Gender Dysphoria, Sexual Dysfunction And Paraphilias Flashcards
What does cisgender mean?
Someone’s sex assigned at birth and gender identity correspond in the expected way
What does cross dresser mean?
A person who dresses as the binary opposite gender expression for relaxation and fun. Generally refers to a man who occasionally wears clothes of the opposite sex, wears makeup and accessories associated with women.
They are usually heterosexual
What does gay mean?
Experiencing attraction solely to some members of the same gender
What is gender expression?
External display of one’s gender, combination of clothing, grooming, demeanor, social behavior, scales or masculinity and femininity
What is gender identity?
Internal perception of one’s gender, how they label themselves. A person’s internal deeply held sense of their gender. Refers to an individual’s identifications man, woman, both or neither
What is gender nonconforming ?
A gender identity label that indicates a person who identifies outside of the gender identity
What does gender queer mean?
An umbrella term for many gender non-conforming or non-binary identifies (e.g., agender bigender, genderfluid)
What does queer mean?
Umbrella term for persons who do not identify as straight +/- cisgender
What is sexual orientation?
Type of sexual, romantic, emotional attraction one has to capacity to feel for some others, based on gender relationship between the person and the people they are attracted to. The physical, romantic +/- emotional attraction to another person. Not the same as sexual preference
What is sexual preference?
Types of sexual intercourse, stimulation and gratification one likes to receive and participate in
What is transgender?
An umbrella term for anyone whose sex assigned at birth and gender identity do not correspond in the expected way. A gender description for someone who has transitioned( or transitioning) from living as one gender to another. Used as an adjective, not a noun
What is a transsexual?
A person who identifies psychologically as a gender/sex other than the one to which they were assigned at birth. Transexuals often wish to transform their bodies hormonally and surgically to match their inner sense of gender/sex. Many transgender people do not identify as transsexual - ask which term + pronoun a person prefers
Contrast gender identity and gender role/expression
Gender identity: who you are on the inside
Gender role/expression: your expression of gender in society
What is gender dysphoria?
When gender identity and gender role don’t match
-feels trapped in the wrong, e.g., biologically (sex assigned at birth) male, gender role male, gender identity female, attracted to male
When do you know gender role and gender identity don’t match?
3-4 years
When do you know your sexual preference or sexuality?
Puberty
When do cross dresser behaviors become appearent?
Parents report cross gender behaviors were appearent before 3 years
What are the diagnostic criteria of gender dysphoria?
A marked incongruence between one’s gender assigned at birth and one’s experienced gender
The incongruence results in clinically significant distress or functional impairment
Symptoms endure 6 month
What is the etiology of sexual dysfunction ?
Psychological factors are the primary cause
- anxiety
- guilt
- body image
A medical condition may co-exist but in sufficiently explains the symptoms
How can sexual therapy be used took treat sexual dysfunction?
Dual sex therapy- emphasis is on treating the couple when the person is in a relationship
Short term with behavioral focus
Sex education
Communication skills
Anxiety reduction through senate focus exercises (e.g., non-coital activities progressing not coital activities
How can sexual dysfunction be treated, aside from sexual therapy?
Psychotherapy- feelings of guilt, poor self-esteem, anxiety, fear
Orgasm-
1. Squeeze-squeeze coronal ridge of the glans penis to cause discomfort (premature ejaculation)
- Stop and go- partner ceases stimulation of the partner to reduce pleasure
Pain
- dilators
- relaxation
Pharmacotherapy
How can pharmacotherapy be used to treat sexual dysfunction?
Pharmacotherapy- medications may be useful adjunct to behavioral therapy
- Vasodilating substances such as Viagra for erectile disorder
- SSRI to slow ejaculation in premature ejaculation
What is a paraphilia ?
Sexual stimuli or acts that are deviations from “normal” sexual behaviors but are necessary for some persons to experience arousal and orgasm
- intense and persistent
- at least 6 months
- manifested by fantasy, urges and behaviors
When does paraphilia become a disorder?
Paraphilia becomes a disorder if any of the following are present:
- Someone acts on the urge with a non-consenting person OR
- someone acts on the urge with a consenting person (or thing) and the actions cause significant distress/functional impairment OR
- Someone does not act on the urge, but the urge causes significant distress/functional impairment
What is exhibitionism?
Type of paraphilia disorder
Sexual arousal from exposing genitals to unsuspecting stranger
Typical features:
- female victim
- masturbation during act
- no attempt to involve the observer
What is voyeurism?
A type of paraphilia disorder where sexual arousal from observing unsuspected person naked or in the process of disrobing or engaging in sexual identity.
Person is Atleast 18 years old
Typical features:
- female victim
- masturbation during act
- no attempt to further involve the stranger
What is fetishism?
