PSYU3337 - Sexual Dysfunctions, Paraphilic Disorder, Gender Dysphoria Flashcards
Why do we not know much about sexual behaviour?
- We have not developed reliable instruments
- Stigma
- Most research on sexuality wasn’t launched until the late 1940s
Who were the 4 key sexual research pioneers?
Alfred Kinsey: conducted interviews with people about their sexuality
Masters and Johnson (1960s): watched people masturbate and have sexual intercourse, then developed the sexual response cycle and a psychological treatment for sexual dysfunctions
Helen Kaplen: refined the sexual response cycle, wrote treatments for sexual dysfunction and encouraged people to have as much sex as possible.
Trend of STIs
As our accessibility to sexual content increases, so to has our risk for STIs
In Aus - 16% of Australians will report having a STI at some point in their life (4 million people), and the most common STI is chlamydia
History of beliefs around homosexuality
- King Henry 8th made homosexuality punishable by death
- in 1861, maximum penalty was reduced to 10 years imprisonment
- Kinsey: when he started conducting interviews, he found that homosexulaity was more common than people thought and trained psychologists could not differentiate between homosexuals and heterosexuals
- 1960s: radical gay liberation movement, leading to the removal of homosexuality from the DSMII (1974)
Prevalence of homosexuality
6% of men will report
12% of women will report
Statistics on masturbation
M: 72% report ever masturbating
F: 42% report ever masturbating
Statistics on sexual activity in elderly people
From age 75-85,
M: 38.5% sexually active
F: 16.7% sexually active
What are the steps of the sexual response cycle
DESIRE PHASE: sexual cue in the environment (or mentally)
AROUSAL STAGE: having a subjective sense of sexual pleasure and physiological signs of sexual arousal
PLATEAU PHASE: brief period occuring before orgasm
ORGASM PHASE: ejaculation / contradictions of the walls of the vagina
RESOLUTION PHASE: decrease in arousal occurs after orgasm (this is pretty specific to men, as women can experience multiple orgasms)
Physical sex differences on the sexual response cycle
- Many women report that desire and arousal comes hand in hand
- 1/3 of women report that the arousal stage goes before the desire stage
- biological and subjective arousal are also not always correlated (this is more so for women, than men)
Statistics on sexual dysfunction
43% of women and 31% of men have reported having a sexual dysfunction in one of these stages lasting for at least 2 months (out of the past year).
40% of men and 63% of women had problems with arousal / orgasm.
Only classified as a disorder when the symptoms cause distress / impairment –> 11-23% of women reported both dysfunction and distress. (should it be classified as a disorder if its that many people?)
How do you assess sexual dysfunctions?
Assess: sexual attitudes, behaviours, sexual response cycle, relationship issues, psychological disorders
Psychophyiological assessment:
- Penile plethysmograph gauge (to measure erection)
- Vaginal plethysmograph (measures blood flow to vagina)
Medical evaluation
- to ensure these aren’t due to medication effects
Male specific sexual dysfunctions
Male hypoactive sexual desire disorder
Erectile disorder
Premature ejaculation disorder
Delayed ejaculation disorder
Female specific sexual dysfunctions
Female sexual interest/ arousal disorder
Female orgasmic disorder
Genito-pelvic pain/penetration disorder
Other sexual dysfunctions
Substance/medication induced
other specified
unspecified
The specifiers for sexual dysfunctions are:
- lifelong vs acquired
- generalized vs situational
- mild, moderate, severe (distress)
Male hypoactive sexual desire disorder
A) Males who don’t have any interest in sex
B) With symptom of a lack of desire persisting for the past 6 months.
C) Causes clinically significant distress.
D) Not better accounted for by a nonsexual mental disorder or severe relationship distress, etc
Female sexual interest/arousal disorder
Women have to meet more criteria than men to meet this disorder (having at least 3 of the 6 for criterion A)
-lack of significantly reduced sexual interest (absent sexual activity, absent thoughts/fantasies, no initiation of sexual activity, absent sexual excitement during activity in +75% of encounters, absent arousal to external cues)
b) symptoms for longer than 6 months
C) clinically significant distress
D) not better accounted for by a nonsexual mental disorder, etc
Erectile disorder
A) at least 1 of the following experienced for >75% of sexual activity (difficulty in getting an erection, difficulty maintaining an erection, decrease in erectile rigidity)
B) symptoms for longer than 6 months
C) symptoms cause clinically significant distress
D) not better accounted for …
PREVALENCE = 50-60%
Female orgasmic disorder
A) in 75-100% of activity - either marked delay/frequency/absence of orgasm OR marked reduced intensity of orgasmic sensation
B) more than 6 months
C) clinically significant distress
D: not better accounted for …
17-41% of women have trouble achieving orgasm
2/3 have fake an orgasm
Premature ejaculation disorder
A) ejaculation occurring within 1 minute following vaginal penetration
B) longer than 6 months, for >75% of activity
C) distress
D: not better accounted for
Affects 21% of all adult males occasionally - only 3% meet criteria (most common in younger males)
Delayed ejaculation disorder
A) >75% of sexual activity occasions, experiencing marked delay or marked infrequency of ejaculation
B) 6 months
C: distress
D: accounted for
<1% of males
Genito-pelvic pain/penetration disorder
Persistent difficulties with one or more: (vaginal penetration, marked vulvovaginal/pelvic pain during penetration, marked fear / anxiety about pain, marked tensing or tightening)
B) 6 months
C) distress
D) not better explained by
Outline the Causes of Sexual Dysfunction
Distal causes (religion, psychosexual trauma, homosexual, excessive alcohol, physiological issues) lead the individual to immediate cause (having fear about performance - taking on a spectator role), resulting in sexual inadequacy
Biological predictors of sexual dysfunction
- smoking
- drinking
cardiovascular problems
diabetes
neurological diseases
low physiological arousal
SSRI medications
antihypertensive medz
drug use
Dave Barlow’s Model of Functional and Dysfunctional Sexual Arousal
Dysfunctional: individual experience negative affect in response to cues - shifts their attentional focus to non-erotic cue , this attentional focus becomes increasingly efficient, leading to anxiety.
