Ch.12, Sexual Disorders Flashcards
sexual dysfunction
refers to impairment either in the desire for sexual gratification or in the ability to achieve it. The impairment varies markedly in degree, but regardless of which partner is experiencing the problem, the enjoyment of sex by both parties in a relationship may be adversely affected. Sexual dysfunctions occur in both same-sex and opposite-sex couples. In some cases, sexual dysfunctions are caused primarily by psychological or interpersonal factors, whereas in others, physical factors are most important, including many cases of sexual dysfunction that are secondary consequences of medications people may be taking for other, unrelated medical condition
four different phases of the human sexual response
The desire phase consists of fantasies about sexual activity or a sense of desire to have sexual activity.
The arousal phase is characterized both by a subjective sense of sexual pleasure and by physiological changes that accompany this subjective pleasure, including penile erection in the male and vaginal lubrication and clitoral enlargement in the female.
Orgasm is the third phase, during which there is a release of sexual tension and a peaking of sexual pleasure.
The final phase is resolution, during which the person has a sense of relaxation and well-being.
why did female sexual interest/arousal disorder replaced two separate disorders in DSM-IV-TR,
, because research has not adequately demonstrated that sexual interest and arousal are distinguishable in women
Male Hypoactive Sexual Desire Disorder/ causes / treatment
Persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity. The judgment of deficiency is made by the clinician, taking into account factors that affect sexual functioning, such as age and general and sociocultural contexts of the individual’s life.
The symptoms in Criterion A have persisted for a minimum duration of approximately 6 months.
The sexual dysfunction is not better explained by a nonsexual mental disorder or as a consequence of severe relationship distress or other significant stressors and is not attributable to the effects of a substance/medication or another medical condition.
= Predictors of low desire included daily alcohol use, stress, unmarried status, and poorer health; Most experts believe that male hypoactive sexual desire disorder is acquired or situational rather than lifelong. Typical situational risk factors include depression and relationship stress.
treatment: testerone
Erectile Disorder
At least one of the three following symptoms must be experienced on almost all or all (approximately 75%–100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):
Marked difficulty in obtaining an erection during sexual activity. Marked difficulty in maintaining an erection until the completion of sexual activity. Marked decrease in erectile rigidity.
Premature (Early) Ejaculation
mature (Early) Ejaculation
A persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within approximately 1 minute following vaginal penetration and before the individual wishes it.
Delayed Ejaculation
ither of the following symptoms must be experienced on almost all or all occasions (approximately 75%–100%) of partnered sexual activity (in identified situational contexts or, if generalized, in all contexts), and without the individual desiring delay:
Marked delay in ejaculation. Marked infrequency or absence of ejaculation.
Female Sexual Interest/Arousal Disorder
Lack of, or significantly reduced, sexual interest/arousal, as manifested by at least three of the following:
Absent/reduced interest in sexual activity. Absent/reduced sexual/erotic thoughts or fantasies. No/reduced initiation of sexual activity, and typically unreceptive to a partner’s attempts to initiate. . There are no common syndromes in which women with low sexual desire have normal levels of sexual arousal, or vice versa. Thus, for women, DSM-5 has combined dysfunctionally low desire with dysfunctionally low sexual arousal into one disorder. The degree to which the diminished sex drive has a biological basis remains unclear; however, in many (and perhaps most) cases psychological factors appear to be more important than biological factors
Genito-Pelvic Pain/Penetration Disorder
Vaginal penetration during intercourse.
Marked vulvovaginal or pelvic pain during vaginal intercourse or penetration attempts.
Marked fear or anxiety about vulvovaginal or pelvic pain in anticipation of, during, or as a result of vaginal penetration.
Marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration.
Female Orgasmic Disorder
Presence of either of the following symptoms and experienced on almost all or all (approximately 75%–100%) occasions of sexual activity (in identified situational contexts or, if generalized, in all contexts):
Marked delay in, marked infrequency of, or absence of orgasm. Markedly reduced intensity of orgasmic sensations.
