Chapter 13: Sexual Dysfunctions, Gender Dysphoria, and Paraphilic Disorders Flashcards
1
Q
Sexual Dysfunctions
A
characterized by a clinically significant impairment in one’s ability to respond sexually or to experience sexual pleasure. It is important to note that some people may have many characteristics of a sexual dysfunction yet not be distressed by them, and in these cases, a diagnosis would not be made.
2
Q
Ex: Sexual Dysfunction
A
an individual may have significant issues with obtaining and maintaining their penile erections, yet they may also derive much pleasure and satisfaction with their partner through activities that do not require an erect penis.
3
Q
Diagnosing SD
A
can be challenging at times, especially because some of the diagnoses require the clinician to make somewhat subjective judgments: to decide, for example, whether a client’s experiences are “persistent,” “recurrent,” or “delayed.”
4
Q
Gender Dysphoria
A
For the diagnosis of gender dysphoria, feelings of distress are experienced due to, for example, the absence of congruence between one’s birth-assigned sex and one’s gender identity.
5
Q
Gender
A
refers to the socio-cultural aspects of being a man, woman, or person of any gender,
6
Q
Sex
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refers to the biological aspects (e.g., anatomy, hormones, chromosomes).
7
Q
Trans
A
in the case of transgender individuals, it refers to one’s identity being on a different side of one’s sex assigned at birth.
8
Q
Cisgender
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it indicates that one’s gender identity is on the same side as one’s sex.
9
Q
Non-Binary (enby), bi gender, agender, and many other terms
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to convey that fitting into one gender or the other does not resonate with how they see themselves or how they wish to be viewed by others.
10
Q
Intersex
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refers to diversities of biological sex due to a variety of processes (e.g., hormonal, chromosomal) that exist outside of or are not seen as fitting norms of the binary sexes of male and female, and often involve unwanted medical attention. For example, some individuals have sex chromosomes that vary from XX (typically female) and XY (typically male), such as XXY (Klinefelter’s Syndrome) and XO (Turner’s Syndrome)
11
Q
Gender dysphoria
A
It refers to distress experienced due to, for example, an incongruence between one’s gender and one’s birth-assigned sex (the sex assigned at birth based solely on genital anatomy).
12
Q
Paraphillias
A
intense and persistent atypical sexual interests—cannot be diagnosed as a disorder unless the individual experiences distress or impairment because of the paraphilia, or it harms others. For example, a person who engages in sexual sadism with consenting, adult partners as part of a kinky lifestyle and who is not distressed by this behaviour would simply have a paraphilia called sexual sadism, but one who engages in this behaviour and harms others would be diagnosed with sexual sadistic disorder.
13
Q
Paraphilic interest is necessary but not sufficient conditions for having a
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Paraphillic disorder
14
Q
Paraphilic disorder involves
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get into trouble with the law due to the harm of others and/or breaking the law (e.g., trespassing, indecent exposure), which is one major factor that differentiates paraphilic disorders from sexual dysfunctions and gender dysphoria.
15
Q
Homosexuality
A
No longer considered a disorder
16
Q
Sexual orientation disorder
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to refer to those who were attracted to members of the same gender/sex and experienced conflict with their sexual orientation or who wished to change their orientation.
17
Q
Egodystonic homesexuality
A
A disorder (not currently in use) in which the person is attracted to people of the same sex, but experiences conflict with their sexual orientation or wishes to change it.
18
Q
Sexual Response Cycle
A
The sequence of changes that occur in the body with increased sexual arousal, orgasm, and the return to the unaroused state, noted by William Masters and Virginia Johnson.
19
Q
Excitement stage
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enital tissues swell as they fill with blood (vasocongestion). This process causes penile erection, engorgement of the clitoris, and vaginal lubrication. Furthermore, the testes and nipples become engorged, muscular tension and heart rate increase, and breathing becomes more rapid and shallow.
20
Q
Plateua stage
A
consolidates this arousal, with additional swelling of the penis and vulvar/vaginal tissues. The testes become elevated and may reach one and a half times their unaroused size. The clitoris retracts underneath the clitoral hood and the inner part of the vagina expands.
