Lecture 4b - Sexual disorders Flashcards
Categories of sexual dysfunctions
- Sexual interest, desire and arousal
- Orgasmic disorder
- Sexual pain
Interest/arousal disorder in women - Criteria
- Diminished, absent, or reduced frequency of at least 3 of the following for 6 months or more:
+interest in sexual activity
+sexual/erotic thoughts or fantasies
+Initiation of sexual activity and responsiveness to partner’s attempts to initiate
+Sexual excitement/pleasure during 75% sexual encounters
+Sexual interest/arousal elicited by any internal or external erotic cues
+Genital or nongenital sensations during 75% sexual encounters. - Causes marked distress or interpersonal problems.
- Not due to a medical illness, another psychological disorder (except another sexual dysfunction or the effects of a drug)
Criteria for Hypoactive sexual desire disorder in Men
- sexual fantasies and desires, deficient or absent
- causes marked distress or interpersonal problems
- Not due to a medical illness, another psychological disorder (except another sexual dysfunction) or the effects of a drug.
Criteria for Male Erectile disorder
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 interferes with penetration or pleasures
+Not due to a medical illness, another psychological disorder (except another sexual dysfunction) or the effects of a drug.
Kinds of Orgasmic disorders
- Female orgasmic disorder
- Early ejaculation disorder
- Delayed ejaculation disorder
What is Female orgasmic disorder?
Absence of orgasm after sexual excitement
What is early ejaculation disorder?
Ejaculation that occurs too quickly
What is delayed ejaculation disorder?
Persistent difficulty ejaculating
Criteria for Female Orgasmic disorder
On at least 75% of sexual occasions:
+Marked delay, infrequency or absence of orgasm
+Markedly reduced intensity of orgasmic sensation
+Causes marked distress or interpersonal problems
+Not due to a medical illness, another psychological disorder (except another sexual dysfunction) or the effects of a drug
Criteria for delayed Ejaculation
+ Marked delay, infrequency or absence of orgasm on at least 75% of sexual occasions.
+Causes marked distress or interpersonal problems
+Not due to a medical illness, another psychological disorder (except another sexual dysfunction) or the effects of a drug
What are the main sexual pain disorders?
- Genitopelvic pain / penetration disorder
2. Vaginismus and Dyspareunia
Criteria for Genitopelvic pain/ penetration disorder
+ Persistent or recurrent pain during intercourse
+Diagnosable in both men and women (rare in men)
+ R/O Medical cause (e.g. infection), lack of vaginal lubrication or menopausal problems.
+Most women experience sexual arousal and orgasms from manual or oral stimulation that does not involve penetration.
+ 10-30% prevalence rates
Criteria for Genitopelvic pain / penetration disorder
+ Inability to have vaginal intercourse/penetration
+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
+Causes clinically significant distress or interpersonal problems
+ Not due to another psychological disorder, a medical condition, or the effects of a drug.
Etiology of sexual dysfunction
Masters & Johnson (1970) two-tier model:
- Immediate causes
+Performance fears
+Adoption of spectator role
2. Distal (historical) causes \+Sociocultural \+Biological causes \+Sexual traumas \+Homosexual inclinations
Distal and Immediate Causes of Human Sexual inadequacies
Distal \+Guilt about sexuality from religious and other cultural influences \+ Rape or sexual abuse \+ Homosexual preferences \+Lack of knowledge about sexuality \+Excessive alcohol intake \+Physiological problems \+Sociocultural factors
Immediate
+Spectators role and fears about performance
Predictors of successful sexual functioning
Psychological factors \+Good emotional health \+Attraction toward partner \+Positive attitude towards partner \+Positive sexual attitude
Physical factors
+Good physical health
+Regular appropriate exercise
+Good nutrition
Social and Sexual history factors
+Positive sexual experiences in past
+Good relationship with partner
+Sexual knowledge and skills
Predictors of poor sexual functioning
Psychological factors \+Depression or anxiety disorders \+Focus on performance \+Too much routine \+Poor self-esteem \+Uncomfortable environment for sex \+Rigid, narrow attitude toward sex \+Negative thoughts about sex
Physical factors \+Heavy drinking \+Cardiovascular problems \+Diabetes \+Neurological diseases \+Low physiological arousal \+SSRI medications \+ Antihypertensive medication \+Other drugs
Social and Sexual history factors \+ Rape or sexual abuse \+Relationship problems such as anger or poor communication \+Long periods of abstinence \+History of hurried sex
Biological factors of sexual dysfunctions
\+Diseases of vascular system \+Diseases of the nervous system \+Low levels of testosterone or estrogen \+Heavy alcohol consumption before sex \+History of chronic alcoholism \+Heavy cigarette smoking \+Medications - Antihypertensives and SSRIs
Psychosocial factors of sexual dysfunctions
+Rape
+Early childhood sexual abuse
+ Relationship problems - anger, hostility, poor communication, underlying anxiety about relationship security
+Psychological disorders - Major depression, anxiety, or panic disorder
+ Low physiological arousal
+Stress and exhaustion
+Negative cognitions
Treatments of sexual dysfunction
+Anxiety reduction
+directed masturbation
+Procedures to change thoughts and attitudes - sensory awareness procedures and rational emotive therapy
+Sexual skills and communication training
+Couples therapy
+Medications and physical treatments - Squeeze technique for early ejaculation - PDE-5 inhibitors for erectile dysfunction (Viagra, Cialis and Levitra)
What are Paraphilias?
