2. Normal sexuality  Difficult to define  Easier to define abnormal sexuality

3. Abnormal sexuality  Destructive  Compulsive  Cannot be directed to a partner  Excludes stimulation of the primary sex organs  Guilt feeling and anxiety

4. psychosexuality Sexuality and total personality are so entwined that to speak of sexuality as a separate entity is virtually impossible

5. Sexuality and psychosexual factors  Sexual identity  Gender identity  Sexual orientation  Sexual behavior

6. Sexual identity  All mammalian embryos are anatomically female during early stages of fetal life  Differentiation results from the action of fetal androgens  Actions begins at the age of six and ends at age of 12 weeks of gestational age

7. Gender identity  Psychological aspects of behavior related to masculinity and femininity  By the age of 2-3 almost everyone has a firm conviction that “I am male” or “I am female”  Most often congruent  May conflicting or even opposite way  Results from experiences with family members, teachers, friends, and coworkers and from cultural phenomena

8. Sexual orientation Describe the object of a person’s sexual impulse  heterosexual(opposite sex)  homosexual( same sex)  bisexual(both sex)

9. Sexual behavior physiological response  Desire phase  Excitement phase  Orgasm phase  Resolution phase

10. Desire phase  Or appetitive phase  Reflects motivation, drives, and personality  Characterized by sexual fantasies and the desire to have sexual activity

11. Excitement phase Brought on by  Psychological stimulation( fantasy or love object)  Physiological stimulation(stroking or kissing)  Combination of both

12. Excitement phase Male physiological changes  Penile erection  Nipple erection  Increased testes size Female physiological changes  Erection of clitoris then retracts  increased breast size  Labia minor becomes thick and deep red  Orgasmic plateform (constriction along the outer third)

13. Orgasm phase Male  Inevitable ejaculation  Forceful emission of semen  4-5 rhythmic contraction of the prostate, seminal vesicles, vas and urethra Female  3-15 contraction of the lower third of vagina  Strong sustained contraction of uterus

14. Orgasm phase  Facial grimacing  Carpopedal spasm  Increased blood pressure 20-40mm hg  Increased heart rate up to 160  Cloudiness of consciousness  Lasts 3-25 seconds

15. Resolution phase If orgasm occur  Detumescence of genitalia  Subjective sense of well-being  General relaxation  Muscular relaxation If orgasm not occur  Prolonged resolution phase  Irritability and discomfort

16. Sexual disorders  Sexual desire disorder  Sexual arousal disorder  Orgasm disorder  Sexual pain disorder

17. Hypoactive sexual desire disorder 20% of population > Unconscious fear Unresolved oedipal conflict Vagina dentata Chronic stress, anxiety, depression Abstinence from sex Hostility to a partner

18. Female sexual arousal disorder Generally under stimated Often orgasm problem as well 33% of women in happy married couple Anxiety, guilt, fear Usually with dyspareunia and lack of desire Alteration in testosterone, estrogen, prolactin thyroxine

19. Punitive superego Inability to trust Fear, anxiety, moral prohibition 20-50% organic base Male erectile disorder

20. Lifelong, acquired, situational Acquired, 10-20% of all men Lifelong, 1% of all men under age 35 75% of all men over 80 Fear of impotence in all men over 40 Psychological cause VS organic cause  Morning erection  Erection without plan  Erection with masturbation

21. Female orgasmic disorder Inhibited orgasm, anorgasmia Masturbation or coitus Prevalence: 30% Fear of impregnation Rejection by a sex partner Damage to the vagina Hostility toward men Guilt feeling Experince frustration or symptom free Pelvic complaints, lower abdominal pain, itching, vaginal discharge, Fatigue, irritability, tension

22. Acquired male orgasmic disorder  Interpersonal difficulties  Greater demand of partner  Ambivalent for pregnancy  Unexpressed hostility  More common in OCD man Male orgasmic disorder

23. Orgasmic anhedonia Incidence of orgasm disorder Life long orgasmic disorder  Indicate severe psychopathology  Rigid, puritanical Back ground  Sex as sinful act  Conscious or unconscious incest wishes

24. Premature ejaculation More common in college educated men Chief complaint of 35-40% of men Treated for sexual disorder Anxiety regarding the sex act Unconscious fear of vagina Negative cultural conditioning Stressful marriage

25. Dyspareunia > Often with vaginismus Unknown incidence History of rape History of childhood sexual abuse Anxiety about the sex act 30% of all genital area surgical procedure

26. Vaginismus High educated women High socioeconomic status Sexual trauma (rape) Psychosexual conflict Strict religious upbringing Protest in nonverbal fashion

27. paraphilia  Unusual fantasies or sexual urges or behaviors  Recurrent  Sexually arousing  Focus on a person’s humiliating himself or herself or a partner, on children or other nonconsenting people, or on nonhuman objects  6 months duration  Clinically significant distress or impairment

28. classification  Exhibitionism  Fetishism  Frotteurism  Pedophilia  Sexual sadism  Sexual masochism  Voyeurism  Transvestic fetishism  Paraphilia not otherwise specified

29. Epidemiology  Practiced only by small percentage of the population  But large proportion of the population victimized due to repetitive nature of disorder  Pedophilia is most common  Fetishism almost always occur in men  Peak of incidence 15-25  Usually 3-5 paraphilia in a person

30. Etiology  Psychological factors failure to resolve oedipal crisis early experiences  Biological factors abnormal hormone level, hard or soft neurological signs, chromosomal abnormalities, seizure, major mental disorder