21
Q
Orgasm
A
rhythmic, muscular contractions in the genital region occur at about eight-second intervals. Penile orgasm usually comprises two stages, which quickly follow one another. First, seminal fluid collects in the urethral bulb, at the base of the penis. As this process occurs, there is a sense of orgasmic inevitability that signals impending ejaculation. Within two or three seconds, contractions lead to expulsion of the ejaculate. In those with uteruses and vaginas, the uterus and muscles surrounding the vagina contract during orgasm. Blood pressure and heart rate reach a peak during orgasm, and there are involuntary muscular contractions. Following orgasm, the body gradually returns to its pre-aroused state, in the stage that Masters and Johnson called resolution
22
Q
Four stages in sexual response: Excitement, platau, orgasm, and resolution for binary gender/sexes
A
23
Q
Resolution phase
A
the level of sexual arousal returns to the pre-aroused state. For some people with penises, there may be a refractory period following orgasm. As shown by the broken line, however, orgasm can be possible once past the refractory period (which can last a few seconds to hours/days depending on many factors, including age) and when levels of sexual arousal have returned to pre-plateau levels.
24
Q
There can be many sequences of sexual response to exist
A
Thus, a sexual encounter may sometimes involve excitement followed by diminished arousal without orgasm.
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Sexual dysfunctions: Categories and Subtypes
Sexual dysfunctions can be further characterized
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Sexual Desire and Arousal Disorders Subtypes
Sexual interest/Arousal Disorder (female)
Hypoactive sexual desire disorder
Erectile disorder
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Orgasmic disorders Subtypes
Delayed ejaculation
Orgasmic Disorder
Premature (early) Ejaculation (male)
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Lifelong Sexual Dysfunction
if the person has always experienced the problem,
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Acquired sexual dysfunction
Any sexual dysfunction that the sufferer has developed after a dysfunction-free period of time.
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generalized sexual dysfunctions
Any sexual dysfunction that is apparent in all sexual situations, including with the person's sexual partners and during solitary sexual activity.
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Situational Sexual Dysfunctions
Any sexual dysfunction that is apparent only in a specific sexual situation, for example, with a certain sexual partner.
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Hyperactive sexual desire disorder
A sexual dysfunction characterized by persistent or recurrent deficiency of sexual fantasies and desire for sex, causing marked distress or interpersonal difficulty.
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Sexual Interest/Arousal Disorder
A sexual dysfunction characterized by a lack of, or significantly reduced sexual arousal/interest (e.g., reduced sexual thoughts and sexual pleasure) for a minimum of six months in 75% to 100% of sexu
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Hypoactive
Implies an established standard
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Sexual arousal disorders
arousal disorders involve difficulty becoming physically aroused when the person desires such arousal. In those with penises, sexual arousal, or lack thereof, is usually gauged by penile erection, not the only physiological response but certainly the most obvious.
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Erectile disorder
haracterized by difficulties with obtaining an erection during sexual activity, maintaining an erection until the completion of sexual activity, and/or a marked decrease in erectile rigidity in 75% to 100% of sexual occasions. These symptoms must be distressing and be present for a minimum of six months. Erectile disorder is a commonly reported sexual dysfunction (McCabe et al., 2016a). Several factors can influence the rates of erectile disorder, including smoking, heart disease, and age, the last factor being particularly important given that the prevalence of erectile disorder increases with age
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Female Orgasmic Disorders
A sexual dysfunction characterized by a delay in, infrequency of, or absence of orgasm and/or a reduction in the intensity of orgasmic sensations in all or almost all (75% to 100%) occasions of sexual activity for a minimum of six months, causing marked distress or interpersonal difficulty. Also known as anorgasmia.
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Orgasm gap
refers to a notable difference in orgasm frequency between women and men during penetrative sexual activity, such that women report lower orgasm frequency than do men
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Delayed Ejaculation
is diagnosed when there is a marked delay in ejaculation or a marked infrequency or absence of ejaculation that is present in 75% to 100% of sexual occasions with a partner and for a minimum duration of six months.
the individual must not desire the delay and must be distressed about the symptoms
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Premature or early ejaculation
A sexual dysfunction characterized by ejaculation within approximately one minute of vaginal penetration during 75% to 100% of occasions of sexual activity for a minimum of six months, with marked distress.
