1. Sexual Disorders
Dr. Vidumini De Silva

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

3. Disorders
Paraphilia
Sexual dysfunctions
Other

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

5. 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

6. 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

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

8. 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

9. Exercise 01
What’s your role?

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

11. 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

12. 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

13. 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

14. 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 : ?

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

16. Exercise 02
What’s your role?

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

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

19. Thank You!