SEXUAL DISORDERS

CATEGORIES:

I. SEXUAL DYSFUNCTIONS
1. Sexual Desire Disorder
a. Hypoactive Sexual Desire Disorder
b. Sexual Aversion Disorder
2. Sexual Arousal Disorder
a. Female Sexual Arousal Disorder
b. Male Erectile Disorder
3. Orgasm Disorder
a. Female Orgasmic Disorder
b. Male Orgasmic Disorder
c. Premature Ejaculation
4. Sexual Pain Disorder
a. Dyspareunia
b. Vaginismus

II. PARAPHILIA
1. Pedophilia
2. Voyeurism
3. Fetishism
4. Frotteurism
5. Exhibitionism
6. Sexual Masochism
7. Sexual Sadism

III. GENDER IDENTITY DISORDER

IV. COMPULSIVE SEXUAL BEHAVIOR

SEXUAL RESPONSE CYCLE:

1. DESIRE (also called libido)

- This stage, in which a man or woman begins to want or desire sexual
intimacy or gratification, may last anywhere from a moment to many years.
2. EXCITEMENT (also called arousal)
- This stage, which is characterized by the bodys initial response to
feelings of sexual desire, may last from minutes to several hours.
3. PLATEAU
- This stage, the highest point of sexual excitement, generally
lasts between 30 seconds and 3 minutes.
4. ORGASM
- This stage, the peak of the plateau stage and the point at which
sexual tension is released, generally lasts for less than a minute.
5. RESOLUTION
- The duration of this stage, the period during which the body returns to its pre-excitement state, varies
greatly and generally increases with age.
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SEXUAL DYSFUNCTIONS
Might occur as the result of psychological, physiologic, and pharmacologic factors.

1. SEXUAL DESIRE DISORDERS

disruption in the desire phase of the sexual response cycle
Types:
a. Hypoactive Sexual Desire Disorder
deficiency or absence of sexual fantasies and desire
for sexual activity that causes marked distress or
interpersonal difficulty.
b. Sexual Aversion Disorder
aversion to and active avoidance of genital sexual contact with a sexual partner that causes
marked distress or interpersonal difficulty.

2. SEXUAL AROUSAL DISORDERS

disruption of the excitement phase of the sexual response cycle
Types:
a. Female Sexual Arousal Disorder
persistent or recurrent inability to attain or to maintain, until completion of the sexual activity,
an adequate lubrication-swelling response of sexual excitement, which causes marked distress
or interpersonal difficulty.
b. Male Erectile Disorder
persistent or recurrent inability to attain or maintain, until completion of the sexual activity, an
adequate erection, which causes marked distress or interpersonal difficulty.

3. ORGASM DISORDERS
disruptions of the orgasm phase of the sexual response cycle
Types:
a. Female Orgasmic Disorder
persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement
phase, which causes marked distress or interpersonal difficulty.
b. Male Orgasmic Disorder
persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement
phase, which causes marked distress or interpersonal difficulty.
c. Premature Ejaculation
persistent or recurrent onset of orgasm and ejaculation with minimal sexual stimulation before,
on, or shortly after penetration and before the person wishes it, causing marked distress or
interpersonal difficulty.

4. SEXUAL PAIN DISORDER

involve pain associated with sexual activity
Types:
a. Dyspareunia
genital pain associated with sexual intercourse causing marked distress or interpersonal
difficulties.
b. Vaginismus
persistent or recurrent involuntary contractions of the perineal muscles surrounding the outer
third of the vagina when vaginal penetration with penis, finger, tampon, or speculum is
attempted, causing marked distress or interpersonal difficulties.

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PARAPHILIA
Involve sexual activity with objects, children, and consenting or non-consenting adults that are
socially prohibited, unacceptable, or biologically undesirable.
DSM Criteria
The following paraphilic activities last over a period of 6 months and
cause distress or impairment in social, occupational, or other important
areas of functioning.