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Genito Pelvic Pain/Penetration Disorder
A sexual dysfunction characterized by persistent or recurrent difficulties with one or more of the following: 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; and marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration on 75% to 100% of sexual occasions for at least six months, resulting in distress.
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Hypersexuality
Excessive interest or involvement in sexual activity at levels high enough to become clinically significant.
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“hyperaesthesia”
excessively increased sexual desire
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Nymphomania
excessive desire in women
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Satyriasis
excessive desire in men
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Hypersexuality
typically report experiencing a loss of control over sexual urges, fantasies, and behaviours, and they often engage in sexual activity to regulate negative emotional states (e.g., anxiety, depression)
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Atheoretical treatment-focused models
For example, it is important to examine those with hypsersexuality who are, or are not, paraphilic. Other subtypes include (1) those who present with problems with pornography and masturbation, (2) those with infidelity and multiple partner issues, and (3) those “designated” as patients by their partners or their own imposed (religious) norms around “normal” sexuality
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Risk factors of Sexual Dysfunctions
diabetes, heart disease, urinary tract disorders, chronic illness, depression and anxiety (as well as the medications used to treat these disorders), substance abuse, and psychosocial factors (e.g., poor relationship quality)
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High levels of depressive symptoms
correlation between high levels of depressive symptoms and reduced levels of sexual desire
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Reasons for sexual Desire Disorders
dysfunctional attitudes about sex, relationship problems, and a strict upbringing that associated sexual pleasure with guilt. A history of sexual abuse, emotional neglect, and other traumatic experiences (e.g., sexual harassment) has been associated with low sexual desire
Cognitive factors (e.g., stress, distraction, anxiety, self-consciousness) have been implicated in addition to relationship factors (e.g., sexual dysfunction in the partner/s, relationship duration and satisfaction, quality of communication
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Performance anxiety and sexual dysfunctions
is the response of individuals who feel that they are expected to perform sexually.
Worried that their performance will not be up to the expectations of their partner, they become spectators of their own behaviour, monitoring their own sexual performance and the perceived responses of their partner. When this happens, the person’s focus is on the performance rather than on enjoyment of the sexual experience.
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Hormone Imbalances can also play a role
ertainly, hormones such as estrogens, androgens, and prolactin are involved in sexual activity and desire, and variations in the levels of these hormones can lower or increase sex drive
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Erectile disorder involves a complex interplay between physiological and psychological factors.
cardiovascular disease, neurological diseases, damage due to pelvic surgery, or various medications, whereas psychological factors include performance anxiety (described above), stress, mood disorders, problems in the relationship, and psychological traumas
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Risk factors for erectile disorder
include age, diabetes, hypertension, cigarette smoking, and alcoholism (Russell & Nehra, 2003). Hormonal factors have also been proposed, where a loss of androgens may contribute to erectile dysfunction. Overall, both psychological and physiological factors are important and should be considered in a comprehensive assessment by a multidisciplinary team.
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Premature (Early) Ejaculation
Several factors have been implicated in premature (early) ejaculation. For example, genetic factors involved in the sensitivity of the ejaculatory response may play a role, as can the presence of erectile disorder, anxiety, hyperthyroidism, and prostatic inflammation or infection (Donatucci, 2006). In addition, sexual conditioning is important to assess; some individuals develop a habit of masturbating quickly and efficiently, which over time may generalize to other sexual situations (recall Mo’s experience). Furthermore, a low frequency of ejaculation (Donatucci, 2006), younger age, and life stressors such as relationship or work dissatisfaction (Corona et al., 2004; Corona et al., 2006) have been implicated.
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Genito-Pelvic Pain/Penetration Disorder (GPPPD)
GPPPD can result from underlying physical pathologies such as pelvic floor muscle dysfunction, endometriosis, interstitial cystitis, lichen sclerosus, and genital infections (e.g., candidiasis, herpes, bacterial vaginosis; Pukall et al., 2016). Psychosocial factors also play an important role in the onset and maintenance of GPPPD (Bergeron, Rosen, Pukall, & Corsini-Munt, 2020). For example, childhood victimization, anxiety and depression, and relationship factors have been found to play a role in the expression of GPPPD. In addition, cognitive factors such as pain catastrophizing, hypervigilance to pain, lower pain self-efficacy, and negative attributions about the pain—all of which may lead to an avoidance of sexual activity—have been associated with increased pain in GPPPD
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Treatments for Sexual Dysfunctions
Effective sexual communication first requires each partner to develop an understanding of their own sensations and bodily response. Acceptance of their own bodies may be limited because of embarrassment or guilt.
