12. Sexual and gender identity disorders Flashcards
Driving concern of sexual disorders…
Am I normal?
Hyde (1994) ways of determining normal
Statistical deviance (what few people do)
Sociological deviance (what a cultural regards as deviant)
Psychological deviance (criteria vary, include harm, nonhuman objects, levels of distress, issue of consent)
Problem of distinguishing the illegal and, at least in some cultures, the immoral, from the abnormal.
Confusion of the cultural optimal with the normal – eg, in our culture relationships are regarded as more valid forms
of sexual expression than masturbation or celibacy, but does this make these later sexual expressions (or nonexpressions) abnormal?
Types of sexual disorders
Homosexuality Frigidity Hysteria Masturbation Sado-masochism Transgender Nymphomania Sex addiction
Sexual disorders in the DSM-5… Not official?
The mental disorders included in DSM 5 have not gained their official status through any rational process of elimination.
They made it into the system and have survived because of practical necessity, historical accident, gradual accretion, precedent and inertia - not because of some independent set of abstract and universal definitional criteria.
No surprise then that the DSM disorders are something of a hodgepodge, not internally consistent or mutually exclusive
Three broad categories of sexual disorders in DSM-5
Sexual Dysfunctions
Paraphilias
Gender Identification
Buss (1966) and Bancroft (1978) symptoms of sexual disorders
Buss: discomfort, inefficiency and bizarreness
Bancroft: sexual responsiveness, formation of relationships, gender identity
Change in the DSM5 relating to sexual disorders
One of the major chances in DSM 5 is the separation of the sexual disorders from a single section to three separate sections
The two neighbouring sexual disorders
Sexual dysfunctions and gender dysphoria
The third group of sexual disorder
Paraphilic disorder - follows the section on personality disorder
Categorisation of other sexual problems in the DSM 5
the broad categorisation into problems with normal heterosexual penetrative intercourse, ‘unusual’ objects of desire or ‘unsafe’ practices, and gender inappropriateness/incongruence has been retained.
Why are other criteria added to sexual disorders?
Because there so many ‘judgement calls’ are necessary in ‘diagnosing’ sexual disorders, usually other criteria are added, including some measure of the person’s own distress (as in the case of most DSM categories).
Eg., a person who is not interested in sex is not regarded as abnormal unless their disinterest bothers them, not necessarily those close to them. (Although one might still ask, why would it bother the person unless others were hassling them?)
Parahilic disorder
‘A paraphilic disorder is a paraphilia that is currently causing distress or impairment to the individual or a paraphilia whose satisfaction has entailed personal harm, or risk of harm, to others. A paraphilia is a necessary but not a sufficient condition for having a paraphilic disorder, and a paraphilia by itself does not automatically justify or require clinical intervention.’
What must diagnostic judgements take into consideration in diagnosing sexual disorders?
‘For many types of disorder, the clinician must decide whether the person has engaged in sexual activities that would normally be expected to produce sexual arousal or orgasm. Diagnostic judgments must take into consideration the person’s age, as well as the circumstances in which the person is living, such as the presence of a partner, access to privacy, and so on. For all of these reasons, the reliability of diagnostic decisions for sexual dysfunctions is probably quite low.’
Further considerations when diagnosing sexual disorders
– Whether the disorder has been present since the ‘onset of sexual functioning’ (lifelong type) or whether it has
developed ‘after a period of normal functioning’ (acquired type).
– Whether it is limited to specific situations (situational type) or not (generalised type), eg, erectile dysfunction.
– Whether the dysfunction is due to psychological factors alone, or a combination of psychological and medical
factors.
– Whether it can be accounted for by any other axis one disorder (eg, major depression), substance abuse or a medical condition. DSM 5 adds that partner, relationship, individual, and cultural/religious factors must also be considered.
– How many dysfunctions are present, as they often occur multiply.
Sexual dysfunctions
Normed on heterosexual, penetrative intercourse.
Assumes both partners need to be aroused and satisfied in the sexual act, and that this occurs most likely with penetrative intercourse.
