Sexual and Gender Identity Disorders Flashcards
name 8 sexual dysfunctions
hypoactive sexual desire dis female arousal ./ pain dis males erectile dis male orgasmic dis feamle orgasmic dis premature ejaculation dyspareunia genito/pelvic pain dis
differences between males and females
females -XX chromosomes - estrogen hormones -vagina -ovaries males -XY chromosomes -androgen hormones -penis -testes
gender
psychosocial meaning of maleness or femaleness
gender identity
psychological sense of being male or female
gender role
cultural norms for male and female behaviour
masculine and feminine expectations of the sexes
case of john / joan
circucision mishap one twin had sex-reassignment surgery raised as a female given hormonal replacement therapy in teens was used as a case for enviornment influences as being strong enough to develop appropriate gender identity -was miserable as a teenager -sex re-reassignment -married a woman, adopted her children -committed suicide in may 2004 aged 38 nurture is not enough
summary of normal sexual behaviours accross different genders
by in large gender gap is decreasing for everything men -masturbate more -better premarital sex attitudes -more sexual partners women -more love and intimacy -more negative core beliefs equal views on homosexuality
cultural differences in normal sexual behaviour example
sambia new guinea
younger boys give blowjobs to older boys
older boys did not engage in masturbation
then older boys marry and stay with one wife, younger boys become the older boys etc
no increased incidene of homosexuality
normal behaviour in the cultural context
what is normal sexual behaviours
not
-by default - ie haven’t met the right girl yet
-seduction - ie gay teacher leading astray
-contagion - ie same sex couple adopting (no increased incidence of gay kids, more accepting kids)
-parentsv- ie mum over nurtures boys, but is true gay men more often report having strained relationships with their father = maybe unaccepting father, men are much harsher at enforcing gender roles than women
may be based on
-genetics (50% concordance in mz twins)
-hormones - gay men = women finger thing
-structural (brain) - hypothalamus smaller in women and in gay men more similar to women
-gene-environment interaction (Bem’s exotic becomes exotic, no evidence simply boys who are girly play with girls, then when puberty hits joins in the girls looking at boys and starting to find them attractive)
DSM 5 gender dysphoria
incongrunence between experienced gender and primary / seconday sex characteristics
stated desire to gte rid of primary / secondary characteristics because of above point
desire for sex characteristics of other gender
desire to be the other gender
conviction of other gender feelings
lasts at least 6 months
gender dysphoria stats and background
rare
more ocmmon in natal males (3:1)
different to transvestic fetishism
not due to physical abnormalities (as with intersex)
goal is to live life as the opposite gender; not sexual
independent of sexual orientation
causes are unknown, 62% genetic concordance
sex reassignment surgery as treatment for gender dysphoria
surgery to alter physical anatomy to conform to their psychological gender identity
must live in the opposite sex role 1-2 years before surgery (can seem too long so go abroad)
must be stable psychologically, financially and socially
outcomes of sex reassignment surgery as treatment
75% satisfied
female to male conversions abdjust better than male to female (upgrade idea)
7% regret surgery
can maintain erection with added surgical options eg pump a balloon, titanium rod
explain the sexual response cycle and where problems can occur
(X)desire phase - sexual urgers occur in response to sexual cues or fantasies, parasympathetic nervous system
(X)arousal stage - subjective sense of sexual pleasure and physiological signs of arousal
plateau phase - period before orgasm
(X)orgasm phase - in males feelings of inevitability of ejaculation followed by ejaculation; in females contractions of the walls of the lower third of the vagina
resolution phase - decreased arousal occurs after orgasm (particularly in men)
back to desire phase
physiological signs of arousal
males
-penile tumescence (increased flow of blood into penis)
females
-vasocongestion (blood pools in the pelvic area) leading to vaginal lubrication and breat tumescence (erect nipples)
overview of sexual dysfunctions
pain may be associated with sexal functioning - in men is entirely medically explained
males and females experience parallels of most disorders
may be lifelong, chronic or aquired
may be generalized or specific
43% females
31% males
female sexual interest / arousal disorder
low sexual interes and recurrent inability to become excited
maintain adequate lubrication and maintain arousal from erotic cues until completion of sexual activity
