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Discussion: Sexual Addiction

Discussion: Sexual Addiction. What, if anything, is disordered? Sexaholics Anonymous. Addiction criteria. Overuse or other misuse of a substance Continued use despite significant adverse personal consequences Legal problems Employment difficulties Damage to relationships

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Discussion: Sexual Addiction

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  1. Discussion: Sexual Addiction What, if anything, is disordered? Sexaholics Anonymous

  2. Addiction criteria • Overuse or other misuse of a substance • Continued use despite significant adverse personal consequences • Legal problems • Employment difficulties • Damage to relationships • Subjective sense of compulsion or loss of control: Inability to limit the behavior • Preoccupation with the substance

  3. Is sexual addiction a myth? • Do addiction criteria apply to sexuality? • Is the idea of sexual addiction an example of using psychiatry to categorize a current social concern? • Is it helpful to consider sexual addiction pathological? Helpful to whom? • Does the idea of sexual addiction oversimplify a complex issue?

  4. Arguments about “sexual addiction” • It punishes people for normal behavior (Henkin, 1991) • It absolves people from responsibility for inappropriate, even harmful behavior • It acknowledges the role of brain chemistry in behavioral problems • It is co-morbid with psychiatric conditions like eating disorders and compulsions

  5. Sexuality as differences • Did Western culture hold that there was only one sex, as Laqueur (1992) argues? • Why do we think that there are two sexes? • Anatomical distinctions • Reproductive roles • Social roles: Gender and the “division of labor”

  6. What determines sexuality? • Genetics • Embryonic and fetal hormones • Maternal and environmental hormones • Society and culture

  7. History of sex-determination theories • Homer (8th C. B.C. ?): Conception is influenced by the wind, north for males and south for females…at least in sheep & goats • Aristotle added the influence of male semen molding the embryo from the menstruum • Galen (130-200A.D.) Semen from left testis makes females, right makes males. A mixture produces hermaphrodites.

  8. More history • Avicenna or Ibn Sina (11th C) Gender depends on the side of the uterus to which the placenta attaches • Anton van Leeuwenhoek, 1677: sperm • Albrecht von Haller, 18th C., reported a man with one testis having children of both genders, and a woman with no right fallopian tube having a boy and a girl. • Carl Ernst von Baer, 1827: ovum

  9. Sex determination vs. sex differentiation • Sex determination includes the triggering events that determine gonadal tissue development as testes or ovaries • Sex differentiation includes the following events producing the male or female phenotype. • Gonadogenesis precedes sex determination • Steroidogenic factor 1 (SF-1) • WT-1 (after Wilms’ tumor) on 4 autosomes

  10. Chromosomal determination • C.I. McClung (1902) discovers the “Accessory chromosome” • Barr & Bertram (1949) discover Barr bodies • Drosophila studies link the X-chromosome/ autosome ratio to sex determination • Welshons & Russell (1959): The role of the Y chromosome

  11. Genetics: Testis determining factor • H-Y Antigen? • Zinc-Finger Proteins (ZFY) (Page et al., 1987) • SRY (Goodfellow and Lovell-Badge, 1993) • Found in testes, midbrain, and hypothalamus of XY mice • Translatable linear form in brain (Lahr et al, 1995): May directly masculinize brain • SRY triggers Mullerian Inhibiting Substance • SRY is the rate-limiting factor for other sex-differentiating genes, like SOX-9

  12. DSS and DAX-1 • Dosage-sensitive sex reversal (DSS) • DSS, adrenal hypoplasia, X-linked (DAX-1) • A locus on the X chromosome. If there are two of these loci, female development occurs. Effects opposite to SF-1. • May be duplicated on one X chromosome, making possible an X-Y karyotype with female differentiation

  13. Genetics and sexual differentiation • 46,XX : Double DSS or 46,XY: TDF/SRY • 46,XX with translocated TDF/SRY • 46,XY with missing or mutated TDF/SRY or doubled DSS: 1/20,000 • 46,XY females without SRY mutation: Downstream mutations • 46,XX males with no Y-derived gene sequences

  14. More genetic abnormalities • 45,XO or Turner’s syndrome: 1/2,500 • 45, YO: Not viable • 47,XXX • 47,XXY or Klinefelter’s syndrome: 1/500 • 47,XYY Supernumerary Y or “Super-male” • 48,XXYY; 48,XXXY; 49,XXXXY • Mosaicism: eg. 46,XX/47,XXY

  15. Intersexuality • Hermaphroditism • True hermaphrodites • Pseudohermaphrodites • Sexual neutrality

  16. Embryonic and fetal hormones • Fetal gonadal anlage • SRY --->Testosterone at six weeks • 10X higher than in females from 12-17 weeks • By 7th month, identical levels until pubescence • Mullerian Inhibiting Substance from Sertoli cells • Wolffian tissue stimulated by androgens from Leydig cells

  17. Maternal and environmental hormones • Diethylstilbesterol (DES) • Fetal androgenization • Environmental estrogen-like compounds (?) • Dioxins, PCBs, DDT: Banned in the West • Current suspects: a phthalate, endosulfan, and bisphenol-A: synergistic effects of 1000x • Morphology and sperm counts • Phytoestrogens and menopausal complaints

  18. Hormone-based abnormalities • Congenital Adrenal Hyperplasia (CAH) or Adrenogenital (not androgenital) syndrome • Induces masculinization in girls • Precocious puberty in boys • Androgen Insensitivity syndrome • Complete or partial • 5-a reductase or DHT-deficiency syndrome: Machihembra • “Dominican Republic Syndrome” in textbook

  19. Society and culture • North American Anglo views of intersexuality • Defined as abnormal • Forced choice scenario • Native North American views: • Some Plains Indians: The berdache • A social role for non-aggressive males • Sometimes shamanistic

  20. Other cultural views • Ulrichs and the Uranians • Myanmar: Manguedon and acaults • India: Hijra • Samoa: Fa’afine • Castrati and eunuchs

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