Chapter 10

Question 1

Gender identity

Answer 1

The psychological sense of being male or female. For most its consistent with their physical or genetic sex

Question 2

Gender Dysphoria

Answer 2

(prev. called gender identity disorder) applies to thos who expierence distress or impaired functioning as result of conflict between their anatomic sex and gender identity. Dysphoria means “difficult to bear” and refers to feelings of dissatisfaction or discomfort in ones gender. Often begins in childhood.

Question 3

Transgender identity

Answer 3

those who have the psychological sense of belonging to one gender while possessing the sexual organs of another. Not all of transgenders hae dysphoria. (only those who demonstrate distress)
- Many do not warrant diagnosis of dysphoria

Question 4

Sex Reassignment Surgery -5

Answer 4

1. Male to female more successful.
2. Hormone treatments promote development of secondary sex characteristics.
3. Generally positive effects on life after surgery.
4. Postoperative adjustment tend to be better for female to male.
5. Men seeking surgery outnumber women by 3 to 1

Question 5

Psychodynamic perspective of transgender identity

Answer 5

Close mother son relationships, empty relation with parents, fathers who were absent. These family cicumstances foster strong identitfication with the mother in young males, leading to reversal of expected gender roles and identity. Girls with weak mothers may overly identify with fathers.

Question 6

Learning theory of transgender identity

Answer 6

points to fathers absence in the case of boys to the unavailability of male role models. Children brought up by parents who had wanted children of other gender and who encouraged cross dressing may learn socialization patterns and develop gender identity disorder
*However, those with these kinds of families usually don’t develop gender identity disorders

Question 7

Biological perspective of transgender identity -2

Answer 7

1. May result from effects of male sex hormones in brain during prenantal development. high levels of testostoren during prenatal development leads to more masculinized children.
2. Distrubance in endocrine environment during gestations leads brain to become differenctiated with respect to gender identity in one direction while genitals develop in another.
3. Brain differences in transponders

Question 8

Sexual Dysfunctions (2)

• Prevalence
• Types/Groups

Answer 8

Persistent problems with sexual interest, arousal, or response. Classified in two categories: lifelong vs. acquired and general vs situational

• Worldwide review estimated they effect 40-45% of adult women and 20-30% of adult men.
• Groups: Disorders involving problems with sexual interest, desire, arousal. Disorders involving problems with orgasm. Problems involving pain during intercourse

Question 9

Disorders of interest and arousal

Answer 9

1. Male hypoactive sexual desire disorder
2. Female sexual interest/arousal disorder
3. Erectile disorder

Question 10

Male hypoactive sexual desire disorder

- Prevalence

Answer 10

have little if any desire for sexual activity or lack sexual erotic thoughts
- 8 to 25%

Question 11

Female sexual interest/arousal disorder

Answer 11

• lack of or reduced level of sexual interst, drive, or arousal
• 10-55%

Question 12

Erectile Disorder
- to diagnose?
Prevalence rates (age ranges)

Answer 12

to diagnose requires problem be persistent for period of about six months or longer and that it occurs on all or almost all (75-100%) occasions of sexual activity. - 50% of men in the 40-70 age range experience some degree of this.

• 1-10% under age 40
• 20-40% in men in their 60s

Question 13

Orgasm Disorders

Answer 13

Female orgasmic disorder, Delayed ejaculation, premature ejaculation

Question 14

Female orgasmic disorder
-Prevalence
To diagnose?

Answer 14

persistent difficulty achieving orgasm despite adequate stimulation. Also includes a reduction in intensity of orgasims. To diagnose must be present for six months, and occurs on almost all occasions.
- 10-42%

Question 15

Delayed ejaculation
-Prevalence
To diagnose?

Answer 15

persistent delay in achieving orgasm despite arousal (formerly called male orgasmic disorder) To diagnose must be present for six months, and occurs on almost all occasions
- Less than 1-10%

Question 16

Premature ejaculation
-Prevalence
To diagnose?

Answer 16

recurrent pattern of ejaculation occurring within one minute of vaginal sex
- 30% report rapid and 1-2% report within one minute

Question 17

Genito-pelvic-pain penetration disorder

- prevalence?

