Sexual Disorders & Gender Identity Disorder
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Sexual Response Cycle (4 phases)
- 1. Appetitive: Sexual interest & desire, associated with sexually arousing fantasies. Desire= urge, feeling, affective state, cognition.
- 2.Excitement: Subjective feelings of sexual pleasure, accompanied by physiological changes (erection, lubrication/swelling)
- 3.Orgasm: Females 3 stages (a) sensation or suspention or stoppage(b) warmth in pelvic area (c) throbbing or pulsating contraction of vagina, uterus and sphincter/ males 2 components: emission & ejaculation
- 3.Resolution: Feeling of content and relaxation. Refractory period/ detumescence (reduced swelling).
- Disturbance in sexual functioning in at least one phase of sexual response cycle or involving pain.
- Inhibition of sexual desire & interference with the physiological response leading to orgasm.
- Sexual dysfunction that meets DSM- IV-TR criteria for sexual disorder.
- Dysfunction & marked distress or interpersonal conflict.
Disorders of Appetitive phase
- 1.Hypoactive Sexual Desire Disorder: Persistently or recurrently deficience (or absent) of sexual fantasies & desire for sexual activity.
- 2.Sexual Aversion Disorder: Persistent or recurrent extreme aversion to (fear/panic) & avoidance of genital sexual contact with a sexual partner.
Disorders of Excitement phase
- 1. Female Sexual Arousal Disorder: Por R inability to attain or maintain until completion of the sexual activity, adequate lubrication-swelling response of sexual excitement.
- 2.Male Erectile Disorder : P or R inability to attain or maintain until completion of the sexual activity, an adequate erection
Disorders of Orgasm phase
- 1. Female Orgasmic disorder: P or R delay in or absence of orgasm following a normal sexual excitement phase.
- 2. Male Orgasmic disorder: P or R delay in or absence of orgasm following a normal sexual excitement phase.
- 3. Premature Ejaculation: P or R ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before person wishes it.
Sexual Disorders Involving Pain Symptoms
1. Dyspareunia: R or P genital pain associated with sexual intercourse in either a male or female
2.Vaginismus: R or P involuntary spasm oft he musculature of the outer third of the vagina that interferes with sexual intercourse.
Biological Aetiology of Sexual Disorders
- (a)Sexual desire linked to levels androgens in M & F.
- (b) Testosterone in males linked to sexual appetite or desire (not sexual performance). Sexual interest impaired if testosterone levels are low-(explains decrease in desire with age.)
- (c) Vascular Problems: Effect blood flow to penis-erectile dysfunction
- (d) Neurological problems: Epilepsy, Diabetes or MS interfere with spinal reflexes- erectile
- dysfunction, diabetes is most common neuro cause of erectile dysfuntion.
- (e) Alcohol,Tobacco & other drugs :neg effects on sexual arousal (alcohol and Maj) /cigarettes linked to erectile dysfunction. All linked to Orgasm dysfunction in M & F
- (f) Medications:SSRI side effect is inability to reach orgasm.
- Females: Neuro, pelvic disease & hormonal dysfunction interfere with vaginal swelling & lubrication.
Psychological Aetiology of Sexual Disorders
- 1.Beleifs & attitudes toward sexuality & Quality of interpersonal relationships
- 2.Learned scripts
- 3.Cultural factors
- 4.History of trauma, abuse, neglect
- 5.Anxiety, Performance anxiety.
Prevalence & gender difference in Sexual disorders
Some sexual disorders are relatively common & signifiantly increase with age
- Israeli military study =29.6% men resort sexual
- disorders such as erectile dysfunction
Premature ejaculation is most common sexual dysfunction in men (1in 3)
All other sexual dysfunctions reported higher in females
Definition of Normal Sexuality
“Pleasurable, consensual, non-coercive and non-exploitive sexual bhv that is free of compulsive elements.
When does sexual development start?
Sexual dev occurs from before birth, with physical, behavioural and emotional elements.
Evidence that Brain plays equal or greater role in sexuality
People show some sexual bhv after loss of ALL Gonadal hormones which means:
- Human sexual desire affected less by hormonal changes than nonhuman species (evident through).
- Once sexually experienced the brain plays equal role (or greater) in our level of desire
Senate Focus treatment for sexual disorders: (Masters& Johnson)
- Psychological treatment
- -Discouraged from intercourse, whilst working way through hierarchy of progressively more stimulating intimate touch.
- -Couple learns to touch each other in quiet relaxed setting- to focus on erotic sensations not performance demands.