Substance/Medication-Induced Sexual Dysfunction
A clinically significant disturbance in sexual function is predominant in the clinical picture.
There is evidence from the history, physical examination, or laboratory findings of both (1) and (2):
The symptoms in Criterion A developed during or soon after substance intoxication or withdrawal or after exposure to a medication. The involved substance/medication is capable of producing the symptoms in Criterion A.
lifelong vs situational erectile disorder
lifelong erectile disorder, a man with adequate sexual desire has never been able to sustain an erection long enough to accomplish a satisfactory duration of penetration. In acquired or situational erectile disorder, a man with adequate sexual desire has had at least one successful experience of sexual activity requiring an erection but is presently unable to produce or maintain the required level of penile rigidity.
causes of erectile dysfunction
erectile dysfunction is primarily a function of anxiety about sexual performance. In other reviews of the accumulated evidence, however, subsequent research has questioned the causal role of anxiety—because under some circumstances, anxiety can actually enhance sexual performance in normally functioning men and women
ognitive distractions frequently associated with anxiety in dysfunctional people that seem to interfere with their sexual arousal
- related finding is that men with erectile dysfunction make more internal and stable causal attributions for hypothetical negative sexual events than do men without sexual dysfunction, much as people with depression do for more general hypothetical negative events
The most frequent cause of erectile disorder in older men
vascular disease, which results in decreased blood flow to the penis or in diminished ability of the penis to hold blood to maintain an erection. Thus hardening of the arteries, high blood pressure, and other diseases such as diabetes that cause vascular problems often account for erectile disorder.
Priapism
For young men, one cause of erectile problems is having had priapism—that is, an erection that will not diminish even after a couple of hours, typically unaccompanied by sexual excitement. Priapism can occur as a result of prolonged sexual activity, as a consequence of disease, or as a side effect of certain medications. Untreated cases of priapism are likely to result in erectile dysfunction and thus should be regarded as a medical emergency
treatments for erectile dysfunction
A variety of treatments—primarily medical—have been employed in recent years, often when cognitive-behavioral treatments have failed. These include medications that promote erections like Viagra, Levitra, and Cialis (covered in more detail next) as well as injections of smooth-muscle-relaxing drugs into the penile erection chambers (corpora cavernosa
how does viagra work
Viagra works by making nitric oxide, the primary neurotransmitter involved in penile erection, more available. Viagra is taken orally at least 30 to 60 minutes before sexual activity. Unlike some other biological treatments for erectile dysfunction, Viagra promotes erection only if some sexual excitation is present. Thus, contrary to some myths, Viagra does not improve libido or promote spontaneous erections
ejaculatory reflex and individual control
In sexually normal men, the ejaculatory reflex is, to a considerable extent, under voluntary control. They monitor their sensations during sexual stimulation and are somehow able, perhaps by judicious use of distraction, to forestall the point of ejaculatory inevitability until they decide to “let go,” with the average latency to ejaculation from penetration being 10 minutes for men with no sexual problems. Men with early ejaculation are for some reason unable to use this technique effectively. Explanations have ranged from psychological factors such as increased anxiety, to physiological factors such as increased penile sensitivity and higher levels of arousal to sexual stimuli.
