Transcript
PSY 281 Chapter 11: Disorders of Sex and Gender Sexual Dysfunctions A disorder marked by a persistent inability to function normally in some area of the sexual response cycle. Stages of Sexual Response Sexual response can be described as a cycle with four phases. Sexual dysfunction affects one or more of the first three phases. Desire Excitement Orgasm Resolution Consists of the relaxation and reduction in arousal that follow orgasms. Disorders of Desire Desire Phase The phase of the sexual response cycle consisting of an urge to have sex, sexual fantasies, and sexual attraction to others. Male Hypoactive Sexual Desire Disorder For at least 6 months, individual repeatedly experiences few or no sexual thoughts, fantasies, or desires. Individual experiences significant distress about this. A male dysfunction marked by a persistent reduction or lack of interest in sex. Female Sexual Interest/Arousal Disorder Two dysfunctions affect the desire phase. The latter disorder actually cuts across both the desire & excitement phases of the sexual response cycle. It’s considered a single disorder in DSM-5-TR because, according to research, desire & arousal overlap particularly high for women, & many women express difficulty distinguishing feelings of desire from those of arousal……………………………………….. Female dysfunction marked by persistent reduction or lack of interest in sex, as well as, in some cases, limited excitement and few sexual sensations during sexual activity. For at least 6 months, individual usually displays reduced or no sexual interest and arousal, characterized by the reduction or absence of at least three of the following: Sexual interest, sexual thought or fantasies, sexual initiation or receptiveness, excitement or pleasure during sex, responsiveness to sexual cues, genital or non-genital sensations during sex. Individual experiences significant distress. Biological Causes of Low Sexual Desire A number of hormones interact to help produce sexual desire & behavior, & abnormalities in their activity can lower a person’s sex drive. In both men & women, a high level of the hormone prolactin, a low level of the male sex hormone testosterone, & either a high or low level of the female sex hormone estrogen can lead to low sex drive. Low sex drive has been linked to high levels of estrogen in birth control pills. Further indicated that sex drive can be lowered by certain pain medications, psychotropic drugs, & illegal drugs such as cocaine & heroine. Long-term physical illness can also lower a person’s sex drive. Psychological Causes of Low Sexual Desire Increase in anxiety, depression, or anger may reduce sexual desire in both men and women. People with low sexual desire have particular attitudes, fears, or memories that contribute to their dysfunction, such as a belief that sex is immoral or dangerous. Other people are so afraid of losing control over their sexual urges that they try to resist them completely. Psychological disorders may also contribute to low sexual desire. Obsessive-compulsive symptoms find contact with another person’s body fluids and odors to be highly unpleasant. Sociocultural Causes of Low Sexual Desire Many people who have low sexual desire are feeling situational pressures – divorce, a death in the family, job stress, infertility difficulties, having a baby. Other people may be having problems in their relationships. Even in basically happy relationships, if one partner is very unskilled & unenthusiastic sexually, the other can begin to lose interest in sex. The one who needs more personal space may develop low sexual desire as a way of keeping distance. Disorders of Excitement Excitement Phase The phase of the sexual response cycle marked by changes in the pelvic region, general physical arousal, & increases in heart rate, muscle tension, blood pressure, & rate of breathing. Erectile Disorder Involves dysfunction during the excitement phase only. A dysfunction in which a man repeatedly fails to attain or maintain an erection during sexual activity. DSM5 For at least 6 months, individual usually finds it very difficult to obtain an erection, maintain an erection, &/or achieve past levels of erectile rigidity during sex. Individual experiences significant distress. Biological Causes Hormonal imbalances that cause that can cause male hypoactive sexual desire disorder can also produce erectile disorder. Vascular problems- problems with the body’s blood vessels- are involved. Any condition that reduces blood flow into the penis, such as heart disease or clogging of the arteries, may lead to erectile disorder. Could also be caused by damage to the nervous system as a result of diabetes, spinal cord injuries, multiple sclerosis, kidney failure, or treatment by dialysis. Various forms of substance abuse, from also alcohol abuse to cigarette smoking, may interfere with erections. Nocturnal Penile Tumescence (NPT) Erection during sleep Psychological Causes As many as 90 percent of all men with severe depression, for example, experience some degree of erectile dysfunction. Performance Anxiety The fear of performing inadequately & a related tension that are experienced during sex. Spectator Role A state of mind that some people experience during sex, focusing on their sexual performance to such an extent that their performance & their enjoyment are reduced. Sociocultural Causes Sociocultural factors contribute to male hypoactive sexual desire