Answer 17

Women who have pain and difficutly engagning in intercourse. Cannot be explained by underlying medical condition. However, most can be traced to underlying med condition.

• about 15% in North America report pain
• Vaginismus happens when muscles surrounding vagina involuntarily contract whenever vaginal penetration is attempted. Not a medical condition but a conditional response in which contact triggers an involuntary spasm of vaginal musculature preventing penetration.

Question 18

Psychological perspective of sexual dysfunctions

• Emphasizes (5)
• Women
• Men
• Erection
• irrational beliefs

Answer 18

-Emphasize the role of anxiety, lack of sexual skills, irrational beliefs, perceived causes of events, and relationship problems.
- Women who have trouble becoming aroused may harbor deep seated anger towards partner
- Performance anxiety represents an excessive concern about the ability to perform successfully. - Western cultures make connection between how man performs and sense of manhood.
- a reflex and cannot be forced. Erectile reflex is controlled by the parasympathetic branch of the autonomic nervous system and activation of the symthatic branch when we are nervous can prevent the reflex. (therefore heightened arousal can trigger rapid ejac)
- Albert Ellis: underlying irrational belifs and attitudes can contribute to sexual dysfunctions: 1. We must have approval at all times of everyone who is important to us 2. We must be thoroughly competent at everything we do
If we cannot accept occasional disappointing sexual experience we may catastrophize the single episode. If we insit that every experience must be perfect, we set stage for failure

Question 19

Biological perspective for sexual dysfunctions (6)

- ED(4)

Answer 19

1. Low testosterone levels and disease can dampen sexual desire. Testostorene involved in both males and females. (Adrenal glands and ovaries are sites in Women were testo is produced)
2. However, those with sexual dysfunctions usually have normal levels of hormones
3. Cardiovascualr problems like impaired blood flow to penis can cause erectile disorder. Erectile disorder shares common risk factors with CVD which should alert doctors that it may be an early sign of heart disease.
4. Erectile disorder is linked to obesity in men and men with urinary and prostate problems
5. ED and delayed ejaculation may result from multiple sclerosis, a disease in which nerve cells lose their protective coatings that facilitate the smooth transmission of nerve impulses
6. Other forms of nerve damage, chronic kidney disease, hypertension, cancer, and emphysema can also impair erectile response as can endocrine disorders that suppress testo production.

Question 20

Harvard ED study

Answer 20

by Eric Rimm of Harvard found that ED associated with having large waist, physically inactive, and drinking too much alcohol (or not drinking). Common link among these factors may be high levels of cholesterol. Chlosterol can impede blood flow to the penis.

Question 21

Psychotropics effects

- drugs

Answer 21

1 in 3 women who use SSRI’s have impaired or lack of orgasm. Tranqs such as Valium and Xanax cause orgasmic disorders in both men and women. Some high blood and cholesterol drugs can impair arousal too.
- Depressants such as alcohol, heroin can depress testo production which diminish sexual desire

Question 22

Sociocultural perspective of sexual dysfunctions

Answer 22

−Greater incidence of erectile dysfunction in cultures with more restrictive attitudes toward premarital sex, sex among females, sex in marriage, and extramarital sex.

Question 23

Treatment of sexual dysfunctions (2)

Answer 23

1. Until William Masters and Virginia Johnson in 1960’s, there was no treatment for most sexual dysfunctions. Their sex therapy uses CBT techniques in a brief therapy
2. Today there is more emphasis on biological factors in sex problems and medical treatments like Viagra. ED drugs represent 5$ billion income

Question 24

Treatment for low sex drive or desire (3)

Answer 24

1. Therapist may help those with low sex drive rekindle their appetite through the use of self stimulation (masturbation) together with erotic fantasies.
2. When working with couples, therapist can prescribe mutual pleasuring exercises.
3. Some cases of low sex desire are assoc with hormonal defeciences. Males can use testo gel patch. However, testo treatments can lead to liver damage and possible prostate cancer

Question 25

Treatment of sexual arousal (2)

- sexual arousal

Answer 25

• sexual arousal results in the pooling of blood in the genital region, causing erection in the male and vaginal lubrication in the female. These changes in blood flow are reflexes
  1. Men and Women with arousal disorders are first educated that they need not do anything to become arousad. As long as the problem is psychological they only need to expose themselves to sexual stimulation under relaxed conditions.
  2. Masters and Johnson have a couple counter performance anxiety by engaging in sensate focus exercise- nondemand sexual contacts; sensuous exercises that do not demand sexual arousal in the form of lubrication or erection. Partners begin by massaging one another without touching the genitals. Uses communication to guide eachother. Countermands anxiey bcause there is no demand for sexual arousal.