pause and squeeze method
This technique requires the man to monitor his sexual arousal during sexual activity. When arousal is intense enough that the man feels that ejaculation might occur soon, he pauses, and he or his partner squeezes the head of the penis for a few moments until the feeling of pending ejaculation passes, repeating the stopping of intercourse as many times as needed to delay ejaculation. Initial reports suggested that this technique was approximately 60 to 90 percent effective; however, newer studies have reported a much lower overall success rate
treatment for delayed ejaculation disorder
Psychological treatments include couples therapy in which a man tries to get used to having orgasms through intercourse with a partner rather than via masturbation. Treatment may also emphasize the reduction of performance anxiety about the importance of having an orgasm versus sexual pleasure and intimacy in addition to increasing genital stimulation
causes of arousal disorders
Prior or current depression or anxiety disorders may contribute to many cases of sexual desire disorders (Meston & Bradford, 2007). Although sexual desire disorders typically occur in the absence of obvious physical pathology, there is evidence that physical factors sometimes play a role. For example, in both men and women, sexual desire depends in part on testosterone. That sexual desire problems increase with age may be in part attributable to declining levels of testosterone, but testosterone replacement therapy is usually not beneficial, except in men and women who have very low testosterone levels (Meston & Rellini, 2008). In addition, some antidepressants reduce sexual desire. Notably, antidepressants vary considerably in their negative effect on sexual function, and psychiatrists have not always paid close enough attention to the impact that these effects have on patients’ general functioning (Serretti & Chiesa, 2009). Psychological factors thought to contribute to sexual desire disorders include low relationship satisfaction, daily hassles and worries, increased disagreements and conflicts, low levels of feelings, and reduced cues of emotional bonding (Meston & Rellini, 2008). In some cases a history of unwanted sexual experiences such as rape may also contribute.
most common female sexual dysfunction in most countries across the world
Hypoactive sexual desire
problems with the linear sequence of desire for women
. One emerging finding is that it is uncommon for women to cite sexual desire as a reason or incentive for sexual activity. For many women, sexual desire is experienced only after sexual stimuli have led to subjective sexual arousal (Basson, 2003; Meston & Bradford, 2007), and for others, motivation for sexual activity may involve a desire for increasing emotional intimacy or increasing one’s sense of well-being and one’s self-image as an attractive female (Basson, 2005). Thus, some research suggests that the supposedly linear sequence of desire leading to arousal, leading to orgasm that was originally posited for women as well as men by Masters and Johnson (1970) and the DSM is not very accurate for women
testerone use for arousal disorders
. As noted, testosterone appears to be effective only in men and women who have very low levels of testosterone; that is, raising levels of this important sex hormone above normal levels has no beneficial effects
Sensate focus exercises and rousal disorders
. Sensate focus exercises are also used in the treatment of several other forms of sexual dysfunctions, as we will see. They involve teaching couples to focus on the pleasurable sensations brought about by touching without the goal of actually having intercourse or orgasm. Relationship problems often contribute importantly to low sexual desire, as do concerns related to body image
why doesnt viagra work for women
In addition, because female genital response depends in part on the same neurotransmitter systems as male genital response, there has been great interest in the possibility that Viagra, Levitra, or Cialis would have positive effects for women analogous to their positive effects for men (Meston & Rellini, 2008). Unfortunately, enough research has now been performed to make it clear that such drugs are not as useful for women as they are for men (Basson et al., 2002; Meston & Rellini, 2008). Although these medications may enhance genital arousal and perceptions of physical sensations in women, they do not affect women’s psychological experiences of arousal. It is likely that women’s sexual desire and arousal are more dependent on relationship satisfaction and mood than they are in men.
previous diagnosis of vaginismus
, no scientific evidence exists that women with vaginismus have vaginal spasms or that vaginismus could be reliably diagnosed. In contrast, women diagnosed with vaginismus commonly complained of pain during penetration and anxiety before and during sexual encounters (Reissing et al., 2003). The latter symptoms made the distinction between vaginismus and dyspareunia (which is genital pain associated with sexual intercourse) unclear. That is, women with a past diagnosis of vaginismus were not clearly distinct from those with a past diagnosis of dyspareunia. Furthermore, as noted, the hallmark “symptom” of vaginismus, vaginal spasms, does not clearly occur, while the hallmark symptom of dyspareunia, genital pain during penetration, occurs commonly in women with vaginismus as well. Thus, in DSM-5 there is only one genito-pelvic pain/penetration disorder, which combines the genital pain of dyspareunia with muscle tension (not muscle spasms) and fear and anxiety related to genital pain or penetrative sexual activity.