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Sensate focus
essentially a form of desensitization applied to sexual fears. It is assumed that once the sexual dysfunction has emerged, the person develops performance anxiety or fear, which serves to worsen and entrench the problem.
Sensate focus involves a series of exercises where partners engage in predetermined stages of sexual interaction (Weiner & Avery-Clark, 2014). In the first step, they undress together with the light on to desensitize any embarrassment they may have about being naked together. They next take turns at massaging or touching one another all over, except for the genital or breast areas. They are learning to enjoy touching and being touched without any fear of imminent demands for sex. After several sessions of this, each person begins to tell the partner during the touching exercises what each enjoys.
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Stop-start and squeeze techniques
behavioural approaches used to treat premature (early) ejaculation, and can be used either with or without a partner (Cooper et al., 2015). With the stop-start technique, manual stimulation of the penis occurs until the earliest signs of approaching orgasm are perceived, at which point stimulation is stopped. After a period of time (approximately 40 seconds to 1 minute), stimulation recommences. This procedure is repeated so that the entire process lasts approximately 15 minutes (employing as many stops as is necessary). Sometimes, just stopping is not enough to prevent ejaculation. In those cases, the squeeze technique is employed by squeezing around the coronal ridge of the penis. Although it is not painful, the squeeze technique diminishes arousal and prevents ejaculation. When the individual can last approximately 15 minutes with only one or two “stops,” the couple can proceed to more arousing stimulation methods (e.g., oral sex)
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Vaginal dilation
(i.e., the use of dilators to aid in relaxing the vaginal opening), is recommended for those who have GPPPD. Vaginal dilatation involves the gradual insertion of dilators of increasing diameter during general body (e.g., deep breathing) and pelvic floor muscle relaxation exercises to normalize muscle tone
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phosphodiesterase inhibitors (PDE5 inhibitors) designed to treat erectile disorders
sildenafil (marketed under the trade name Viagra), tadalafil (Cialis), and vardenafil (Levitra), and all restrict the breakdown of cyclic guanine monophosphate, which leads to increased blood flow and stronger erections. Each medication has been approved by Health Canada, although some adverse side effects have been noted (e.g., problems with vision). Some patients prefer one type over another, given differences with regard to duration of action (Viagra has the shortest duration at four to six hours and Cialis has the longest duration, up to 36 hours) and interactions with fatty foods
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PDE5 Inhibitors
Given the encouraging results and typically mild side effects, these drugs have become the first-line medical treatment option for erectile disorder, with intracavernous treatment being recommended as second-line.
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transurethral therapy- erectile disorder
tracavernous treatment, via self-injection of smooth muscle relaxants (e.g., phentolamine, papaverine, and alprostadil) into the corpus cavernosum of the penis, facilitates an erection by relaxing smooth muscle tissue
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Alprostadil, in particular, represents the most common form of intracavernous treatment
for erectile dysfunction and, upon administration, erections may last for about an hour, irrespective of whether there is direct sexual stimulation. Erections typically occur within 10 minutes, and side effects include mild pain and priapism (Shamloul & Ghanem, 2013); however, studies have shown that this type of treatment is efficacious and safe (for a review, see
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Transurethral therapy consists
of the insertion of an erectogenic drug (usually alprostadil) in the form of a pellet into the urethra with a small applicator. Side effects include penile and/or urethral pain, syncope, and priapism (Shamloul & Ghanem, 2013). Studies have reported a rate of 49% to 66% for erections that are sufficient for intercourse and a rate of 64% for successful intercourse, but other studies have reported much lower success rates
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Antidepressants (SSRIs)
have also been used off-label, typically in the treatment of premature (early) ejaculation, as they have demonstrated the ability to delay the ejaculatory response and have led to improved sexual satisfaction
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Pelvic floor physiotherapy
emerged as a potential treatment for men with erectile dysfunction (primarily in the UK; Dorey et al., 2004), although the use of vacuum erection devices is more common. Both retrospective (Bergeron et al., 2002) and prospective studies (Goldfinger, Pukall, Gentilcore-Saulnier, McLean, & Chamberlain, 2009) have documented positive outcomes of pelvic floor physiotherapy for GPPPD in terms of pain reduction and improvements in sexuality after treatment.