Question 26

Treatment for disorders of orgasm

- For women

Answer 26

Women with orgasm disorder often harbor underlying beliefs that sex is dirty or sinful. Treatment in these cases includes modification of negative attitueds about sex. In either case Masters and Johnson would first work with the couple and first use sensate focus exercises to lessen performance anxiety, open channels of communications, and help the couple acquire sexual skills. The woman directs her parent to stimulate her; by taking charge the woman is psychologically freed from the stereotype of the passive submissive female role. Masters and Johnson preferred working with the couple in cases of female dysfunction, but others prefer working with just the woman by directing her to masturbate. Directed masturbation provides women opportunities to learn about their own bodies at their own pace and has success rate of 70-90%.

Question 27

Treatment for orgasm disorders

- For men

Answer 27

• Delayed ejaculation has received little attention in the clinical literature. Treatment focuses on increasing stimulation and reducting performance anxiety.
• • Most widely used behavioral approach to treating premature ejaculation called the stop-start or stop-and-go technique was introduced in 1956 by a urologist, James Semans. Partners suspend sexual activity when the man is about to ejaculate and then resume stimulations when his sensations subside. Repeated practice enables him to regulate ejaculation by sensitizing him to the cues that precede ejaculator reflex. High success rates buy high relapse rates.

Question 28

Treatment for Genital pain disorders

Answer 28

• Treatment of painful interecours generally requires medical intervention to determine and treat problems such as urinary tract infections.
• Cases of vaginismus use psycho treatment to relieve pain. Represents a psychologically based fear of penetration rather than a medical problem. Treatment includes combo of behavioral methods like relaxation and gradual exposure to desensitize the vaginal musculature to penetration by having the women insert fingers or plastic dilators.

Question 29

Biological treatment for sexual dysfunctions

1. ED
2. lack of sexual desire
3. Premature ejaculation

Answer 29

1. ED frequently has organic causes so most used is medicine
   Viagra and Cialis increase blood flow to penis and are safe. Combining psychotherapy with meds is more effective
   When pills don’t work, self-injection in penis of drug that increases blood flow may be used or vacuum erection device that works like penis pump. Surgery may be used to unblock blood vessels
2. Problems of sexual desire should not be treated in isolation but in a larger context that takes inot account psychological, cultural, andinterpersonal contexts.
3. SSRI’s work by increasing serotonin which can have side effect of delaying ejaculation

Question 30

Paraphilic Disorders

- Types (6)

Answer 30

unusual or atypical pattersn of sexual attraction that involve sexual arousal in response to atypical stimuli. Involve strong and recurrent sexual arousal to atypical stimuli as evidenced by fantasies, urges, or behaviors (acting upon the urges for a period of six months or longer)

• Almost never diagnosed in women with exception of masochism
  1. Exhibitionism 2. Fetishism 3. Trasvestism 4. Voyeurism 5. Frotterurism 6. Pedophilla

Question 31

Exhibitionism

• Prevalence
• Why?

Answer 31

strong and recurrent urges, fantasies, or behaviors of exposing of one’s genitals to unsuspecting individuals for the purpose of sexual arousal. Few cases are women and few are reported to police.
-Survey found that 4% of men (2% of women) report exposing genitals for sexual arousal.
−Men who engagne in this act do so as a means of indirectly expressing hostility toward women. They tend to be shy, lonely, dependent. Vicitms revulsion boosts their sense of master of the situation.