treatments for Genito-Pelvic Pain/Penetration Disorder
In past treatment studies of vaginismus and dyspareunia, cognitive-behavioral interventions have been effective in some cases. Cognitive-behavioral treatment techniques tend to include education about sexuality, identifying and correcting maladaptive cognitions, graduated vaginal dilation exercises to facilitate vaginal penetration, and progressive muscle relaxation (Bergeron et al., 2001). Medical treatments, such as surgical removal of the vulvar vestibule, a small area of the vulva between the labia minora, can be very successful (Binik, 2010a). It is likely that genito-pelvic pain/penetration disorder comprises several distinct syndromes with different etiologies and potentially different treatments.
causes of female orgasmic disorder
What causes female orgasmic disorder is not well understood, but a multitude of contributory factors have been hypothesized. For example, some women may feel fearful or uncertain whether her partner finds her sexually attractive, and this may lead to anxiety and tension, which then interfere with her sexual enjoyment. Or she may feel inadequate or experience sexual guilt (especially common in those who are religious) because she is unable to have an orgasm or does so infrequently.
biological causal factors of female orgasmic disorder
Possible biological causal factors sometimes contributing to orgasmic difficulties in women (as they do in men) include intake of SSRIs and the presence of medical conditions previously mentioned with other sexual disorders (Meston & Rellini, 2008). Some evidence suggests that differences between women’s genital anatomies may allow some women to have orgasms during intercourse more easily than other women can
lifelong and situational female orgasmic dysfunction. vs situational anorgasmia
. Cognitive-behavioral treatment of orgasmic dysfunction usually involves education about female sexuality and female sexual anatomy, as well as directed masturbation exercises. Later the partner may be included to explore these activities with the client. For those with lifelong orgasmic dysfunction, such programs can have nearly a 100 percent success rate in terms of the woman’s ability to have an orgasm at least through masturbation, but transition to having an orgasm with a partner can be slow and difficult in some cases (Meston & Rellini, 2008). “Situational” anorgasmia (where a woman may experience orgasm in some situations, with certain kinds of stimulation, or with certain partners, but not under the precise conditions she desires) often proves more difficult to treat, perhaps in part because it is often associated with relationship problems that may also be hard to treat
Gender dysphoria
characterized by persistent distress resulting from a perceived mismatch between one’s assigned gender at birth (based on their biological sex) and their gender identity. Gender dysphoria can be diagnosed at two different life stages, either during childhood (gender dysphoria in children) or adolescence or adulthood (i.e., gender dysphoria in adolescents and adults).
boys vs girls symptoms of gender dysphoria
Boys with gender dysphoria often show a preoccupation with traditionally feminine activities (Cohen-Kettenis & Klink, 2015). They may prefer to dress in female clothing. They enjoy stereotypical girls’ activities such as playing dolls and playing house. They usually avoid rough-and-tumble play and often express the desire to be a girl.
Girls with gender dysphoria typically prefer traditional boys’ clothing and short hair. Fantasy heroes often include powerful male figures like Batman and Superman. They show little interest in dolls and increased interest in sports. Although many girls considered to be “tomboys” frequently have many or most of these traits, girls with gender dysphoria are distinguished by their desire to actually be a boy or to grow up as a man.
gender and treatment differentials for girls vs boys gender dysphoria
“fa’afafine” and non western ideals of gender binaries
n Samoa, very feminine males are often considered “fa’afafine” (roughly meaning “in the manner of women”), a kind of third gender, neither male nor female. Fa’afafine are identified as young children by their behavior and usually are accepted by their families and culture. As adults these individuals are sexually attracted to other men and typically have sexual relations with heterosexual men. They generally do not recall that their childhood gender nonconformity was associated with distress. Because of this, some have argued that childhood gender dysphoria should not appear in DSM-5
gender dysphoria and most common comorbid disorder
Studies of adults with gender dysphoria have shown that those with this condition in adulthood suffer from elevated rates of other mental disorders and health risk behaviors during their lifetime. The risk is highest for comorbid mood disorders (60% of people with gender dysphoria) and anxiety disorders (28%), with approximately one-third of those with gender dysphoria during adulthood also suffering from intentional self-injury in the form of suicidal thoughts or behaviors or nonsuicidal self-injury
Treatment for Gender Dysphoria
children and adolescents with gender dysphoria are often brought in by their parents for psychotherapy (Zucker et al., 2008). Specialists attempt both to treat the child’s unhappiness with his or her biological sex and to ease strained relations with parents and peers. Children with gender dysphoria often have other general psychological and behavioral problems, such as anxiety and mood disorders, that also need therapeutic attention
Paraphilic disorders
characterized by recurrent, intense sexually arousing fantasies, sexual urges, or behaviors that generally involve (1) abnormal targets of sexual attraction (e.g., shoes, children), (2) unusual courtship behaviors (e.g., watching others undress without their knowledge, or exposing oneself to others against their wishes), or (3) the desire for pain and suffering of oneself or others.