at leat 3 of the following:
-absent / reduced interest
-absent/ reduced erotic thoughts
-no/ reduced and unreceptive to partner attempts
-absent/ reduced excitement during sex
-absent/ reduced response to sexual cues
-absent/ reduced genital sensation
female orgasmic disorder
recurrent dealy or absence of orgasm in some women following normal sexual excitement phase, relative to prior experience and current stimulation
delay, infrequency or absence of orgasm
reduced intensity of orgasmic sensation
5-10% females never orgasm (only 50% females experience reasonably regular orgasms)
causes are typically situational or cultural
symptoms for 6 months
genito-pelvic pain / penetration disorder
specific to women
pain / anxiety, tensions associated with sexual activity muscle spasms in the vagina that interefere with penetration
persistent difficulties with:
-vaginal penetration during intercourse
-vulvovaginal or pelvic pain during intercourse (or attempts)
-marked anticipatory fear or anxiety about genital pain
-marked tensing or tightening of the pelvic floor muscles during attempted vaginal penetration
-symptoms present for 6 months
male hypoactive sexual desire disorder
lack of interest in sexual activity or fantasy that wouldn’t be expected considering the persons age and life situation
persistent or recurrently deficient or absent sexual fantasies and lack of desire for sexual activity
may be associated with another dysfunction
may masturbate or have sex even with low desire
typically stop initiating
erectile disorder / erectile dysfunction
inability in some men to attain or maintain adequate penile erection until completion of sexual activity
increases as you get older - normal part of the ageing process
delayed ejaculation
achieve orgasm with great difficulty or not at all
delay, infrequency, or absence of orgasm following normal desire and arousal phases, relative to prior experience
premature ejaculation
recurring ejaculation within 1 minute following penetration and before the person wishes it (1-3% all adult males)
-note 75% college males note that they ejaculate sooner than they wished; cultural expectations associated with porn as primary method of sex education
DSM 4 categoris of sexual dysfucntions
secual desire disorders - lack of interest in sex or aversion to sexual contact
sexual arousal disorders - failure to become adequately sexually aroused to engage in or sustain sexual intercourse
orgasmic disorders - difficulty reaching orgasm or reaching orgasms more rapidly than one would like
sexual pain disorders - persistent or recurrent experience of pain during coitus
risk factors for sexual dysfunction
- Occur in women more than men
- Occurs after age of 30
- Old age increases the chance
- Painful intercourse
- Cardiovascular disease, depression, diabetes
- Alcohol abuse
- Some medications (e.g., antidepressants)
- Estrogen deprivation (postmenopausal)
- Emotional or stress related problems
- Decreased libido
- Delay/absence of orgasm
- Inability to attain vaginal lubrication/swelling
- Inability to maintain erection
- Lost of interest in sexual activity
bio causes of sexual dysfunction
medical conditions -neuro diseases -diabetes -vascular disease -chronic illness reaction to medications -beta blockers (anti-performance anxiety) -tricyclics -SSRIs recreational drugs
psych causes of sexual dysfunctions
cognitive -low expectations -avoid sexual cues physiologically -underestimated their arousal emotionally -experience sexual situation more negatively and experience negative emotion in the process
social and cultural causes of sexual dysfunctions
erotophobia = learned early that sexuality is negative and threatening
negative or traumatic sexual experiences (orgasmic disorder)
close interpersonal relationships - poor communication and sexual skills
script theory of sexual functioning - guided by scripts reflecting social and cultural expectations
interaction - negative attitudes may predispose one toward performance anxiety leading to sexual dysfunction
psychosocial sexual dysfunction treatments
masters and johnsons treatment - male and female therapist to facilitate communication in a couple (daily for 2 weeks); goal is to eliminate anxiety. not used muhc now as expensive but ideas are the core of most therapies
-education about sexual functioning (altering myths, fostering communication)
-sensate focus, couples approach, naked touching without arousal
-non-demand pleasuring - don’t have to react to touching
removes anxiety and pressure
medical treatments for sexual dysfunctions
viagra + CBT = more effective than drug alone
vasodilating drugs - injecting into the penis when they want to have sex, this produces and erection
penile prostheses - surgical option
vacuum device therapy
masters and johnson treatments for
