Sexual and relationship problems/Gender dysphoria Flashcards
What are the two main theories of sexual functioning?
Linear model: sequence of stages from desire to arousal to orgasm
A circular model (Basson, 2000) –desire may not be the first phase –Better model of sexual dysfunction in women
What are the different Sexual Dysfunctions?
Desire Stage: Male hypoactive sexual desire disorder, female sexual interest/arousal disorder
Arousal stage: Male erectile disorder
Orgasm stage: Male Delayed ejaculation or premature ejaculation, Female orgasmic disorder
Pain: Female genito-pelvic pain/penetration disorder
What are Sexual Desire Disorders?
Sexual desire: interest in engaging in sexual activity either alone or with a partner
DSM-5hypoactive sexual desire disorder: individual’s desire for sex is severely diminished and associated with great distress
What are Sexual Arousal Disorders and what is their prevalence for both men and women?
For men: inability to attain or maintain an erection sufficient for intercourse –Lifetime prevalence of up to 50% –Higher risk for men who smoke or who have a range of medical conditions
For women: difficulty in attaining or maintaining adequate lubrication until the completion of the sexual act
–Lifetime prevalence of up to 52%
What are Orgasmic Disorders?
Men: DSM-5: two types of orgasmic disorders: –Delayed ejaculation (4% in Aus)–Premature ejaculation (8% in Aus)
Women: marked delay or absence or reduced intensity of orgasmic sensations, accompanied by significant distress–51% (Aus)
Genito-pelvic pain/penetration disorder: pain or discomfort during intercourse–4% (Aus)
What are key aetiological findings of sexual dysfunction?
Biological Factors: Increasing problems with age, Comorbid medical conditions, Medications
Psychosocial Factors: Emotions, Development, Relationship
How is Sexual Dysfunction treated?
CBT: challenge unrealistic beliefs associated with sexual dysfunction
Behaviour therapy: combination of –Education–Communication skills training–Sensate focus exercises
Internet-based treatment promising
Medication: some efficacy
What is Paraphilic Sexual Activity?
Atypical sexual activities that involve one of the following: –Non-human objects–Non-consenting adults–The suffering or humiliation of oneself or one’s partner–Children
What are the different Paraphilic Disorders?
Exhibitionistic—exposing genitals to an involuntary observer
Fetishistic—use of nonliving object for sexual gratification
Frotteuristic—touching or rubbing against a non-consenting person for sexual gratification
Paedophilic—sexual activity with children
Sexual masochistic and sexual sadism—experience of sexual stimulation through the infliction of pain or humiliation on another person
Transvestic—cross-dressing
Voyeuristic—looking at unsuspecting individuals as they undress
What are key aetiological findings of Paraphilic Disorders?
Little data but probably originate in childhood or adolescence
How are Paraphilic Disorders treated?
Behaviour therapies: aversion therapy and exposure therapy
Social skills training: some support but findings are generally mixed
For some disorders, chemical or surgical castration, in conjunction with other therapies
What are key relationship problems?
Personality characteristics (1940s)
Interactional styles between couples (1950s)
Power and power imbalances / family dynamics (1960s and 1970s)
Interaction patterns and predictors of divorce (1980s and 1990s)
Complex processes and relationships between different variables (more recently)
What are key patterns of interaction within relationships?
Good communication and self-disclosure
Conflict
–Lower levels of conflict
–Lack of extreme levels of conflict
–Satisfactory resolution of conflict
Association between sexual satisfaction and relationship satisfaction
What are contextual factors of relationship problems?
Becoming a parent
Negotiations of balance between work and family
Same-sex relationships: negative social attitudes towards homosexual couples
How are Relationship Problems treated?
Behavioural and cognitive-behavioural couple therapy–Behavioural training, communication training, problem solving and challenging dysfunctional cognitions
How is Trans and Gender Diverse defined?
Trans and gender diverse (TGD): those whose gender expression or identity varies from that generally expected for someone assigned to their sex at birth
The DSM-5: ‘gender identity disorder’ replaced by with ‘gender dysphoria’ to decrease stigma
Shift from ‘male’ and ‘female’ to fluidity in gender experiences
How is Gender Dysphoria diagnosed?
Experience of gender incongruence with associated distress or impairment in life functioning can occur with the following:
Desire to be another gender
Desire for cross gender pay
Preference for toys and clothing typically associated with preferred gender
Resistance or rejection to toys and clothing typically associated with assigned gender
Preference for playmates of the preferred gender
Dislike of primary and/or secondary sex characteristics
Desire for primary and/or secondary sex characteristics of preferred gender
What are the differential diagnosis’ for Gender Dysphoria?
–Transvestic disorder –Schizophrenia and other psychotic disorders –Body dysmorphic disorder –Personality disorder –Dissociative identity disorder –Autism spectrum disorder
What are key epidemiological of gender dysphoria?
1 in 22,145 Australian passport holders has modified the gender marker on their passport
Age of onset varies with developmental changes–Early onset –commences in childhood and persists–Late onset –commences in puberty or later in life
Poorer mental health common in TGD individuals linked with stigma, violence and social rejection
What are key aetiological findings of gender dysphoria?
Interactions between biological, psychological and social forces •Gender identity may be formed in utero–Possibly due hormones •Potential neuroanatomical differences •Possible genetic influences
Sociocultural influences on gender variance vary greatly across cultures–Gender expression are typical–Gender variance is sharply repressed
What are the guiding principles of Gender Dysphoria treatment?
Individualise treatment Avoid harm Use appropriate language Be respectful Consider sociocultural factors
What are common interventions for Gender Dysphoria?
Pharmacological: Hormonal therapy E.g. Testosterone and Oestrogen
Removal of undesired genitalia/Modification of existing structures and creation of new tissues: Most individuals have favourable outcomes. However, 2–3 per cent choose to revert to their birth-assigned gender
Voice and communication therapy
What is the prevalence of Sexual Desire Disorders?
8 per cent of men & 55 per cent of women
