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Sexual Disorders. Kinsey Report (1948). 90 percent of men interviewed had masturbated 85 percent had engaged in premarital intercourse 60 percent had engaged in oral sex 37 percent had at least one homosexual contact resulting in orgasm
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Kinsey Report (1948) • 90 percent of men interviewed had masturbated • 85 percent had engaged in premarital intercourse • 60 percent had engaged in oral sex • 37 percent had at least one homosexual contact resulting in orgasm • 17 percent of farm boys had sexual relations with animals
What is Normal Sexuality? • Prevalence of Sexual Practices (CDC, 2007) • 15 or more partners (lifetime) • Male = 29% • Female = 9% • 2 or more partners (year) • Male = 17% • Female = 10% • Similar in Britain, France
What is Normal Sexuality? • Homosexual sex • 6.5% of men and 11% of women had engaged in same-sex sexual behaviors (ever)(Mosher et al., 2005) • 1.1% (homosexual only)(CDC, 2007) • Similar in Britain, France • Previous reports: 10% attraction or behavior (ever) • Sexuality in the elderly • Activity can and does last past age 80 • Age 70-79 • M = 50% active • F = 36% active • Decreases predicted by physical health changes
Gender Differences and Attitudes • Casual premarital sex • Men are more permissive, gap is shrinking • Elements of satisfaction • Women = demonstrations of love, intimacy • Men = focus on arousal
Gender Dysphoria • A marked incongruence between one’s experienced/expressed gender and assigned gender for a period of at least 6 months B) Disturbance causes clinically significant distress or impairment
Possible Causes: • Biological • no conclusive evidence linking prenatal hormone influence and gender identity • Environmental factors • Green (1987) found that boys who consistently displayed “feminine” interests were sometimes encouraged. • Some had lack of male playmates - excessive attention by mother • Most of these do not develop GD • Causes of GD are largely unknown
Treatment Options 1) sex reassignment surgery 2) psychosocial treatment
paraphilia: sexual arousal occurs almost exclusively in the context of inappropriate objects or individuals.
Paraphilias • almost never diagnosed in females • over a period of at least six months • recurring sexual fantasies, urges or behavior involving. . . . . • exhibitionism: exposing one’s genitals to an unsuspecting stranger • onset usually before age 18 • much less severe after age 40
Paraphilias • fetishism: nonliving objects Three types of objects: 1) inanimate objects 2) tactile stimulation 3) part of body (partialism) • usually begins in adolescence • object often required for sexual excitement • absence of object sometimes leads to erectile dysfunction
Paraphilias • frotteurism: touching and rubbing against a nonconsenting person • usually occurs in crowded locations • person often fantasizes about having an exclusive, caring relationship • often occurs between ages 15-25
Paraphilias • pedophilia: prepubescent children • must be at least age 16 and 5 years older than the child • reports of female victims more common • often rationalize actions • nonexclusive subtype: • sometimes prefer adult partners (often married) • exclusive subtype: • attracted only to children
Paraphilias • sexual masochism: the act of being humiliated beaten, bound, or otherwise made to suffer • males diagnosed more 20:1 • sometimes leads to accidental deaths • hypoxyphilia – sexual arousal by oxygen deprivation • sexual sadism:psychological or physical suffering of a “victim” • some have consenting partner – others use nonconsenting victims • severity of acts increases over time
Paraphilias • transvestic fetishism: cross-dressing • ranges from wearing a single hidden item of female clothing to dressing up entirely as females (makeup, etc) • most common in heterosexual males • usually begins in childhood
Paraphilias • voyeurism: observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity • “peeping Tom” • onset usually before age 15
Possible Causes of Paraphilias • early inappropriate sexual associations or experiences • inadequate development of consensual adult arousal patterns • lack of appropriate social skills relating to adults • inappropriate sexual fantasies reinforced through repeated association with masturbation • attempts to inhibit undesirable arousal / behavior makes things worse
Treatment • covert sensitization: associate sexually arousing images with averse consequences of the behavior that bring them to treatment • orgasmic reconditioning: masturbate while substituting more desirable fantasies • drug treatment 1) cyproterone acetate 2) medroxyprogesterone acetate (Depo-Provera)
RAPE • not a DSM-V category • majority of rapes are acquaintance rapes • only about 4% involve a total stranger • “Power vs. Sex?” controversy • often involves both
Types of Rapists(Knight & Prentky’s Typology) • Motivation primarily sexual • Sadistic • Non-sadistic • Motivation primarily aggressive • Vindictive • Opportunistic
Sexual Dysfunction • Disorder of Desire • Female Sexual Interest/Arousal Disorder • Male Hypoactive Sexual Desire Disorder • Disorder of Arousal • Male erectile disorder • Female sexual arousal disorder • Disorder of Orgasm • Delayed ejaculation • Early ejaculation • Inhibited female orgasm • Disorders involving pain • Dyspareunia • Vaginismus