Sex Differences and Defects

1. Sex Differences and Defects Sexual Dysfunctions and Therapies Hormones

2. Sexual Dysfunctions and Therapies • Statistical definition – • An abnormal sexual behavior is rare or not practiced by many people. • Sociological approach– • Sexual behavior that violates the norms of society. • Psychological approach– • Criteria include discomfort, inefficiency, and bizarreness. • Medical approach– • The Diagnostic and Statistical Manual of Mental Disorders recognizes 8 paraphilias. • A paraphilia is a recurring, unconventional sexual behavior that is obsessive and compulsive.

3. Sexual Dysfunctions and Therapies Normal-Abnormal Continuum: • Normal and abnormal sexual behavior are not two separate categories, but rather gradations on a continuum.

4. Sexual Dysfunctions and Therapies Compulsive Sexual Behavior: • A disorder in which the individual experiences intense, sexually arousing fantasies, urges, and associated sexual behaviors. • Intrusive, driven, and repetitive. • Lacking in impulse control. • Often incur social and legal sanctions. • Interfere with personal and occupational functioning. • Create health risks.

5. Sexual Dysfunctions and Therapies • Fetishism is characterized by sexual fantasies, urges, or behaviors involving use of nonliving objects: • To produce or enhance sexual arousal. • With or in the absence of a partner. • Over a period of at least six months. • Causing significant distress.

6. Sexual Dysfunctions and Therapies • Learning theory: • Fetishes result from classical conditioning, in which a learned association is built between the fetish object and sexual arousal and organism. • Cognitive theory: • Fetishists have a serious cognitive distortion in that they perceive a nonconventional stimulus as erotic.

7. Sexual Dysfunctions and Therapies Transvestism: • Refers to dressing as a member of the other gender. • Drag queens are male homosexuals that dress up as women. • Female impersonators are men who dress as women, often as part of an entertainment job. Transvestite fetishism: • Refers to a heterosexual man who dresses in female clothing to produce or enhance sexual arousal. • Transvestism is almost exclusively a male sexual variation and is essentially unknown among women.

8. Sexual Dysfunctions and Therapies • Sadist - A person who derives sexual satisfaction from inflicting pain on another person. • Masochist - A person who derives sexual satisfaction from experiencing pain. • Sadomasochism (S-M) Rare form of sexual behavior. • Causes are not precisely known.

9. Sexual Dysfunctions and Therapies • Bondage and discipline– • Use of physical or psychological restraints to enforce servitude. • Dominance and submission(D-S) – • The use of power consensually given to control the sexual stimulation and behavior of the other person. • Voyeur – • A person who becomes sexually aroused from secretly viewing nudes. • Scoptophilia – • A sexual variation in which the person becomes sexually arouse by observing others’ sexual acts and genitals.

10. Sexual Dysfunctions and Therapies Exhibitionism: • The person derives sexual pleasure from exposing his genitals to others in situations where this is clearly inappropriate. • A man who exposes himself is considered offensive, but a women who reveals most of her breast is likely to be thought of as attractive. • Causes of exhibitionism are not known.

11. Sexual Dysfunctions and Therapies • Nymphomania (women) and Satyriasis (men): • High level of sexual activity. • Excessive sex drive; person is apparently insatiable. • Leads to compulsive behavior; sexuality overshadows all other concerns and interests. Difficult to determine what is “excessive.” • Terms are imprecise; couples may disagree. • Especially difficult diagnosing women: • One definition for men was seven or more orgasms per week for six months, but this may not be abnormal for multiorgasmic women, and hypersexual women may have no orgasms.

12. Sexual Dysfunctions and Therapies Asphyxiophilia: • The desire to induce in oneself a state of oxygen deficiency in order to create sexual arousal or to enhance excitement and orgasm. • People engage in asphyxiophilia in the belief that arousal and orgasm are intensified by reduced oxygen.

13. Sexual Dysfunctions and Therapies Cybersex: • Use of the Internet to access sexually oriented materials, chat rooms, and bulletin boards. • Characterized by anonymity, accessibility, and affordability. • Can become compulsive, addictive and paraphilic.

14. Sexual Dysfunctions and Therapies • Troilism – (triolism) Refers to three people having sex together. • Saliromania - Disorder found mainly in men; desire to damage or soil a woman or her clothes. • Coprophilia - Feces are important to sexual satisfaction. • Urophilia - Urine is important to sexual satisfaction.

