SEXUAL DISORDERS

- Sexual expression and sexual behaviours vary so widely from person to person

such that it is difficult to define what is “normal” and “abnormal.”

- Sexual behaviour is regarded as a disorder if

- it causes personal distress on the individual

- if it causes harm to self

- if it causes harm to others

- There was little scientific information about sexuality until the late 1960s,

when Masters and Johnson began investigating and documenting the human

sexual response cycle in the laboratory.

- These investigations resulted in a more open attitude in studying,

discussing, and understanding issues regarding human sexuality.

- According to Masters and Johnson, the sexual response cycle is divided

into 4 phases:
- Desire phase

- Sexual fantasies and the desire to have sexual activity

- Excitement phase

- For men, after 10—30 seconds after stimulation, erection

of the penis begins as blood flow into the erectile tissue

increases. The testicles elevate and and the scrotum

thickens. Secretions appear on the glans of the penis.

(Secretions contain viable sperm.)

- For women, the breasts enlarge. The nipples become erect.

The labia majora and minora engorge with blood and

spread. The clitoris lengthens.

- Orgasm phase

- Peaking of sexual pleasure, with release of sexual tension

and rhythmic contraction of the perineal muscles and

reproductive organs
 - Resolution phase

- General relaxation and well-being

- Men have a refractory period wherein erection and orgasm

are not possible for a period of time

- Women, on the other hand, have no refractory period and

can therefore have multiple orgasms.

SEXUAL DYSFUNCTIONS

- Sexual dysfunctions are disturbances in the normal sexual cycle.

- Distresses the individual.

- Begins as a minor problem but becomes more problematic because the

individual becomes more self-consciousness about the problem.

- Anxiety over sexual performance leads to spectatoring.

- Causes of sexual dysfunctions include physical factors like

- medical illnesses

- substances such as alcohol, medications, illicit drugs, and even cigarettes

- anxiety and major depression

- relationship problems:
 - in such cases, treat the medical illnesses, substance addiction,

psychiatric illness, emotional problem before doing sex therapy

Problems with the Desire phase

- Hypoactive Sexual Desire:

- Lack of desire for sexual activity

- Absence of fantasies

- Sexual Aversion disorder:

- Avoidance of and distaste for sexual contact

Problems with the Excitement phase

- Female sexual arousal disorder:

- Inability to achieve or sustain lubrication or excitement

- May be able to have orgasm by means other than sexual

intercourse

- Male erectile disorder:

- Inability to achieve or sustain erection

Problems with the orgasmic phase

- Female/Male Orgasmic disorders:

- Delay or absence of orgasm after normal excitement

- Premature ejaculation:

- Ejaculation occurs with brief or minimal stimulation

- Orgasmic anhedonia

- No physical sensation of orgasm

Problems with the Resolution phase

- Post-coital dysphoria

- Feel of discomfort after sexual activity

- Post-coital headache

SEXUAL DYSFUNCTION
NOT OTHERWISE SPECIFIED

- Dyspareunia:

- Genital pain before, during, or after intercourse

 - Vaginismus:

- Involuntary spasm of vaginal musculature

- Masturbatory Pain

- Peyronie’s disease: abnormal curvature of the penis

- Other organic causes

- A careful sexual history is important

- This is the basis for designing the educational and treatment program for

people with sexual disorders.

- Treatment of sexual disorders includes

- Couples therapy

- Behavioral therapy and cognitive-behavioral therapy to reduce the

individual’s level of sexual anxiety.

- Physiological interventions such as penile rings/ injections/ implants for

males with erectile disorders

- Several specific therapies can also be used:

- Premature ejaculation: the squeeze method and the stop-start

technique

- Sensate focus program

 The couple is instructed to proceed in stages from non-genital

pleasuring to full sexual intercourse.

PARAPHILIAS
- Characterized by sexual fantasies, arousal, and urges in response to

inappropriate stimuli.

- Specific non-human objects (e.g., fetishes)

- Inappropriate persons (e.g., pedophilia, necrophilia)

- Inappropriate acts (e.g., exhibitionism, voyeurism)

- The paraphilias may involve

- The risk of harm to self or others (e.g., sadism-masochism, pedophilia),

and

- The risk of arrest and incarceration (necrophilia, zoophilia).

