Lecture 16 - Sexual dysfunction and paraphilias

Question 1

What is sexual dysfunction?

Answer 1

A problem with sexual functioning. These are common, with 43% of women and 31% of men reported having experienced at least one sexual dysfunction during the previous 12 months.

Psychological effects include sexual frustration, guilt about failure, loss of self-esteem, and emotional problems with the sex partner.

Most dysfunctions can be treated successfully in relatively brief therapy.

Question 2

Name male sexual dysfunctions

Answer 2

Hypoactive (low) sexual desired disorder.
Sexual aversion disorder.
Male erectile disorder. (most common)
Inhibited male orgasm.
Premature ejaculation. (most common)
Dyspareunia

Question 3

Name female sexual dysfunctions

Answer 3

Hypoactive sexual desire disorder. (most common)
Sexual aversion disorder.
Female sexual arousal disorder.
Inhibited female orgasm.
Dyspareunia. (most common)
Vaginismus.

Question 4

What is Dyspareunia

Answer 4

Difficulty during or pain during intercourse.

Question 5

What is hyposexual desire

Answer 5

Hyposexual desire has three main disorders which must be present independently of other disorders such as depression:
Hypoactive sexual desire disorder is persistent or recurrent deficiency or absence of sexual desire or sexual fantasies, which cause distress.
Sexual arousal disorder is the inability to achieve or maintain adequate lubrication or swelling response of sexual excitement, which causes distress.
Orgasmic disorder is the persistent or recurrent delay in or absence of orgasm following a normal sexual excitement phase.

Question 6

What is Flibanserin/Addyi

Answer 6

It was tested on 11,000 women but didn’t work in Europe. It is meant to treat hyposexual desire disorder, but can cause fainting if women drink alcohol and only increased sexually satisfying events by .5-.7 times per month

Question 7

What is vaginismus

Answer 7

Vaginismus is the persistent or recurrent involuntary spasm of the vaginal muscles that interferes with sexual intercourse, which causes distress and is not better accounted for by another medical condition or medication.

Question 8

What is dyspareunia

Answer 8

Persistent or recurrent genital pain associated with sexual intercourse, which causes distress and is not better accounted for by another medical condition or medication.

Women are more likely to feel this pain is their vaginal walls are thinning, have yeast infections or experienced sexual trauma as a child.

Question 9

Discuss vaginismus’ prevalence across cultures

Answer 9

Lifetime prevalence usually studies 6-30% women from general community samples. Vaginismus has been documented from canada to UK, to Japan, to Braxil, Israel, Iran and Morocco.

It is espeically common in patriarchal, fundamentalist cultures with arranged marriage, minimal female choice and female genital mutilation

Question 10

Discuss what is meant by the subjective experience of vaginismus

Answer 10

A defense, a barrier or a way of being separated. Keystone 1994 said “vaginismus is a womans way of refusing when she cannot verbalise her feelings”.

It can be treated with botox to stop muscles from clamping.

Question 11

What is impotence/erectile dysfunction?

Answer 11

The inability to develop or maintain an erection. It is often caused by drugs, aging (it is 4 times more common in 60s than 40s), lifestyle (smoking nicotene is a key cause), and disease (diabetes).

Question 12

Discuss how viagra works to treat erectile dysfunction

Answer 12

Starts with sexual stimuli, which releases nitric oxide in corpus cavernosa. Erection ends so viagra inhibits, leading to the results of a normal process of erection which is smooth muscle relaxes. Inflow of blood creates erection and inflation or erectile tissue prevents outflow of blood through veins.

Question 13

Discuss erectile function as a sensitive fitness indicator

Answer 13

Poor erectile function is a sensitive early marker for cardiovascular disease.

Good erectile function predicts lower risk of heart attack, stroke and diabetes. Reveals better physical fitness in men 18-40 years old. Reveals lower oxidative stress and inflammation. Reveals aerobis capacity and exercise level. It is a general marker for male health.

Question 14

What is premature ejaculation

Answer 14

When a man experiences orgasm and expels semen soon after sexual activity and with minial penile stimulation. Mens typical ejaculatory latency is about 4-7 minutes. But from an evolutionary perspective, is premature ejaculation really a disorder?

Assessments of this are comprised of clinical interviews, medical examination and psychophysiological assessment procedues. Most of the treated now has evolved from Masters and Johnsons work in St Louis. Treatments include using sensate focus and nondemand pleasuring. This refers to the gap between affection and sex, it introduces an entirely different way of conceptualising and experiencing affection, sensuality and sexuality.

Question 15

What are paraphilias

Answer 15

Recurrent sexual desires or behaviours that are problematic enough to be considered mental disorders.

There is no clear, precise or objective boundary between normal and abnormal sexual feelings and behaviours.

DSM states it as “recurrent, intense sexually arousing fantasies, sexual urges or behaviors generally involving nonhuman objects, the suffering or humiliation of oneself or one’s partner, or children or other nonconsenting persons that occur over a period of six months”.

Question 16

What turns sexual urges or behaviours into paraphilias

Answer 16

Recurrent or long term in nature, rather than one time or short lived.

They must cause significant distress to the person who experiences them and/or they must harm other people.

Question 17

What is fetishism

Answer 17

Fetishism refers to sexual arousal by inanimate objects or body parts. Common objects include feet, shoes, lingerie, jockstraps, leather and fur.

Question 18

Discuss some generalisations about paraphilias

Answer 18

They are often extensions or exaggerations of common sexual desires and behaviours.

More men than women.

Paraphilias begin at an early age - usually around puberty - and tend to become more pronounced over time.

