Sexual Dysfunctions & Disorders

Human Sexual Response Cycle Appetitive or DesireAppetitive or Desire ArousalArousal OrgasmOrgasm ResolutionResolution

Phases of Sexual Act AppetitiveAppetitive –Person has a desire for sexual activity –Person has thoughts or fantasies about sex –Person feels attracted to another person –Daydreams increase about sex

Phases of Sexual Act ExcitementExcitement –Specific and direct sexual stimulation (not necessarily physical) –Heart rate, blood pressure and respiration rate (Increase) –Blood flow to genitals

Phases of Sexual Act OrgasmOrgasm –Involuntary muscular contractions throughout the body –Eventual release of sexual tension –Ejaculation in males –Vaginal contractions in females

Phases of Sexual Act ResolutionResolution –Relaxation of the body –Heart rate, blood pressure and respiration (Return to normal) (Return to normal) –Occurs after ejaculation for males –Occurs after single or multiple orgasms for females

Homosexuality No longer considered a disorder (since DSM- IIIR)No longer considered a disorder (since DSM- IIIR) –No physiological differences in arousal –No difference in psychological disturbance –No gender identity confusion –Similar concerns regarding life issues

Dysfunction vs. Disorder DysfunctionDysfunction –Disruption of any part of the normal response cycle Sexual desireSexual desire Psycho-physiological changesPsycho-physiological changes Response cycleResponse cycle Causes distress for the personCauses distress for the person DisorderDisorder –Recurrent, intense sexual urges, fantasies or behavior that involves unusual objects, activities or situations –Causes distress or impairment

DSM-IV-TR Groupings Sexual DysfunctionsSexual Dysfunctions Gender Identity DisordersGender Identity Disorders ParaphiliasParaphilias

Sexual Dysfunctions Sexual Desire DisordersSexual Desire Disorders Sexual Arousal DisordersSexual Arousal Disorders Orgasmic DisordersOrgasmic Disorders Sexual Pain DisordersSexual Pain Disorders PrevalencePrevalence –Ranges from 5 to 35 percent of the general population

Sexual Desire Disorders Disorders related to the appetitive phaseDisorders related to the appetitive phase 40 to 50% of all sexual dysfunctions are desire (Spector & Carey, 1990)40 to 50% of all sexual dysfunctions are desire (Spector & Carey, 1990) Hypoactive sexual desire disorderHypoactive sexual desire disorder –Absent or low sexual interest or desire –20% of adults –Can be lifelong Sexual Aversion disorderSexual Aversion disorder –Avoidance of and aversion to sexual intercourse –Can be lifelong

Sexual Arousal Disorders Relate to the excitement phase.Relate to the excitement phase. Problems involving feelings of sexual pleasure.Problems involving feelings of sexual pleasure. Kaplan estimates that approximately 50% of men have experienced transient impotence.Kaplan estimates that approximately 50% of men have experienced transient impotence.

Sexual Arousal Disorders Female Sexual Arousal DisorderFemale Sexual Arousal Disorder –Inability to attain or maintain physiological response during sexual activity Male Erectile Disorder –Inability to attain or maintain an erection –Primary –Secondary

Orgasmic Disorders Female Orgasmic DisorderFemale Orgasmic Disorder –Persistent delay or inability to achieve orgasm Male Orgasmic DisorderMale Orgasmic Disorder –Persistent delay or inability to achieve an orgasm Premature EjaculationPremature Ejaculation –Ejaculation with minimal sexual stimulation

Orgasmic Disorders Female Orgasmic DisorderFemale Orgasmic Disorder –actually rare –less than 1% of women Male Orgasmic DisorderMale Orgasmic Disorder –rare –often associated with trauma Premature EjaculationPremature Ejaculation –38% of men experience this disorder

Sexual Pain Disorders DyspareuniaDyspareunia –Genital pain in a man or women not due to lack of lubrication in her vagina VaginismusVaginismus –Involuntary spasm of the vaginal preventing or interfering with sexual intercourse Possible causes (Masters & Johnson)Possible causes (Masters & Johnson) –Impotent partner –Rigid religious beliefs about sex –Sexual trauma