paraphilias and paraphilic disorders
Paraphilias are unusual sexual interests, but they need not cause harm either to the individual or to others. Only if they cause such harm do they become paraphilic disorders. Thus, foot fetishists have a paraphilia, but only those who suffer due to their sexual interest have a paraphilic disorder.
-. Paraphilias also frequently have a compulsive quality, and some individuals with paraphilias require orgasmic release as often as 4 to 10 times per day (Garcia & Thibaut, 2010). Individuals with paraphilias may or may not have persistent desires to change their sexual preferences. Because nearly all such persons are male (a fact whose etiologic implications we consider later), we use masculine pronouns to refer to them
voyeuristic disorder and causes
if he has recurrent, intense sexually arousing fantasies, urges, or behaviors involving the observation of unsuspecting people who are undressing or of couples engaging in sexual activity
-Moreover, if a young man with such curiosity feels shy and inadequate in his relations with the opposite sex, he may accept the substitute of voyeurism, which satisfies his curiosity and to some extent meets his sexual needs without the trauma of actually approaching a female. He thus avoids the rejection and lowered self-status that such an approach might bring. In fact, voyeuristic activities often provide important compensatory feelings of power and secret domination over an unsuspecting victim, which may contribute to the maintenance of this pattern. If a voyeur manages to find a wife in spite of his interpersonal difficulties, as many do, he is rarely well-adjusted sexually in his relationship with his wife, as the following case illustrates.
Exhibitionistic Disorder
Exhibitionistic disorder (indecent exposure in legal terms) is diagnosed in a person with recurrent, intense urges, fantasies, or behaviors that involve exposing his genitals to others (usually strangers) in inappropriate circumstances and without their consent
Exhibitionism, which usually begins in adolescence or young adulthood, is the most common sexual offense reported to the police in the United States, Canada, and Europe, accounting for about one-third of all sexual offenses
Frotteurism
sexual excitement at rubbing one’s genitals against, or touching, the body of a nonconsenting person. As with voyeurism, frotteurism reflects inappropriate and persistent interest in something that many people enjoy in a consensual context.
Being the victim of a frotteuristic act often occurs among regular riders of crowded buses or subway trains. Some have speculated that frotteurs’ willingness to touch others sexually without their consent means that they are at risk for more serious sexual offending, but there is currently no evidence to support this concern
Sexual Sadism Disorder
person must have recurrent, intense sexually arousing fantasies, urges, or behaviors that involve inflicting psychological or physical pain on another individual. Sadistic fantasies often include themes of dominance, control, and humiliation (Kirsch & Becker, 2007). A closely related, but less severe, pattern is the practice of “bondage and discipline” (B&D), which may include tying a person up, hitting or spanking, and so on to enhance sexual excitement.
Sexual Masochism Disorder
masochism is derived from the name of the Austrian novelist Leopold V. Sacher-Masoch (1836–1895), whose fictional characters derived sexual pleasure from being dominated and made to experience pain. In sexual masochism, a person experiences sexual stimulation and gratification from the experience of pain and degradation in relating to a lover.
