Lecture 10: Sexual Disorders: Chapter 12 Flashcards
What are 2 forms of sexual problems?
- Sexual dysfunctions
- Paraphilic disorders
What are 3 categories of sexual dysfunctions?
- Dysfunction sexual interest, desire and arousal
- Orgasmic disorders
- Pain associated with intercourse
What are paraphilic disorders?
Persistent and troubling attractions to unusual sexual activities or objects
How did the availability of the birth pill change people’s attitude on sex?
It was okay now to have premarital sex and it started the sexual revolution of the 1970s
What was the impact of the AIDS epidemic?
It changed the risk with sexual behavior
In which countries is inhibition in sexual orientation a big issue?
African and Middle Eastern countries
What percentage of sex ends up in conception?
0,1%
How often do normal couples have sex? (Median)
3 times in 4 weeks
What are 4 reasons humans have sex?
- Physical reasons: stress reduction, pleasure, experience seeking
- Goal attainment: status, revenge, resources
- Emotional: love, commitment
- Insecurity: self-esteem boost, duty, mate guarding
What are the 3 insecurity subfactors as reasons for having sex?
- Self-esteem boost
- Duty/Pressure
- Mate guarding
What is important to keep in mind when studying sexual behavior?
Varying cultural norms and response biases
What is response bias?
Situations where people don’t respond truthfully for some reason
What is the difference between genders for masturbating alone?
Males start masturbating way more early than females
Males: 79% age 16-17
Females: 52% age 16-17
What is the difference in timing of development of sexual behavior in boys vs. girls? (5)
- Girls start masturbating later than boys
- Girls experience first orgasm later than boys
- Girls have their first kiss later than boys
- Girls have manual sex and oral sex earlier than boys
- Girls have sexual intercourse earlier than boys
What is the gender difference for being not exclusively hetero?
1/4 girls
1/9 boys
How did the perception of own sexual orientation change from generation to generation?
Baby boomers saw themselves as only attracted to opposite sex
Gen Z only half is only attracted to opposite sex, more and more homosexual, bisexual and other
What model is important to take in account when discussing sexual behavior?
Biopsychosocial model
What do penile plethysmographs and vaginal plethysmographs measure? How do they work?
Biological arousal, defined as blood flow to the genitalia
Penile: thin rubber around penis, stretching it records changes on computer
Vaginal: tampon shaped thing in vagina, measures blood flow
What is the main motivation for having sex in women?
Sexual attraction and physical gratification
(Not promoting relationship closeness!!!)
What is the issue with sexual education about the female body?
The clitoris is shown way smaller than it actually is
What could be a possible explanation why girls have more issues with orgasms at a young age?
Boys know their body better than girls, because they start masturbating more early
What is vasocongestion?
More blood going to the penis or clitoris, resulting in swelling/erection
What is the tunica albuginea?
The shaft of the penis. It’s very hard material, like a toilet roll
What are the physiological prerequisites for a man to enable pleasurable penetration?
Erection and rigidity due to vasocongestion
What are the physiological prerequisites for a woman to enable pleasurable penetration?
Swelling and humidity (lubrication) due to vasocongestion
What are the 4 phases of sexual intercourse?
- Excitement
- Plateau
- Orgasm
- Resolution
(similar to jumping of a cliff (climbing, cliff, jumping, in the water)
These phases can differ in order. Women can have multiple orgasms
What are the 4 phases of the sexual response cycle?
- Desire: interest associated with arousing fantasies
- Excitement: increased blood flow to genitalia
- Orgasm: sexual pleasure peaks
- Resolution: relaxation and sense of well-being following an orgasm
What is difficult about putting sex on Maslow’s pyramid of needs?
Sex can be at the bottom: purely physiological, for reproduction
Or higher up in the pyramid, where it can fulfill the need of belonging/love or even esteem or self-actualization
How can you compare sex with eating?
It’s not like eating (no sex doesn’t mean death)
But sexual desire can be compared to eating, since you can crave and desire it, love it, have opportunity, as negative reinforcement or as part of making a deal
What is libido?
Incentive motivation for rewards
What are synonyms for stimulus based and goal based?
Stimulus based = bottom up
Goal based = top down
What is a stimulus based part of sex?
Fast, automatic, outside of conscious control
What is a goal based part of sex?
Slow, intentional, goal-directed, full conscious control and insight
What is hypoactive sexual desire disorder?
