1 / 48

Human Sexuality

Human Sexuality. Sexual Disorders: Dysfunction, Dysphoria, and Paraphilia. Sexual Myths and Realities. Pre-1966/ Masters & Johnson’s “Human Sexual Response”; The Science of Sexuality Accepted beliefs about Human Sexuality: Masturbation is rare and causes disease in men Women never masturbate

lmichele
Download Presentation

Human Sexuality

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Human Sexuality Sexual Disorders: Dysfunction, Dysphoria, and Paraphilia

  2. Sexual Myths and Realities • Pre-1966/ Masters & Johnson’s “Human Sexual Response”; The Science of Sexuality • Accepted beliefs about Human Sexuality: • Masturbation is rare and causes disease in men • Women never masturbate • Homosexuality is abnormal • Most couples have exclusively missionary sex • Women are not sexual and rarely have orgasms • Premarital sex is rare; so is extramarital sex

  3. What is “Normal” Sexual Behavior? • Normal Sexual Behavior: Wide range; research is recent and evolving • Difficult to determine what is normal • Example: people report tremendous variation in frequency of sexual outlet or release • Influenced by cultural norms and values • Kinsey: “The only unnatural sex act is that which you cannot perform” • Definitions of sexual disorders are inexact

  4. Defining Sexual Behavior as a Mental Disorder • Controversy surrounding definition of deviant sexual behavior • Current Def: Only deviant if it threatens society, causes distress to participants, or impairs social or occupational functioning • Is gender dysphoria a psychiatric disorder? • Is Sex Addiction a disorder? • Is hyposexuality a disorder if there is no distress?

  5. The Sexual Response Cycle • Appetitive/Excitement phase • Characterized by person’s interest in sexual activity • Arousal/Plateau phase • May follow or precede the appetitive phase • Heightened when specific, direct sexual stimulation occurs • Various physical changes occur • Example: increased blood flow to penis in males

  6. The Sexual Response Cycle (cont’d.) • Orgasm phase • Characterized by involuntary muscular contractions throughout the body and eventual release of sexual tension • Resolution phase • Characterized by relaxation of the body after orgasm • Heart rate, blood pressure, and respiration return to normal

  7. Human Sexual Response Cycle

  8. Sexual Dysfunctions • Recurrent and persistent disruption of any part of the normal sexual response cycle • DSM-5 requires that symptoms be present for at least six months and be accompanied by significant distress • Types of dysfunctions • Lifelong – onset since beginning of sexual behavior • Acquired – after a period of normal sexual behavior • Generalized – across situations, partners, all stimulation • Situational – specific to certain situations, partners, stim

  9. Sexual Dysfunction Dx • DSM-5 diagnosis for sexual dysfunction not made if better explained by another disorder (i.e., depr) • Sexual Dysfunction can be comorbid with relational difficulties and psychological disorders Example: Loss of Sexual Arousal Drive subsequent to relationship conflict; poor body image; grief

  10. Lifetime Prevalence of Sexual Disorders in the United States (40–80 Age Range)

  11. Sexual Interest/Arousal Disorders • Problems with initial phase of sex: little interest in sex but capable of orgasm • What is normal frequency? 2-3x wk? year? • Male hypoactive sexual desire disorder • Little or no interest in sexual activities • Female sexual interest/arousal disorder • Little or no interest, or diminished arousal to sexual cues • Most common in women – 33% • 40-50% of all sexual difficulties involve deficits in interest

  12. Orgasmic Disorders • Female orgasmic disorder (prevalence 10-40%) • Persistent delay or inability to achieve orgasm despite receiving adequate sexual stimulation • Marked reduced intensity of orgasmic sensation • Not dx if orgasm is possible with stimulation • Delayed ejaculation – (worsens with age) • Persistent delay or absence of ejaculation after excitement phase is reached • Lifelong type can occur • Rule out Medical Cause: surgical injury to lumbar nerves; nerve supply to genitals

  13. Orgasmic Disorders • Premature Ejaculation • Recurrent pattern of having an orgasm with minimal sexual stimulation before, during, or after vaginal penetration • Must occur within one minute of penetration • Most common sexual dysfunction for young men • Affects 21-33 percent of men

  14. Orgasmic Disorders • Pain Penetration Disorders: Involves physical pain or discomfort associated with intercourse/penetration • Dyspareunia • Pain in the pelvic region during intercourse • Vaginismus • Involuntary spasm of the outer third of the vaginal wall • Prevents or interferes with sexual intercourse

  15. Arousal Disorders: Aging • Sexual Changes across Lifespan: • Female drop in estrogen: Interest drop; Thinning of vaginal walls; lower lubrication • Male drop in Testosterone – drop in arousal & ED • Delayed Ejaculation/Absence • Erectile Dysfunction: inability to form penile erection • Psychological cause: may experience Nocturnal erections • Medical Cause: Poor circulation/heart disease • Prostate Discomforts

