1. Sexual and Gender Identity Disorders What Is “Normal” vs. “Abnormal” Sexual Behavior? What Is “Normal” vs. “Abnormal” Sexual Behavior?  Cultural considerations  Gender differences in sexual behavior and attitudes  Complex interaction of biopsychosocial influences Including partner’s characteristics Including partner’s characteristics

2. Sexual and Gender Identity Disorders Gender Identity Disorder Gender Identity Disorder Sexual Dysfunctions Sexual Dysfunctions Paraphilias Paraphilias Not Sexual Orientation (Homosexuality) Not Sexual Orientation (Homosexuality)

3. Gender Identity Disorder Difference between sex and gender Key feature: sense of being trapped in the body of the wrong sex  Assume the identity of the desired sex  Goal is not sexual Causes are unclear  Gender identity develops between 18 months and 3 years of age

4. Gender Identity Disorder Transsexualism Transsexualism  Goal is Not Sexual  No Physical Abnormalities  Independent of Sexual Arousal Patterns NOT Transvestism NOT Transvestism Homosexuality Homosexuality  Unrelated

5. Gender Identity Disorder Sex-reassignment as a treatment  Who is a candidate? – Basic prerequisites before surgery  75% report satisfaction with new identity  Female-to-male conversions adjust better Psychosocial treatment  Realign psychological gender with biological sex  Few large scale studies

6. Sexual Dysfunctions Involve desire, arousal, and/or orgasm Pain associated with sex can lead to additional dysfunction Men and Women experience parallel versions of most dysfunctions  Affects about 43% of all women and 31% of men  Most prevalent class of disorder in the United States

7. Classification of Sexual Dysfunctions Lifelong vs. acquired Generalized vs. situational Psychological factors alone Psychological factors combined with medical condition

8. Sexual Response Cycle

9. Sexual Dysfunctions Desire Desire  Hypoactive Sexual Desire  Sexual Aversion Disorder Arousal Arousal  Male Erectile Disorder  Female Sexual Arousal Disorder

10. Sexual Dysfunctions Orgasm Orgasm  Inhibited Orgasm  Premature Ejaculation Pain Pain  Dyspareunia  Vaginismus

11. Sexual Dysfunctions Causes? Causes?  Medical Conditions  Medications  Alcohol and Other Drugs  Traumatic and/or Negative Experiences  Performance Anxiety and Distraction  Interpersonal Factors  Cultural Factors

12. Sexual Dysfunctions Biological Treatments Biological Treatments  Medications and Injections  Surgery and Implants  Vacuum Device Therapy

13. Sexual Dysfunctions Psychosocial Treatments Psychosocial Treatments  Education  Eliminate Performance Anxiety (Spectator Effect)  Relationship Enhancement  Gradual Building of Intimacy Sensate focus and nondemanding pleasuring Sensate focus and nondemanding pleasuring  Squeeze technique (Premature ejaculation)  Masturbation training (Female orgasm disorder)  Use of dilators (Vaginismus)  Exposure to erotic material (Desire problems)

15. Paraphilias Definition Definition Often multiple paraphilic patterns of arousal Often multiple paraphilic patterns of arousal High comorbidity with anxiety, mood, and substance abuse disorders High comorbidity with anxiety, mood, and substance abuse disorders

16. Paraphilias Pedophilia Pedophilia Fetishism Fetishism  Transvestic Voyeurism Voyeurism Exhibitionism Exhibitionism Sadism and Masochism Sadism and Masochism Frotteurism Frotteurism

18. Other Paraphilias Scatologia -- Obscene Calls Scatologia -- Obscene Calls Klismaphilia -- Enemas Klismaphilia -- Enemas Coprophilia -- Feces Coprophilia -- Feces Zoophilia -- Animals Zoophilia -- Animals Necrophilia -- Corpses Necrophilia -- Corpses

19. Paraphilias Biological Treatments (Medication) Biological Treatments (Medication)  Anti-Androgen Reduces Testosterone Levels Reduces Testosterone Levels  Reduces Sexual Desire / Fantasy  Used for Sex Offenders  Seen as Only a Temporary Solution

20. Paraphilias Psychosocial Treatment Psychosocial Treatment  Suppression Paradoxically Backfires Paradoxically Backfires  Covert Sensitization  Orgasmic Reconditioning  Family and Marital Therapy  Relapse Prevention

21. Clarifications Homosexuality is not considered a disorder Homosexuality is not considered a disorder Homosexuality is unrelated to gender identity disorder Homosexuality is unrelated to gender identity disorder “Cross-dressing” could be due to: “Cross-dressing” could be due to:  Transvestic fetish  Transsexualism  “Being a Drag Queen”