Ch 12 (lesson 14) Sexual disorders Flashcards
Cultural influences beliefs about sexuality
- pleasure vs procreation
- acceptable sexual behaviors vary w times and culture
- 19th and early 20th c believed excess sexuality was a problem
differences btwn men and women in sexuality
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
sexual response cycle
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)
Debates about gender dysphoria
- 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
DSM-5 three categories of sexual dysfunction
1) sexual desire, arousal, interest disorders
2) Orgasmic disorders
3) Sexual pain disorders
DSM-IV-TR vs DSM-5 diagnosis of sexual dysfucntions
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
disorders involving sexual interest, desire, and arousal
- 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
DSM-5 criteria for Sexual interest/arousal disorder in women
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
DSM-5 Criteria for Hypoactive Sexual Desire Disorder in men
- 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
DSM-5 criteria for Male Erectile Disorder
-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
Orgasmic Disorders
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
DSM-5 criteria for Female Orgasmic DIsorder
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
DSM-5 Criteria for Delayed Ejaculation:
- 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
DSM-5 Criteria for Premature Ejaculation:
-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
Sexual Pain Disorder- Genitopelvic pain/ penetration disorder
- 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
DSM-5 criteria for Genitopelvic pain/ penetration disorder
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
Etiology of Sexual Dysfunction- Masters and Johnson’s two tier model
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)
distal causes/ predictors of sexual dysfunction- biological factors
biological factors
- heavy drinking/smoking
- cardiovascular disease
- diabetes
- neurological disease
- hormone dysfunction
- SSRIs
- other illnesses/ meds
distal causes/ predictors of sexual dysfunction- psych factors
- 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
distal causes/ predictors of sexual dysfunction- psych factors
psych factors
- depression and anxiety, panic disorder
- low physiological arousal
- stress and exhaustion
- neg cognitions/ self blame
- spectator role and performance fears ( immediate cause)
treatments of sexual dysfunction
- 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)
Paraphilic disorders
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
Paraphilias - 2 categories
- sexual attractions based on inanimate objects
- sexual attractions based on children
Paraphilias included in DSM-5
- 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
Prevalence of paraphilic disorders
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
Fetishistic Disorder
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
DSM-5 criteria of fetishistic disorder
- 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
Pedophilic Disorder
- 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
Incest
- 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
rape
- attempted/completed intercourse through force/ threat of force/ or when victim incapacitated and unable to give consent
- 19.3% women raped, 1.7% men
etiology of rape
- 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
treatment for rapists
same general approaches as paraphilic disorders:
- motivational strategies
- cognitive behavioral techniques
- pharmacological treatments
little evidence for effectiveness
voyeuristic disorder
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
exhibitionistic disorder
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
frotteuristic disorder
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
Sexual sadism disorder
intense and recurrent desire to obtain or increase sexual gratification by inflicting pain or psychological suffering on another person
sexual masochism disorder
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
Etiology of Paraphilias
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
- male hormones or androgens
- 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
Treatment for Paraphilias- treatment studies
- 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
types of treatments for paraphilias
- enhance motivation
- cognitive behavioral treatment
- biological treatments
types of treatments for paraphilias- enhance motivation
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
types of treatments for paraphilias- Cognitive behavioral treatment
- 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
types of treatments for paraphilias- Biological treatments
- castration used in past
- medications
- hormonal agents to reduce androgens (depo-provera)
- SSRIs, not much evidence
legal issues- protecting the public vs civil liberties of those w paraphilias
- 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
q- Speculations about the role of hormones in paraphilias center on
androgens
q- someone who derives sexual pleasure from contact with prepubertal children would be diagnosed with
pedophilic disorder
q- Delayed ejaculation disorder
is defined as persistent difficulty in ejaculating.
q- Those with fetishistic disorder are sexually aroused by
inanimate objects.
q- Persistent disruptions in the ability to experience sexual arousal, desire, or orgasms, or pain associated with intercourse, is called
sexual dysfunction.
q- The squeeze technique is used in the treatment of
premature ejaculation
q- Persistent or recurrent pain during sexual intercourse is called __________ in the DSM-5
Persistent or recurrent pain during sexual intercourse is called __________ in the DSM-5
After exhibiting, Ethan said of his victim, “She smiled, so I guess she was amused.” This is an example of
minimizing consequences.
q- Which of the following is a current or proximal cause of sexual dysfunctions, according to Masters and Johnson?
fear of performance
q- Which of these diagnoses does not include a criterion specifying that the victim be non-consenting?
Sexual masochistic disorder