Etiology of Sexual Dysfunctions BiologicalBiological –Often secondary to medical problems e.g., androgen levels in womene.g., androgen levels in women e.g., vascular disease in mene.g., vascular disease in men –Chronic illness –Medications –Alcohol PsychologicalPsychological –Mood disorders –Attitudes about sex –Performance anxiety in men Social and culturalSocial and cultural –Sexual abuse

Treatment EducationEducation Physical examinationPhysical examination –Possible biological causes –Possible medication conflict TherapyTherapy Psychological Psychological –Sensate focus –Marital counseling –Communication training Medical - Viagra - Physical implants

Gender Identity Disorder Strong and persistent cross-gender identificationStrong and persistent cross-gender identification –Desire to be the other gender Persistent discomfort with one’s anatomical sexPersistent discomfort with one’s anatomical sex Causes distress or impairmentCauses distress or impairment TransexualismTransexualism

Gender Identity Disorder Onset tends to be in childhoodOnset tends to be in childhood BoysBoys –Tend to be called as girls –Tend to play more with “girl” toys –Often show personality problems in addition GirlsGirls –May insist she has a penis –Interest in “boy” play –Often labeled as boys

Gender Identity Disorder PrevalencePrevalence –More common in males –Ranges from 1 in 100,000 to 1 in 37,000 for males –Ranges from 1 in 400,000 to 1 in 100,000 for females (Arndt, 1991)

Etiology UnclearUnclear BiologicalBiological –Hormone imbalance PsychoanalyticPsychoanalytic –Unconscious conflict BehavioralBehavioral –Encouragement for certain behaviors

Treatment Usually involves both parent and childUsually involves both parent and child EducationEducation Behavioral modificationBehavioral modification Sex change operationsSex change operations –Female to male: some positive results –Male to female: fewer positive results –Often remain depressed

Paraphilias Sexual disorders of at least 6 monthsSexual disorders of at least 6 months Person has acted or is distressed by recurrent urges or fantasiesPerson has acted or is distressed by recurrent urges or fantasies Often co-morbid with more than one sexual disorderOften co-morbid with more than one sexual disorder Nearly 50% had engaged in a variety of sexually deviant behaviorsNearly 50% had engaged in a variety of sexually deviant behaviors Much more prevalence in males than femalesMuch more prevalence in males than females

Paraphilia Categories Non-human objectsNon-human objects Non-consenting PersonsNon-consenting Persons Suffering or HumiliationSuffering or Humiliation

Non-Human Objects FetishismFetishism –Sexual attraction involving nonliving objects –Most common: female underwear –Often used during masturbation or intercourse –Rare among women –As a group, these people are not usually dangerous nor do they tend to commit serious crimes Transvestic FetishismTransvestic Fetishism –Sexual arousal by cross-dressing –Not trans-sexualism –Majority are heterosexual, married and have children

Non-Consenting Persons ExhibitionismExhibitionism –Urges, acts or fantasies involving exposure of genitals to strangers –Relatively common –Most often males in their 20s –Arousal is to commonly neutral situations –No contact desired FrotteurismFrotteurism –Involving touching or rubbing against a non- consenting person –Contact is the motive –Often occurs in crowded public places

Non-Consenting Persons VoyeurismVoyeurism –Involves observing unsuspecting person disrobing or engaging in sexual behavior –95% involve strangers –No contact is desired –Arrest is predictable PedophiliaPedophilia –Involving sexual contact with a prepubescent child Pedophilia –The person must be at least 16 years old to receive the diagnosis –The victim must be at least 5 years younger

Suffering or Humiliation SadismSadism –Sexually arousing urges associated with inflicting suffering on another. –Range from pretended infliction of pain to extremely dangerous pathological form of sadism involving murder MasochismMasochism –Sexual urges associated with being humiliated, bound or made to suffer. –Passive role. –Not dangerous.