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Chapter 14 Sexual and Gender Identity Disorders

Chapter 14 Sexual and Gender Identity Disorders. Ch 14. Murphy's Law About Sex. Nothing improves with age Sex has no calories Sex takes up the least amount of time and causes the most amount of trouble There is no remedy for sex but more sex

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Chapter 14 Sexual and Gender Identity Disorders

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  1. Chapter 14 Sexual and Gender Identity Disorders Ch 14

  2. Murphy's Law About Sex • Nothing improves with age • Sex has no calories • Sex takes up the least amount of time and causes the most amount of trouble • There is no remedy for sex but more sex • Never sleep with anyone crazier than yourself

  3. Murphy's Law About Sex • Sex is dirty only if it is done right • Sex is hereditary. If your parents never had it, chances are you won’t either • Don’t do it if you can’t keep it up • Sex is like a box of chocolates, you never know what your going to get

  4. What is Normal Sex

  5. What is Normal Sex • Multiple Partners • Mostly Heterosexual • Mostly Monogamous • Condom Use Has Increased • Over 50% College Women Still Practice Unprotected Sex • Older Populations are Still Active

  6. Gender Differences in Sexual Behavior • Masturbation • Males > Females (Primates Too!) • Casual Premarital Sex • Males > Females • No Gender Differences in • Attitudes About Homosexuality, Sexual Satisfaction, Masturbation • Big Gap in Views About Sex • Females (Love); Males (Arousal)

  7. The Development of Sexual Orientation • Are You Born • Straight • Homosexual • Bisexual? • Nature vs. Nurture

  8. The Development of Sexual Orientation • Homosexuality • Runs in Families • More Common in Monozygotic Twins • Prenatal Exposure to Hormones • The Biological Basis Argument • Promoted by the Media, but Narrow • The Link is Not That Strong • Inherit Sexual Predispositions

  9. Biopsychosocial Developmental Model for Sexual Orientation Figure 10.2 Barlow/Durand, 3rd. Edition Sequence of events leading to sexual orientation(from Bem, 1996)

  10. Gender Identity • Gender Identity refers to our sense of ourselves as either male or female • Sexual orientation refers to the preference we have for the sex of a partner • Gender identity and sexual orientation need not match up • A man may be attracted to other men but hold the view that he is a male Ch 14.1

  11. Gender Identity Disorder • Gender Identity Disorder (GID) occurs when a person feels that they are really of the opposite sex and have an aversion to same-sex clothing and activities • GID can be observed in children • Occurs more often in boys than girls and more often in men than women • The prevalence of GID is slight • One in 30,000 for men • One in 100,000 for women Ch 14.2

  12. Overview of Sexual and Gender Identity Disorders Main Classes of Disorders • Gender Identity Disorders • Sexual Dysfunctions • Paraphilias

  13. Features of Gender Identity Disorders • Man or Woman? • Trapped in the Body of the Wrong Sex • Transexualism • Transgendered • Rare

  14. The Nature of Gender Identity Disorders • Goal is Not Sexual • No Physical Abnormalities • Independent of Sexual Arousal Patterns • May be Attracted to People With Desired Identity

  15. The Causes of Gender Identity Disorders • No Specific Biological Link • Probably Learned Early in Life

  16. Therapies for Gender Identity Disorder • Body alteration programs • Require 6-12 months psychotherapy to treat anxiety and depression • Cosmetic surgery can be used to alter appearance (e.g. remove facial hair) • Hormonal treatment to induce breast formation • Sex-reassignment surgery involves surgical alteration of the genitals • Psychological alteration of gender identity Ch 14.3

  17. The Treatment of Gender Identity Disorders • Sex Reassignment Surgery • Costs $25 - 30,000 • Double $ for Female to Male • Female-to-Male Adjust Better • Psychosocial Treatment

  18. Overview of Sexual and Gender Identity Disorders Main Classes of Disorders • Gender Identity Disorders • Sexual Dysfunctions • Paraphilias

  19. The Nature of Sexual Arousal and Function Normal Functioning Desire Phase Resolution Arousal - Excitement Plateau Orgasm

