Ch 12 (lesson 14) Sexual disorders

Question 1

Cultural influences beliefs about sexuality

Answer 1

• pleasure vs procreation
• acceptable sexual behaviors vary w times and culture
  
  • 19th and early 20th c believed excess sexuality was a problem

Question 2

differences btwn men and women in sexuality

Answer 2

men:
- think more about sex/ want more
- masturbate more
- want and have more partners
- consistency across cultures
- have more sexual dysfunction as age

women
- desire for sex more often linked to relationship status/social norms
- tend to be more ashamed of appearance flaws
- may interfere w sexual satisfaction
- all ages, women more likely to report sexual dysfunction
- most common: lack of desire

Question 3

sexual response cycle

Answer 3

Masters and Johnson

1) desire phase (added by kaplan)
- refers to sexual interest
2) excitement phase
- physiological changes
- blood flow to penis/ vagina
- vaginal lubrication
3) orgasm phase
- emission and ejaculation
- outer walls of vagina contract
4) resolution phase
- relaxation, sense of well-being
- men have refractory period, orgasm cannot re-occur

(plateau left out)

Question 4

Debates about gender dysphoria

Answer 4

• 1/200 transgender in US
• DSM-5 criteria of gender dysphoria includes that the desire to be opposite sex causes marked distress of functional impairment

why it should not be labeled as a disorder:
- cross-gender behavior is universal, not specific to humans
- diagnosis contradicts the need to transition
- diagnosing gender nonconformity may foster stigma

BUT
diagnosis may be a step in getting insurance coverage for therapy and transition surgery

Question 5

DSM-5 three categories of sexual dysfunction

Answer 5

1) sexual desire, arousal, interest disorders

2) Orgasmic disorders

3) Sexual pain disorders

Question 6

DSM-IV-TR vs DSM-5 diagnosis of sexual dysfucntions

Answer 6

desire and arousal disorders:
- hypoactive sexual desire disorder —> hypoactive sexual desire disorder in men, sexual interest/arousal disorder in women
- erectile disorder (stayed same)
- sexual aversion disorder (no longer disorder)

Orgasmic disorders
- Female orgasmic disorder (same)
- male orgasmic disorder —> delayed ejaculation
- premature ejaculation (same)

sexual pain disorders
- dyspareunia —>
- vaginismus —> both became Genito-pelvic pain/penetration disorder

Question 7

disorders involving sexual interest, desire, and arousal

Answer 7

• sexual interest/arousal disorder in women
  
  • persistent deficits in sexual interest (fantasies/urges), biological arousal, or subjective arousal
• Hypoactive sexual desire disorder in men
  
  • deficient or absent sexual fantasies/ urges
• Male erectile disorder
  
  • failure to attain/maintain erection

Question 8

DSM-5 criteria for Sexual interest/arousal disorder in women

Answer 8

at least 3 diminished, absent, or reduced for 6+ months

• interest in sex
• sexual/erotic thoughts/fantasies
  -initiation of sexual activity/ responsiveness to partners initiations
• sexual excitement/pleasure during encounters
• sexual interest/ arousal elicited by any internal/external erotic cues
• genital or nongenital sensations during most sexual encounters

causes marked distress or interpersonal problems

not due to medical illness, another psych disorder (except another sex. disfunction), or effects of a drug

Question 9

DSM-5 Criteria for Hypoactive Sexual Desire Disorder in men

Answer 9

• persistently deficient or absent sexual fantasies and desires, as judged by clinician
• causes marked distress or interpersonal problems
• not due to med illness, another psych disorder (except another sex disorder), or effects of a drug

Question 10

DSM-5 criteria for Male Erectile Disorder

Answer 10

-Persistent inability to attain/mantain erection adequate for completion of sex
- marked decrease in erections interferes w/ penetration or pleasure
- causes marked distress/ int. probs
- symptoms have been present most occasions for atleast 6 months
- not due to illness, another psych disorder (except other sex dysfunc) or effects of a drug