- -Aim is for couple to become more comfortable with physical sharing & intimacy, to relax & enjoy, and talk about what feels good & what doesn’t (includes scheduling)
Education & Cognitive restructuring treatment for Sexual disorders
- Psychological Treatment
- -Changing the way people think about sex.
- -Correct mistaken belief’s and attitudes,
- -Providing info on norms to alleviate guilt &
- anxiety about own experiences & fantasies.
Communication Training( Masters & Johnson)
Psychological treatment for sexual disorders.
- -Structured training procedures aimed at improving couple communication about sex, esp what they find/don’t find sexual arousing,
- as poor communication is high among those experiencing sexual dysfunction.
Medications used to treat sexual dysfunction
- Biological treatment
- -Viagra (Cialis & Levitra): Erectile disorder. Facilitate blood low to penis, increase ability to respond to sexual stimuli but doesn’t influence desire (can cause sudden drop in blood pressure if taken with nitrates for heart disease)
- -Intrinsa: (for women, patch releasing testosterone to increase sexual desire esp post-menopausal or after hysterectomy.- not approved due to side effects and possible links to cancer.
- -Provera (progesterone) drug used to treat paraphilia’s by reduces sexual desire & fantasise but only whilst taking drugs
What is Pseudohermaphroditism:
-XY (genetically male) but with Androgen insensitivity
-Has testies but a female appearance-most identify (are raised) as female.
- -Androgens (male hormone- produced by testies)
- -Estrogens (female hormone- produced by ovaries)
-Both types present in M & F, + androgens also produced by adrenals.
Set of culturally specific norms concerning the expected bhv, skills & attitudes of Male & Female (masculine vsfemine).
Person’s subjective sense of self as being male or female (usually fixed by 2-3 yrs and almost always reflects physical anatomy), Distinct from gender roles.
Psychological and sociocultural characteristics associated with our sex.
Sex: Biological maleness & femaleness
Chromosones & prenatal development
-Genotype : XX female/ XY male
-Other variants: XO, XXY, XYY
-F & M foetus have simular initial Characteristic, but develop differently depending on hormonal environment
-by default all have female sex characteristics (genatilia), if sufficient androgens are present external genitalia take on male appearance.
Key features of Gender Identity Disorder
Person is convinced anatomy and gender identity do not match (aka: transexualism or gender dysphoria)
Aware early in childhood and intensifies with age.
Differentiated from: intersex condition (genetic) & transvestic fetishism (cross dress to feel more comfortable about themselves not for sexual arosal).
DSM-IV Criteria for Gender Identity Disorder
1. Strong/persistent cross-gender identification.
2. Persistent discomfort with own sex or sense of inappropriateness in gender role of that sex.
3. No due to in physical intersex condition
- 4.Causes clinically sig distress or impairment in social, occupational or other important areas of
Aetiology of GID
Not well understood; some insights offered by research on;
1. Sex hormones during prenatal period
- 2.Pseudohermaphroditim;genetically male but unable to product hormone that shapes penis and scrotum in the foetus. External genitals are ambiguous. Usually raised female but becomes apparent they're males in adolescent when testosterone kicks in secondary sex characterises
- develop. The Ease at which they adapt to this change suggests their brains are prenatally programmed for this alternative.
Prevalence & Gender difference
Rare but more common in males
1: 12 000 males
1: 30 000 females
Treatment options for GID
- Gender Reassignment
- Change anatomy to match identity
- -Stringent selection procedure & assessment by appropriate ‘behavioural science clinician’
- -Hormone therapy
- *Sig reduction in anxiety & depression*
- -Changing identity to match anatomy:
- -Various forms of psychotherapy have been ineffective in changing gender identity.
Organising & Activing Effects of Hormones
Organising: Influence of hormones on structure/development (promotes development of physical sex characteristics
Activating: Influence of hormones on function
Normal Sexual Development
1.Pleasurable touching in parent-infant relationship that is paced to child’s reactions
2.Age appropriate sexual information throughout development
3.Non-coercive sensual and sexual experiences
4.Information & rehearsal play with peers & siblings
5.Parents response to child’s sexual bhv that are calm & age appropriate
6.Models of loving, physically affectionate adult relationships
7. Models of conventional sexual expression
Abnormal Sexual Development
1. Disrupted early attachment
2. Absent or inaccurate sexual information
3.Coercive sexual experience
4. Poor social relationships with peers- miss opportunity for rehearsal play
5.Punitive responses of parents to child sexual bhv
6. Models of coercive or unstable adult relationships
7. Models of unusual sexual expression
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