Sexual + Gender Identity Disorders Flashcards
What is gender dysphoria?
unsure which gender you belong to
- gender incongruence. my physical body =/= feeling inside
- many forms, depends on age of person
- diagnosis requires clinically significant distress or impairment
sexual orientation?
preference for sex of a partner
sexual identity
gender to which one identifies
prevalance of gender dysphoria
natal males : .005-.014%
natal females: .002-.003%
– not all adults seek hormones or surgery reassignment = estimate
evidence of physical disturbance may relate to gender dysphoria
- influenced by hormones
how hormones relate to gender dysphoria
sex hormones during pregnancy = behave like opposite sex + have anatomical abnormalities
- girls with synthetic progestins = tomboys
- boys + female hormones = less athletic, less rough+tumble play.
- not necessarily abnormal in gender identity
body alteration in gender dysphoria
- if want to alter body , do 6-12 months of psychotherapy.
- cosmetic surgery (M-> F: electrolysis to remove facial hair
- hormones to bring body closer to their beliefs about their gender.
- sex-reassignment/gender-affirming surgery
what is sex-reassignment and gender-affirming surgery
- first one in 1930
- worldwide attention = 1952
- more frequently by men than women
- controversy in benefit ( no + in social rehab led to termination of program in US not great)
benefits of gender-affirming surgery
- many say they are satisfied
- pre-operative factors have effect
what are pre-operative factors that predict favourable post-surgery adjustment?
- emotional stability
- successful adaptation in new role at least 1 year before surgery
- understanding of limitations + consequences of surgery
- psychotherapy in context of established gender identity program
prevelence of gender-affirming surgery in US?
1,000 a year.
what are paraphilia?
group of disorders involving sexual attraction to unusual objects or sexual activities that are unusual in nature
- 6 months + causes significant distress/impairment
- often not diagnosed because no distress/impairment
define para
deviation
what paraphilic disorder does not require distress?
paedophilia
paedophilia DSM-5 criteria
- over 6 months, recurrent, intense, sexually arousing fantasies etc with a prepubescent child or children.
- acted on sexual urges or sexual urges/fantasies cause marked distress/difficulty
- individual is at least 16yoa and 5 years older than child
stats of paraphilias
- accurate stats are unavailable bc most ppl don’t admit to it.
- most ppl with parapilias are male
- females mostly do masochism or paedophilia.
define fetishism
reliance on an inanimate object for sexual arousal
- recurrent/sexual urges toward non-living objects called fetishes.
- almost always males as opposed to females
- compulsive quality: involuntary + irresistible
- secret, masturbate to, use all senses, ask partner to don
degree of erotic focalization in fetish?
special sexual stimulant.
- must touch object
- drive to touch object is overwhelmingly strong.
what is transvestic disorder?
over 6 months, recurrent + intense sexual arousal fro cross-dressing.
- distress or impairment
- degree of variation differs
what is autogynephilia
males tendency to become aroused at the thought/image of himself as a woman.
characteristics of transvestic disorder
- begins in adolescence
- heterosexual
- almost always male
- cross-dress episodically not regularly
- masculine in appearance/demeanour + sexual preference
- many are married
- in private
- cause distress
what is voyeurism?
obtaining sexual gratification by watching others in a state of undress or having sexual relations.
- best if others dunno they’re watching
true voyeur - important element?
almost always a man,
NOT exciting when woman undressing for his special benefit
- element of risk seems important.
voyeurism begins when?
adolescence
voyeurism + illegality
difficult to assess frequency because often unnoticed.
- but trespass by night is common charge
voyeurism + fear
think that they’re fearful of more direct sexual encounters with others.
exhibitionism - define
recurrent, marked preference for obtaining sexual gratification by exposing one’s genitals to an unwilling stranger/child
- sexual arousal comes from fantasizing about exposure or doing it.
- desire to shock/embarrass observer
- high likelihood of feeling good, low likelihood of getting caught
when does exhibitionism begin?
attempt to have sexual contact
- begins in adolescence
- seldom an attempt to have contact with stranger
highest recidivism rate?
exhibitionism
- high feeling good, low getting caught
define frotteurism
sexually oriented touching of an unsuspecting person
- rub penis against woman, fondle her
- crowded place = easy means of escape
- begins in adolescence
sexual sadism and sexual masochism
obtain or increasing sexual gratification by inflicting pain or psychological suffering = sadism
subjecting oneself to pain/humiliation = masochism
motivation for sadism?
control, overcome resistance
– violence or aggression!
S+M type of relationships - who? - begin when? - ratio of S +M
heterosexual or homosexual
- often s gets with m
- some are women.