Question 11

Orgasmic Disorders

Answer 11

Female Orgasmic Disorder
- Absence of orgasm after sexual excitement
- many women achieve arousal but not orgasm

Premature Ejaculation Disorder
- Ejaculation that occurs too quickly

Delayed ejaculation disorder
- Persistent difficulty ejaculating

Question 12

DSM-5 criteria for Female Orgasmic DIsorder

Answer 12

on most occasions of sexual activity for at least 6 months
- marked delay, infrequency, or absence of orgasm
- markedly reduced intensity of orgasmic sensation
- causes marked distress or interpersonal problems
- not due to medical illness, another psych disorder (except another sex dysfunc) or effects of a drug

Question 13

DSM-5 Criteria for Delayed Ejaculation:

Answer 13

• marked delay, infreq., or absence of orgasm on most occasions of sexual activity for atleast 6 months
• causes marked distress or int. probs
• not due to med illness, another psych disorder (except sex dysfunc) or drug

Question 14

DSM-5 Criteria for Premature Ejaculation:

Answer 14

-Tendency to ejaculate during partnered sexual activity within one min of sexual activity
- causes clinically significant distress or int. probs
- not due to effects of drug, psych disorder, med condition

Question 15

Sexual Pain Disorder- Genitopelvic pain/ penetration disorder

Answer 15

• persistent or recurrent pain during intercourse
• diagnosable in men and women
  
  • rare in men
• rule out medicale cause (infection), lack of vaginal lubrication, or menopausal problems
• most women experience sexual arousal and orgasm from manual/oral stimulation w/out penetration
• 10%-30% prevalence rates
• Vaginismus and DYspareunia in DSM-IV-TR

Question 16

DSM-5 criteria for Genitopelvic pain/ penetration disorder

Answer 16

persistent or recurrent difficulties for at least 6 mo w at least 1:
-inability to have intercourse/penetration
- marked vulvovaginal or pelvic pain during vaginal penetration
- marked fear/anxiety about pain/ penetration
- marked tensing of pelvic floor muscles during attempted penetration

causes significant distress/ int probs

not due to drug, psych disorder, med condition

Question 17

Etiology of Sexual Dysfunction- Masters and Johnson’s two tier model

Answer 17

1) immediate causes
- performance fears
- Adoption of “spectator role”
- being an observer vs participant

2) distal (historical) causes
- sociocultural
- biological causes
- sexual traumas
- homosexual inclinations (not anymore)

Question 18

distal causes/ predictors of sexual dysfunction- biological factors

Answer 18

biological factors
- heavy drinking/smoking
- cardiovascular disease
- diabetes
- neurological disease
- hormone dysfunction
- SSRIs
- other illnesses/ meds

Question 19

distal causes/ predictors of sexual dysfunction- psych factors

Answer 19

• rape/sexual abuse
  
  • early childhood sexual abuse assoc. w diminished arousal/desire, genital pain, premature ejaculation
• lack of information/learning about sex
• relationship difficulties
  
  • anger, hostility, poor communication
  • underlying anxiety about relationship security
• neg cultural attitudes towards sex

Question 20

distal causes/ predictors of sexual dysfunction- psych factors

Answer 20

psych factors
- depression and anxiety, panic disorder
- low physiological arousal
- stress and exhaustion
- neg cognitions/ self blame
- spectator role and performance fears ( immediate cause)

Question 21

treatments of sexual dysfunction

Answer 21

• Anxiety reduction
• Directed masturbation (often for those w difficulty achieving orgasm)
• Procedures to change thoughts and attitudes
  
  • sensory awareness procedures
  • rational-emotive therapy
• couples therapy
  -Sexual skills and communication training

-medications and physical treatments
- squeeze technique for early ejaculation, SSRI dapoxetine also used
- PDE-inhibitors for erectile dysfunction
- Phosphodiesterase type 5 inhibitors : sildenafil (Viagra), tadafil (Cialis) and vardenafil (levitra)