- Masochism appears to be more common than sadism and occurs in both men and women
autoerotic asphyxia
involves self-strangulation. Although some writers have speculated that loss of oxygen to the brain intensifies orgasm, there is little evidence that this motivates practitioners of autoerotic asphyxia. In contrast, studies of such practitioners have found that their sexual fantasies are strongly masochistic
Fetishistic Disorder
e individual has recurrent, intense sexually arousing fantasies, urges, and behaviors involving the use of some inanimate object or a part of the body not typically found erotic (e.g., feet) to obtain sexual gratification. As is generally true for the paraphilias, reported cases of female fetishists are extremely rare
Transvestic Disorder
According to DSM-5, heterosexual men who experience recurrent, intense sexually arousing fantasies, urges, or behaviors that involve cross-dressing as a female may be diagnosed with transvestic disorder, if they experience significant distress or impairment due to the condition. Although some gay men dress “in drag” on occasion, they do not typically do this for sexual pleasure and hence do not have the paraphilia transvestism. Typically, the onset of transvestism is during adolescence and involves masturbation while wearing female clothing or undergarments
autogynephilia:
hypothesized that the psychological motivation of most heterosexual transvestites includes autogynephilia: paraphilic sexual arousal by the thought or fantasy of being a woman
causes of paraphilia
Several facts about paraphilia are likely to be important in their development. First, as we have already noted, nearly all persons with paraphilias are male; females with paraphilias are so rare that they are found in the literature only as case reports or a series of case reports (Fedoroff et al., 1999). Second, paraphilias usually begin around the time of puberty or early adolescence. Third, people with paraphilias often have a strong sex drive, with some men masturbating many times a day. Fourth, people with paraphilias frequently have more than one. For example, men who died accidentally in the course of autoerotic asphyxia were partially or fully cross-dressed in 25 to 33 percent of cases
why do men develop paraphilias and women typically don’t
others have suggested that male vulnerability to paraphilias is closely linked to their greater dependence on visual sexual imagery. Perhaps sexual arousal in men depends on physical stimulus features to a greater degree than in women, whose arousal may depend more on emotional context such as being in love with a partner. If so, men may be more vulnerable to forming sexual associations to nonsexual stimuli, which may be most likely to occur after puberty, when the sexual drive is high. Many believe that these associations arise as a result of classical and instrumental conditioning and/or social learning that occurs through observation and modeling. When observing paraphilic stimuli (e.g., photographs of models in their underwear), or when fantasies about paraphilic stimuli occur, boys may masturbate, and the reinforcement gained from orgasm release may serve to condition an intense attraction to paraphilic stimuli
treatments for paraphilia
Cognitive behavioral treatments focusing on using behavioral exposures in combination with behavioral management skills, such as impulse- control and problem-solving skills, have shown positive effects in the treatment of both adolescents and adults with paraphilic disorders and related conditions (Hallberg et al., 2017; Merricks et al., 2016). Pharmacological treatments have concentrated mostly on the use of SSRIs, as such medications have shown an ability to decrease intrusive thoughts and compulsive behaviors (such as in the treatment of OCD), and they often have the side effect of decreasing a person’s libido—which often is an undesirable feature for those taking SSRIs, but is the intended outcome in the current context. Another pharmacological approach sometimes used in the treatment of paraphilic disorders is antiandrogen therapy, in which medications are given that reduce a person’s levels of circulating testosterone as another means of reducing libid
Consequences of Childhood Sexual Abuse
People who were sexually abused during childhood are approximately twice as likely as children who were not sexually abused to develop a later mental disorder (Kessler, McLaughlin, et al., 2010), with the highest risk being for fear/anxiety and substance use disorders (McLaughlin, Green, et al., 2012). Children who are the victims of sexual abuse also have a significantly increased risk of later suicidal thoughts and behavior
wide variety of sexual symptoms have also been alleged to result from early sexual abuse (e.g., Leonard & Follette, 2002; Loeb et al., 2002; see review in Maniglio, 2009), ranging, for example, from sexual aversion to sexual promiscuity. A similar range of negative consequences has also been reported in a sample of about 3,000 male and female adults in China, although the rate of childhood sexual abuse in China is lower than in Western countriesr
when is pedophilic disorder diagnosed
pedophilic disorder is diagnosed when an adult has recurrent, intense sexual urges or fantasies about sexual activity with a prepubertal child; acting on these desires is not necessary for the diagnosis if they cause the pedophile distress. DSM-5 indicates that a child is someone who is “generally age 13 or younger.” In doing so, the DSM-5 rejected two potentially important suggestions from the DSM-5 subcommittee on paraphilias: first, that pedophilia be diagnosed according to the degree of physical maturity of the child (as rated by Tanner scores, which index degree of pubertal maturation) and, second, that diagnostic criteria for pedophilia (attraction to prepubescent children) be changed to include men with hebephilia (attraction to pubescent children—children in the early stages of puberty).