Disorder where someone has low sexual desire
What are the most common sexual issues men seek help for? And in women? What can you say about this?
Men: erectile problems
Women: problems of interest
It could be possible these presentations of problems are because of gender differences in self-perception and gender role differences. (men think it’s more physical, women think it’s more psychological)
What is the main issue in men vs. women in frequency of orgasms?
Men: premature ejaculations
Women: no/little orgasms
What is the social exchange theory?
A balance between costs and rewards. If the costs are higher than the rewards, a relationship may be terminated
How can you apply the social exchange theory on sex?
Explaining why two people may have sex and another 2 may not
E.g. sex for love, love for sex, sex for money
What is the chronological order of sexual interest, biological arousal and subjective arousal in men?
Interest and subjective arousal co occur, then follows biological arousal
What is the difference between subjective and biological arousal?
Subjective: self perceptions of sexual excitement
Biological: changes in blood flow to genitalia
What is sexual interest?
Sexual desire, often associated with sexually arousing fantasies or thoughts
What is an orgasm in men and women?
Men: ejaculation
Women: contraction of vagina walls
What is resolution?
Post-orgasm phase, men can’t have an erection
What is the chronological order of sexual interest, biological arousal and subjective arousal in women? What is the difference with men?
There is no clear order: depends on the situation
Sometimes when biological arousal is measured, women don’t report subjective arousal
So biological and subjective arousal are less correlated than men’s
What 2 things shape sexuality?
Culture + experience
Describe 2 gender differences most often observed in current survey research on sexuality
- Men higher frequency of masturbation
- Men higher use of porn
Identify 3 historical changes that influenced sexuality in the 20th century
- Availability birth pill
- AIDS epidemic
- Availability online pornography
What are the female and male variants of sexual interest, desire and arousal disorders?
Female: sexual interest/arousal disorder
Male: hypoactive sexual desire disorder, erectile disorder
What are the female and male variants of orgasmic disorders?
Female: Female orgasmic disorder
Male: Premature ejaculation and delayed ejaculation
What are the female and male variants of sexual pain disorders?
Female: genito pelvic pain/ penetration disorder
Male: no disorder!!
How do you interpret sexual concerns in combination with relationship distress?
You can’t interpret sexual concerns as sexual dysfunctioning in this case. Especially for women, sexuality has strong links with relationship satisfaction
Why might people with one form of sexual dysfunction often report a second form of sexual dysfunction?
Because of a vicious cycle. Someone with erectile problems, might begin to worry about sex and then experiences problems with sexual desire
What is female sexual interest/arousal disorder? Name the 6 symptoms from the DSM classification + how many symptoms are necessary
Diminished, absent or reduced frequency of at least 3:
- Interest in sexual activity
- Erotic thoughts or fantasies
- Initiation of sexual activity and responsiveness to partner’s attempts to initiate
- Sexual excitement/pleasure during 75% of sexual encounters
- Sexual interest/arousal elicited by any internal or external erotic cues
- Genital or nongenital sensations during 75% of sexual encounters
What are the 2 dimensions of sexual problems?
- Acquired vs. lifelong
- Situational vs. generalized
What is the main symptom of male hypoactive sexual desire disorder?
Sexual fantasies and desires, as judged by the clinician are deficient or absent
What are the 3 symptoms of erectile disorder and how often do they have to be present?
On at least 75% of sexual occasions
- Inability to attain an erection
- Inability to maintain an erection for completion of sexual activity
- Marked decrease in erectile rigidity that interferes with penetration or pleasure
Which 2 sexual disorders are the most subjective? Why?
Female sexual interest/arousal disorder + male hypoactive disorder
It’s subjective, because it is uncertain how often a person should want sex and what the optimal intensity is
On what 2 aspects do expectations of sexual desire depend?
- Culture: American women show more distress about desire than European women
- Age: Postmenopausal women are more likely than women in their 20s to report low levels of desire
What worries women more: lack of subjective desire or lack of biological desire?
Lack of subjective desire
What is the difference between erectile disorder and low sex drive?
Men with erectile disorder report frequent desires, so there is high sex drive. The problem in erectile disorder is mainly physical arousal
What is the prevalence of erectile disorder in relation to age?
50% of men age >60 report erectile dysfunction
What is early ejaculation disorder? What is the time frame?