disorder has also been tied to erectile disorder. Men who have lost their jobs & are under financial stress, for example, are more likely to develop erectile difficulties. Stress has also been tied to this dysfunction. Disorders of Orgasm Orgasm Phase The phase of the sexual response cycle during which a person’s sexual pleasure peaks and sexual tension is released as muscles in the pelvic region contract rhythmically. Premature Ejaculation Dysfunction in which a man persistently reaches orgasm & ejaculates within one minute of beginning sexual activity with a partner & before he wishes to. Also called early or rapid ejaculation. For at least 6 months, individual usually ejaculates within 1 minute of beginning sex with a partner, & earlier than he wants to. Individual experiences significant distress. Delayed Ejaculation A dysfunction in men dealing with semen being ejaculated. For at least 6 months, individual usually displays a significant delay, infrequency, or absence of ejaculation during sexual activity with a partner. Individual experiences significant distress. Female Orgasmic Disorder A dysfunction in the outer third of the vaginal wall contracting. Where a woman persistently fails to reach orgasm, has very low-intensity orgasms, or have very delayed orgasms. For at least 6 months, individual usually displays a significant delay, infrequency, or absence of orgasm, &/or is unable to achieve past orgasmic intensity. Individual experiences significant distress. Biological Causes Diabetes can damage the nervous system in ways that interfere with arousal, lubrication of the vagina, & orgasm. Lack of an orgasm has sometimes been linked to multiple sclerosis & other neurological diseases. Often postmenopausal, in skin sensitivity & structure of the clitoris, vaginal walls, or the labia. Psychological Causes Women with high levels of sexual inhibition are particularly likely to experience female orgasmic disorder. They worry greatly about their sexual performance, have related negative thoughts about it, and are easily distracted during sexual activity. Sociocultural Causes Result from society’s recurrent message to women that they should repress & deny their sexuality, a message that has often led to less permissive sexual attitudes & behavior among women than among men. Disorders of Sexual Pain Genito-Pelvic Pain/Penetration Disorder Sexual dysfunction characterized by significant physical discomfort during intercourse. For at least 6 months, individual repeatedly experiences at least one of the following problems: Difficulty having vaginal penetration during intercourse Significant vaginal or pelvic pain when trying to have intercourse or penetration Significant fear that vaginal penetration will cause vaginal or pelvic pain. Significant tensing of the pelvic muscles during vaginal penetration. Treatments for Sexual Dysfunctions Sex Therapy Interventions from the various models, particularly cognitive-behavioral, couple, & family systems therapies. Goal is to help clients function better sexually and achieve a higher level of sexual satisfaction & psychological well-being. 9 Principles and Techniques of Sex Therapy Assessing & conceptualizing the problem Mutual responsibility Education about sexuality Emotion identification Attitude change Mindfulness Elimination of performance anxiety & the spectator role Increasing sexual & general communication skills Changing destructive lifestyles & couple interactions Addressing physical & medical factors Disorders of Desire Treatments Affectual awareness: patients visualize sexual scenes in order to discover any feelings of anxiety. Self-instruction training; help them change their negative reactions to sex Hormone treatments Erectile Disorder Treatments Focuses on reducing a man’s performance anxiety, increasing his stimulation, or both, using a range of behavioral, cognitive, and relationship interventions. Sildenafil: one of the drugs used to treat erectile disorder that helps increase blood flow to the penis during sexual activity. Marketed as Viagra. Premature Ejaculation Treatments Stop-start, or pause, procedure, the penis is manually stimulated until the man is highly aroused. The couple then pauses until this arousal subsides, after which the stimulation is resumed. This sequence is repeated several times, so the man ultimately experiences much more total time of stimulation than he has ever experienced before. Eventually the couple progress to intercourse, making sure the penis is withdrawn whenever the man becomes too highly aroused. Delayed Ejaculation Treatments Techniques to reduce performance anxiety & increase stimulation. A man may be instructed to masturbate to orgasm in the presence of his partner or to masturbate just short of orgasm before inserting his penis for intercourse. This increases the likelihood that he will ejaculate during intercourse. Ejaculation is cause by physical factors such as neurological damage or injury; treatment may include a drug to increase arousal of the sympathetic nervous system. Few studies have systematically tested the effectiveness of such biological treatments. Female Orgasmic Disorder Treatments Directed Masturbation Training Sex therapy approach that teaches women with female arousal or orgasmic problems how to masturbate effectively & eventually to reach orgasm during sexual interactions. Genito-Pelvic Pain/Penetration Disorder Treatments First, a women may practice