hebephiles.
subgroup who are most aroused not to prepubescent children, but to pubescent children (children in the early stages of puberty). Scientists have called such men hebephiles. Pubescent children are not fully sexually mature, despite showing some signs of pubertal development. Pedophilia and hebephilia appear to be closely related, because it is not uncommon for pedophiles also to be attracted to pubescent children and hebephiles to prepubescent children.
expanding criteria in DSM 5 to include attraction to pubescent children
The suggested changes proved highly controversial because of the proposed expansion of pedophilia to include attraction to pubescent children. Opponents of its inclusion asserted that attraction to pubescent girls is characteristic of normal men (e.g., Rind & Yuill, 2012; Wakefield, 2012). However, the idea that normal men are attracted to pubescent children is largely mistaken, and represents a failure to appreciate the physical immaturity of children in the early stages of puberty, compared with children or adolescents who have completed puberty. In the end, the DSM-5 rejected both the expansion of the definition of pedophilia to include attraction to pubescent children and diagnosing pedophilia on the basis of desired children’s degree of sexual maturity (focusing on developmental markers of prepubescence and pubescence). Instead, DSM-5 retains the internally contradictory criteria of DSM-IV-TR, namely, that pedophilia is attraction to prepubescent children, and that prepubescence is understood as “younger than age 13” even though many such children are not prepubescent. Many people working in the area are not pleased that DSM-5 did not make the proposed changes. What do you think?
incest
refers to culturally prohibited sexual relations between family members such as a brother and sister or a parent and child.
most common forms of incest
Brother–sister incest is the most common form of incest even though it is rarely reported (LeVay & Baldwin, 2012). The second most common pattern is father–daughter incest. Mother–son incest is thought to be relatively rare
rape
penetration, no matter how slight, of the vagina or anus with any body part or object, or oral penetration by a sex organ of another person, without the consent of the victim”
Statutory rape is sexual activity with a person who is legally defined (by statute or law) to be under the age of consent (18 in most states) even if the underage person consents.
sexual assault
refers to acts, separate from rape, that involve unwanted sexual contact, such as groping or fondling another person without their consent.
rape stats
refers to acts, separate from rape, that involve unwanted sexual contact, such as groping or fondling another person without their consent.
Is Rape Motivated by Sex or Aggression?
rape has been classified as a sex crime, and society has assumed that a rapist is motivated by lust. However, in the 1970s some feminist scholars began to challenge this view, arguing that rape is motivated by the need to dominate, to assert power, and to humiliate a victim rather than by sexual desire for her
“victim-precipitated” rape/ rape shield laws
a position often invoked by defense attorneys trying to prevent the perpetrator from being charged with rape. According to this view, a victim (especially a repeat victim), though often bruised both psychologically and physically, is regarded as the cause of the crime, often on such grounds as the alleged provocativeness of her clothing, her past sexual behavior, or her presence in a location considered risky
rape shield laws began to be introduced in the 1970s. These laws protect rape victims by, for example, preventing the prosecutor from using evidence of a victim’s prior sex history; however, many problems in these laws still remain
causal factors of rape
Perpetrators of rape, who are overwhelmingly male, are characterized by impulsivity, quick loss of temper, lack of personally intimate relationships, and insensitivity to social cues or pressures (Giotakos et al., 2004), and a subset qualify for a diagnosis of psychopathy (Knight & Guay, 2006). Many rapists also show some deficits in social and communication skills (Emmers-Sommer et al., 2004), as well as in their cognitive appraisals of women’s feelings and intentions (Ward et al., 1997). For example, they are particularly deficient in skills required for successful conversation, which is necessary for developing consenting relationships with women. In addition, they have difficulty decoding women’s negative cues during social interactions and often interpret friendly behavior as flirtatious or sexually provocative
sex offender recidivism
In general, sex offender recidivism is actually markedly lower than for many other kinds of crimes. However, sex offenders with deviant sexual preferences (e.g., exhibitionists, severe sadists, and those who are most attracted to children) have particularly high rates of sexual recidivism
four goals therapy for sex offenders
Therapies for sex offenders typically have at least one of the following four goals: to modify patterns of sexual arousal and attraction, to modify cognitions and social skills in order to allow more appropriate sexual interactions with adult partners, to change habits or behavior that increases the chance of reoffending, or to reduce sexual drive. Attempts to modify sexual arousal patterns usually involve aversion therapy, in which a paraphilic stimulus such as a slide of a nude prepubescent girl for a man with pedophilia is paired with an aversive event such as forced inhalation of noxious odors or a shock to the arm.