- Paraphilias are fixed and rigid behaviours such that the individual is unable to

achieve sexual gratification without the particular object or situation.

- Onset is typically in adolescence, and patients are usually male.

- Causes of Paraphilias:

- Biological predisposition

- Early learning experiences

- A loss of higher-order control in the nervous system that makes a person

sexually impulsive.

- Exhibitionism:

- Exposing the genitals to strangers or public performance of

sexual acts

- Voyeurism:

- Observing others undressing or engaging in sexual activity

- Frotteurism:

- Touching or rubbing against an unsuspecting or non-

consenting person

- Pedophilia:

- An adult (usually male) has a preference for sexual activity

with children.
 - Three types of Pedophiles:

- Situational molesters

- Preference molesters, and

- Child rapists.

- Many pedophiles were themselves abused sexually as children.

- Current theories of pedophilia emphasize the factors of

- Learning

- Stress

- Faulty socialization, and

- Personality traits.

- Sexual sadism:

- Deriving pleasure from humiliating or abusing others by

inflicting physical, psychological, or emotional pain.

- Sexual masochism:

- Being beaten, bound, humiliated, or otherwise made to suffer

- Often, sadism and masochism occur together in the same

individual- a condition described as sadomasochism.

- Fetishism:

- Specific objects such as shoes, garments, or materials like

rubber
 - Individual with fetish prefers the object over sexual intimacy

wth a partner

- Trasvestic fetishism:

- Cross dressing; Sexual gratification by dressing up in women’s

clothing

- Heterosexual male

PARAPHILIA NOT OTHERWISE SPECIFIED (NOS)

- Telephone scatologia – obscene phone calling or online

messaging with an unsuspecting person

- Necrophilia – obtaining sexual gratification from cadavers

- Partialism – sexual focus on one part of the body

- Zoophilia - animals are trained to participate in sexual activities

which include intercourse, masturbation, and oral sex

- Coprophilia - sexual pleasure associated with the desire to

defecate on a partner, to be defecated on

- May be accompanied by coprophagia (eating feces) and

coprolalia (talking dirty)

 - Urophilia - sexual pleasure associated with the desire to urinate on

a partner or to be urinated on

- Hypoxyphilia – desire to achieve a state of altered consciousness

due to hypoxia while experiencing orgasm

- Also known as auto-asphyxiation or self-suffocation

- Compulsive masturbation

- Paraphilias can be long-term and highly resistant to treatment.

- Behavioral interventions for redirecting arousal

- Group therapy

- Social skills training

- Cognitive therapy

- Biological interventions:

- Castration

- Medical

- Surgical

- Psychosurgery

- Because of the extreme nature of these interventions and lack of

consistent effectiveness, they are not considered treatment of

choice.
 GENDER IDENTITY DISORDER
- Gender identity refers to the internal feelings of being male or female.

- Gender identity disorder: Characterized by

- A discrepancy between a person’s biological sex and gender identity.

- Also referred to as transexualism

- Patients often express intense distress, rejection, and disgust

toward their genitals and secondary characteristics of their sex

(e.g., breasts, facial hair).

- A strong and persistent identification with the opposite sex

- Cross gender identification is expressed by:

- Endeavouring to appear as a member of the opposite sex

- Wearing clothing of the opposite sex,

- Adopting behaviours of social roles,

- Characteristics are typically observed in childhood or adolescence.

- Causes:

- Biological vulnerability

- Early learning experiences.

- Psychotherapy is focused on helping the client

 - Learn to live with the feelings of distress associated with their assigned

sex.

- To enhance the appearance or feeling of what they believe to be the correct

sex, patients may seek

- Hormonal treatment

- Surgical enhancement or reduction

- Full sex-reassignment surgery

- Good adjustment after surgery depends on good adjustment

before surgery

- Social and emotional support systems

- occupational stability

- Better outcome is also found in better-educated patients

OTHER SEXUAL DISORDER NOT OTHERWISE

SPECIFIED (NOS)
- Unconsummated marriage

- Body image problems

- Hypersexuality

- Don Juanism in men

- Nymphomania in women