15. Sexual Dysfunctions and Therapies • Frotteurism -Sexual fantasies, urges, or behaviors involving touching or rubbing one’s genitals against the body of a nonconsenting person. • Necrophilia - Sexual contact with a dead person. • Zoophilia (bestiality) - Sexual contact with an animal.

16. Sexual Dysfunctions and Therapies Diagnosing: • Categories for diagnosis are not nearly as clear-cut as the may seem • Multiple diagnoses for one person are not uncommon. Prevention of Sexual Variations: • Difficult to do primary prevention. • Interest in developing preventive programs targeting children has increased. • Analyze the components of sexual development: • Gender identity • Sexual responsiveness • Formation of relationships with others

17. Sexual Dysfunctions and Therapies • Hormonal treatment: • Use of drugs to reduce androgen production or block effects of androgen. • Psychopharmacological treatment: • Use of psychotropic medications to influence psychological functioning and behavior.

18. Sexual Dysfunctions and Therapies Cognitive-Behavioral Therapies: • Behavior therapy. • Social skills training. • Modification of distorted thinking. • Relapse prevention.

19. Sexual Dysfunctions and Therapies Skills Training: • Programs may include: • How to carry on a conversation. • How to develop intimacy. • Basic sex education. • Sex surrogates interact socially and sexually with the client and a therapist.

20. Sexual Dysfunctions and Therapies • Sexual Disorder(sexual dysfunction) – • A problem with sexual response that causes mental distress. • Lifelong – • Present since the person became sexual. • Acquired – • Dysfunction appeared after a period of normal functioning.

21. Sexual Dysfunctions and Therapies • Sexual desire (libido) - an interest in sexual activity. • Hypoactive sexual desire- when the person is not interested in sexual activity. • Discrepancy of sexual desire- when one partner wants sex considerably less frequently than the other.

22. Sexual Dysfunctions and Therapies Sexual Aversion Disorder: • Strong aversion to sexual interaction, involving- • Anxiety • Fear • Disgust • Avoids any kind of genital contact with a partner. • Common in persons who have panic disorder.

23. Sexual Dysfunctions and Therapies Female Arousal Disorder: • Lack of response to sexual stimulation, including lack of lubrication. • Involves psychological and physiological elements. • Defined partly by a women’s sense that she does not feel aroused despite adequate stimulation.

24. Sexual Dysfunctions and Therapies Erectile Disorder: • Lifelong erectile disorder-Never been able to have an erection that is satisfactory for intercourse. • Acquired erectile disorder - Now has difficulty getting or maintaining an erection, but has had sufficient erections at other times. Male Orgasmic Disorder: • Unable to have an orgasm or it is greatly delayed, despite a solid erection and adequate stimulation. • Far less common than premature ejaculation.

25. Sexual Dysfunctions and Therapies Female Orgasmic Disorder: • Lifelong orgasmic disorder- Never experienced an orgasm. • Acquired orgasmic disorder- Previously had orgasms but no longer does so. • Situational orgasmic disorder- Orgasms in some situations but not others. • 24 percent of female respondents reported difficulty in the last 12 months with having orgasms. • Female orgasmic disorder accounts for 25-35 percent of the cases of women seeking sex therapy.

26. Sexual Dysfunctions and Therapies Painful Intercourse: • Dyspareunia - Pain experienced during intercourse. • Vaginismus - Spastic contraction of the muscles surrounding the entrance to the vagina.

27. Sexual Dysfunctions and Therapies Causes: Physical causes: • Disease and drugs. • Diseases associated with the heart and circulatory system. Hormonal Causes: • Hypogonadism - Under functioning of the testes, so that testosterone levels are very low. • Hyperprolactinemia - Excessive production of prolactin (associated with lactation).

28. Sexual Dysfunctions and Therapies Premature Ejaculation: • Premature ejaculation is more often caused by psychological than physical factors. • Physical factors such as a local infection or a nervous system degeneration may be involved in cases of acquired disorder. Male Orgasmic Disorder: • Most commonly associated with psychological factors. • May be associated with a variety of medical or surgical conditions, such as: • Multiple sclerosis • Spinal cord injury • Prostate surgery

29. Sexual Dysfunctions and Therapies Female Orgasmic Disorder: • Most cases are caused by psychological factors. • May be caused by physical factors, such as: • A severe illness • General ill health • Extreme fatigue • Injury to the spinal cord Dyspareunia: • Painful intercourse in women is often caused by organic factors: • Disorders of the vaginal entrance • Disorders of the vagina • Pelvic disorders • Painful intercourse in men can often be caused by a variety of organic factors: • For an uncircumcised man, poor hygiene may be the cause. • Prostate problems may cause pain on ejaculation.

