Sexual and Gender Identity Disorders

• Debate about what constitutes normal and abnormal sexual behavior

• Definition of “normal” differs across:

– Generation

– Culture

– Religion

Study of Human Sexuality

• Our understanding of human sexuality largely based upon research of:

– Alfred Kinsey and his colleagues

– Masters and Johnson (sexual response cycle)

Sexual Response Cycle

• Treatment of sexual dysfunction requires understanding of human sexual response cycle

– Appetitive Phase – desire for sexual activity

– Arousal Phase – physical stimulation occurs

– Orgasm Phase – involuntary muscle contractions

– Resolution Phase – relaxation after orgasm

Homosexuality

• Both the DSM-I and DSM-II characterized homosexuality as a deviant sexual disorder

• Today, generally accepted that homosexuality is biological and not a choice – no longer considered a psychological disorder

• Sexual issues for homosexual not very different

• Continue to face discrimination

Aging and Sexuality

• Sexual activity generally decreases with age

• Many people lose their partners to death

• Health problems

• Decrease in hormone levels in women after menopause

– Vaginal dryness

– Thinning of vaginal walls

• Men can experience problems with prostate and erectile functioning

Sexual Dysfunctions

• Sexual Desire Disorders

– Hypoactive Sexual Desire

– Sexual Aversion Disorder

• Sexual Arousal Disorders

– Male erectile disorders

– Female sexual arousal disorder

• Orgasmic Disorders

– Female Orgasmic Disorder

– Male orgasmic Disorder

– Premature Ejaculation

• Sexual Pain Disorders

– Dyspaneunia

– Vaginismus

Sexual Desire Disorders

• Related to sexual appetite

• Affects 20% of population

• Hypoactive Sexual Desire

– Little to no interest in sexual activity

• Sexual Aversion

– Avoidance and aversion to sexual intercourse

• Can be physiological or biological in nature

Sexual Arousal Disorders

• 10% of men report erectile disorders

• 50% of men experience transient problems

• Vaginal lubrication problems affect between 10-50% of women

• Can be biological or physical

Orgasmic Disorders

• Female Orgasmic Disorder

– Inability or delay in experience orgasm

– Can be primary or secondary

– Approx 10% of women have never had an orgasm

• Male Orgasmic Disorder

– Delay or inability to have orgasm once in excitement phase

– Generally psychological in nature (trauma, religious background)

Orgasmic Disorders

• Premature Ejaculation

– Ejaculation with minimal sexual stimulation

– Relatively common

– Kaplan defined it as inability to tolerate high levels of excitement without ejaculating

Sexual Pain Disorders

• Dyspareunia

– Recurrent persistent pain in genitals before, during or after intercourse

– Not due to vaginismus

• Vaginismus

– Involuntary spasm of the outer third of vaginal wall preventing intercourse

– Several possible causes including sexual trauma, impotent partner, painful intercourse, rigid religious background

Treatment of Sexual Dysfunction

• Drugs

– Drugs to suppress testosterone decrease sex drive)

– Hormone replacement therapy

– Viagra

• Sex therapy

• Kegel exercises

• Surgery

– Vascular

– Implants

– Injecyion

• Devices

– Pump

– suppository

Gender Identity Disorder

• Conflict between anatomical sex and gender identity

• Relatively rare

• Tend to exhibit gender role confusion at early age

• Transexuals

• Different than homosexuals

Causes of Gender Identity Disorders

• Biological

– For males – reduction in testosterone levels during embryonic development

– For females – higher levels of testosterone during embryonic development

• Supported using rat research

• Debate as to influence of biological factors

Causes of Gender Identity Disorders

• Psychodynamic Perspective

– Oedipal complex not fully resolved

– Conflict between wish for and dread of maternal reengulfment

• Behavioral Perspective

– Early childhood experiences

– Paternal encouragement of opposite sex behavior

– Rejection by same sex peers

Treatment of Gender Identity Disorder

• Separate treatment for child and parents

• Child:

– Sex education

– Exploration of cross gender activities

– Learning stereotypes

• Parents:

– Behavior modification

– Modeling of appropriate same sex behavior

Treatment of Gender Identity Disorder

• Sex change operations

• Prior to surgery need to pass “real-life test”

• Men:

– Removal of testes and penis

– Reconstruction of female genetalia

– Breast implants

– Hormone therapy

• Women

– Remove breasts, uterus, ovaries

– Some construct artificial penis

– Hormone Therapy

Paraphilias

• Fetishism

• Transvestic Fetishism

• Exhibitionism

• Voyeurism

• Frotteurism

• Pedophilia

• Sadism

• Masochism

Sexual Aggression

• Sexual activity against a person’s will

• Two main forms:

– Rape

– Incest

Rape

• Intercourse using force or threat of force against a person’s will

• An act of power and control

• Both men and women can be raped

• Includes statutory rape in most states

• Increase in number of rapes

• Only 16% of reported cases result in conviction

Rape

• Many rapes unreported

• Some people still believe that victim’s partly to blame for rape

• Date rape may account for majority of rapes

• 8-25% of female college students reported unwanted sexual intercourse

Effects of Rape

• 2/3 of rape victims not physically injured

• 20% minor injuries

• 4% serious injuries

• Can lead to PTSD

– Disorganization

– Reorganization

• Lessened desire for any type of sexual activity

Types of Rapists

• Power Rapist

• Anger Rapist

• Sadistic Rapist

• Relationship between pornography and rape?

Incest

• Sexual relations between people that are related

• Most common reported to law enforcement– between father and daughter/step-daughter

• Most common (although not reported) brother-sister

Treatment for Incest Offenders and Rapists

• Incarceration

• Aversion therapy

• Orgasmic Reconditioning

• Cognitive Behavioral Interventions

– Skills training

– Cognitive distortions

– Empathy/victim awareness

– Emotion management

– Relapse prevention

• Physiological interventions

– Physical castration

– Chemical Castration