  16. Etiology of Sexual Dysfunctions

  17. Etiology of Sexual Dysfunctions • Biological dimension • Levels of testosterone (low) or estrogens (low) linked to lower sexual interest in men and women, and erectile difficulties in men • Medications used to treat medical conditions affect sex drive • Many antidepressant and antihypertensive medications • Alcohol as leading cause of disorders – ejaculation/ed issues • Illnesses and other physiological factors (heart disease; diabetes; )

  18. Etiology of Sexual Dysfunctions (cont’d.) • Psychological dimension • History of Sexual Trauma; Emotional Abuse • Increase of Stress; Poor Coping • Anxiety disorder: poor performance • Depression: anhedonia • Performance anxiety and spectator role • Cultural/Religious beliefs about sexuality/body (prohibitions) • Poor Self-Image: Negative thoughts and dysfunctional beliefs

  19. Etiology of Sexual Dysfunctions (cont’d.) • Social dimension • Social relationships: positive sexual experiences • Current sexual relationship: communication/sexual compatibility; partner violence/abuse • Early sexual experiences • Traumatic sexual experiences • Relationship dynamics predictive of sexual disorders • Marital satisfaction associated with greater sexual frequency

  20. Etiology of Sexual Dysfunctions (cont’d.) • Sociocultural dimension: Rigid Scripts • cultural scripts: defines roles, allowable behaviors, pleasures, sexual play script • Examples of sociocultural aspects • People in Asian countries consistently report lowest frequency of sexual intercourse • Cultural scripts for men in the United States • Sexual potency as a sign of masculinity • Homophobia toward lesbians or gays

  21. Treatment of Sexual Dysfunctions • Biological interventions • Hormone replacement – testosterone, estrogen, etc. • Mechanical means to improve functioning • Vacuum pumps, suppositories, penile implants • For ED, injecting medication into penis • Oral medications (Viagra, Levitra, Cialis) • Psychological boost may lead to feelings of enhanced pleasure

  22. Psychological Treatment Approaches • Education • Replace myths and misconceptions with facts • Anxiety reduction • Desensitization or graded approaches • Changing negative thoughts and beliefs about sex • Structured behavioral exercises • Tasks that gradually increase amount of sexual interaction • Sexual Communication training – relationship focused

  23. Gender Dysphoria • Previously called gender identity disorder (GID) or transsexualism • Marked incongruence (mismatch) between one’s experienced or expressed gender and biologically assigned gender • Not the same as sexual orientation • Diagnosed when there is significant distress or impairment – High Suicidality Risk • Childhood – some don’t persist into adulthood • Adolescent/Adult onset - many persist into adulthood

  24. Etiology of Gender Dysphoria • Etiology is unclear • Research has focused on other sexual disorders • Likely an interaction of multiple variables • Most transgender children have normal hormone levels • No specific neurological explanation • Brain alterations associated with psychosocial distress and social exclusion

  25. Psychological and Social Influences • Explanations must be viewed with caution • Hypothesis – • Do Childhood experiences influence development of gender dysphoria? Mediating role? • Parent encouragement of feminine behavior, overprotection, lack of male role models, etc. • Psychosocial stressors • Stigma and lack of societal acceptance play a role in distress and impairment associated with gender dysphoria

  26. Treatment of Gender Dysphoria • Gender reassignment therapies • Changing physical characteristics through hormone therapy or surgery • Many involve reconstructing genital organs • Some insurance beginning to include coverage for transgender individuals • Studies show positive outcomes

  27. Paraphilic Disorders • DSM-V definition • Sexual arousal in objects, body parts, or abnormal targets (feet, lingerie, hair, voyeurism, porn, etc.) • May involve unusual erotic behavior • Diagnosed only when paraphilia harms, or risks harming others and is acted on • Or causes the individual to experience distress or impairment in social functioning

  28. Paraphilic Disorders

  29. Paraphilic Disorders Involving Nonhuman Objects • Fetishistic disorder – predominantly men • Extremely strong sexual attraction and fantasies involving inanimate objects • Examples: shoes or undergarments • Person is often sexually aroused to the point of erection in the presence of the fetish item • Person may choose sexual partners on the basis of having that item (e.g., bound feet) • Must cause significant distress or harm to others

  30. Transvestic Disorder • Intense sexual arousal associated with cross-dressing (wearing clothes appropriate to the opposite gender) • Do not confuse with gender dysphoria • Most people who cross-dress are exclusively heterosexual • Incidence higher among men than women • Men may become sexually aroused by thoughts of themselves as female

  31. Paraphilic Disorders Involving Nonconsenting Persons • Exhibitionistic disorder • Urges, acts, or fantasies of exposing one’s genitals to strangers, intent to shock • Voyeuristic disorder • Urges, acts, or fantasies involving observation of an unsuspecting person disrobing or engaging in sex activity • Diagnosed only in those age 18 or older • Individual must be distressed by or have acted on the voyeuristic urges

