Gender and Sexuality Disorders

I. Sex versus Gender A. Sex: either of the two major forms of individuals that occur in many species that are distinguished as female or male on the basis of their reproductive organs and structures. B. Gender: the psychological aspect of being male or female (or other) based on cognitive, emotional, behavioral, sociocultural, and biological factors. C. Transgender Identity: the psychological sense of belonging to one gender while possessing the sexual organs of the other.

II. Gender Dysphoria: the situation in which people experience significant personal distress or impaired functioning as a result of a conflict between their anatomic sex and their gender identity. Not all people with a transgender identity have gender dysphoria or any other diagnosable disorder. Gender Dysphoria is believed to often begin in childhood. About 50% of these children become homosexual adults. Men with Gender Dysphoria outnumber women 2 to 1.

A. Sex Reassignment Surgery Investigators generally find positive postoperative adjustment, although it is typically higher for females-to-males. Men seeking sex-reassignment outnumber women by perhaps 3 to 1. B. Theoretical Perspectives on Transgender Identity 1) Psychodynamic 2) Learning 3) Biological 4) Biopsychosocial

III. Sexual Dysfunctions: persistent or recurrent problems with sexual interest, arousal, or response. A. Two categories of dysfunction 1) lifetime versus acquired 2) situational versus generalized As many as 31% of men and 43% of women in the U.S. suffer from such a dysfunction during their lives.

B. Disorders of Interest and Arousal 1) Male Hypoactive Sexual Desire Disorder: characterized by a lack of interest in sex and little sexual activity and fantasizing. Physical responses may be normal. Prevalent in about 16% of men. 2) Female Sexual Interest / Arousal Disorder: characterized by a lack of normal interest in sexual activity and fantasizing. Women with this condition rarely initiate sexual activity and may experience little excitement during sexual activity. Reduced sexual interest and desire may be found in as many as 33% of women.

Abnormalities in hormone activity, such as low testosterone and estrogen, can lower sex drive.   Recent research has also linked sexual desire disorders to excessive activity of the serotonin and dopamine. Psychological/emotional causes such as an increase in anxiety, depression, or anger may reduce sexual desire in both men and women. Other factors include divorce, death, job stress, infertility, relationship difficulties, and cultural restrictions or expectations. The trauma of sexual molestation or assault is especially likely to produce sexual dysfunction.

3) Hyperactive Sexual Desire Disorder: excessive desire for sexual gratification. Often that desire leads to the person trying to fulfill their needs without concern for their partners and sometimes without any concern for their own well-being. a) Nymphomania: abnormally excessive and uncontrollable sexual desire in women. b) Satyriasis: abnormally excessive and uncontrollable sexual desire in men. It has been difficult to determine the cause of this as an isolated condition because it has been linked as a symptom associated with bipolar disorder, obsessive-compulsive disorder, adult attention deficit disorder, and borderline personality disorder. It has also been noted among some drug addicts and people who have been abused.

4) Erectile Disorder (ED): characterized by a persistent inability to attain or maintain an erection during sexual activity. This problem occurs in as much as 10% of the general male population. According to surveys, half of all adult men have erectile difficulty during intercourse at least some of the time. 5) Sexual Performance Anxiety: the inability to relax and fully enjoy sexual activity due to a preoccupation and concern about one’s execution of sexual activity. Once a man begins to have erectile difficulties, he becomes fearful and worries during sexual encounters; instead of being a participant, he becomes a spectator and judge. This can create a vicious cycle of sexual dysfunction where the original cause of the erectile failure becomes less important than the fear of failure.

Sexual Response in Primary Partnership During Previous Year: This graph illustrates the frequency of orgasmic response as well as differences in perception by men and women in their partners’ responses.

C. Orgasm Disorders During an orgasm sexual pleasure peaks and sexual tension is released as the muscles in the pelvic region contract rhythmically. For men: semen is ejaculated. For women: the outer third of the vaginal walls contract. For the most part, men experience the same level orgasm consistently. However, women may experience various intensities. 1) Premature Ejaculation: characterized by persistent reaching of orgasm and ejaculation within one minute of beginning sexual activity with a partner and before he wishes to. As many as 30% of men experience premature ejaculation at some time. The dysfunction seems to be typical of young, sexually inexperienced men. a) Possible Biological Factors

2) Delayed Ejaculation: characterized by a repeated inability to ejaculate or by a very delayed ejaculation after normal sexual activity with a partner. Occurs in 8% of the male population. a) Possible Biological Factors 3) Female Orgasmic Disorder: characterized by persistent failure to reach orgasm, experiencing orgasms of very low intensity, or delay in orgasm. Almost 24% of women appear to have this problem. 10% or more have never reached orgasm and an additional 10% reach orgasm only rarely. a) Possible Biological Factors b) Possible Psychological Factors

D. Genito-Pelvic Pain/Penetrations Disorder: a disorder that applies to women who experience sexual pain and/or difficulty engaging in vaginal intercourse or penetration. 1) Vaginismus: the muscles surrounding the vagina involuntarily contract whenever vaginal penetration is attempted, making sexual intercourse painful or impossible. The pain cannot be explained by an underlying medical condition, and so is believed to have a psychological component.   A variety of factors can set the stage for this fear, including anxiety and ignorance about intercourse, exaggerated stories, trauma caused by an unskilled partner, and the trauma of childhood sexual abuse or adult rape.

