Sexual Dysfunctions, Paraphiliac Disorders, and Gender Dysphoria

Question 1

Sexual orientation biosocial psycho influences

Answer 1

• Genetics: 50% identical twins raised together share sexual orientation
• Maternal stress levels may predict sexual orientation of males but not fully
• Fraternal birth order hypothesis: males w older brother tend to be gay but not entirely predictive
• more fluid for women

Question 2

Overview of sexual dysfunction

Answer 2

• Involves problems with desire arousal and/or orgasm
  
  • can be lifelong or acquired, generalized or situational
• present 6+ months for diagnosis
• Impairment or distress needed for disorder
• Sexual dysfunctions extremely common and not always distressing
  
  • 60% of women have problems with arousal 40% men have difficult w errection
    *

Question 3

Male Hypoactive Sexual Desire disorder

Answer 3

• Little or no interest in sexual activities
• masturbation, sexual fantasies and sex are rare
• V common
• not asexuality which individuals do not experience distress or impairment

Question 4

Desire/arousal disorders:

Female Sexual Interest/Arousal Disorder and Male Erectile Disorder

Answer 4

Female sexual interest/arousal disorder

• Reduced interest in sexual activity (desire)
• Reduced physiological response or sensations during sexual contact (arousal)
• Different from Asexuality which has no distress/impairment

Male Erectile Disorder

• Difficultly achieving and maintaining erection
• Increases w age 60% men over 60 experience
  *

Question 5

Orgasm Disorders

Answer 5

Female Orgasmic disorder

• Marked delay absence or decreased intensity of orgasm despite sexual arousal and desire
• Not due to relationship distress or other significant stressors
• most common complaint of adult females (25%)

Premature ejaculation

• Ejaculation coming too soon (within 1 minute)
• Common in inexperienced young men
• Most prevalant dysfunction in adult males

Question 6

Genito pelvic pain/penetration disorder

Answer 6

• Difficulty with vaginal penetration during intercourse associated with
  
  • Pain during intercourse or penetration

Question 7

Treatment

Answer 7

• Open communcation and teamwork
• Address non-adaptive
• mastibatory training
• dialators
• exposure to

Question 8

Frotteristic distorder

Answer 8

Sexual Gratification from rubbing up against non-consenting individuals

Question 9

Exhibitionism

Voyeurism

Answer 9

Exhibitionism: flashing others

Voyeurism: sexual gratification from observing

Question 10

Fetishization

Answer 10

Sexual attraction to non-genital body parts or objects

• Only disorder if causes distress

Question 11

Transvestite disorder

Answer 11

• sexual gratification from dressing up as the opposite gender

Question 12

Sadism and masochism

Answer 12

• Sadism: inflicting pain
• Masochism: receiving pain

Question 13

Causes of Paraphilic disorders

Answer 13

• ​Manifest in fantasies urges arousal or behaviors
• Difficulty forming normal relationships
  
  • Deficits in typical sexual experiences
  • Relationship difficulties in childhood or adolescence
• Early experiences may lead to sexual associations by change which are then reinforced by masturbation
• High sex drive difficultly controlling impulses
  
  • supressing desires can increase them
• In the case of paraphilic disorders that cause harm to others, those who have been abused in the past have higher likelihood of committing abuse

Question 14

Paraphilic treatment

Answer 14

• Covert sensitization: imagining aversive consequences to form negative associations with inappropriate behavior
• Orgasmic reconditioning: masturbating to appropriate stimuli
• Efficacy is mixed
  
  • Poorest outcomes for rapists and patients with multiple paraphillias
• Medications
  
  • Used for most dangerous offenders
  • Cyproterone acetate: reduces sexual arousal by decreasing testosterone but stops working if they discontinue drug
  • Depo Provera - reduces testosterone

Question 15

Causes of sexual dysfunctions: Biological

Answer 15

• Physical disorders: diabetes cardiovascular problems
• Normal aging
• Hormone imbalances
• Prescription medications
  
  • SSRIs; beta blockers
• Alcohol and drugs

Question 16

Causes of Sexual Dysfunction: psychological

Answer 16

• Conditions like depression anxiety and traumatic experiences
• Expectations about sex, negative learned associations can also be damaging and contribute to dysfunction
  
  • performance anxiety
    
    • May decrease arousal and lead to decreased performance
    • example: adopting a “spectator role and judging one’s performance instead of enjoying oneself
  • May try to actively avoid awareness of sexual cues
    
    • Example: men w erectile dysfunction tend to distract themselfs to purposefully avoid orgasm

Question 17

Causes of sexual dysfunction: sociocultural

Answer 17

• Anti-sexual education or upbringing
• unpleasant or traumatic sexual experiences
• poor interpersonal relationships, marital distress
• Lack of communications about desires preferences
• stress
• Double standards: beliefs that encourage male sexuality while shaming female
• Sexual scripts: socially dictated descriptions of appropriate behaviors for intercourse

Question 18

Assessing sexual problems

Answer 18

• comprehensive interviews
  
  • A detailed history of sexual behavior lifestyle and associated factors
• medical examinations
  
  • Must rule of potential causes of sexual dysfunction
• psychophysiological evaluation:
  
  • Exposure to erotic material
  • determining the extent and pattern of sexual arousal

Question 19

Paraphilic disorders

Answer 19

• Paraphilia: unusual or atypical sexual interests
  
  • Manifests in fantasies urges arousal or behaviors
• Paraphilic disorders: misplaced sexual attraction and arousal
  
  • Experiences clinically sig distress or impairment OR
  • Acts on urges with non-consenting person
  • More common in men
  • Highly comorbid w anxiety and depression and substance abuse disorders
    
    • 50% sadists suffer from alocholism