Sexual and Gender Identity Disorders

1. Sexual and Gender Identity Disorders What Is “Normal” vs. “Abnormal” Sexual Behavior? Cultural considerations Gender differences in sexual behavior and attitudes Complex interaction of biopsychosocial influences Including partner’s characteristics

2. Sexual and Gender Identity Disorders Gender Identity Disorder Sexual Dysfunctions Paraphilias Not Sexual Orientation (Homosexuality)

3. Gender Identity Disorder • Difference between sex and gender • Key feature: sense of being trapped in the body of the wrong sex • Assume the identity of the desired sex • Goal is not sexual • Causes are unclear • Gender identity develops between 18 months and 3 years of age

4. Gender Identity Disorder Transsexualism Goal is Not Sexual No Physical Abnormalities Independent of Sexual Arousal Patterns NOT Transvestism Homosexuality Unrelated

5. Gender Identity Disorder • Sex-reassignment as a treatment • Who is a candidate? – Basic prerequisites before surgery • 75% report satisfaction with new identity • Female-to-male conversions adjust better • Psychosocial treatment • Realign psychological gender with biological sex • Few large scale studies

6. Sexual Dysfunctions • Involve desire, arousal, and/or orgasm • Pain associated with sex can lead to additional dysfunction • Men and Women experience parallel versions of most dysfunctions • Affects about 43% of all women and 31% of men • Most prevalent class of disorder in the United States

7. Classification of Sexual Dysfunctions Lifelong vs. acquired Generalized vs. situational Psychological factors alone Psychological factors combined with medical condition

8. Sexual Response Cycle

9. Sexual Dysfunctions Desire Hypoactive Sexual Desire Sexual Aversion Disorder Arousal Male Erectile Disorder Female Sexual Arousal Disorder

10. Sexual Dysfunctions Orgasm Inhibited Orgasm Premature Ejaculation Pain Dyspareunia Vaginismus

11. Sexual Dysfunctions Causes? Medical Conditions Medications Alcohol and Other Drugs Traumatic and/or Negative Experiences Performance Anxiety and Distraction Interpersonal Factors Cultural Factors

12. Sexual Dysfunctions Biological Treatments Medications and Injections Surgery and Implants Vacuum Device Therapy

13. Sexual Dysfunctions • Psychosocial Treatments • Education • Eliminate Performance Anxiety (Spectator Effect) • Relationship Enhancement • Gradual Building of Intimacy • Sensate focus and nondemanding pleasuring • Squeeze technique (Premature ejaculation) • Masturbation training (Female orgasm disorder) • Use of dilators (Vaginismus) • Exposure to erotic material (Desire problems)

14. Paraphilias Definition Often multiple paraphilic patterns of arousal High comorbidity with anxiety, mood, and substance abuse disorders

15. Paraphilias Pedophilia Fetishism Transvestic Voyeurism Exhibitionism Sadism and Masochism Frotteurism

17. Other Paraphilias Scatologia -- Obscene Calls Klismaphilia -- Enemas Coprophilia -- Feces Zoophilia -- Animals Necrophilia -- Corpses

18. Paraphilias Biological Treatments (Medication) Anti-Androgen Reduces Testosterone Levels Reduces Sexual Desire / Fantasy Used for Sex Offenders Seen as Only a Temporary Solution

19. Paraphilias Psychosocial Treatment Suppression Paradoxically Backfires Covert Sensitization Orgasmic Reconditioning Family and Marital Therapy Relapse Prevention

20. Clarifications • Homosexuality is not considered a disorder • Homosexuality is unrelated to gender identity disorder • “Cross-dressing” could be due to: • Transvestic fetish • Transsexualism • “Being a Drag Queen”