  32. Frotteuristic Disorder • Recurrent/intense sexual urges, acts, or fantasies of touching or rubbing against a nonconsenting person • For diagnosis, person must be markedly distressed by urges or have acted on them • Prevalence is difficult to determine • Behavior may go unnoticed or presumed to be accidental

  33. Pedophilic Disorder • Adult relates to children as erotic objects • Sexual abuse of children is common • Estimated 1/4 of girls and 1/5 of boys • Most people who act on pedophilic urges are friends, relatives, or acquaintances of their victims • Effects of sexual abuse can be lifelong

  34. Paraphilic Disorders Involving Pain or Humiliation • Sexual masochism disorder • Sexual urges, fantasies, or acts that involve being humiliated, bound, or made to suffer • Individual does not seek harm or injury • Finds sensation of helplessness appealing • Sexual sadism disorder • Sexual urges, fantasies, or acts that involve inflicting physical or psychological suffering on others

  35. Etiology and Treatment of Paraphilic Disorders • We still have much to learn • Some research findings conflict with each other • Some men may be biologically predisposed to pedophilic disorder • Psychological factors also contribute • Paraphilias may result from accidental associations between certain situations and sexual arousal

  36. Behavioral Approaches to Treatment • Extinction or aversive conditioning: punishment or elimination of behavior • Acquiring or strengthening sexually appropriate behaviors: learning healthy sexuality • Developing appropriate social skills • Legal Consequences to inappropriate sexual interest

  37. Rape • Sexual aggression that involves sexual activity performed against a person’s will through the use of force, argument, pressure, alcohol or drugs, or consent • Not considered a psychological disorder • Number of rapes in the U.S. has risen dramatically • One in five adult women has been raped • One in 71 men

  38. Characteristics of Male Rapists • Create situations in which sexual encounters may occur • Misinterpret friendliness as provocation and protests as insincerity • Manipulate women into sexual encounters with alcohol (70%) or other drugs • Attribute failed attempts at sexual encounters to perceived negative features of the woman

  39. More Characteristics of Male Rapists • Come from environments of parental neglect or physical or sexual abuse • Experience Sex earlier in life than men who are not sexually aggressive • Have more sexual partners than non-sexually aggressive men

  40. Date Rape • Many Reluctant to Report • Between eight and 25 percent of female college students report having “unwanted sexual intercourse” • Many universities conducting workshops to encourage understanding that intercourse without consent is rape

  41. Effects of Rape • Rape trauma syndrome symptoms • Include psychological distress, phobic reactions, post-traumatic stress symptoms, and sexual dysfunction • Phases in rape trauma syndrome • Acute phase: disorganization; PTSD Sx • Feelings of self-blame, fear, or depression • Long-term phase: reorganization • Survivors deal directly with feelings and attempt to reorganize their lives

  42. Etiology of rape • Power rapist: 55 percent of rapists • Compensate for feelings of personal/sexual inadequacy by trying to intimidate victims • Anger rapist: 40 percent of rapists • Angry at women in general • Sadistic rapist: 5 percent of rapists • Derives satisfaction from inflicting pain • May torture or mutilate victims

  43. Etiology of Rape (cont’d.) • Rape has more to do with power, aggression, and violence than sex • Sexual motivation also plays a role in rape • Most rape survivors are in their teens or 20s • Vulnerable age group • Most rapists name sexual motivation as primary reason for actions • Many rapists have multiple paraphilias (immature sexuality)

  44. Etiology of Rape (cont’d.) • Why is the rate of rape increasing in US? • Effects of pornography and media portrayals of violent sex may affect rape prevalence • “Cultural spillover” theory • Rape is high in environments that encourage violence • United States has highest rape rate among countries reporting rape statistics

  45. Treatment for Rapists • Many believe sex offenders are not good candidates for treatment • Most common penalty is imprisonment • High recidivism rates • When intervention occurs, it usually incorporates behavioral techniques • Some treatment techniques show success with exhibitionists • Outcomes tend to be poor for rapists

  46. Contemporary Trends and Future Directions Trends in Defining Abnormality: • New Def: “Normal” if no harm to self or others? • Exp: Is a fetish normal if not harmful?? • Gender dysphoria may eventually be removed as a psychiatric diagnosis • Sweden has removed transvestism, fetishism, and sadomasochism from list of mental illnesses

  47. Review • What are normal sexual behaviors? • What do we know about normal sexual responses and sexual dysfunction? • What causes gender dysphoria, and how is it treated? • What are paraphilic disorders, what causes them, and how are they treated? • Is rape an act of sex or aggression?

  48. Group Work: Case Analysis • Each group will work together on each case, evaluate each case, form a diagnosis and develop a rationale for the decision. • Total of 4 cases representing different sexual disorders • Class Discussion • Please turn in group work at end of class

More Related