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Sexual Disorders

Sexual Disorders. Levels of Sexuality Sexual Identity Sexual Orientation Sexual Interest Sex Role Sexual Performance. Sexual Identity. Male or female Usually consistent with biology. Disorder : Gender Identity Disorder (Transsexualism) Belief that you are opposite sex from biology

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Sexual Disorders

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  1. Sexual Disorders Levels of Sexuality • Sexual Identity • Sexual Orientation • Sexual Interest • Sex Role • Sexual Performance

  2. Sexual Identity • Male or female • Usually consistent with biology

  3. Disorder: Gender Identity Disorder (Transsexualism) • Belief that you are opposite sex from biology • Many cross-dress, live as opposite sex • Actions are not sexually arousing

  4. 1 in 100,000 – Men • Usually begins in childhood • Chronic course

  5. Etiology • Prenatal hormonal influences • Masculine hormones => masculine sex organs & male sex identity • Absence => female organs & identity

  6. Treatment 1. Therapy to deal with feelings - Often severe adjustment problems - Usually ineffective in changing sexual identity 2. Sexual-reassignment surgery & hormone treatment - Fairly successful

  7. Sexual Orientation • What sex you fall in love with • Orientation is NOT a choice • Continuum

  8. Disorder: None • Most homosexuals are well-adjusted • Some = unhappy, want to be heterosexual • Women more accepting of homosexuals than men • Prevalence = < 10%

  9. Etiology of Homosexuality • Prenatal hormones -> predisposition • Also influenced by later events • Evidence of different brain structure & genetic data from twin studies • Most research is based on males

  10. Treatment • None • If ego-dystonic, treat either homosexuality or dystonicity • Some success in changing orientation via aversive therapy • Probably would also need orgasmic reconditioning

  11. Sexual Interest • Objects of arousal • Most men = female body • Women = male body

  12. Disorders: Paraphilias • Unusual sexual interests that impair “normal” erotic relations • Paraphilic fantasies are common

  13. Disorder a) person acts on fantasy b) object becomes necessary • person is distressed or object replaces human partners

  14. Paraphilic Categories a) Nonhuman objects • Fetishes • Transvestic fetishism

  15. b) Humiliation/pain • Sadism • Masochism

  16. c) Children or nonconsenting adults pedophilia exhibitionism voyeurism frotteurism

  17. Etiology • Classical conditioning • Paraphilic object/situation (CS) is paired with sexual arousal (US) and sexual pleasure (UR) • Person then strengthens bond between CS & CR • No arousal to “normal” adult stimuli • Maybe deficient social skills • Preparedness

  18. Treatment • Rarely diminish on own • But can be treated • Rationale for tx: A learned/conditioned paraphilia can be unlearned

  19. a) Aversion therapy • electrical shock • chemical nauseants b) Covert sensitization • Aversive stimulus is imagined • Focus on negative consequences

  20. c) Orgasmic Reconditioning • Teach link between sexual pleasure and “normal” stimuli

  21. Treatment is mildly effective • 40% flashers reoffend (vs. 60% untreated) • Cognitive component improves rates (25% reoffend) • Cannot change underlying desire but can change some behavior

  22. Sex Role • Public expression of sexual identity • Parents/society/peers • Fetal hormones

  23. Disorder: None • Previously thought non-sex-typed -> problems

  24. Sexual Performance • Adequacy of performance in sexual situations • Disorders (4 categories) - Decreased sexual desire or response

  25. 1. Sexual Desire * Hypoactive Sexual Desire - No interest in sex, often regarding a particular partner * Sexual Aversion Disorder Extreme dislike of sexual activity

  26. 2. Sexual Arousal * Female Sexual Arousal Disorder * Male Erectile Disorder - difficulty experiencing or maintaining arousal - very common - reaction heightens problem

  27. 3. Orgasmic Disorders * Female & Male Orgasmic Disorders - inability to reach orgasm (women) - premature ejaculation in men (most common male problem) - can lead to Male Erectile Disorder - men also have retarded ejaculation

  28. 4. Pain disorders (women) * Dyspareunia - painful intercourse * Vaginismus - muscle spasms rendering intercourse painful/impossible

  29. Etiology Physical Causes (minority of cases) a) aging b) alcohol/drugs/antidepressants c) medical problems

  30. Psychological Causes • Anger • Cognitions (performance anxiety) • Traumatic sexual experience - condition fear/shame

  31. Treatment Direct Sexual Therapy Masters/Johnson • With couple • Explicit instruction & then practice

  32. Sensate Focus = nondemand pleasuring • Anxiety blocks excitement & pleasure • Reduce anxiety via sensuous exercises with no performance (intercourse)

  33. Rape Rape is not a Paraphilias because 1) Most rapists usually do not need rape to become aroused 2) Calling rape a “disorder” reduces person’s responsibility

  34. What factors may lead to date rape? • Double standard Hidden norms that may condone sexualaggression in men • Changing sexual values Lack of accepted standards about how people should behave

  35. Alcohol/drugs • Impair judgment, decrease inhibitions, render women more vulnerable Miscommunication • Wait to make decision • Woman may then be easily influenced • Social norms re game playing

  36. Media • Sexual violence • Increase acceptance of rape myths • Decrease sensitivity to victims

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