Question 32

Fetishism

Answer 32

recurrent powerful sexual urges, fantasies or behaviors involving inaimate objects such as an article of clothing.
−Orgins can be traced to childhood

Question 33

Transvestism

Answer 33

those who have recurrent and powerfule urges, fantasies, or behaviors in which they become sexually aroused by cross-dressing. Usually found among straight men. Man typically cross-dresses in private and imaginses himself to be a woman. Most married with kids.

Question 34

Voyeurism

Answer 34

involves strong and recurrent sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by watching ppl who are nake. Does not typically seek sexual activity. Almost always occurs in men.
−Often lacking in sexual expereicne and peeping may be only form of sexual outlet

Question 35

Frotterurism

Answer 35

recurrent, powerful sexual urges, fantasies, behaviors, in which the person becomes seually aroused by rubing against perons. Also called mashing and often occurs in crowded places.

Question 36

Pedophilia

- to diagnose

Answer 36

recurrent and powerful sexual urges or fantasies or behaviors involving sexual activity with children (typically 13 or younger). - To be diagnosed with pedophilia disorder person must be 16 and at least 5 years older than the child toward whom the person is sexually attracted. However, the diagnosis doesn’t apply to person in late adolescence who has a continuing relationship with a 12 or 13 year old.
− Not all child molesters have pedophilic disorder; disorder is only when sexual attraction to children is equal or greater than sexual attraction to mature individuals. Some child molesters experience pedophilic urges only occasionally.
- most cases involve law-abiding respected ppl

Question 37

Effects of sexual abuse on children (4)

1. How many before 18?
2. Frequency?
3. Sucidal behaviors?
4. Disorder?

Answer 37

1. Nearly 8% of adult males and nearly 20% of females report some form of sexual abuse before the age of 18
2. Frequency of sexual abuse during childhood may be 30% in girls and 15% in boys
3. those with history of child sexual abuse were between 6 and 10 times more likely to engage in suicidal behavior in adulthood.
4. Childhood sexual abuse is linked to later development of borderline personality disorder.

Question 38

Sexual Masochism

Answer 38

involves strong and recurrent sexual urges, fantasies, or behaviors in which the person becomes sexually aroused by being beaten or made to suffer in other ways. Disorder results in urges that are either acted on or cause distress. Found some times in women but more common in men. Some cases partner is engaged to bondage, sensory bondage. Some desire to be urinated on with verbal abuse.
- Hypoxyphilia is the most dangerous expression of sexual masochism; participants aroused by being deprived of oxygen.

Question 39

Sexual sadism

Answer 39

−Recurrent, powerful sexual urges where person is aroused by inflicting physical/psychological pain on another.
−Sadistic rapist fall into this category however most rapists do not become sexual aroused by inflicting pain; many even lose interest when they see them in pain

Question 40

Sadomasochism

Answer 40

sexual activites between mutual partners involving attainment of gratification by means of inflicting and receiving pain and humiliation.

Question 41

other paraphilias (6)

Answer 41

− Obscene phone calls (telephone scatologia)
− Necrophilia
− Partialism (sole focus on one body part)
− Zoophilia
− Coprophilia (feces)
− Enemas (klismaphilia)
− Urine (urophilia)

Question 42

Psychological perspective of paraphilias

• all paraphilias
• Exhibitionist
• recent theory

Answer 42

• See paraphilia as defenses against leftover castration anxiety from the phaillic period. Failure to successfully resolve it results in conflict; unconscious mind equates the disappearance of the penis during genital intercourse with risk of castration. At unconscious level castration anxiety promts the man to displace his sexual arousal onto safer activites like underwear, or children which can easily be controlled.
• Exhibitionists may be unconsciously seeking reassurance that his penis is secure
- suggest paraphilias may represent a temporary escape from ordinary selfhood. Objects provide temporary relief from responsiblies

Question 43

Learning theory of paraphilias

- family role

Answer 43

explain paraphilias in terms of conditioning and observational learning. Some object or activity becomes inadvertanely associated with sexual arousal. The object then gains ability to elcit arousal. June Reinish speculates that earlies awareness of sexual arousal respons may have been connected with diapers. Orgasm in prescene of object reingorces erotic connection.
- Family relationships may play a role; transvestite men may have had petticoat punishment. They may be attempting to psychologically convert humiliation into mastery by achieveing erection despite being in female clothing.