People who start out with one may eventually exhibit multiple forms by the time they come to professional attention, 54% of paraphilias report experiencing more than one and 18% report 4 or more.

Certain personality traits such as lack of social skills, sense of inadequacy and depression are common in paraphilias.

Paraphilias commonly have cognitive distortions - that their behaviours are sexually exciting or beneficial to people they target.

Most common paraphilia is child molestation, voyeurism and exhibitionism.

Question 19

What is exhibitionism

Answer 19

Men who expose their gentials to women in public or semi-public plaaces. An exhibitionist is sexually aroused by a womans reaction of shock, fear or amusement and sees these reactions as a reciprocation of his sexual interest, a condition termed “cognitive distortion”. It is very common and accounts for one third of al convictions for sex crimes in US and other places.

At one clinic, exhibitionists admitted to an average of over 500 acts each.

1/2 of all adult women have been victimised by them, with half of these before 16.

Victims can develop a debilitating fear of sex crime.

More likely to reoffend and more than 1/3 repeat offenses are more serious hands-on sex crimes.

Question 20

What are obscene phone calls

Answer 20

They are a type of exhibitionism. A man calls an unknown woman and makes sexual suggestions or utters obscentities. They are generally shy men who lack social skills in interactions with women and who have feelings of inadequecy.

Question 21

What is voyeurism

Answer 21

It is one of the most common of all parahilias. They are men who are erotically focused on watching women who are undressing, naked, or engaged in sexual behaviour.

Sexual arousal from watching unsuspecting people.

Voyeurism is very common.

Could be considered an extension of normal male sexuality.

Question 22

What is frotteurism

Answer 22

Obtaining sexual arousal from physical contact with others without their consent.

Rubbing against the woman with usually penis, hands or legs.

1/3 young men say they had committed this at least once

Question 23

What is Pedophilia

Answer 23

A pedophile is a person, usually a man, whose sexual interset in prepubescent children exceds his sexual interst in physically mature adults.

It begins at adolscence and persists over the lifetime. Adults who are primarily attracted to postpubescent teenages are ephebophiles.

Recent research suggests that pedophiles are rather unremarkable men with few distinguishing characteristics except for a relatively low level of intellectual functioning.

Pedophiles may be homosexual or heterosexual and may have a preference for either female or male children. Heterosexual pedophiles outnumber homosexuals by 2 to 1 or 3 to 1.

Briere and Runtz (1989) found that 21% of student had experienced sexual attraction to some small children, with 9% have sexual fantasies and 5% masturbating to fantasies. 7% said they might have sex with a child if they could avoid detection.

Question 24

What is the distinction between child molester and pedophile

Answer 24

Child molestation refers only to overt behaviour and criminal acts.

Some individuals who molest children do not have a sexual interest in them, whereas some individuals may have a sexual interst in children but do not molest them.

Question 25

What is hebephilia

Answer 25

Adults primarily aroused by children going through puberty.

Blanchard showed that some men show greater gential arousal to images of pubescent children than to images of prepubescent children or post-pubescent adolescents or adults.

Question 26

What are viruous pedophiles

Answer 26

A man who does not want to and will not do anything with a real child - they will not act upon their desires because they know it is wrong.

Men who are sexually attracted to underage youths or children risk arrest and lengthy prison sentences. 45% of these men said they had thought about suicide. Minor attracted people is used to describe people who do not experience distress and don’t have sexual contact with minors.

Question 27

What is James Cantor discuss?

Answer 27

Pedophilia refers to the sexual interest in children, whereas child molestation refers to the actual behaviour.

Despite the common notion that all pedophiles are child molesters in waiting, very many know they cannot express their sexual interests and work to be celibate. These are virtuous pedophiles.

All current science says men do not ask to be attracted to children. There is not yet a way to reverse this.

Question 28

What is Mike Bailey discuss?

Answer 28

A growing body of research suggests that a large proportion of pedophiles have never touched a child sexually. No one choses their sexual preferences. Many can resist their urgers, and we ought to make it easier for them to do so.

Question 29

What are the theories of etiology (abnormal behaviour)

Answer 29

Conditioning - learned behaviour/preference, since they themselves were victims or witnesses the act. Accidental pairint of deviant stimuli with sexual arousal leading to reinforcement. E.g - child sits on lap (stimuli), sexual response (unconditioned response), leads to masturbation (repsonse) and as a conditioned response, pedophilic sexual preference emerges.

Question 30

Discuss pedophiles from an evolutionary perspective

Answer 30

Quinsey and Lalumiere (1995) said perhaps youth detector modules are malfunctioning or were not properly masculinsed in utero. WHR as a youth cue that differs between both men and women and between women and children may be the key.

Secondary sex charactersitics that are shared between children and young women (skin smoothness, skin tone, lustrous hair, sprightly gait).

Confusion between cute and sexy.

Question 31

What is zoophilia

Answer 31

Sexual contact between humans and animals isn’t that rare. Kinsey samples said about 3.6% of women and 8% of men stated they had at least one sexual contaxt with an animal after adolescence. 17% of men raised on farms had.

Some persist in having sex with animals and 2/3 would rather have sex with an animal than a human.

Question 32

What is necrophilia

Answer 32

Necrophilia is a sexual fixation on corpses. Its rate, and mostly motivated by a desire for an unresisting and unrejecting partner versus an actual attraction to dead people.

Question 33

Discuss the etiology of paraphilias

Answer 33

Genetics - 19.5% of paraphilias have 1st degree relatives who were also paraphilic vs 3% of people with other psychiatric disorders.

Learning processes - behavioural conditioning, unclear from anecdotes about adolescent experiences.

Sexual escape route - unable to get sex by other means.