Male disorder where ejaculation occurs to quickly
Within 1 minute of penile insertion on at least 75% of sexual occasions
What are the 2 symptoms of female orgasmic disorder? What percentage of time does it have to be present?
On at least 75% of occasions:
1. Marked delay, infrequency or absence of orgasm, or
2. Markedly reduced intensity of orgasmic sensation
What is the main symptom of delayed ejaculation disorder?
Marked delay, infrequency or absence of orgasms on at least 75% of partnered sexual occasions
What are the 4 symptoms of genito-pelvic pain/penetration disorder?
Persistent or recurrent difficulties with at least one:
- Inability to have vaginal penetration during intercourse
- Marked vulvar, vaginal or pelvic pain during vaginal penetration or intercourse attempts
- Marked fear or anxiety about pain or penetration
- Marked tensing of the pelvic floor muscles during attempted vaginal penetration
How is sexual arousal in people with genito-pelvic pain/penetration disorder? Can they have orgasms?
Arousal is present
Orgasms are possible if it’s manually or orally stimulated without penetration
What percentage of people report at least brief symptoms of sexual dysfunction? What percentage reports these symptoms for more than 6 months + distress?
25% brief symptoms
5% persistent symptoms + distress
What percentage of females experience pain during sex? What percentage of these don’t see it as a problem?
50% experience pain
50% of these don’t see it as a problem
How can you apply the biopsychosocial model on predicting sexual dysfunction? Give examples for each factor
Bio: smoking, drinking, diabetes, SSRI medication, neurological disease, hormone dysfunction, cardiovascular disease
Social: rape, sexual abuse, relationship difficulties, lack of learning about sexuality, negative cultural attitudes
Psychological: depression, anxiety, low physiological arousal, exhaustion, negative cognitions about sex/appearance/performance , guilt, self-blame
What is the difference in correlations between subjective arousal and physiological arousal in men vs. women?
Men: r=0,66
Women: r=0,29
So subjective excitement in women may not mirror biological excitement
What are protective factors to prevent sexual problems? Answer according to the biopsychosocial model
Bio: good physical health, regular exercise, good nutrition
Social: good sexual experiences in the past, good relationship with partner, sexual knowledge and skills
Psycho: good emotional health, attraction toward partner, positive attitude toward partner, positive sexual attitude
What are some specific male biological etiologies of sexual dysfunction?
Low levels of testosterone or simply too high levels induced by steroids or testosterone supplements
What is the influence of SSRIs on sexual functioning?
Decreased arousal and higher rates of orgasmic disorders
Which sexual disorder is often related to vascular disorders? Why?
Erectile disorder –> Restricts blood flow into the veins of the penis
How is childhood sexual abuse related to sexual dysfunctioning? (2)
- Diminished arousal and desire
- Higher rates of genital pain
What is the general conclusion of a test of the role of self-blame in erectile dysfunctions?
People who blame themselves when their body doesn’t perform will experience diminished subsequent arousal
What is the impact of cultures disapproving sexuality for the sake of pleasure on actual experienced desire?
It increases guilt about engaging in sexual behavior and can inhibit sexual desire
Why are erectile disorders more common in older men?
Often more cardiovascular problems, decreasing blood flow into the penis
Why are men with depression sometimes experiencing erectile disorders?
He’s worrying about his ability to satisfy his partner, so the change in erections is very distressing. This distress can diminish arousal
What are 4 types of treatment of sexual dysfunction?
- Psychoeducation
- Couples therapy
- Cognitive interventions
- Sensate focus
Which percentage of people who experience sexual dysfunction disorders seek help?
Just over a third (33%)
Why might treatment options have limited success on sexual dysfunctions in females?
Extensive focus on medical treatments fail to recognize complex social and psychological contributions to women’s sexual concerns
What is psychoeducation in treating sexual dysfunctioning?
- Providing clear info about sources of these type of issues
- Normalizing concerns, reduce anxiety, eliminate blame
- Help client understand more about the body and sexual techniques
How can couples therapy help sexual dysfunction disorder? (3)
- Training nonsexual communication skills
- Encouraging partners to communicate their sexual likes and dislikes
- Sexual skill and communication training
Why is it important to involve the partner of the person with the sexual dysfunction in something like couples therapy? (2)
- Distressed relationships can contribute to sexual dysfunctions
- Sexual difficulties can also create relationship problems
What is the aim of cognitive interventions in treating sexual dysfunction disorders?