tightening & relaxing her vaginal muscles until she gains more voluntary control over them. She may receive gradual behavioral exposure treatment to help her overcome her fear of penetration, beginning, for example, by inserting increasingly large dilators in her vagina at home & at her own pace & eventually ending with the insertion of the partner’s penis. Most clients treated with such procedures eventually have pain-free intercourse. Clinical investigators have injected the problematic vaginal muscles with Botox to help reduce spasms in those muscles. Current Trends in Sex Therapy Regularly treat partners who are living together but not married, they work with the LGBTQ clients, including transgender & nonbinary individuals; older adults; the medically ill; the physically handicapped; the intellectually disabled; & individuals who have no long-term sex partner. Sex therapists are also paying more attention to excessive sexuality, sometimes called persistent sexuality disorder, hypersexuality, compulsive sexual behavior disorder, or sexual addiction – a pattern now listed in ICD-11 but not in DSM-5-TR Paraphilic Disorders DSM-5 For at least 6 months, individual experiences recurrent & intense sexually arousing fantasies, urges, or behaviors involving objects or situations outside the usual sexual norms (nonhuman objects; nongenital body parts; the suffering or humiliation of oneself or one’s partner; or children or other nonconsenting persons). Individual experiences significant distress or impairment over the fantasies, urges, or behaviors. (In some paraphilic disorders – pedophilic disorder, exhibitionistic disorder, voyeuristic disorder, frotteuristic disorder, & sexual sadism disorder – the performance of the paraphilic behaviors indicates a disorder, even in the absence of distress or impairment.) Paraphilias Patterns in which a person has recurrent & intense sexual urges, fantasies, or behaviors involving nonhuman objects, children, or nonconsenting adults, or experiences or suffering or humiliation. Paraphilic Disorder Disorder in which a person’s paraphilia causes great distress, interferes with social or occupational activities, or has places the person or others at risk of harm. Fetishistic Disorder A paraphilic disorder consisting of recurrent & intense sexual urges, fantasies, or behaviors that involve the use of a nonliving object or nongenital part, often to the exclusion of all other stimuli, accompanied by clinically significant distress or impairment. Masturbatory Satiation Orgasmic Reorientation Transvestic Disorder A paraphilic disorder consisting of repeated & intense sexual urges, fantasies, or behaviors that involve dressing in clothes of the opposite sex, accompanies by clinically significant distress or impairment. Exhibitionistic Disorder Paraphilic disorder in which persons have repeated sexually arousing urges or fantasies about exposing their genitals to others, & either act on these urges with nonconsenting individuals or experience clinically significant distress or impairment. Voyeuristic Disorder Paraphilic disorder in which a person has repeated & intense sexual desires to observe unsuspecting people in secret as they undress or to spy on couples having intercourse, & either acts on these urges with nonconsenting people or experiences clinically significant distress or impairment. Frotteuristic Disorder Paraphilic disorder in which a person has repeated & intense sexual urges or fantasies that involve touching & rubbing against a nonconsenting person, & either acts on these urges with the nonconsenting person or experiences clinically significant distress or impairment. Pedophilic Disorder Paraphilic disorder in which a person has repeated & intense sexual urges or fantasies about watching, touching, or engaging in sexual acts with children, & either acts on these urges or experiences clinically significant distress or impairment. Sexual Masochism Disorder Paraphilic disorder in which a person has repeated & intense sexual urges, fantasies, or behaviors that involve being humiliated, beaten, bound, or otherwise made to suffer, accompanies by clinically significant distress or impairment. Sexual Sadism Disorder A paraphilic disorder in which a person has repeated & intense sexual urges or fantasies that involve inflicting suffering on others, & either act on these urges with nonconsenting individuals or experiences clinically significant distress or impairment. Gender Dysphoria A disorder in which a person persistently feels clinically significant distress or impairment due to their assigned gender & strongly wishes to be a member of another gender. DSM-5 For 6 months or more, an individual’s experienced gender is markedly incongruent with their assigned gender, as indicated by two or more of the following symptoms: Gender-related feelings &/or behaviors clearly contradict the individual’s primary or secondary sex characteristics Powerful wish to eliminate one’s sex characteristics Yearning for the sex characteristics of another gender Powerful wish to be a member of another gender Firm belief that one’s feelings & reactions are those that characterize another gender Individual experiences significant distress or impairment. Explanations of Gender Dysphoria Treatments for Gender Dysphoria Sexual Reassignment Surgery Patterns of Gender Dysphoria Female-to-Male Male-to-Female: Androphilic Type Male-to-Female: Autogynephilic Type
