Gender Identity Disorder, Paraphilias, and Sexual Dysfunctions Flashcards
In most cases of sexual assault…
the woman was acquainted with the assailant
Premature ejaculation affects about …
one in three men
maybe not throughout lifetime, but becomes temporarily problematic
Sexual behaviour may be labeled as abnormal if it: (4)
- deviates from the norms of one’s society (defining society is complex; sub-groups, etc.)
- is self-defeating/causes personal distress
- harms others
- interferes with one’s ability to function
Gender Expression
the way one presents their gender outwardly
Gender Identity
one’s psychological sense of being female or male
Gender Dysphoria
A disorder in which the individual believes that her or his anatomic gender is inconsistent with his or her psychological sense of being male or female
What shouldn’t we assume?
someone’s sexual preference for a partner based on their gender identity
-> sexual preference and gender identity is correlated but correlation is not perfect! ex: Caitlyn Jenner
Transvestite
a fetish; cross-dressing (mostly males because much less obvious in females) typically in private; typically not gender dysphoria
Gender Dysphoria Treatment
- Hormone therapy
- Living as the identified gender ~1 year (RLE)
- sex assignment surgery (tracheal shave, breast removal/construction, vaginoplasty, phalloplasty)
- psychotherapy (necessary throughout, screen for other conditions motivating desired for gender change, etc.)
Surgical removal of the penis and creation of a vagina
Vaginoplasty
Phalloplasty
- clitoris embedded in shaft of penis created from skin taken from thigh or forearm
- normal size penis, erection achieved via prosthesis
What is more complicated building penis or vagina?
Building penis out of nothing is more complicated
-> phalloplasty and metoidioplasty
Metoidioplasty
- vaginal lining is scraped and allowed to heal together to seal closed
- alternative to phalloplasty
- starts with hormone therapy to enlarge clitoris about 5 cm
- labia are fashioned into a scrotum, usually with prosthetic testicles
- clitoris located at end; maintains orgasmic capacity
Gender transformation is a ________ process
lifelong
- > neither begins nor ends with surgery
- > not every transgendered person want the full range of affirming surgeries (choose whatever subset they feel best resolves their gender dysphoria)
- -> may mean NO surgeries or hormones at all
Paraphilic Disorders
LOTS
- exhibitionistic
- fetishistic
- transvestic (don’t confuse with GD)
- voyeuristic
- frotteuristic
- toucheristic
- klismaphilic
- pedophilic
Exhibitionistic Disorder
Obtaining sexual gratification from exposing themselves to someone who wasn’t expecting it ; sometimes want an appreciative audience, some get gratification of ppl running away; ABOUT sexual arousal, so have to have erection; usually ppl exposed to are females .. Dr. frenzel’s encounter .. Wasn’t in isolation
Voyeuristic Disorder
- opposite of exhibitionistic (taking a peek)
- must be non-consenting
Frotteuristic vs. Toucheristic Disorder
F - Rubbing genitals, kinda like flashing except instead of flashing it’s touching genitals ; ex: train bumping man against you and he looks pleased
T - similar to above, but touching with hands in crowded place; may be hard to see!
Klismaphilic Disorder
sexual arousal from receiving an enema
Pedophillic Disorder
Erotic interest in children (pre-adults); not necessarily molester
T or F. Most individuals with pedophilic disorder do not become molesters
T; it is possible to molest children without being a pedophile also
The Development of Persistent Sexual Offending Against Children (2):
- Antisociality
- Sexual attraction to prepubescent children (pedophilia)
^^ Presence of both significantly increases likelihood that a person will offend against children
Legalities of real life experience (RLE) =
no longer a legal requirement (clinically still required) // but there is expectation for them to live for 1 year as transgender]
Primary means of assessing erotic preference
Patient self-report
-> prone to distortion, especially when motivated by shame or possible legal censure
Assessment of erotic preference
- self-report
- web browsing history examination
- VRT
- Plethysmographic studies
VRT
- visual response time (done under lab conditions)
- indirect
- seated so can’t move
- viewing hundreds of pictures (naked people) in a large screen close to them
- becomes clear where they are staring; measures where eyes are and computer measures amount off time they linger, where, etc.