  20. Features of Sexual Dysfunctions Where Problems Arise Desire Phase Resolution Arousal - Excitement Plateau Orgasm

  21. The Nature of Sexual Dysfunctions • Can be Either • Lifelong or Acquired • Generalized or Situational • Specify as Due to • Psychological Factors Alone • Psych Factors Plus Medical Condition Desire Phase Resolution Arousal - Excitement Plateau Orgasm

  22. Main Types of Sexual Dysfunctions • Sexual Desire Disorders • Sexual Arousal Disorders • Orgasm Disorders Desire Phase • Sexual Pain Disorders Resolution Arousal - Excitement Plateau Orgasm

  23. Sexual Dysfunctions • Sexual dysfunctions represent disturbances of the normal sexual response cycle • The response cycle comprises 4 phases: • Appetitive involves sexual interest or desire • Excitement is a subjective pleasurable state linked to increased blood flow to the genitals • Orgasm is a peak of sexual pleasure accompanied by ejaculation and/or muscle contraction • Resolution is the restoration after orgasm • Feminists argue that the DSM notion of female sexual dysfunction is limited. • It should include any aspect (emotional, physical, or relational) that impacts the sexual experience Ch 14.13

  24. Sexual Desire Disorders • Hypoactive sexual desire disorder refers to deficient or absent sexual fantasies or urges • Sexual aversion disorder involves avoidance of all genital contact with others • Prevalence may be greater than 20% • Causes of low sex drive include • Religious orthodoxy • Fear of loss of control • Depression • Medication side effects (tranquilizers) Ch 14.14

  25. The Nature of Sexual Desire Disorders Hypoactive Sexual Desire Disorder • No Interest in Any Sex Activity • Common Presenting Problem • Accounts for half of all complaints at sexuality clinics • 22% of women and 5% of men suffer from this disorder • How Much Sex Is Enough?

  26. The Nature of Sexual Desire Disorders Hypoactive Sexual Desire Disorder Sexual Aversion Disorder • Anything Sexual Evokes Fear, Disgust, or Panic • 10% Males Have Panic Attacks

  27. Sexual Arousal Disorders • Persons with sexual arousal disorders experience sexual desire, but are unable to maintain arousal during intercourse • Female sexual arousal disorder involves inadequate vaginal lubrication • Male erectile disorder involves failure to maintain an erection during intercourse • Can be induced by disease, drugs or depression • Most common sexual problem for which men consult with specialists (50% of referrals) Ch 14.15

  28. Orgasmic Disorders • Female orgasmic disorder refers to the absence of orgasm after a period of normal sexual excitement • Female orgasmic disorder may reflect • Difficulty in learning to become orgasmic • Chronic use of alcohol • Fear of losing control • Male orgasmic disorder refers todifficulty in ejaculation • Premature ejaculation is early ejaculation Ch 14.16

  29. Sexual Pain Disorders • Dyspareunia refers to persistent or recurrent pain during sexual intercourse • Associated with depression, anxiety and marital difficulties • Vaginismus refers to an inability to achieve intercourse due to involuntary spasms of the outer third of the vagina • Associated with fear of pregnancy, relationship problems and negative attitudes toward sex Ch 14.17

  30. Current Causes of Sexual Dysfunction • Masters & Johnson (1970) model • Fears of performance • Spectator role • No conclusive evidence for these factors • Contemporary views: sexually dysfunctional couples have both sexual and interpersonal problems • Secondary gain may be a “hidden” factor

  31. Religious orthodoxy involves negative views of sexuality (procreation only, not for pleasure) Psychosexual trauma Homosexual inclination: sexual desire is impaired if a homosexual engages in sex with a heterosexual Excessive alcohol intake Historical Causes of Sexual Dysfunction

  32. The Nature of Sexual Arousal Disorders Male Erectile Disorder Female Sexual Arousal Disorder • Problem is NOT Desire, but Arousal • Males: “Impotence” • Maintaining /Achieving Erection • Females: “Frigidity” • Maintain / Achieve Lubrication

  33. The Nature of Orgasm Disorders Inhibited Orgasm • Adequate Arousal and Desire • BUT Unable to Achieve Orgasm • Common in Females; Rare in Males • Only 50% Women Experience Regular Orgasms During Intercourse: 25% report significant difficulty experiencing orgasms; most common referral complaint of women