Prevalence of Sexual Dysfunctions: This graph shows the percentage of respondents who reported having sexual difficulties at some time during the previous 12 months. Note the differences in the problems reported by men and women.

IV. Treatments for Sexual Dysfunctions A. Masters and Johnson They are considered two of the most influential figures to revolutionize sex therapy, working with many couples and with various sexual problems. B. Kegel Exercises The kegel muscle is near the pelvic floor in both men and women. They are also the muscles that are used to interrupt the urine stream. For men, kegel exercises can help with premature ejaculation. For women, kegel exercises can help strengthen vaginal muscles.

C. Low Sexual Drive or Desire 1) Masturbation 2) Novelty 3) Testosterone 4) Androgens D. Disorders of Sexual Arousal 1) Erectile Disorder Treatments for ED focus on reducing a man’s performance anxiety and / or increasing his stimulation.   Treatment may include sensate-focus exercises such as the “tease technique”.

1) Premature Ejaculation E. Disorders of Orgasm 1) Premature Ejaculation Premature ejaculation has been successfully treated for years by behavioral procedures such as the “stop-start” or “pause” procedure. 2) Delayed Ejaculation 3) Female Orgasmic Disorder Directed masturbation provides women opportunities to learn about their own bodies at their own pace and has a success rate of 70% to 90%. F. Genital Pain Disorders

V. Paraphilic Disorders A. Paraphilias: unusual or atypical patterns of sexual attraction that involve sexual arousal in response to atypical stimuli. For a paraphilic disorder to be diagnosed, the paraphilia must cause personal distress or impairment in important areas of daily functioning, or involve behaviors presently or in the past in which satisfaction of the sexual urge involved harm, or risk of harm, to other people. B. Exhibitionism: strong and recurrent urges, fantasies, or behaviors of exposing of one’s genitals to unsuspecting individuals for the purpose of sexual arousal. Typically, the person seeks to surprise, shock, or sexually arouse the victim.

C. Transvestism: a paraphilia (also called transvestic fetishism) in which individuals have recurrent and powerful urges, fantasies, or behaviors related to cross-dressing and are sexually aroused by cross-dressing. These men may wear full feminine attire and makeup or favor one particular article of clothing, such as women’s stockings. D. Voyeurism: a type of paraphilia involving strong and recurrent sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by watching unsuspecting people, generally strangers, who are naked, disrobing, or engaging in sexual activity. The voyeur usually masturbates while watching or while fantasizing about watching.

E. Frotteurism: a type of paraphilia involving recurrent, powerful sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by rubbing against or touching a non-consenting person. Frotteurism, also called “mashing,” often occurs in crowded places, such as subway cars, buses, or elevators. F. Pedophilia: a type of paraphilia involving recurrent and powerful sexual urges or fantasies or behaviors involving sexual activity with children (typically 13 years old or younger). To be diagnosed with pedophilia, the person must be at least 16 years of age and at least 5 years older than the child or children toward whom the person is sexually attracted or has victimized. To be diagnosed with pedophilic disorder, the sexual attraction to children has to be greater than or equal to any sexual attraction to adults. Many pedophiliacs were sexually abused by adults as children.

G. Sexual Masochism: strong and recurrent sexual urges, fantasies, or behaviors, in which the person becomes sexually aroused by being humiliated, bound, flogged, or made to suffer in other ways. 1) Hypoxyphilia: a paraphilia in which a person seeks sexual gratification by being deprived of oxygen by means of using a noose, plastic bag, chemical, or pressure on the chest. H. Sexual Sadism: strong and recurrent, powerful sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by inflicting physical or psychological suffering or humiliation on another person. I. Sadomasochism: refers to a practice of mutually gratifying sexual interactions between partners involving both sadistic and masochistic acts.

J. Fetishism: a type of paraphilia characterized by recurrent, powerful sexual urges, fantasies, or behaviors involving objects or nonsexual body parts. 1) Partialism: sole focus on part of the body, such as the breasts.

VI. Theoretical Perspectives and Treatment Regarding Paraphilias K. Other more rare paraphilias include... 1) Zoophilia 2) Coprophilia 3) Urophilia 4) Autonepiophilia 5) Necrophilia VI. Theoretical Perspectives and Treatment Regarding Paraphilias A. The Learning Perspective B. The Biological Perspective C. Treatment