- begin in early adulthood
- comfortable with sex practices; otherwise conventional lives
- more M than S.
other specified paraphilic disorders
necrophilia
zoophilia (beasteality)
telephone scatalogia (obscene phone calls)
coprophilia: feces for sexual excitement
klismaphilia: enemas as sexual excitement
uruophilia: urine as sexual excitement
what are sexual dysfunctions?
the range or problems considered to represent inhibitions in the normal sexual response cycle
- “normality” varies with time + place
- inhibitions, expressions that underlie abnormality
4 categories of sexual dysfunction
- sexual desire disorder
- sexual arousal disorders
- orgasmic disorders
- sexual pain disorders
when is it sexual dysfunction?
persistent and recurrent
- marked distress or interpersonal problems
- diagnosis not made if due to medical illness or other disorder
4 phases in human sexual response cycle
- appetitive: arousing fantasy
- excitement: subjective experience of sexual pleasure assoc with physiological changes = increased blood flow to genitalia, F lubrication, M erection
- orgasm: sexual pleasure peaks
- resolution: relaxation, wellbeing that follows orgasm. refractory period in men. females able to continue
co-morbidity + treatment of sexual dysfunction
may not think they need treatment, only need if persistent + recurrent
- co-morbid with other dysfunctions in cycle
what are sexual desire disorders
hypoactive sexual desire disorder
- deficient or absent sexual fantasy
- more extreme form, actively avoids nearly all genital contact with another person
why sexual desire disorder is loaded statement
what’s problematic? is above or below average bad?
potential causes of sexual desire disorder
- religious orthodoxy
- sex with non-preferred partner
- fear loss of control
- fear of pregnancy
- depression
- side effects from meds
- lack of attraction
6 most significant factors in sexual desire disorders
relationship factors - communication, unhappy with how conflict is resolved
- history of sexual trauma
- fear of contracting sti
- anger
- stress
- low T
sexual arousal disorders
difficult obtaining/maintaining sexual arousal
Female orgasmic disorder
absence of orgasm after period of normal sexual excitement
- common in women
- prevalence rates from 16-46%
reasons for female orgasmic disorder
- have to learn to be orgasmic, may not be innate
- lack of sexual knowledge
- chronic use of alcohol has effect
- different thresholds for orgasm.
- fear of losing control
- fear of scream, fainting
- belief that letting go is unseemly
delayed ejaculation - prevalence?
- cause?
rare.
3-8% of clients
- fear of impregnation, withholding love, expressing hostility
- may be traced to physical source
premature ejaculation
- probs most prevalent disorder in males
- before or immediately upon intromission
- assoc with anxiety
- 16-27%
- negative impact on quality of life
Premature ejaculation + sexual responsiveness
- more sexually responsive = premies.
- pre: have longer periods of abstinence
what may influence premature ejaculation?
learning may have been proposed as factor
- situations may have promoted + reinforce short ejaculation latency
- cultural component - taboo around sex
sexual pain disorders - 4 symptoms
- distress + impairment
1. difficulty with vag penetration
2. pain during sexual intercourse or during penetration attempts.
3. fear/anxiety about pain
4. involuntary spasms in lower third of vagina = vaginismus
historical views of cause of sex dysfunction
past: moral degeneracy
1900’s: excessive masturbation and sexual activity
psychoanalytic: underlying repressed conflicts
current views on sex dysfunction
fears about performance
OR
fear of adoption of spectator role over participant
target for therapy for sex dysfunction
- most couples have sexual and interpersonal problems
- lack knowledge + skill
- may be deficiencies
- poor communication
considerations about sex dysfunction
unsatisfying episodes of sex life; this can pass.
usually not persistent sexual dysfunction
therapies for sex dysfunction
- hard to get help, 75% of those with sex dysfunction DID NOT get medical assistance
- aim: reduce or eliminate fears of performance + bring into participant role
- focus on sexual value system + potentially changing it
- couples mutual responsibility
what is sexual value system?
ideas of what’s acceptable + what’s needed for each partner
sensate focus therapy
- choose a time when both partners felt “a natural sense of warmth, unit compatibility or gamesmanship”
- undress + pleasure each other
- receiving allowed to enjoy, not required to feel anything, but say if something is uncomfy
- roles switched
- intercourse forbidden
what is anxiety reduction?
wolpe’s systematic desensitization + in vivo desensitization (irl)
directed masturbation
multi-step program - for women
- carefully examine her nude body
- touch her genitals and erogenous zones
- partner enters the picture, watched her masturbate then doing what she does, then having intercourse
sensory awareness procedures
clients encouraged to tune in to pleasant sensations that accompany even incipient sexual arousal.
- sensate-focus
- rational-emotive behaviour therapy : substitute less self-demanding thoughts (no I must/need)
- increase attractiveness of sex: courtship + dating assignments
skills + communication training
- assign “homework”: videos, techniques
- exposed to anxiety provoking material = desensitizing effect
- communicate likes + dislikes
couples therapy
sexual dysfunctions embedded in distressed relationship, may need non-sexual communication training
surgery for ED
semi-rigid silicone rod implanted.
stiffened with fluid in reservoir.
- long-term follow up = poor sexual functioning continues
- vascular surgery: increase: increase blood flow to genitals. mixed results, can have complications
non-surgical intervention
cylinder attached to vacuum pump
- effective
drugs for ED
viagra
- relax smooth muscle, increase blood flow to penis
- improvement in biological or psychological ED
- great side effects
- dangerous for ppl with CVD