Deal with problems obtaining and holding an erection, being penetrated, and level of sexual desire.
must be present for at least 6 months to be considered a sexual disorder
male erectile disorder prevalence
Thought to be the most common sexual dysfunction, striking most men at some point in their lives. Reuben estimates 30/40% men suffer at any given time (NHSLS * data, 1999, suggest premature ejaculation is most common male sexual dysfunction affecting one in three men in a 12 month period).
causes of male erectile disorder
Half caused by medical problems: including circulation problems, spinal chord damage, alcohol, stress and fatigue.
Other half thought to be psychological; eg., spectatoring, Madonna/whore syndrome.
When are the causes of male erectile disorder not physical?
Generally, if a man can have an erection in sleep, in the early morning or whilst masturbating, the causes are not physical.
premature ejaculation
Hard to define: Masters and Johnson, the inability to delay until your partner has an orgasm 50% of the
time.
Helen Singer Kaplan states it is a loss of voluntary control over ejaculation (similar to DSM IV).
Waldinger (2003, 2009) & DSM 5.0 suggest a period of less than a minute to orgasm following penetration. (Normal according to Reuben is 5 to 10 minutes; between 50 to 100 pelvic thrusts.)
Usually psychological, can be caused by local infection. Tends to effect younger men than older men.
Although this is usually regarded as a male problem, some women also report reaching orgasm too quickly as well (see your text, 2015 version, p. 346)
Inhibited or delayed ejaculation (male orgasmic disorder)
Occurs to only around 10% of the population.
Psychoanalytic approaches sometimes regard it as a form of withholding, linked to anger against women.
Not as positive as one might think – Reuben suggests it leads to exhaustion and frustration for many couples.
Female Sexual Arousal Disorder
Inhibition of arousal response despite desire.
Failure to sustain an adequate ‘lubrication-swelling response of sexual excitement’. Can be generalised or situational
the woman may actually be experiencing sexual arousal physically but not noticing her response subjectively. It also refers to NHSLS data which suggests over one in three women experience it over a 12 month period)..
Female Orgasmic Disorder
Absence of or failure to achieve orgasm following a period of ordinary sexual arousal and excitement.
In fact, it is very common for women not to have orgasm during penetrative sex, usually because the clitoris does not receive sufficient stimulation.
Commonality of females to have orgasms during sex
Hite (1976) found only 24% of 3000 women in her sample said they always had orgasm through penetrative sex alone without hand stimulation. Your textbook mentions that the NHSLS study reported only 29% of women always had an orgasm with their partners.
Commonality of women faking orgasms
50-60% of women in most studies report faking orgasms at least some of the time. Cooper (2013) found this was usually to spare their partner’s feelings and/or end the sexual encounter
Most effective method of ensuring an orgasm in women
For women, masturbation or manual stimulation is usually the most effective method of ensuring orgasm. The woman on top position is better than the traditional ‘missionary’ position for women to effectively orgasm through penetration.
What disorders are included in the category o Genito-Pelvic Pain/Penetration Disorder
Vaginismus Painful Intercourse (dyspareunia)
Vaginismus
– Spastic contractions of muscles of outer third of vagina which prevents penetration.
– Will prevent penetration but also medical examinations and the insertion of tampons.
Causes of Vaginismus
Thought to usually be trauma induced (eg, childhood sexual abuse)
Cause of Painful Intercourse (dyspareunia)
– Can also occur in men, but more rarely.
– According to LeVay and Valente (2006) causes in women may be due to scarring, developmental malformations, infections such STIs, allergic reactions to spermacides, insufficient lubrication, thinning of vaginal walls with ageing.
Hypoactive Sexual Desire Disorder
Common to both men and women
– Low sexual desire, lack of sexual fantasies, lack of interest in sexual experiences.
– Keep in mind that level of sexual interests in all people varies over time. 1/3 of women in NHSLS survey reported lack of sexual desire
Hypoactive Sexual Desire Disorder in the DSM-5
In DSM 5.0 this disorder is restricted to males only, whilst females have a separate sexual interest/arousal disorder. This lack of sexual interest must distress them to be considered a sexual disorder.
Causes of sexual disorders
organic
Drug
Psychological