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Surgical interventions are also recommended for some individuals with sexual dysfunctions
vestibulectomy (surgical removal of the superficial vestibule) for women with a particular form of GPPPD called provoked vestibulodynia is the most commonly reported treatment and has positive outcomes (Bergeron et al., 2020). Penile implants for those with erectile disorder are typically recommended as an option after other treatments (drugs, injections) have yielded unsatisfactory results. While a number of different implants were used in the past, the most popular approach is to implant inflatable silicone cylinders in the penis
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“Two-Spirit”
Indigenous individuals who express diverse masculine and feminine spirits; this term is usually used by many Indigenous individuals when describing not only their gender/sex and sexual identity, but also their spiritual identity and connection to Indigeneity.
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Gender identity
a person’s sense of self as boy/man, girl/woman, both, or something else, the first signs of which appear between 18 and 36 months of age; Money, 1987) may align with one’s birth-assigned sex, and it may change over time, as can dimensions of sex (e.g., with puberty or bodily gender affirmation).
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Gender expression
is how a person publicly expresses their gender through, for example, their behaviour, outward appearance, chosen name, and pronoun.
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Gender role
is the collection of those characteristics that a society defines as masculine, feminine, or androgynous. Because roles relate to social standards, ideas about gender roles change over time and vary among cultures. In some instances, these “variables of sex/gender” do not all coincide
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Intersex
variation may be reflected, with the reproductive structures or genital anatomy presenting as different from what is typically considered to be “male” or “female.”
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Gender dysphoria
When biological variables are coincident with each other, but are discordant or branched with the person’s sense of self,
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Gender Identity disorder
Several studies have reported evidence indicating a significant heritable pattern for children with gender identity disorder (GID), the diagnosis that existed prior to gender dysphoria
It has also been proposed that an “excess” or absence of testosterone during a critical point in fetal development may affect the individual’s gender identity. One of the most predominant neurobiological theories for the development of gender dysphoria has focused on the role of prenatal hormones. In particular, prenatal exposure to male-typical levels of androgens is theorized to masculinize postnatal behaviour, whereas “underexposure” to male-typical levels of androgens has the opposite effect
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Treatments
Some, but not all, people with gender dysphoria request hormonal treatment or surgery to align their body with their identified gender/sex
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The Standards of Care include the following minimum eligibility criteria for gender-affirming surgery:
1) persistent, well-documented gender dysphoria; (2) capacity to make a fully informed decision and to consent for treatment; (3) age of majority in a given country; (4) if significant medical or mental health concerns are present, they must be well controlled; and (5) 12 continuous months of hormone therapy (unless medical issues preclude the use of hormones).
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Hormonal therapy
assists in developing the desired secondary sex characteristics (Dickey & Steiner, 1990) and is a crucial aspect in mental health outcomes
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Those who were assigned male sex at birth and who were treated with androgen-suppressing and estrogenic hormones
how breast enlargement, skin softening, increased fat deposits, and decreased muscle bulk, as well as decreased facial and body hair.
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Treatment of those who were assigned female sex at birth with estrogen-suppressing and androgenic hormones leads
to an increase in muscle bulk, facial hair and body hair, potential receding and loss of head hair, deepening of the voice, enlargement of the clitoris, increased libido, and suppression of ovarian function.
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Paraphillias
paraphilias are characterized by “intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory fondling with phenotypically normal, physically mature, consenting human partners”
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Paraphillic disorder
as a paraphilia that currently causes distress or impairment to the individual, or a paraphilia that causes personal harm, or risk of harm, to others when acted upon. According to this perspective, which has taken decades for the DSM to adopt, if a clinician ascertained the presence of a paraphilia, it would not necessarily require psychiatric diagnosis or intervention. Only in the case that this paraphilia caused distress to the individual experiencing it or harm to others would it then be diagnosed as a paraphilic disorder. In addition, the criterion for the paraphilic disorders that involves nonconsenting persons is more specific in terms of the number of nonconsenting persons involved, and this number varies depending on the paraphilic disorder.
