Sexual Disorders

1. Sexual Disorders

2. Kinsey Report (1948) • 90 percent of men interviewed had masturbated • 85 percent had engaged in premarital intercourse • 60 percent had engaged in oral sex • 37 percent had at least one homosexual contact resulting in orgasm • 17 percent of farm boys had sexual relations with animals

3. What is Normal Sexuality? • Prevalence of Sexual Practices (CDC, 2007) • 15 or more partners (lifetime) • Male = 29% • Female = 9% • 2 or more partners (year) • Male = 17% • Female = 10% • Similar in Britain, France

4. What is Normal Sexuality? • Homosexual sex • 6.5% of men and 11% of women had engaged in same-sex sexual behaviors (ever)(Mosher et al., 2005) • 1.1% (homosexual only)(CDC, 2007) • Similar in Britain, France • Previous reports: 10% attraction or behavior (ever) • Sexuality in the elderly • Activity can and does last past age 80 • Age 70-79 • M = 50% active • F = 36% active • Decreases predicted by physical health changes

5. Gender Differences and Attitudes • Casual premarital sex • Men are more permissive, gap is shrinking • Elements of satisfaction • Women = demonstrations of love, intimacy • Men = focus on arousal

6. Gender Dysphoria • A marked incongruence between one’s experienced/expressed gender and assigned gender for a period of at least 6 months B) Disturbance causes clinically significant distress or impairment

7. Possible Causes: • Biological • no conclusive evidence linking prenatal hormone influence and gender identity • Environmental factors • Green (1987) found that boys who consistently displayed “feminine” interests were sometimes encouraged. • Some had lack of male playmates - excessive attention by mother • Most of these do not develop GD • Causes of GD are largely unknown

8. Treatment Options 1) sex reassignment surgery 2) psychosocial treatment

9. paraphilia: sexual arousal occurs almost exclusively in the context of inappropriate objects or individuals.

10. Paraphilias • almost never diagnosed in females • over a period of at least six months • recurring sexual fantasies, urges or behavior involving. . . . . • exhibitionism: exposing one’s genitals to an unsuspecting stranger • onset usually before age 18 • much less severe after age 40

11. Paraphilias • fetishism: nonliving objects Three types of objects: 1) inanimate objects 2) tactile stimulation 3) part of body (partialism) • usually begins in adolescence • object often required for sexual excitement • absence of object sometimes leads to erectile dysfunction

12. Paraphilias • frotteurism: touching and rubbing against a nonconsenting person • usually occurs in crowded locations • person often fantasizes about having an exclusive, caring relationship • often occurs between ages 15-25

13. Paraphilias • pedophilia: prepubescent children • must be at least age 16 and 5 years older than the child • reports of female victims more common • often rationalize actions • nonexclusive subtype: • sometimes prefer adult partners (often married) • exclusive subtype: • attracted only to children

14. Paraphilias • sexual masochism: the act of being humiliated beaten, bound, or otherwise made to suffer • males diagnosed more 20:1 • sometimes leads to accidental deaths • hypoxyphilia – sexual arousal by oxygen deprivation • sexual sadism:psychological or physical suffering of a “victim” • some have consenting partner – others use nonconsenting victims • severity of acts increases over time

15. Paraphilias • transvestic fetishism: cross-dressing • ranges from wearing a single hidden item of female clothing to dressing up entirely as females (makeup, etc) • most common in heterosexual males • usually begins in childhood

16. Paraphilias • voyeurism: observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity • “peeping Tom” • onset usually before age 15

17. Possible Causes of Paraphilias • early inappropriate sexual associations or experiences • inadequate development of consensual adult arousal patterns • lack of appropriate social skills relating to adults • inappropriate sexual fantasies reinforced through repeated association with masturbation • attempts to inhibit undesirable arousal / behavior makes things worse

18. Treatment • covert sensitization: associate sexually arousing images with averse consequences of the behavior that bring them to treatment • orgasmic reconditioning: masturbate while substituting more desirable fantasies • drug treatment 1) cyproterone acetate 2) medroxyprogesterone acetate (Depo-Provera)

19. RAPE • not a DSM-V category • majority of rapes are acquaintance rapes • only about 4% involve a total stranger • “Power vs. Sex?” controversy • often involves both

20. Types of Rapists(Knight & Prentky’s Typology) • Motivation primarily sexual • Sadistic • Non-sadistic • Motivation primarily aggressive • Vindictive • Opportunistic

21. Sexual Dysfunction • Disorder of Desire • Female Sexual Interest/Arousal Disorder • Male Hypoactive Sexual Desire Disorder • Disorder of Arousal • Male erectile disorder • Female sexual arousal disorder • Disorder of Orgasm • Delayed ejaculation • Early ejaculation • Inhibited female orgasm • Disorders involving pain • Dyspareunia • Vaginismus