1. SS440: Unit 8 Sexual and Gender Identity Disorders Dr. Angie Whalen 1

2. Sexual and Gender Identity Disorders: An Overview What is “normal” vs. “abnormal” sexual behavior? ▫Normative facts and statistics ▫Cultural considerations ▫Gender differences in sexual behavior and attitudes 2

3. Sexual and Gender Identity Disorders: An Overview (continued) The development of sexual orientation ▫Complex interaction of bio-psycho-social influences ▫The example of homosexuality DSM-IV-TR sexual and gender identity disorders ▫Gender identity disorder ▫Sexual dysfunctions ▫Paraphilias 3

4. Defining Gender Identity Disorder Clinical overview – 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

5. Defining Gender Identity Disorder (continued) 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 5

6. Overview of Sexual Dysfunctions Sexual dysfunctions ▫Involve desire, arousal, and/or orgasm  Examples: Hypoactive Sexual Desire Disorder, Sexual Aversion Disorder, Male Erectile Disorder, Female Sexual Arousal Disorder, Inhibited Orgasm, Premature Ejaculation ▫Pain associated with sex can lead to additional dysfunction  Examples: Dyspareunia, Vaginismus 6

7. Overview of Sexual Dysfunctions (continued) Males and females experience parallel versions of most dysfunctions ▫Affects about 43% of all females and 31% of males ▫Most prevalent class of disorder in the United States 7

8. Overview of Sexual Dysfunctions (continued) Classification of sexual dysfunctions ▫Lifelong vs. acquired ▫Generalized vs. situational ▫Psychological factors alone ▫Psychological factors combined with medical condition 8

9. Causes and Treatment of Sexual Dysfunction Biological contributions ▫Physical disease, medical illness, prescription medications ▫Use and abuse of alcohol and other drugs Psychological contributions ▫The role of “anxiety” vs. “distraction” ▫The nature and components of performance anxiety ▫Psychological profiles associated with sexual dysfunction 9

10. Causes and Treatment of Sexual Dysfunction (continued) Social and cultural contributions ▫Erotophobia – learned negative attitudes about sexuality ▫Negative or traumatic sexual experiences ▫Deterioration of interpersonal relationships, lack of communication 10

11. Treatment of Sexual Dysfunction Education alone Psychosocial intervention Medical Treatment of Sexual Dysfunction ▫Erectile dysfunction  Viagra – is it really the wonder drug? ▫Few medical procedures exist for female sexual dysfunction 11

12. Paraphilias: Clinical Descriptions and Causes Nature of paraphilias – misplaced sexual attraction and arousal ▫Focused on inappropriate people, or objects ▫Often multiple paraphilic patterns of arousal ▫High comorbidity  With anxiety, mood, and substance abuse disorders 12

13. Paraphilias: Clinical Descriptions and Causes (continued) Main types of DSM-IV-TR paraphilias ▫Fetishism ▫Voyeurism ▫Exhibitionism ▫Transvestic fetishism ▫Sexual sadism and masochism ▫Pedophilia 13

14. Transvestic Fetishism Transvestic fetishism ▫Sexual arousal with the act of cross-dressing ▫Males may show highly masculine compensatory behaviors  Most do not show compensatory behaviors ▫Many are married and the behavior is known to spouse 14

15. Pedophilia Overview ▫Pedophiles – sexual attraction to young children ▫Incest – sexual attraction to one’s own children ▫Victims  Male and/or female children or very young adolescents ▫Pedophilia is rare, but not unheard of, in females 15

16. Pedophilia (continued) Associated features ▫Most perpetrators are male ▫Incestuous males may be aroused by adult women ▫Male pedophiles are not aroused by adult women ▫Most rationalize the behavior  Often engage in other moral compensatory behavior 16

17. Pedophilia: Causes and Assessment Causes of pedophilia ▫Associated with sexual and social problems and deficits ▫Patterns of inappropriate arousal and fantasy  May be learned early in life ▫High sex drive, coupled with suppression of urges 17

18. Pedophilia: Causes and Assessment (continued) Psychophysiological assessment of pedophilia ▫Deviant patterns of sexual arousal ▫Desired sexual arousal to adult content ▫Social skills deficits ▫Have difficulties forming appropriate adult relationships 18

19. Pedophilia: Psychosocial Treatment Psychosocial interventions ▫Most are behavioral ▫Target deviant and inappropriate sexual associations ▫Covert sensitization – imagining aversive consequences ▫Orgasmic reconditioning – masturbation plus appropriate stimuli ▫Family/marital therapy – address interpersonal problems ▫Coping and relapse prevention – self-control and risk management 19

20. Pedophilia: Psychosocial Treatment (continued) Efficacy of psychosocial interventions ▫About 70% to 100% of cases show improvement ▫Poorest outcomes – rapists/multiple paraphilias ▫Run a chronic course with high relapse rates 20

21. Pedophilia: Drug Treatments Medications: The equivalent of chemical castration ▫Often used for dangerous sexual offenders Efficacy of medication treatments ▫Drugs work to greatly reduce sexual desire, fantasy, arousal ▫Relapse rates are high with medication discontinuation 21

22. Summary of Sexual and Gender Identity Disorders Gender identity and gender identity disorder ▫Problem is not sexual ▫Feeling trapped in body of wrong sex Sexual dysfunctions are common in men and women ▫Problems with desire, arousal, and/or orgasm Paraphilias represent inappropriate sexual attraction ▫Desire, arousal, and orgasm gone awry 22