Challenging self-demanding, perfectionistic thoughts that cause problems for many people with sexual dysfunctions
What is sensate focus therapy? What are 2 aspects that are improved?
It promotes contact, constituting a first step toward reestablishing sexual intimacy. It’s like starting all over again with touching your partner, talking about it and then go step by step.
- It helps counter the destructive tendency to think about one’s performance or attractiveness during sex
- It helps communication between partners
How can female sexual interest/arousal disorder be treated?
There is no effective treatment yet. The drug flibanserin/addyi has limited effects
What is the male version of flibanserin/addyi?
Viagra: it emerged when the feminist movement also wanted a female version of viagra
What medication can treat erectile disorder?
Viagra
What are 2 treatment options for premature ejaculation?
- SSRI medication
- Squeeze technique
What is the squeeze technique? What is the evidence on this?
Masturbating and learning to control your response
No convincing evidence yet
What is a treatment option for female orgasmic disorder? What are the 5 steps of that treatment?
Directed masturbation
- Examine genitals, identify various areas
- Touch genitals and find areas that produce pleasure
- Increase intensity of masturbating with fantasies
- If necessary, use vibrator
- Later partner joins in, watching her masturbate, later doing to her what she did to herself
What is a treatment option for genito-pelvic pain/penetration disorder?
Practicing inserting smaller and then larger dilators into vagina. Evidence supports this!
How does viagra work?
It relaxes smooth muscles, allowing blood to flow into the penis, creating an erection
What are 3 important boundaries between normative and problematic sexual behavior?
- Distress
- Impairment
- Engagement of nonconsenting others
What is fetishistic disorder?
Attraction to an inanimate object or nongenital body part
What is transvestic disorder?
Sexual attraction to cross-dressing
When can a fetishistic/transvestic disorder be diagnosed?
When the person really feels guilty and ashamed because he or she has internalized stigma about this behavior.
Which 2 paraphilic disorders are rarely diagnosed?
Fetishistic and transvestic disorder
When is the onset of sexual sadism disorder/sexual masochism disorder?
Early adulthood
What is the relation between all paraphilic disorders?
A person with one form of paraphilic interests is often aroused by other paraphilic stimuli as well
What are the 8 paraphilic disorders?
- Fetishistic disorder
- Transvestic disorder
- Pedophilic disorder
- Voyeuristic disorder
- Exhibitionistic disorder
- Frotteuristic disorder
- Sexual sadism disorder
- Sexual masochism disorder
What are 3 DSM symptoms of pedophilic disorder?
- At least 6 monts, recurrent and intense sexually arousing fantasies, urges or behaviors involving sexual contact with a prepubescent child
- Person has acted on these urges or the urges and fantasies cause marked distress/interpersonal problems
- Person is at least 16 years old and 5 years older than the child
What is incest? In which relationship does this occur most often?
Sexual relations between close relatives for whom marriage is forbidden. It’s a subtype of pedophilic disorder
Most often between brother and sister or father and daughter
Father who abuse their daughters tend to do so … (age)
after daughter achieves puberty
Why would the incest taboo make sense?
The offspring from father-daughter or brother-sister union have a greater probability of inheriting a pair of recessive genes, which are most likely to have negative biological effects
–> So it has adaptive evolutionary significance
Which children do people with pedophilic disorder generally molest?
Children they know (neighbors, friends of the family)
What are the 2 demographic characteristics of people who meet the criteria for pedophilic disorder?
- Most are heterosexual
- Half of convicted pedophilics have never been married
What is one of the strongest predictors of repeated sexual offenses of children?
Arousal in response to pictures of young children, measured by the penile plethysmograph
What are 2 symptoms of voyeuristic disorder?
- For at least 6 months, recurrent and intense sexually arousing fantasies, urges or behaviors involving the observation of unsuspecting naked others, disrobing or engaged in sexual activity
- Person has acted on these urges with a nonconsenting person or the urges cause distress or interpersonal problems
What is most exciting for voyeurs?
The element of risk and threat of discovery, so they don’t find it exciting to watch someone undress for their benefit
What are 2 symptoms of exhibitionistic disorder?