Question 22

Paraphilic disorders

Answer 22

recurrent sexual attraction to unusual objects or sexual activities
- lasting at least 6 months
- deviation (para) in what the person is attracted to (philia)
- should only be diagnosed if causes marked distress or done w nonconsenting persons
- cross-dressing usually doesn’t involve non-consenting persons or impairment, only diagnosed if individual is distressed by it

Question 23

Paraphilias - 2 categories

Answer 23

• sexual attractions based on inanimate objects
• sexual attractions based on children

Question 24

Paraphilias included in DSM-5

Answer 24

• Fetishistic disorder - inanimate object or nongenital body park
• transvestic disorder (dated term)- cross-dressing
• pedophilic disorder- children
• Voyeuristic disorder- watching unknowning others undress/have sex
• exhibitionistic disorder: exposing to strangers
• frotteuristic disorder- sexual touching of unsuspecting other
• sexual sadism disorder- inflicting pain
• sexual masochism disorder- receiving pain

Question 25

Prevalence of paraphilic disorders

Answer 25

accurate prevalence statistics not available - data does indicate, mostly male and heterosexual - onset for many (includ. fetishistic, voyeuristic, exhibitionistic, pedophilic disorders) occur in adolescents - onset of sexual sadism/masochism occur early adulthood

Question 26

Fetishistic Disorder

Answer 26

Reliance on inanimate object or unsexual part of body for arousal - eg shoes, stockings, underwear, rubber garments, hair, feet, etc. - occurs most often in men - object strongly prefered and often necessary for sexual arousal attraction to object irresistable and involuntary fetishes often co-occur w other paraphilias

Question 27

DSM-5 criteria of fetishistic disorder

Answer 27

- at least 6 mo, recurrent intense fantasies/urges/behaviors involving body parts or objects - causes sig distress or impairment in functioning - objects not limited to clothing used in cross-dressing or sex toys

Question 28

Pedophilic Disorder

Answer 28

- Pedos = child, philia = attraction - sexually arousing urges/ fantasies/ behaviors involving sexual contact with a prepubertal or pubescent child - offender at least 16 and 5 years older than victim - child pornography widely used victims usually know to pedophile - neighbors, family members, friends, clergy - most pedophilia doesn't involve violence other than sexual activity relative interest in children vs adults is more telling about pedophilia- show more arousal for children than adults

Question 29

Incest

Answer 29

- listed as subtype of pedophilic disorder - most common btwn brother and sister - less common but more pathological: father and daughter - incest taboo almost culturally universal - genetically adaptive- offspring have greater likelihood of inheriting pairs of recessive genes w possible neg biological effects

Question 30

rape

Answer 30

- attempted/completed intercourse through force/ threat of force/ or when victim incapacitated and unable to give consent - 19.3% women raped, 1.7% men

Question 31

etiology of rape

Answer 31

- sexually aggressive men tend to show antisocial and impulsive personality traits - unusually high hostility towards women - distorted beliefs about sexual coercion - exposure to violence may increase likelihood to rape - rapists more likely to have been victim of sexual and physical abuse

Question 32

treatment for rapists

Answer 32

same general approaches as paraphilic disorders: - motivational strategies - cognitive behavioral techniques - pharmacological treatments little evidence for effectiveness

Question 33

voyeuristic disorder

Answer 33

sexually arousing fantasies, urges, behaviors while observing others who are undressed or engaging in sexual activity - usually men - excitement from knowing victim is unaware; element of risk important - seldom results in physical contact

Question 34

exhibitionistic disorder

Answer 34

intense desire to obtain sexual gratification by exposing genitals to unwilling strangers - sometimes children - seldom results in physical contact - usually involves desire to shock or alarm victim often comorbid w voyeuristic and frotteuristic disorders DSM-5 criteria includes that person has acted on urges, or it causes distress/interpersonal problems

Question 35

frotteuristic disorder

Answer 35

sexually oriented touching of a nonconsenting person - individual rubs his genitals against a womens body or fondles her - often occurs in crowded subway/ other public place