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Fetishistic disorder
as recurrent and intense sexual arousal from either the use of nonliving objects or a highly specific focus on a nongenital body part or parts. Fetish objects are not limited to articles of clothing used in cross-dressing or devices designed for genital stimulation (e.g., a vibrator). As with all of the paraphilic disorders, the fetish needs to have occurred over a period of at least six months, as manifested by fantasies, urges, or behaviours. For this to be a paraphilic disorder, as opposed to a fetish (a paraphilia), there needs to be clinically significant distress or impairment in functioning
-women's underwear or shoes
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Apotemnophilia
is the fetish for amputation and genital mutilation. One case was even documented where a man cut off his own penis due to a genital mutilation fetish (Lowenstein, 2002). Many individuals have more than one fetish
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Other fetishes
typically like to smell or rub the object against their bodies or, in some cases, wear the article or have their partner wear it.
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Transvestic disorder
When the articles worn by the person with the fetish are clothes of the other sex and this behaviour is considered distressing
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Transvestic disorder
According to the DSM-5-TR, a person who cross-dresses—wears the clothing associated with the other sex—to produce or enhance sexual excitement is said to have transvestism. If this cross-dressing (or fantasies or urges to cross-dress for sexual excitement) occurs over a period of at least six months and causes significant distress or impairment, it becomes transvestic disorder, as opposed to transvestism. Although the prevalence of transvestic disorder is not known, it appears to be more common in men than women
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Sexual sadism
describes a sexual preference toward inflicting pain or psychological suffering on others.
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Sexual masochism
describes individuals who enjoy experiencing pain or humiliation from another individual.
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Sexual sadism and masochism
diagnosed when the individual has acted upon these sexual urges with a nonconsenting person (in the case of sadism), or the sexual urges or fantasies cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
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BDSM
refers specifically to bondage and discipline, domination and submission, and sadism and masochism. Many sadists and masochists in the context of BDSM are generally well-adjusted individuals with otherwise conventional lifestyles.
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Sexual sadism
occurs when a person experiences sexual pleasure from inflicting physical pain or psychological suffering on another person, often to gain power or to humiliate the other person. Those with the disorder find ritualized sadism with a willing partner to be unsatisfying and seek out nonconsenting partners, thus satisfying the definition of a sexual offence. These individuals will be considered in more detail in the later section dealing with sexual assault.
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Sexual masochism
can include behaviours that range from harmless (likely not meeting the definition of a disorder), such as being restrained, to potentially dangerous and meeting criteria for a sexual masochism disorder, such as hypoxyphilia (also known as autoerotic asphyxia or asphyxiophilia), a paraphilic interest that strongly overlaps with masochism, with 71% to 99% of those who partake in autoerotic asphyxia identifying as masochists
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Exhibitionistic Disorder
exhibitionism (i.e., exposing one’s genitals to an unsuspecting and nonconsenting individual or individuals) is the most frequently occurring sexual offence in Western countries. According to one survey, just over 40% of university women had been victims of exhibitionism
They found that a substantial number of exhibitionists go on to commit more serious “hands-on” sexual offences and that such individuals are at greater risk for committing another offence when compared to other types of sexual offenders
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Dick picks and exhibitionist disorder
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Voyeuristic disorder
Voyeurs are individuals who experience recurrent and intense sexually arousing urges/fantasies or behaviours involving the observation of unsuspecting individuals who are naked, disrobing, or engaged in sexual activity
An essential feature of this disorder is that the person of interest must be unaware that they are being watched. Usually, voyeurs do not seek sexual relations with the person being watched and will often masturbate while engaged in the voyeuristic activity or later in response to the memory of what the person has witnessed. The DSM-5-TR specifies that voyeuristic disorder cannot be diagnosed in individuals under the age of 18, in order to avoid pathologizing normative sexual interest and behaviour during puberty.