Recurrent sexual attraction to unusual objects or sexual activities
+For at least 6 months
+ Deviation (para) in what the person is attracted to (Philia)
+ Should only be diagnosed when they cause marked distress or are done with nonconsenting persons.
What are the categories of Paraphilias?
- Sexual attraction to an inanimate objects
2. Sexual attractions based on children
What are the different types of Paraphilias?
- Fetishistic disorder
- Transvestic disorder
- Pedohebephilic disorder
- Voyeuristic disorder
- Exhibitionistic disorder
- Frotteuristic disorder
- Sexual sadism disorder
- Sexual masochism disorder
What is a Fetishistic disorder?
+For at least 6 months, recurrent and intense sexually arousing fantasies, urges or behaviors involving the use of nonliving objects or nongenital body parts.
+The sexually arousing objects are not limited to articles used in cross-dressing or to devies designed to provide tactile genital stimulations, such as a vibrator.
Prevalence of Fetishistic disorder
+Occurs most often in men
+Object often necessary for sexual arousal
+Attraction to object irresistible and involuntary
+Fetishes often co-occur with other paraphilias.
Pedohebephilic Disorder
Pedos = child
hebe= pubscence
philia=attraction
+Sexually arousing urges, fantasies or behaviours involving sexual contact with a prepubertal or pubescent child
+Ofender at least 16 years old and 5 years older than victim
+child pornography is widely used
+Person has acted on urges or the urges and fantasies cause marked distress or interpersonal problems.
+Victims usually known to pedophile
+Most pedophilia does not involve violence other than the sexual activity
What is incest?
+Subtype of pedohebephilic disorder
+Most common brother and sister
+ Less common but more pathological - father and daughter
+Incest taboo almost culturally universal
+genetically adaptive
+Offspring of father-daughter or brother and sister have a greater likelihood of inheriting pairs of recessive genes with possible negative biological effects.
What is Voyeuristic disorder?
+Sexually arousing fantasies, urges, or behaviors while observing other who are unclothed or engaging in sexual activity
+Almost always men
+Excitement comes from knowing the victim is unaware of the voyeur; element of risk important
+Seldom results in physical contact
+Orgasm achieved by masturbation
+Victims unaware that they are being watched
Diagnostic criteria of voyeuristic disorder?
+For at least 6 months, recurrent and intense sexually arousing fantasies, urges, or behaviors involving the observation of unsuspecting others who are naked, disrobing, or engaged in sexual activity
+Person has acted on these urges with a nonconsenting person, or the urges and fantasies cause marked distress or interpersonal problems
What is Exhibitionistic disorder?
+Intense desire to obtain sexual gratification by exposing one’s genitals to unwilling strangers
+Victims can be children
+Seldom results in physical contact
+Usually involves desire to shock or alarm victim
+ Often comorbid with voyeuristic and frotteuristic disorders
Diagnostic criteria for Exhibitionistic disorder?
+For at least 6 months, recurrent, intense, and sexually arousing fantasies, urges, or behaviors involving showing one’s genitals to an unsuspecting person
+Person has acted on these urges to a nonconsenting person, or the urges and fantasies cause clinically significant distress or interpersonal problems
What is Frotteuristic disorder?
+Sexually oriented touching of a
nonconsenting person
+The individual rubs his genitals against a women’s body or fondles her breast or genitals
+Often occurs in crowded subway or other public place
What is sexual sadism and sexual masochism disorders?
• Intense and recurrent desire to obtain or increase sexual gratification by inflicting pain or psychological suffering on another person
• Must cause clinically significant distress or the person has acted on these
urges with a nonconsenting person.
• Intense and recurrent desire to obtain or increase sexual gratification through receiving pain or humiliation
• Must cause marked distress or impairment in functioning
What is Asphyxiophilia?
+Sexual arousal by oxygen deprivation
+Can result in death or serious brain damage
What is the Etiology of the Paraphilias?
Neurobiological factors
• Male hormones or androgens
+Almost all individuals with paraphilias are men
+Do not have unusual levels of testosterone
Clasical conditioning
+Research has not supported orgasm conditioning hypothesis
Operant conditioning
+Poor social skills or reinforcement of unconventionally
+History of childhood physical and sexual abuse
+Alcohol and negative affect are common triggers
+Cognitive distortions
Treatment for Paraphilias
+ Incarceration and ordered treatment are common
+Often difficult to interpret outcome from treatment studies
Studies vary greatly
Many lack control groups
Dropout rates high
Treatment of Paraphilias
Enhance motivation • Denial and minimization of problem often present • Some blame the victim \+Lack of motivation for treatment \+Drop out of treatment
Cognitive behavioral treatment • Aversion therapy • Covert sensitization • Counter distorted thinking • Often combined with social skills and empathy training
Biological treatments • Castration used in past • Medications Hormonal agents to reduce androgens Depo SSRIs