- For at least 6 months, recurrent, intense sexually arousing urges involving showing one’s genitals to an unsuspecting person
- Person has acted on these urges towards a nonconsenting person or the urges cause distress or interpersonal problems
How do exhibitionists reach their orgasm most often?
They masturbate during the exposure
What are the 2 symptoms of frotteuristic disorder?
- For at least 6 months, recurrent, intense sexually arousing urges involving touching or rubbing against a nonconsenting person
- Person has acted on these urges towards a nonconsenting person or the urges cause distress or interpersonal problems
Where do frotteuristic attacks often occur?
Crowded places or places where there is an easy escape
What are the 2 defining symptoms of sexual sadism disorder?
- For at least 6 months, recurrent, intense sexually arousing urges involving the physical or psychological suffering of another person
- Causes marked distress or impairment in functioning or person has acted on these urges with nonconsenting person
What are the 2 defining symptoms of sexual masochism disorder?
- For at least 6 months, recurrent, intense and sexually arousing urges involving the act of being humiliated, beaten, bound or made to suffer
- Causes marked distress or impairment in functioning
What are problems of researching the etiology of paraphilic disorders?
- Small sample sizes
- Most available research focuses on men who are arrested for their sexual behavior. Little is known about those whose sexual behavior doesn’t lead to arrest
What are neurobiological influences on the etiology of paraphilic disorders?
Androgen (testosterone like) levels are high –> more sexually desire
What is the gender difference in prevalence of paraphilic disorder?
Vast majority of people with paraphilic disorder are male
What role does childhood sexual abuse play in developing paraphilic disorder?
About 40-60% of adult sexual offenders report a history of sexual abuse (significantly higher compared to nonsexual offenders)
What is some evidence stating that sexual abuse can’t be the whole etiology behind paraphilic disorders?
Only 5% of abused boys eventually become sex offenders
What is the link between emotion regulation and developing paraphilic disorder?
Problems with emotion regulation. Their sexual behaviors are more likely to happen in the context of negative moods, so it’s used as an escape
What is the link between impulsivity and developing paraphilic disorder?
People with paraphilic disorders involving nonconsenting others tend to show heightened impulsivity
What are 2 neurocognitive problems associated with pedophilia?
- Lower IQ
- Higher rates of neurocognitive problems than general population
What is a prenatal factor contributing to pedophilia?
Physical anomalies related to atypical prenatal development
What is the most common idea behind treatment of paraphilic disorders? What was this idea back in the days?
History: inhibition of sexual impulses
Now: behavioral modification and self-acceptance
What are 2 reasons why we know very little about the effectiveness of treatments used for paraphilic disorders?
- Most research focuses on men who have been charged with sexual offenses
- Little long treatment data available
- Many researchers find it unethical to withhold treatment, when consequences of sexual offenses are so severe
What are RCTs?
Randomized Controlled trials, used to randomly assign people into control groups
Why are strategies to enhance motivation for treatment of paraphilic disorders important? (3)
- Many deny the problem
- Many refuse to take part in treatment
- Many drop outs
What was the behavioral aversion therapy for paraphilic disorders?
A person with a pedophilic disorder would be given a shock on the hands or a drug that produces nausea when looking at a photograph of a nude child
What is satiation as a form of aversion therapy?
Men are coached to pair paraphilic fantasies with another aversive stimulus: masturbating for 55 minutes after an orgasm
What is covert sensitization therapy?
People would be asked to imagine negative consequences of their inappropriate sexual behavior
What is the aim of cognitive interventions in treating paraphilic disorders?
Counter distorted thinking
E.g. exhibitionist might claim that the girls he exposes to are too young to be harmed. The therapist would counter by saying the younger the victim, the worse the harm will be
How is medication used in treating paraphilic disorders?
Often in combination with psychological treatment
Which type of medication is used to treat paraphilic disorders? What are some ethical issues with it?
Agents that reduce androgens (testosterone)
Ethics: long term use leads to feminization, infertility, liver problems etc. Informed consent concerning these risks must be obtained
What is the dunkelfeld project?
Prevention method for paraphilics to become sex offenders. They get a 1-year treatment with CBT and option for medication
Name 8 cognitive behavioral strategies used in the treatment of paraphilic disorder
- Aversion therapy/satiation
- Covert sensitization
- Addressing maladaptive beliefs
- Social skills training
- Sexual impulse control training
- Focus on early abuse
- Empathy training
- Relapse prevention