30. Sexual Dysfunctions and Therapies • Some drugs may have side effects that cause sexual disorders. • Effects of alcohol vary considerably. Marijuana: • Many respondents report that marijuanaincreases sexual desire. • Chronic users report decreased sexual desire. Cocaine: • Said to increase sexual desire. • Chronic use is associated with- • Loss of desire • Orgasmic disorders • Erectile disorders

31. Sexual Dysfunctions and Therapies Stimulants: • Stimulant drugs such as amphetamines are associated with increased sexual desire, but in some cases, orgasm becomes impossible or difficult. • People high on crystal methamphetamine (ice) have a tendency to engage in risky sexual behaviors. Opiates: • Morphine • Heroin • Methadone • Have strong suppression effects on sexual desire and response. • Long-term use of heroin leads to decreased testosterone levels in males.

32. Sexual Dysfunctions and Therapies Psychiatric Drugs: • Psychiatric drugs alter functioning of the central nervous system which, in turn, affects sexual functioning. • Some antidepressants are associated, in both men and women, with • Arousal problems. • Delayed orgasm problems.

33. Sexual Dysfunctions and Therapies

34. Sexual Dysfunctions and Therapies Psychological Causes: • Immediate causes– • Various things that happen in the act of lovemaking itself that inhibit the sexual response. • Prior learning– • Things people learned earlier (childhood, adolescence, earlier adulthood), which now inhibit their sexual response. • Cognitive interference– • Thoughts that distract the person from focusing on erotic experience. • Spectatoring – • When the person behaves like a judge of his or her own sexual performance. • Failure of the partners to communicate– • One of the more important and immediate causes of sexual disorders.

35. Sexual Dysfunctions and Therapies • Emotional factors- • Such as depression, anger, sadness, and anxiety can interfere with sexual responding. • Behavioral or lifestyle factors- • Such as smoking, alcohol consumption, and obesity all are associated with higher rates of sexual disorders.

36. Sexual Dysfunctions and Therapies

37. Sexual Dysfunctions and Therapies • Interpersonal factors- • Disturbances in a couple’s relationship. • Anger or resentment toward one’s partner. • Fear of intimacy can cause a person to draw back from a sexual relationship before it becomes truly fulfilling.

38. Sexual Dysfunctions and Therapies • Behavior therapy – • Eliminates goal-oriented sexual performance. • Sensate focus exercises – • Gradually increase the sexual component as the couple successfully complete assignments. • Couple therapy - • Sexual and performance anxiety reduction. • Education and cognitive intervention. • Script assessment and modification. • Conflict resolution and relationship enhancement. • Relapse prevention training.

39. Sexual Dysfunctions and Therapies • Stop-start technique - Used in the treatment of premature ejaculation. • Kegel exercises - Strengthen the pubococcygeal muscle (PC muscle) along the sides of the vagina. • Bibliotherapy - Using self-help books to treat a disorder.

40. Sexual Dysfunctions and Therapies • Viagra (sildenafil), Cialis(tadalafil), and Levitra(vardenafil) • Treat erectile disorders • Do not seem to cause priapism (an erection that won’t go away) • Intrinsa – • A testosterone patch for post menopausal women experiencing low sexual desire, is in clinical trials.

41. Sexual Dysfunctions and Therapies • Suction devices - • A tube is placed around the penis until a reasonably firm erection is present. • Can be helpful in combination with cognitive-behavioral couple therapy. • Surgical therapy - • Inflatable penis – • Involves implanting a prosthesis into the penis. • This is radical treatment that should be reserved for cases that have not been cured by sex or drug therapy.

42. Sexual Dysfunctions and Therapies

43. Inflatable Penis

44. Sexual Dysfunctions and Therapies

45. Sexual Dysfunctions and Therapies • Masters and Johnson • Failure rate of 20% • Success rate of 80% • There is a lack of carefully controlled studies that investigate the success of various therapies compared with other therapies. • Disorders may be given a quick fix with drugs while the patient’s anxieties and relationship problems are ignored. • We must be sensitive to the values expressed in labeling something as being, or someone as having, a “disorder.”