covert sensitization and asssisted covert sensitization
n alternative to electric aversion therapy is covert sensitization, in which the patient imagines a highly aversive event while viewing or imagining a paraphilic stimulus, or assisted covert sensitization, in which a foul odor is introduced to induce nausea at the point of peak arousal
benefits and costs to meagans law
Megan’s murder sparked outrage at the fact that dangerous sex offenders could move into a neighborhood without notifying the community of their presence. In response, the New Jersey state legislature passed Megan’s Law, which mandates that, upon release, convicted sex offenders register with police, and that authorities notify neighbors that convicted sex offenders have moved in by distributing fliers, alerting local organizations, and canvassing door-to-door. Similar laws have been passed in many other states, and it is now possible in several states to visit a website containing pictures and addresses of convicted sex offenders, subject to that state’s Megan’s Law.
Although Megan’s Laws have been enormously popular with state legislators and citizens, they have not been uncontroversial. Civil libertarians have objected to community notification requirements, which, they contend, endanger released offenders (who have arguably paid their debts to society) and also prevent them from integrating successfully back into society. Although the various Megan’s Laws are intended to protect potential victims rather than to encourage harassment of sex offenders, the latter has occurred, with up to one-third to one-half of registered offenders in some states experiencing one or more of the following: loss of a job or home, threats, harassment, property damage, and/or harm to family members (Levenson et al., 2007). In addition, the limited amount of relevant data has brought the effectiveness of Megan’s Laws into question. For example, since 1995 a number of studies have compared recidivism rates from the period before which registration as a sex offender was required to rates after these laws were passed. Unfortunately, the results have not really provided any reassuring evidence that notifying communities has enhanced community safety (Levenson et al., 2007). A recent analysis in New Jersey, where Megan Kanka lived and died, found that Megan’s Law had made no difference (Zgoba & Levenson, 2008).
cbt for sex offenders vs social skills training
The remaining psychological treatments are aimed at reducing the chances of sexual reoffending. Cognitive restructuring attempts to eliminate sex offenders’ cognitive distortions because these may play a role in sexual abuse
, social-skills training aims to help sex offenders (especially rapists) learn to process social information from women more effectively and to interact with them more appropriately
chemical castration treatment
The most controversial treatment for sex offenders involves castration—either surgical removal of the testes or the hormonal treatment sometimes called “chemical castration” (Berlin, 2003; Weinberger et al., 2005). Both surgical and chemical castration lower the testosterone level, which in turn lowers the sex drive, allowing the offender to resist any inappropriate impulses. Chemical castration has most often involved the administration of antiandrogen steroid hormones
-Recidivism rates for castrated offenders are typically less than 3 percent, compared with greater than 50 percent for uncastrated offenders (Berlin, 1994; Green, 1992; Prentky, 1997). Despite the apparently high success rates, many feel that the treatment is brutal, unethical, and dehumanizing (Farkas & Stichman, 2002; Gunn, 1993), although this assumption has been challenged
