Sexual Disorders Levels of Sexuality Sexual Identity Sexual Orientation Sexual Interest Sex Role Sexual Performance

Sexual Identity Male or female Usually consistent with biology

Disorder: Gender Identity Disorder (Transsexualism) Belief that you are opposite sex from biology Many cross-dress, live as opposite sex Actions are not sexually arousing

1 in 100,000 – Men Usually begins in childhood Chronic course

Etiology Prenatal hormonal influences Masculine hormones => masculine sex organs & male sex identity Absence => female organs & identity

Treatment 1.Therapy to deal with feelings - Often severe adjustment problems - Usually ineffective in changing sexual identity 2.Sexual-reassignment surgery & hormone treatment - Fairly successful

Sexual Orientation What sex you fall in love with Orientation is NOT a choice Continuum

Disorder: None Most homosexuals are well-adjusted Some = unhappy, want to be heterosexual Women more accepting of homosexuals than men Prevalence = < 10%

Etiology of Homosexuality Prenatal hormones -> predisposition Also influenced by later events Evidence of different brain structure & genetic data from twin studies Most research is based on males

Treatment None If ego-dystonic, treat either homosexuality or dystonicity Some success in changing orientation via aversive therapy Probably would also need orgasmic reconditioning

Sexual Interest Objects of arousal Most men = female body Women = male body

Disorders: Paraphilias Unusual sexual interests that impair “normal” erotic relations Paraphilic fantasies are common

Disorder a)person acts on fantasy b)object becomes necessary c)person is distressed or object replaces human partners

Paraphilic Categories a)Nonhuman objects Fetishes Transvestic fetishism

b)Humiliation/pain Sadism Masochism

c) Children or nonconsenting adults pedophiliaexhibitionism voyeurism frotteurism

Etiology Classical conditioning Paraphilic object/situation (CS) is paired with sexual arousal (US) and sexual pleasure (UR) Person then strengthens bond between CS & CR No arousal to “normal” adult stimuli Maybe deficient social skills Preparedness

Treatment Rarely diminish on own But can be treated Rationale for tx: A learned/conditioned paraphilia can be unlearned

a)Aversion therapy electrical shock chemical nauseants b)Covert sensitization Aversive stimulus is imagined Focus on negative consequences

c)Orgasmic Reconditioning Teach link between sexual pleasure and “normal” stimuli

Treatment is mildly effective 40% flashers reoffend (vs. 60% untreated) Cognitive component improves rates (25% reoffend) Cannot change underlying desire but can change some behavior

Sex Role Public expression of sexual identity Parents/society/peers Fetal hormones

Disorder: None Previously thought non-sex-typed -> problems

Sexual Performance Adequacy of performance in sexual situations Disorders (4 categories) - Decreased sexual desire or response

1. Sexual Desire *Hypoactive Sexual Desire - No interest in sex, often regarding a particular partner *Sexual Aversion Disorder Extreme dislike of sexual activity

2. Sexual Arousal *Female Sexual Arousal Disorder *Male Erectile Disorder - difficulty experiencing or maintaining arousal - very common - reaction heightens problem

3. Orgasmic Disorders *Female & Male Orgasmic Disorders - inability to reach orgasm (women) - premature ejaculation in men (most common male problem) - can lead to Male Erectile Disorder - men also have retarded ejaculation

4. Pain disorders (women) *Dyspareunia - painful intercourse *Vaginismus - muscle spasms rendering intercourse painful/impossible

Etiology Physical Causes (minority of cases) a)aging b)alcohol/drugs/antidepressants c)medical problems

Psychological Causes a)Anger b)Cognitions (performance anxiety) c)Traumatic sexual experience - condition fear/shame

Treatment Direct Sexual Therapy Masters/Johnson With couple Explicit instruction & then practice

Sensate Focus = nondemand pleasuring Anxiety blocks excitement & pleasure Reduce anxiety via sensuous exercises with no performance (intercourse)

Rape Rape is not a Paraphilias because 1)Most rapists usually do not need rape to become aroused 2)Calling rape a “disorder” reduces person’s responsibility

What factors may lead to date rape? Double standard Hidden norms that may condone sexual aggression in men Changing sexual values Lack of accepted standards about how people should behave

Alcohol/drugs Impair judgment, decrease inhibitions, render women more vulnerable Miscommunication Wait to make decision Woman may then be easily influenced Social norms re game playing

Media Sexual violence Increase acceptance of rape myths Decrease sensitivity to victims