PEDOPHILIA
Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
that involve sexual activity with a child or children generally 13 years of
age or younger.
The person is at least 16 years f age and at least 5 years older than the
child or children involved.
VOYEURISM
Act of observing an unsuspecting person who is naked, in the process of
disrobing, or engaging in sexual activity.
FETISHISM
Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
using nonliving objects.
TRANSVESTIC FETISHISM
Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
involving cross-dressing by a heterosexual male.
FROTTEURISM
Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
involving touching and rubbing against a non-consenting person.

EXHIBITIONISM
Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
involving exposing ones genitals to unsuspecting strangers.
SEXUAL MASOCHISM
Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
involving the act of being humiliated, beaten, restrained, or otherwise
made to suffer.
SEXUAL SADISM
Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors
involving acts in which the psychological or physical suffering of the
victim is sexually exciting to the person.
OTHERS
Partialism exclusive focus on one part of the body
Bestiality / Zoophilia - animals
Necrophilia - corpses
Telephone Scatalogia obscene phone calls
Urophilia - urine
Coprophilia feces
Emetophilia vomit

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GENDER IDENTITY DISORDER

DSM-IV-TR Criteria
A. Strong and persistent cross-gender identification.

Children:
a. Stated desire or insistence that he or she is the other sex.
b. In boys, dressing in female attire; in girls, wearing only
masculine clothing.
c. Make believe play or fantasies of being the other sex.
d. Desire to participate in games and pastimes of the other sex.
e. Prefers playmates of the other sex.
Adolescents and adults:
a. Stated desire to be the other sex.
b. Frequently passes as the other sex.
c. Desires to be treated as the other sex.
d. Conviction that he or she has typical feelings and reactions
of the other sex.
B. Feelings of discomfort with own sex or inappropriateness in gender role of own sex. also
called
Transexualism
Persistent discomfort with ones biologic gender

COMPULSIVE SEXUAL BEHAVIOR

also called hypersexuality, nymphomania, erotomania or sexual addiction
overwhelming urge for sex
Behavior patterns:
1. Having multiple sexual partners or extramarital affairs.
2. Having sex with anonymous partners or prostitutes.
3. Avoiding emotional involvement in sexual relationships.
4. Using commercial sexually explicit phone and
internet services.
5. Engaging in excessive masturbation.
6. Frequently using pornographic materials.
7. Exposing sexual activity in public.
8. Use sex as an escape from other problems,
such as loneliness, depression, anxiety or
stress.
9. Continue to engage in risky sexual behavior despite serious consequences, such as
health
problems, the potential for sexually transmitted diseases and the loss of important
relationships.
10. Seek gratification through sexual behavior but are unlikely to achieve emotional
fulfillment and lives may feel empty.

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MANAGEMENT

TNPR
Trust
Acceptance
Empathy
Nonjudgmental attitude
Legal obligation to report suspected and actual sexual abuse

PSYCHOPHARMACOLOGY
Antiandrogen medications diminish sexual desire and fantasy
Oral / IM
1. Medroxyprogesterone (Provera)
2. Leuprolide acetate (LPA, Lupron)
- inhibit the release of the LH by the pituitary glad which decreases
the production of testosterone by the testes
3. Luteinizing hormone-releasing hormone (LH-RH) agonists
- inhibit the production of testosterone and reduce sexual drive.
SSRIs

MILIEU
Group therapy
self-help groups
groups dealing with self-esteem, assertiveness, anger management, social and relationship skills, sex
education, and stress management

Cognitive-Behavioral Therapies
1. Imaginal Desensitization
sexual situations are described in detail and the individual uses
relaxation techniques to tolerate discomfort and to suppress
sexual urges
2. Covert Sensitization
verbalization and association of negative consequences for
behavior
3. Cognitive Restructuring
irrational beliefs and rationalizations about the behavior are
challenged by group members or therapist
4. Victim Empathy Training
develop sensitivity to victims feelings
5. Aversive Stimulation
pairing of unpleasant experience with the deviant fantasy to
interrupt the fantasy and suppress the behavior