A paraphilia disorder where sexual aroudal is derived from objects (shoes, gloves, stockings) or highly specific sexual focus on non-genital part
Devices used for tactile stimulation do not qualify as fetish
Typical features:
- Masturbation accompanies a multi sensory fondling of the object
- Object May be required in order to get aroused
What is transvestism?
Sexual arousal by cross dressing -wearing clothing of the opposite sex
Typical features:
- unrelated to gender dysphoria
- cross dressing may involve a single article of clothing or complete dressing as opposite sex
- Distress May be manifested as “purging and acquisition” behavior
What is frotteurism?
-sexual arousal From touching or rubbing against a non consenting person
Typical features:
-Occurs in crowded places
- Frottuer fantasies about a relationship
- frottage tends to be their sole sexual outlet
What is sexual sadism?
Sexual arousal from causing the physical and psychological suffering of another person
What is sexual masochism ?
Sexual arousal from receiving physical and psychological suffering —> humiliation, beaten, bound, asphyxia
What are the typical features of sexual masochism and sadism?
S and M acts (simulation) May occur between consenting partners as normal variety
- True S and M acts are NOT simulated. If they occur between non-consenting partners or if distress/harm results, then acts are diagnosable
- Actions tend to increase in severity over time for both sadist and masochist to achieve arousal
What is pedophilia?
Sexual arousal from prepubescent child
The child typically is less than 13 years old (depends on whether they have reached puberty)
-Perpetrator is at least 16 years old AND at least 5 years older than the child
What are the typical features of pedophilia?
Involves viewing, fondling, oral sex(cunnilingus or Felatio)
Lack of remorse, and use of rationalization to justify actions
What is the epidemiology of pedophilia?
People with paraphilic disorders are:
- rare and almost exclusively males
- frequent offenders
Give onset and course of pedophilia
- urges typically start in childhood/teens with actions becoming better defined with age
- disorders are chronic and associated with a high recidivism rate after treatment/ prison release
Give the etiology of paraphilias
Multifactorial and unknown
Theories: psychological factors
-improper identification with opposite sex parent
- exhibitionism and voyeurism —> calm anxiety about castration
- fetishism —> shoe fetishism, the shoe symbolizes the female penis
- pedophilia and sadism —> compensation for powerlessness
- masochism —> overcome fear of injury and sense of powerlessness by showing they are impervious to harm
- Early childhood abuse —>spanking, enemas, verbal humiliation (classical conditioning)
Give the THEORIES of paraphilia
Biological factors:
-Abnormal hormone levels—> testosterone levels affecting sex drive
-Neurological —> frontal lobe dysfunction, serotonin Dysregulation affecting impulse control
Psychological-environmental factors:
Classical conditioning (e.g., in fetishism) -the object /situation was paired with sexual excitement in the past
Imitation(e.g., in pedophilia)
-the person imitating abuse that was sustained in the past (I.e., the person is “identifying with the aggressor”)
Summarize methods of paraphilia disorders
Behavioral therapy - aversion and CBT
reduction of sexual drives
Treatment of comorbid conditions
External control
How can behavioral therapy be used to treat paraphilic disorders?
Aversion therapy
-when engaging in paraphilia, a noxious stimulus is applied to the patient
-when fantasizing about the paraphilia, the patient imagines an aversive consequence —> covert sensitization
CBT
-social skills, sex education, development of victim empathy, cognitive restructuring
How can we reduce sexual drives to treat paraphilic disorders?
Antiandrogens (Depo-provera)
- decreased serum testosterone levels —> decrease sex drives
- Chemical castration
- Non-compliance is a problem
How can comorbid conditions of paraphilias be treated?
Depression , anxiety
SSRI —> decrease libido, control impulse and reduce obsessions
How can external controls be used to treat paraphilia?
Eliminate opportunities for the perpetrator to act on the urges
How does registration on the sex offenders list occur?
Person convicted of certain sex crimes must register in the jurisdiction in which they work or attend school
- update information: annually, every 6 months or every 3 months
- duration : 15 years, 25 years or for life
What law allows for the sex offenders list to be made publicly available ?
Notification: this information is made publicly available
-Megan’s law- Megan Kanka was raped and murdered by a repeat sex offender
What legal issues have involved the registered sex offenders list?
Sex offenders have challenged the registration and notification laws
- they cannot be punished twice
- the registry is punitive
US Supreme Court rejected their argument
When was being gay, ceased being considered an ailment ?
DSM eliminated homosexuality as a disorder in 1973; it was not listed after DSM-II
When and how is sexual orientation determined?
Sexual orientation is not alterable. It is established in-utero after a subtle difference in hormone exposure changes brain development.
Conversion therapies