- measures trends and consistencies
Abel battery
- VRT
- also elicits subjective rating from 1 (disgusting) to 7 (highly arousing)
- not always accepted in court
Plethysmographic studies
- more direct
- mostly in males; far more effective in M too
- measurement of arousal (changes in blood flow) while watching/hearing stimuli in several categories
- electrical resistance increases when erection occurs to the round mercury thing
- in females = the more aroused the less light is coming through sensor (infared diode)
Psychodynamic theory for paraphilic/gender identity disorders
- castration anxiety leads to a projection of sexual desires onto ‘safer’ targets
- the penis vanishing into a vagina is symbolic of castration
- masochism is symbolic aggresion toward the internalized father
Treatment of Paraphilias
- Psychodynamic: resolution of Oedipal complex and corresponding to castration anxiety allows the emergence of non-paraphilic interests; little empirical support
- behaviour therapy: aversive conditioning; prone to extinction; no promotion of alternate interests
- CBT: development of adaptive thoughts and social skills
- pharmacological: SSRIs are sometimes helpful (paraphilia subtype of OCD?)
Possible effects of sexual assault: (6)
- PTSD
- depression
- impaired intimate relationships
- increased substance abuse
- lower sexual drive/enjoyment
- physical symptoms (headache, disrupted menses, etc.)
3 levels of sexual assault
Level 1: non-consensual bodily contact for sexual purpose (toucherism and frotteurism)
Level 2: assault with a weapon
Level 3: aggravated; physical harm and/or threat of death
**used by police more than psychologists
In North America,, incidence rate of women sexually assaulted
1 in 4 women; minority is forced intercourse, could be groping, forced themselves on you but unsuccessful
Males is 1 in 10 (childhood to adulthood)
T or F. Deviant interest is not a crime
T, acting on them? then you’re legally liable
Types of Sexual Dysfunction
- Sexual Interest Disorder
- Sexual Arousal Disorder
- Orgasm Disorder
- Sexual Pain Disorder
DSM-5 groups most sexual dysfunctions into the following categories:
- Sexual Interest/Arousal Disorders
- Orgasm Disorders
- Sexual Pain Disorders (Genito-Pelvic Pain/Penetration Disorder)
**first three categories correspond to first three phases of sexual response cycle
Sexual Desire Disorers
- Hypoactive sexual desire disorder
- Sexual aversion disorder
Sexual Arousal Disorders
- Female sexual interest/arousal disorder
- Male erectile disorder
- Orgasm Disorders (female/male orgasmic disorder, premature ejaculation)
Vagnismus
painful and involuntary contraction of vagina so penetration is difficult and uncomfortable (reflex – often result of previously uncomfortable experiences)
can co-occur with dysparenuria
Dysparenuria
recurring pain in the genital area or within the pelvis during sexual intercourse; the pain can be sharp or intense; can occur before, during, or after sexual intercourse; more common in women than men
T or F. Over the years, testosterone decreases and sex drive decreases slightly
T!
Injecting testosterone or patches of it
treatment for hypoactive sexual desire
–> sometimes doing this for women can induce secondary characteristics such as hair everywhere, etc.
Treatment for Sexual Desire Disorders
Testosterone patches
Treatment for Disorders of Arousal
Sensate focus
Sensate Focus
works by refocusing the participants on their own sensory perceptions and sensuality, instead of goal-oriented behaviour focused on the genitals and penetrative sex.
Treatment for Disorders of Orgasm
Masturbation to become acquainted with arousal patterns
Treatment for Vaginismus and Dysparenuria
Sensate focus followed by genital massage
Biological treatments for Male Sexual Dysfunction
- Phosphodiesterase 5 (PDE-5) inhibitors: Viagra, Cialis, Levitra
SSRIs: delay ejaculation
Sexual Masochism Disorder
involves strong, recurrent urges and fantasies relating to sexual acts that involve being humiliated, bound, flogged, or made to suffer in other ways. The urges are either acted on or cause significant personal distress
hypoxyphilia
(also known as autoerotic asphyxiation ); participants are sexually aroused by being deprived of oxygen— for example, by using a noose, plastic bag, chemical, or pressure on the chest during a sexual act, such as masturbation. The oxygen deprivation is usually accompanied by fantasies of asphyxiating or being asphyxiated by a lover.
Sexual sadism disorder
type of paraphilic disorder or sexual deviation characterized by recurrent sexual urges and sexually arousing fantasies involving inflicting humiliation or physical pain on sex partners, in which the person has either acted on these urges or is strongly distressed by them.
Sadomasochism
sexual activities between consenting partners involving the attainment of gratification by means of inflicting and receiving pain and humiliation.