premature ejaculation
squeeze technique - establish erection and the partner squeeze the penis near the top to quickly reduce arousal
teaches man to be aware and control his arousal
but have to top it up ie effects diminish
masters and johnson treatments for
female orgasmis disorder
masturbatory training procedures
masters and johnson treatments for
vaginismus
dilator insertion (with relaxation techniques)
masters and johnson treatments for
low sexual desire
reeducation and communication
masturbatory training
introduction of erotic material
paraphilia
sexual attraction or arousal directed at innappropriate people and or objects that causes significant distress or harm common comorbities -mood -anxiety -substance abuse
11 types of paraphillias and in their subgroups
noncoercive -fetishistic -transvestic coercive -voyeurism -exhibitionism -frotteurism -pedophilia -zoophilia (beastiality) -telephone scatologia -necrophilia S&M -sexual sadism -sexual masochism
fetishism
recurrent, intense, sexually arousing fantasies, urges or behaviours involving the use of nonliving objetcs
symbolic transformation - the object is part of the essence of its owner so that the child responds to the object as he might react to the actual person
operatn condition + incredibly strong sex drive (OCD)
transvestic disorder
recurrent and intense sexual arousal from cross-dressing (fantasies, urges, behaviours)
males may show highly masculinized compensatory behaviours
many are married and the behaviour is known to spouse/ partner
majority are heterosexual
voyeurism
the practice of observing an unsuspecting person undressing to become aroused = and the risk associated with it
exhibitionism
sexual arousal and gratification by exposing ones genital to unsuspecting stranger
the shock of other is the bit that causes arousal
frotteurism
sexual arousal and gratification through ribbing the body parts on unsuspecting strangers (usually in crowded areas)
pedophilia
sexual attraction to young children (incest = to ones own children)
both may involve male and or female children or veyr young adolescence (ie 14 = illegal but past puberty wouldn’t be pedophilia)
in women is rare but not unheard of
incestous males are more aroused by adult women
most molestors are not physically abusive to their victims
rationalize behaviour loving the child or teaching
almost never consider the psych damage to their victims
often highly religious
warning signs of pedophilia
- Vast majority are males and heterosexual
- Sexual urges geared towards prepubescent child
- Sexual fantasies with prepubescent child
- Record of prior sexual conviction
- Lack of intimate partners
- Never being married
- Poor relations with own mother
- Overly touchy and affectionate with kids
- Being alone with kids a lot
- Being a victim of child abuse at a younger age
- Excessive use of alcohol
- Low self-esteem
- Repeated lying
causes of pedophilia
no classic profile of the pedophile offender exists
pedophilia is assciated with sexual and social problems and deficits
pattterns of inappropriate arousal and fantasy may be learned early in life
the role of high sex drive, coupled with suppression of urges
sexual sadism
sexually arousing fantasies, urges or behaviours involving acts involving the suffering of another
sexual masochism
sexually arousing fantasies, urges or behaviours involving act of being humiliated, beaten bound or otherwise made to suffer development -need for heightened arousal -escape from self-awareness -guilt relief
treating paraphilia - psychosocial treatments
covert sensitization
family / marital therapy
orgasmic reconditioning
coping ad relapse prevention
results of psychosocial treatments for paraphillia
70-100% effective
men who rape have the second to lowest success rate
those with multiple paraphillias have the lowest success rate (multiple paraphillias are unfortunately more common than single)
clinicians expertise appears important
predictors of failure of treatment of paraphillias
unstable social relationships unstable employment history strong denial history of multiple victims continues to live with victim chronic course with high rates of recurrence
drug treatments of paraphillias
anti-androgen medications to reduce testosterone
reduces desire, but not funcitoning
only successful while on medication
excpetions 2 dis there isnt another gender version ie only effects one gender
vaginismus
premature ejaculation
understanding arousal study
men say yes to porn more
both men and women = aroused when watching (women only slightly less so then men)
women consistently said no didn’t arouse me, men said yes it did
women = taught to ignore their internal cues for arousal
pneumonic mainstream sex therapists use
PLISSIT P ermission L imited I nformation S pecific S suggestions I ndividual T herapy