We have to change people’s attitudes towards sex, which will help change what they focus on during sex.
What is erotophobia
Associating sexuality with negative feelings, anxiety or threat
Treatment types for sexual dysfunction
- education
- couples therapy
- communication training
- masters and johnson’s psychosocial interventions (daily treatment for 2 weeks)
–> phase 1: refrain from intercourse, but engage in foreplay
–> phase 2: genital pleasuring (with no orgasm or intercourse)
–> phase 3A: begin penetration limiting depth and time
–> phase 3B: resuming intercourse
What is a paraphilic disorder
- misplaced attraction and arousal
- focused on inappropriate people or objects
- often multiple paraphilic patterns of arousal
–> only considered disordered when the individual experiences clinically significant distress or impairment OR acts on urges with a nonconsenting person - most occur in males and start in adolescence (with the exception of sexual sadism and sexual masochism)
- high comorbidity with anxiety, mood, substance use)
Frotteuristic disorder
A: >6 months, recurrent arousal from touching or rubbing against a nonconsenting person (fantasies, urges or behaviours)
B: acted on these urges with a nonconsenting person, or its causing clinically significant distress / impairment
Fetishistic disorder
A: >6 months, recurrent sexual arousal rom use of nonliving objects or nongenital body parts
B: cause clinically significant distress
C: fetish objects are not limited to clothing used in cross dressing, or devices designed for the purpose of arousal
Voyeuristic disorder
A: >6 months - arousal from observing an unsuspecting person who is naked or engaging in sexual activity
B: nonconsenting person, or these are distressing
C: have to be at least 18 years old
Exhibitionistic disorder
A: arousal from exposure of one’s genitals to unsuspecting person >6 months
B: acted on these with unconsenting person, or its distressing
Specifications:
- exposing to prepubertal children
- exposing to mature individuals
- exposing to both
Might be a type of compulsion, feels remorseful after
Transvestic disorder
A: >6 months, arousal from cross dressing
B: distress
but why is this a disorder?
Sexual masochism
A: >6 months, arousal from the act of being humiliated/beaten/bound/made to suffer
B: distressS
Sexual sadism
A) >6 months, arousal from the suffering of another person
B) acted with a nonconsenting person, cause distress
5-10% of people may engage in some S&M so not all that abnormal
Pedophilic disorder
A) >6 months, arousal from sexual activity with prepubscent child
B) acted on these urges, or its causing distress
C) individuals has to be at least 16 years old, and 5 years older than the child
specified with gender, or exclusivity to children
Causes of paraphilic disorder
- 2/3 of sex offenders have a history of child sexual abuse
- heightened impulsivity combined with poor emotion regulation
- hostile attitudes and lack of empathy toward women
- cognitive distortions
- high sex drive
Treatment of paraphilia disorders
- studies have been restricted to sex offenders who may not be motivated for treatment
- aversion therapy
- covert sensitization: imagining aversive consequences to form negative associations with deviant behaviour
- orgasmic reconditioning
Medication:
- chemical castration (reduces desire while taking the medication)
- depo-provera: reduces testosterone
What is gender dysphoria?
when a person experiences distress resulting from incongruence between current gender and gender assigned at birth
but not all trans people experience gender dysphoria
Gender dysphoria in adolescents and adults
A) a marked incongruence between one’s experienced gender and assigned gender (lasting > 6 moths), indicated by 2 of the following
–> marked incongruence between one’s experienced gender and primary/secondary sex characteristics
–> strong desire to be rid of one’s primary/secondary characteristics
–> strong desire for the sex characteristics of the experienced gender
–> strong desire to be of a gender not assigned at birth
–> strong conviction that one has typical feelings and reactions o fthe other gender
B) distress
Specifiy: with a disorder of sex development, or post transition
Gender dysphoria in children
A) Marked incongruence between one’s experienced gender and assigned gender (>6 months duration) –> needing SIX of the following
–> desire to be of the other gender
–> preference for ‘cross dressing’
–> strong preference for cross-gender roleplaying
–> preference for toys/games/activities stereotyped for otehr gender
–> preference for the playmates in other gender
–> strong rejection of stereotyped activities / toys
–> strong dislike of sexual anatomy
–> strong desire for primary / secondary sex characteristics that match their experienced gender
B) distress
causes of gender dysphoria
no clear biological causes, but has genetic component (62-70% variance explained by genetics)
Treatment of gender dysphoria
- social affirmation
- legal affirmation
- medical treatment (gender affirming surgeries and hormone therapies)
- puberty blockers (to get access, you need a diagnosis of gender dysphoria, fertility preservation counselling, consent from a guardian)