  34. The Nature of Orgasm Disorders Inhibited Orgasm Premature Ejaculation • Ejaculation Occurs Too Quickly • Hard to Define “Too Quickly” • 21% of all adult males meet criteria for premature ejaculation • Perception of Lack of Control Over Orgasm in the Chief Complaint

  35. The Nature of Sexual Pain Disorders Dyspareunia • Intercourse Associated With Pain • Rule out Medical Causes of Pain • Rare Condition in Males (1% to 5%) • More Common in Women (10% to 15%) • Vaginismus (involuntary spasms during penetration)

  36. Let's Test Your Sexual IQ • How Often Do Married Couples • Do it (i.e., Have Sex)? • 8% < 1 Time / Month • 23% 2-3 Times / Month • 24% Once Per Week • 12% 4-5 Times Week • 1% Daily • 2% Never

  37. Assessment of Sexual Behavior and Dysfunction Interviews • How Would You Describe Your Current Interest in Sex? • Do You Have Sexual Fantasies? • How Often Do You Masturbate?

  38. Assessment of Sexual Behavior and Dysfunction Interviews Thorough Medical Evaluation • Medications can Disrupt Sexual Functioning • Check Vascular Functioning • Check Hormonal Levels

  39. Assessment of Sexual Behavior and Dysfunction Interviews Thorough Medical Evaluation Psychophysiological Assessment • Listen to Audiovisual Erotic Material • Measure Arousal Directly • Penile Strain Gauge • Vaginal Plethysmograph

  40. The Causes of Sexual Dysfunctions Biological Contributions • Diabetes and Kidney Disease • Cardiovascular Diseases • Chronic Illness • Prescription Medications • Using Alcohol and Other Drugs

  41. The Causes of Sexual Dysfunctions Biological Contributions Psychological Contributions • More Than Performance Anxiety • Performance Anxiety Involves • Arousal, Cognition, and Negative Affect • The Role of Distraction • Arousal Level is Underestimated

  42. The Causes of Sexual Dysfunctions Biological Contributions Psychological Contributions Social and Cultural Contributions • Learn That Sexuality is Negative • Traumatic Sexual Experiences • Poor Interpersonal Relationship • Inaccurate Beliefs and Myths

  43. Treatment of Sexual Dysfunctions Providing Education About Sex Psychosocial Treatments • Eliminate Performance Anxiety • Sensate Focus / Nondemand Pleasuring • Gradual Process of Building Intimacy • Several Other Available Treatments • Squeeze technique – Premature ejaculation • Masturbatory training – Female orgasm disorder • Use of dilators – Vaginismus • Exposure to erotic material – Low sexual desire problems • Many Treatments Work! (50% to 100% effective)

  44. Treatment of Sexual Dysfunctions Providing Education About Sex Psychosocial Treatments Medical Treatments • Medications • Vasodilating Drugs (Viagra) • Surgery and Implants • Vacuum Device Therapy

  45. Overview of Sexual and Gender Identity Disorders Main Classes of Disorders • Gender Identity Disorders • Sexual Dysfunctions • Paraphilias

  46. The Nature of Paraphilic Disorders An Overview • Para • “Beyond” or “Amiss” • Philia • “Love” Sexual Stimulation Requiring Bizarre or Unusual Acts, Imagery, or Objects

  47. The Paraphilias • The paraphilias involve sexual attraction to unusual objects or unusual sexual activities • The fantasies, urges or behaviors must • Endure for at least 6 months • Cause significant distress or impairment (this criterion is arguable) • Prevalence statistics for the paraphilias are unknown, since many of these are illegal activities Ch 14.4

  48. Etiology of the Paraphilias • The psychodynamic view argues that the paraphilias are defensive processes • Paraphilias protect against repressed fears • A person with a paraphilia is fearful of heterosexual relationships • Behaviorists argue that the paraphilia represent classical conditioning of sexual arousal that has gone awry • Biological: Role of testosterone is unknown Ch 14.9

  49. The Causes of Paraphilic Disorders Psychosocial Contributions • Inability to Develop Adequate Relationships • Early “Unusual” Sexual Experiences • Person’s Early Sexual Fantasies • Excessive Sex Drive & Suppression • Specific Causes are Still Unclear

  50. Developmental Model of Paraphilia Figure 10.9 Barlow/Durand, 3rd. Edition. A model of the development of paraphilia

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