1. Sexual and Gender Identity Disorders

2. Sexual Disorders Sexual Dysfunctions Paraphilias Gender Identity Disorders Sexual Disorder NOS

3. Sexual Dysfunctions Disturbance in sexual response or pain with intercourse. –Four phases Desire Excitement Orgasm Resolution No time frames or number of incidents, use clinical judgement

4. Subtypes Lifelong Acquired Generalized Situational Due to Psychological factors Due to combined factors

5. Sexual Desire Disorders Hypoactive Sexual Desire Disorder- lack of fantasies and desire for sexual activity that is causing distress or interpersonal difficulties and is not due to medical, substance or other Axis I Sexual Aversion Disorder-Recurrent and persistent aversion to and avoidance of genital sexual contact with partner

6. Sexual Arousal Disorders Female Sexual Arousal Disorder- Inability to attain or maintain adequate lubrication- swelling response Male Erectile Disorder- recurrent and persistent inability to maintain erection

7. Orgasmic Disorders Female Orgasmic Disorder- persistent/recurrent delay in or absence of orgasm following normal excitement phase Male Orgasmic Disorder- persistent/recurrent delay in or absence of orgasm following normal excitement phase Premature Ejaculation- persistent/recurrent ejaculation with minimal sexual stimulation

8. Sexual Pain Disorders Dyspareunia- genital pain with sexual intercourse Vaginismus- recurrent involuntary contraction of perineal muscles surrounding the outer third of the vagina when vaginal penetration is attempted (finger, penis, tampon, speculum…)

9. Other Sexual Dysfunctions Due to a medical condition Substance Induced NOS

10. Paraphilias Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving 1) nonhuman objects, 2) suffering or humiliation of self or partner, 3) children or nonconsenting partner AND At least 6 months AND Must cause significant distress or impairment except for pedophilia, voyeurism, exhibitionism, frotteurism, sexual sadism with nonconsenting partner (these just need to be acted on)

11. Types of Paraphilias Exhibitionism (genitals to unsuspecting stranger) Fetishism (non living objects not designed for sexual stimulation) Frotteurism (touching/rubbing up against a nonconsenting person) Pedophilia (sexual activity with prepubescent child- cl is at least 16 and 5 yrs older than child..If lat adolescent, do not count ongoing sexual relationship with 12 or 13 yr old)

12. Paraphilias Continued Sexual Masochism (being humiliated, beaten, bound, or made to suffer- Submissive/bottom/etc) Sexual Sadism (humiliation or physical suffering of victim is sexually exciting- Top/Dom/etc) Transvestic Fetishism- (heterosexual male and cross dressing) Voyeurism- observing unsuspecting person who is naked, disrobing, or engaged in sexual activity) NOS

13. Gender Identity Disorders Strong/persistent cross gender identification (desire to be or insistence one is the other sex) Evidence of persistent discomfort with one’s assigned sex AND clinically significant distress or impairment Does not apply to intersex individuals

14. Remember At one time, homosexuality was considered a disorder in the DSM and treatment plans were made. This is UNETHICAL. Keep this in mind if you have personal judgments about other’s sexuality. Fetishisms, the desire to be another sex than the one assigned to you, BDSM, etc are not disorders unless the client is distressed NOT OPPRESSED (and since the distress is often due to society’s issues, not the client’s- be careful and use careful clinical judgment in diagnosing) You can be more confident in the diagnosis if a nonconsenting party is involved.

15. Remember If a client comes to you asking you to help them change their sexual orientation, it is unethical to tell them this is possible from your treatment. Be careful as well with other areas of sexuality.