Question 36

Sexual sadism disorder

Answer 36

intense and recurrent desire to obtain or increase sexual gratification by inflicting pain or psychological suffering on another person

Question 37

sexual masochism disorder

Answer 37

intense and recurrent desire to obtain or increase sexual gratification through receiving pain or humiliation - asphyxiophilia - sexual arousal by oxygen deprivation - can result in death or brain damage more masochists than sadists

Question 38

Etiology of Paraphilias

Answer 38

ultimately we don't understand the etiology - Neurobiological factors - male hormones or androgens - almost all ppl w paraphilias are men - don't have unusual levels of testosterone - Classical conditioning - research hasn't supported orgasm conditioning hypothesis (orgasm associated with a certain thing) - Operant Conditioning - poor social skills or reinforcement of unconventionality - History of childhood physical and sexual abuse - 1/3 of ppl who commit sexual offenses against children don't report history of sexual abuse, not whole story - Psychological Factors - Cognitive distortions - heightened impulsivity and poor emotion regulation - pedophilia- slightly lower IQ, higher rates of neurocognitive problems, - minor physical anomalies related to atypical prenatal development - alcohol and negative affect are common triggers

Question 39

Treatment for Paraphilias- treatment studies

Answer 39

- Incarceration and court-ordered treatment are common - often difficult to interpret outcome from treatment studies - studies vary greatly - Many lack control groups - dropout rates high

Question 40

types of treatments for paraphilias

Answer 40

- enhance motivation - cognitive behavioral treatment - biological treatments

Question 41

types of treatments for paraphilias- enhance motivation

Answer 41

why to use: - denial and minimization of problem often present - blaming the victim - lack of motivation for treatment - many drop out enhancing motivation: - bolster clients hope that they can gain control over urges - focus on reasons for change, such as legal consequences

Question 42

types of treatments for paraphilias- Cognitive behavioral treatment

Answer 42

- aversion therapy - satiation: pairing a neg association w the attraction - covert sensitization - make more sensitized to effects of their behavior - counter distorted thinking - challenge distorted thoughts - often combined w social skills and empathy training - sexual impulse control strategies

Question 43

types of treatments for paraphilias- Biological treatments

Answer 43

- castration used in past - medications - hormonal agents to reduce androgens (depo-provera) - SSRIs, not much evidence

Question 44

legal issues- protecting the public vs civil liberties of those w paraphilias

Answer 44

- supreme court ruled person high risk for sex crimes can be detained if risk is related to psych disorder that diminishes ability to control their sexual behavior - Megan's law: police publicize whereabouts of registered sex offenders

Question 45

q- Speculations about the role of hormones in paraphilias center on

Answer 45

androgens

Question 46

q- someone who derives sexual pleasure from contact with prepubertal children would be diagnosed with

Answer 46

pedophilic disorder

Question 47

q- Delayed ejaculation disorder

Answer 47

is defined as persistent difficulty in ejaculating.

Question 48

q- Those with fetishistic disorder are sexually aroused by

Answer 48

inanimate objects.

Question 49

q- Persistent disruptions in the ability to experience sexual arousal, desire, or orgasms, or pain associated with intercourse, is called

Answer 49

sexual dysfunction.

Question 50

q- The squeeze technique is used in the treatment of

Answer 50

premature ejaculation

Question 51

q- Persistent or recurrent pain during sexual intercourse is called __________ in the DSM-5

Answer 51

Persistent or recurrent pain during sexual intercourse is called __________ in the DSM-5

Question 52

After exhibiting, Ethan said of his victim, “She smiled, so I guess she was amused.” This is an example of

Answer 52

minimizing consequences.

Question 53

q- Which of the following is a current or proximal cause of sexual dysfunctions, according to Masters and Johnson?

Answer 53

fear of performance

Question 54

q- Which of these diagnoses does not include a criterion specifying that the victim be non-consenting?

Answer 54

Sexual masochistic disorder