Question 44

Biological perspective of paraphilias -5

Answer 44

1. Higher than average sex drives in men illustrated by higher frq of sex fantasies and shorter refractory period after orgasm. • 2. Hypersexual arousal disorder and may cause some cases of paraphillias
2. Differences in brain wave patterns in response to paraphillic images and control nude images.
3. distinguish men with pedophilia from non with near 100% accuracy by measuring brain responses of fMRI to images of nude children
4. John Money traced origins of paraphilias to childhood. Suggested that childhood experiences etch a pattern in brain with he called lovemap which determindes the types of stimuli and activities that become sexually arousing. In paraphillias the love maps become distorted by early trauma.

Question 45

Psychoanaylsis treatment of paraphilic disorders

Answer 45

• Attempts to bring childhood sexual conflicts into awareness so they can be resolved in light of the individuals adult personality
• Very little evidence to support

Question 46

CBT treatment of paraphilic disorders

Answer 46

• Briefer and focuses directly on changing the problem behavior. Uses:

1. Aversive conditioning- goal is to induce a negative emotional response to unacceptable stimuli. Uses a conditioning model; stimuli involving children are paired with aversive stimuls in hope that person will develop a conditioned adversion towared the paraphilic stimuls.
2. Covert sensitization- variation of aversive therapy in which paraphilic fantasies are paired with aversive stimuli in imagination. Landmark study with men with pedophilia and exhibitionist were instructed to fantasize pedo or flashing scenes then aversive images are presented. In 25 year follow up, 7,275 sex offenders found that benefits had remained in men with exhibitionism but few with pedo. However, fewer than 50% of the original paricpants could be contacted.
3. Social skills training- helps person improve his ability to develop and maintain relationships with adult partners. Therapist might model a desired behabior.

Question 47

Biomedical therapies for paraphilic disorders (2)

Answer 47

1. SSRI’s show progress with exhibitioinism, voyerurism and fetishism
2. Antiandrogen drugs can reduce levels of testosterone in the bloodstream. They however don’t change the stimuli that you are attracted to or completely eliminate urges

Question 48

Rape

- emotional distress

Answer 48

• Emotional distress with rape victims tends to peak by about three weeks following the attack and generally remains high for a month or so before declining

Question 49

Rape statistics

1. Military women
2. FBI stat
3. Recent study
4. Recent US estimate
5. Age range
6. Age range

Answer 49

1. women in military who had been raped shown psychological and physical problems a decade after the assault
2. FBI reports 90,000 forcible rapes annually in the US; however these rates are underreported because most of rapes ore not reported or prosecuted
3. found that 1 in 5 women reported being raped or expierenced attempted rape. Estimated 1.3 million women suffer rape or attempted rape annually.
4. 1 in 4 women in US will suffer rape at some point in life.
5. 2 out of 3 rapes involve young women between the ages of 11 and 24
6. 80% involve girls and young women under 25

Question 50

Types of rape

Answer 50

stranger rape, acquintance, mariatal, and male

Question 51

Acquaintance rape

1. How many this type?
2. View as rape?
3. How many raped/attempted
4. How many of college rapes with acquaintances ?
5. How many college rapes in give year?
6. Date rapes?

Answer 51

1. More than 4 out of 5 rapes are this type.
2. Only one-quarter of women in a large-scale national survey who were sexually assaulted viewed themselves as victims of rape (1 in 4)
3. Survey also showed that 15.4% of women have been raped or attempted.
4. Nearly 90% of rapes in college sample were cases where woman was acquainted with the assailant.
5. In any given year about 3% of college women in US suffer from rape/attempted.
6. Date rape is a type of acquaintance rape; surveys show that as many as 1 in 4 college women report rape on dates.

Question 52

Martial rape

- prevalence

Answer 52

Investigators report 10-14% of married women suffer from martial rpe. Men who are better educated and less accepting of tradiotnal stertypes are less likely to commit rape.

Question 53

Male rape

- prevalence

Answer 53

1-3% of men at some point in lives become victims of rape. Most men who engage in male rape are heterosexual. Their motives are domination and control, revnec. Sexual motives often absent.