Sexual Disorders • Disorders fall into one of three very broad categories: • 1) Gender Identity Disorders • 2) Sexual Dysfunction • 3) Paraphilia
Gender Identity Disorder • Gender identity disorder exists when the person’s sense of identity (male vs. female) is inconsistent with who they are physically. “I’m a man trapped in a woman’s body” or vice versa. Has also been referred to as transexualism. • Not the same as being gay. • Not the same as intersex individuals, who have anatomically ambiguous genitalia.
Gender Identity Disorder • Causes are unknown, although one would assume there is a biological link • Sexual reassignment surgery
Sexual Dysfunctions • The golden age of Viagra…. • MEN: hypoactive sexual desired disorder, sexual aversion disorder, male erectile disorder, inhibited male orgasm, premature ejaculation, dyspareunia • WOMEN: hypoactive sexual desire disorder, sexual aversion disorder, female sexual arousal disorder, inhibited female orgasm, dyspareunia, and vaginismus. • Men more commonly have erectile dysfunction and premature ejaculation, while women have hypoactive sexual desire.
Assessment and Treatment • Thorough assessment is a necessity, and is comprised of clinical interviews, medical examination, and psychophysiological assessment procedures. • Much of what we know about treatment evolved out of Masters and Johnson’s work in St. Louis. • Example of treating erectile dysfunction/premature ejaculation using sensate focus and nondemand pleasuring.
Paraphilias • When the weird get going, the going gets weird… • Focus of sexuality is on something or someone other than a consenting adult. • Includes the following: • 1) Fetishism • 2) Voyeurism/Exhibitionism • 3) Transvestic Fetishism • 4) Sexual Sadism and Sexual Masochism • 5) Sadistic Rape • 6) Pedophilia and Incest
Paraphilias • Fetishism: sexual attraction to nonliving objects, i.e., shoes and undergarments • Voyeurism and Exhibitionism: The former involves observing individuals in a state of undress without their knowledge (peeping), while exhibitionism involves exposing oneself to strangers. Has a thrill-seeking component.
Paraphilias • Transvestic Fetishism: sexual excitement is related to the act of cross-dressing. Spouses are often quite supportive. • Sexual Sadism/Masochism: Sadism involves sexual excitement when hurting others, while masochism involves sexual excitement when one is on the receiving end of the hurt. Wide range of activities are involved and seems to lie on a continuum. According to Barlow a subset of rapists appear to be highly sadistic and meet criteria for a paraphilia
Paraphilias • Pedophilia and Incest: Sexuality is focused on children, and can involve either or both sexes. Now aware of the widespread nature of childhood sexual abuse in our country, and it’s long term impact on both women as well as men. • The majority of perpetrators are men. Speculation as to why?
Paraphilias-Causal Factors • Inability to access “normal” sexual outlets may result in accessing other sexual outlets. • Early sexual fantasies may be repeatedly reinforced through repeated masturbation, resulting ultimately in a paraphilia.
Treatment • Psychosocial treatments have been largely unsuccessful; the Barlow text is quite misleading. The success rates he quotes have not been found in most clinical settings.