapy 2. Sexual Aversion Disorder – aversion/avoidance of genital sexual contact with the partner - systematic desensitization - antidepressants

Sexual Arousal Disorder 1. Female Sexual Arousal Disorder – failure to attain/maintain until completion of sexual activity, an adequate lubrication response of sexual excitement 2. Male erectile disorder Group therapy Hypnotherapy Systematic desensitization Testosterone Siladenfil Penile implantation

Orgasmic Disorder Anorgasmia (Female orgasmic disorder) – recurrent/persistent delay/absence of orgasm following normal sexual excitement phase Retarded ejaculation Premature ejaculation – persistent/recurrent ejaculation with minimal sexual excitement or before upon or shortly after penetration and before the person wishes it

Sexual Pain Disorders Dyspareunia – genital pain before/during/after sexual intercourse not associated with vaginsmus or lack of lubrication Rx : systematic desensitization 2. Vaginismus – involuntary constriction of outer 1/3 of vagina that prevents penile insertion and IC Rx : ?

Aetiological factors Biological – drugs (antihypertensives, antipsychotics, antidepressants, anxiolytics, anticonvulsants) , Co-morbidities ( DM) , substance abuse Psychosocial factors - childhood sexual abuse, rape, fear of getting pregnant

Exercise 02 What’s your role?

Sexual Orientation What are these terms mean & what can be done for them? Homosexuality Transsexualism Bisexuality

Sexually transmitted diseases Who are the risk groups? What are the STDs you know of? How they can be prevented?

Thank You!