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Frotteuristic disorder
Almost all detected frotteurs are male. Frotteurism (or frottage—from the French frotter, “to rub”), according to the DSM-5-TR refers to touching or rubbing up against a noncompliant person so that the frotteur can become sexually aroused and, in many cases, reach orgasm
crowded places such as busy sidewalks, stores, or shopping malls, or on packed public transport.
fondling the victim’s genitals, buttocks, or breasts, or rubbing the penis vigorously against the victim until orgasm occurs. Observations like these encouraged Langevin (1983) to view frotteurism as a form of sexual aggression belonging to the same category as rape/sexual assault.
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Pedophillic disorder
ndividuals who exhibit a predominant sexual interest in, or preference toward, prepubescent children (Freund, 1981; Marshall, 1997). Specifically, this paraphilia is characterized by recurrent, intense sexually arousing fantasies, sexual urges, or behaviours involving sexual activity with a prepubescent child (generally defined as aged 13 years or younger in the DSM-5-TR;
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Child molestor
is an individual who has engaged in a sexually motivated act against a prepubescent child, without an indication of preference,
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Pedophile
is an individual who has displayed a preference for sexual behaviour with a child
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Sexual assault
Sexual assault refers to the many ways in which a person can be violated. Historically, the only sexual assault considered was rape. The term rape, in its traditional sense, refers to forced penetration of an unwilling female’s vagina by a male assailant’s penis. Not only did this definition exclude the sexual assault of males, it placed quite unnecessary emphasis on penile–vaginal intercourse. In terms of legal processes, this requirement of demonstrated forced vaginal intercourse in order to obtain a conviction of rape caused so many problems that Canadian legislators decided to change the law
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Others
Sexual satisfaction derived from receiving enemas (klismaphilia), as well as urination (urophilia) or defecation (coprophilia), occurs frequently enough that pornographers cater to such interests. Some less frequent paraphilias, however, involve activities that break the law, such as sex with animals (zoophilia or bestiality), or that take the form of obscene telephone calls (scatologia)
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Conditioning theories
A young man, for example, might be caught in the act of masturbating by an attractive woman, and this association between high sexual arousal and a woman seeing his exposed penis might, according to this conditioning account, serve to entrench an attraction to (or preference for) exposing his penis to women. Similar accidental associations between sexual arousal and seeing younger children were said to be the conditioning bases of future child molestation, while masturbating to pornographic images of, or to thoughts of, sexually assaulting a woman were said to instill a preference for rape.
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Neurodevelopment theories
Non-right-handedness and minor physical anomalies are signs of neurodevelopmental problems in utero, and in support of a neurodevelopmental hypothesis, non-right-handedness was found more frequently in pedophiles (Cantor et al., 2004), as were minor physical anomalies (Dyshniku et al., 2015). Pedophiles were also more likely to have head injuries before, but not after, the age of 13 years (Blanchard et al., 2002). Findings from numerous studies also show that pedophiles have lower IQs than non-pedophile offenders, and they are more likely to have repeated school grades or received special education
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Childhood and social development theories
Sexual offenders do typically have disrupted childhoods, and there is clear evidence that such experiences leave a child feeling unlovable, lacking in self-confidence, with poor social skills, and with a propensity for antisocial behaviour (Loeber, 1990). In this theory, however, it is not just poor parenting that produces sexual offending; socio-cultural factors, accidental opportunities, and transitory states all contribute to the complex array of influences that set the stage for sexual offending.
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Medical Interventions
The aim of medical interventions is to eliminate or to reduce sexual drive so the person will be uninterested in sex or will easily be able to control the expression of paraphilic interests. Physical castration, the surgical removal of the testicles, essentially eliminates the body’s production of testosterone, the sex steroid that plays a role in sexual drive. The relationship between testosterone and sexual aggression is well established (Bradford, 2000). Castration is associated with lower recidivism rates in offenders
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Anti-androgens reduce
sexual interest, fantasies, and behaviours in sexual offenders (Rösler & Witztum, 2000), though side effects are considerable.
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Other treatments
selective serotonin reuptake inhibitors (SSRIs) and luteinizing hormone-releasing hormone (LHRH) agonists. Both medications have demonstrated an ability to reduce or allvliate sexual fantasy, urges, and behaviours (Briken, Nika, & Berner, 2001; Fedoroff, 1993; Rösler & Witztum, 1998) without causing significant side effects.
