Sexual Dysfunctions, Paraphilias, Paraphilic Disorders, and Gender Identity Disorders

What is Normal Sex Multiple Partners Mostly Heterosexual Mostly Monogamous Condom Use Has Increased Older Populations are Still Active

The Development of Sexual Orientation Are You Born Nature vs. Nurture Straight Homosexual Bisexual? Nature vs. Nurture

The Development of Sexual Orientation Homosexuality Runs in Families More Common in Monozygotic Twins Prenatal Exposure to Hormones The Biological Basis Argument Promoted by the Media, but Narrow The Link is Not That Strong Inherit Sexual Predispositions

Overview of Sexual and Gender Disorders Main Classes of Disorders Gender Dysphoria (Gender Identity Disorder) Sexual Dysfunctions Paraphilias vs Paraphilic Disorders

Features of Gender Identity Disorders Man or Woman? Trapped in the Body of the Wrong Sex Transexualism Transgendered Rare

The Nature of Gender Identity Disorders Goal is Not Sexual No Physical Abnormalities Independent of Sexual Arousal Patterns May be Attracted to People With Desired Identity

The Causes of Gender Identity Disorders No Specific Biological Link, but… Probably Developed Early in Life

The Treatment of Gender Identity Disorders Sex Reassignment Surgery Costs ? Double $ for Female to Male Female-to-Male Adjust Better Psychosocial Treatment

The Nature of Sexual Arousal and Function Normal Functioning Desire Phase Resolution Arousal - Excitement Plateau Orgasm

Features of Sexual Dysfunctions Where Problems Arise Desire Phase Resolution Arousal - Excitement Plateau Orgasm

The Nature of Sexual Dysfunctions Can be Either Specify as Due to Lifelong or Acquired Generalized or Situational Specify as Due to Psychological Factors Alone Psych Factors Plus Medical Condition Desire Phase Resolution Arousal - Excitement Plateau Orgasm

Main Types of Sexual Dysfunctions Sexual Desire Disorders Sexual Arousal Disorders Orgasm Disorders Desire Phase Sexual Pain Disorders Resolution Arousal - Excitement Plateau Orgasm

The Nature of Sexual Desire Disorders Hypoactive Sexual Desire Disorder No Interest in Any Sex Activity Common Presenting Problem How Much Sex Is Enough?

The Nature of Sexual Arousal Disorders Male Erectile Disorder Female Sexual Arousal Disorder Problem is NOT Desire, but Arousal Males: “Impotence” Maintaining /Achieving Erection Females: “Frigidity” Maintain / Achieve Lubrication

The Nature of Orgasm Disorders Inhibited Orgasm Adequate Arousal and Desire BUT Unable to Achieve Orgasm Common in Females; Rare in Males About 50% Women Experience Regular Orgasms During Intercourse

The Nature of Orgasm Disorders Inhibited Orgasm Premature Ejaculation Ejaculation Occurs Too Quickly Hard to Define “Too Quickly” but 1 min Problem Occurs Commonly, esp. in Younger Males Perception of Lack of Control Over Orgasm is the Chief Complaint

The Nature of Sexual Pain Disorders Intercourse Associated With Pain Rule out Medical Causes of Pain Rare Condition in Males More Common in Women Vaginismus

Behavior and Dysfunction Assessment of Sexual Behavior and Dysfunction Interviews How Would You Describe Your Current Interest in Sex? What Behaviors do You Engage In? Describe Your Sexual Fantasies... How Often Do You Masturbate?

Behavior and Dysfunction Assessment of Sexual Behavior and Dysfunction Interviews Thorough Medical Evaluation Medications can Disrupt Sexual Functioning Check Vascular Functioning Check Hormonal Levels

Behavior and Dysfunction Assessment of Sexual Behavior and Dysfunction Interviews Thorough Medical Evaluation Psychophysiological Assessment Listen to Audiovisual Erotic Material Measure Arousal Directly Penile Strain Gauge Vaginal Plethysmograph

The Causes of Sexual Dysfunctions Biological Contributions Diabetes and Kidney Disease Cardiovascular Diseases Chronic Illness Prescription Medications Using Alcohol and Other Drugs

The Causes of Sexual Dysfunctions Biological Contributions Psychological Contributions Couple problems Performance Anxiety Involves Arousal, Cognition, and Negative Affect The Role of Distraction Arousal Level is Underestimated

Treatment of Sexual Dysfunctions Providing Education About Sex Psychosocial Treatments Eliminate Performance Anxiety Sensate Focus / Nondemand Pleasuring Gradual Process of Building Intimacy Other Specific Techniques Many Treatments Work

Treatment of Sexual Dysfunctions Providing Education About Sex Psychosocial Treatments Medical Treatments Medications Vasodilating Drugs (Viagra) Surgery and Implants Vacuum Device Therapy

Paraphilic Disorders Main Classes of Disorders Gender Dysphoria Overview of Disorders Main Classes of Disorders Gender Dysphoria Sexual Dysfunctions Paraphilic Disorders

The Nature of Paraphilic Disorders An Overview Para Philia “Beyond” or “Amiss” Philia “Love” Sexual Stimulation Requiring Bizarre or Unusual Acts, Imagery, or Objects

The Nature of Paraphilic Disorders Fetishism Sexual Attraction to: Inanimate Objects Tactile Stimulation Parts of the Body

The Nature of Paraphilic Disorders Exhibitionism “The Flasher” Expose Genitals to Unsuspecting Strangers Element of Risk is Important May Not Be “Harmless” (Many Rape / Molest)

The Nature of Paraphilic Disorders Voyeurism “The Peeping Tom” Watching Unsuspecting Strangers Naked or Undressing

The Nature of Paraphilic Disorders Transvestic Fetishism “Cross Dresser” Sexual Arousal by Dressing in Clothes of the Opposite Sex Most are Male Heterosexuals Most are Married

The Nature of Paraphilic Disorders Sexual Sadism and Masochism What The “Sadist” Sexual Arousal by Inflicting Pain / Humiliation Domination, Beatings The “Masochist” Suffers the Pain / Humiliation Helps the Sadist What About Sadistic Rape?

The Nature of Paraphilic Disorders Pedophilia and Incest Pedophilia Sexual Attraction to Children More Aroused to Young Children Incest Children Related to Perpetrator

The Nature of Paraphilic Disorders Other Forms of Paraphilia Frotteurism -- Rubbing Necrophilia -- Corpses Klismaphilia -- Enemas Coprophilia -- Feces Zoophilia -- Animals Scatologia -- Obscene Calls

Other Paraphilic Disorders Nonparaphilic Compulsive Sexual Behaviors: (not in DSM) Compulsive Cruising & Multiple Partners Fixation on Unattainable Partner Compulsive Autoeroticism Multiple Love Relationships (obsessed with finding intense feeling of a new relationship)

The Causes of Paraphilic Disorders Psychosocial Contributions Poor Stress/Anxiety Management Inability to Develop Adequate Relationships Early “Unusual” Sexual Experiences Person’s Early Sexual Fantasies Excessive Sex Drive Specific Causes are Still Unclear

Treatment of Paraphilic Disorders Psychosocial Treatments Suppression Covert Sensitization Orgasmic Reconditioning Relapse Prevention Treatment Can Work But… follow-up issues are a concern

Treatment of Paraphilic Disorders Drug Treatments Anti-Androgen Cyproterone Acetate; Depo-Provera Reduces Testosterone Levels Eliminates Sexual Desire / Fantasy Use for Sex Offenders Only a Temporary Solution