Chapter 14 Sexual and Gender Identity Disorders

1. Chapter 14 Sexual and Gender Identity Disorders Ch 14

2. Murphy's Law About Sex • Nothing improves with age • Sex has no calories • Sex takes up the least amount of time and causes the most amount of trouble • There is no remedy for sex but more sex • Never sleep with anyone crazier than yourself

3. Murphy's Law About Sex • Sex is dirty only if it is done right • Sex is hereditary. If your parents never had it, chances are you won’t either • Don’t do it if you can’t keep it up • Sex is like a box of chocolates, you never know what your going to get

4. What is Normal Sex

5. What is Normal Sex • Multiple Partners • Mostly Heterosexual • Mostly Monogamous • Condom Use Has Increased • Over 50% College Women Still Practice Unprotected Sex • Older Populations are Still Active

6. Gender Differences in Sexual Behavior • Masturbation • Males > Females (Primates Too!) • Casual Premarital Sex • Males > Females • No Gender Differences in • Attitudes About Homosexuality, Sexual Satisfaction, Masturbation • Big Gap in Views About Sex • Females (Love); Males (Arousal)

7. The Development of Sexual Orientation • Are You Born • Straight • Homosexual • Bisexual? • Nature vs. Nurture

8. The Development of Sexual Orientation • Homosexuality • Runs in Families • More Common in Monozygotic Twins • Prenatal Exposure to Hormones • The Biological Basis Argument • Promoted by the Media, but Narrow • The Link is Not That Strong • Inherit Sexual Predispositions

9. Biopsychosocial Developmental Model for Sexual Orientation Figure 10.2 Barlow/Durand, 3rd. Edition Sequence of events leading to sexual orientation(from Bem, 1996)

10. Gender Identity • Gender Identity refers to our sense of ourselves as either male or female • Sexual orientation refers to the preference we have for the sex of a partner • Gender identity and sexual orientation need not match up • A man may be attracted to other men but hold the view that he is a male Ch 14.1

11. Gender Identity Disorder • Gender Identity Disorder (GID) occurs when a person feels that they are really of the opposite sex and have an aversion to same-sex clothing and activities • GID can be observed in children • Occurs more often in boys than girls and more often in men than women • The prevalence of GID is slight • One in 30,000 for men • One in 100,000 for women Ch 14.2

12. Overview of Sexual and Gender Identity Disorders Main Classes of Disorders • Gender Identity Disorders • Sexual Dysfunctions • Paraphilias

13. Features of Gender Identity Disorders • Man or Woman? • Trapped in the Body of the Wrong Sex • Transexualism • Transgendered • Rare

14. The Nature of Gender Identity Disorders • Goal is Not Sexual • No Physical Abnormalities • Independent of Sexual Arousal Patterns • May be Attracted to People With Desired Identity

15. The Causes of Gender Identity Disorders • No Specific Biological Link • Probably Learned Early in Life

16. Therapies for Gender Identity Disorder • Body alteration programs • Require 6-12 months psychotherapy to treat anxiety and depression • Cosmetic surgery can be used to alter appearance (e.g. remove facial hair) • Hormonal treatment to induce breast formation • Sex-reassignment surgery involves surgical alteration of the genitals • Psychological alteration of gender identity Ch 14.3

17. The Treatment of Gender Identity Disorders • Sex Reassignment Surgery • Costs $25 - 30,000 • Double $ for Female to Male • Female-to-Male Adjust Better • Psychosocial Treatment

18. Overview of Sexual and Gender Identity Disorders Main Classes of Disorders • Gender Identity Disorders • Sexual Dysfunctions • Paraphilias

19. The Nature of Sexual Arousal and Function Normal Functioning Desire Phase Resolution Arousal - Excitement Plateau Orgasm

20. Features of Sexual Dysfunctions Where Problems Arise Desire Phase Resolution Arousal - Excitement Plateau Orgasm

21. The Nature of Sexual Dysfunctions • Can be Either • Lifelong or Acquired • Generalized or Situational • Specify as Due to • Psychological Factors Alone • Psych Factors Plus Medical Condition Desire Phase Resolution Arousal - Excitement Plateau Orgasm

22. Main Types of Sexual Dysfunctions • Sexual Desire Disorders • Sexual Arousal Disorders • Orgasm Disorders Desire Phase • Sexual Pain Disorders Resolution Arousal - Excitement Plateau Orgasm

23. Sexual Dysfunctions • Sexual dysfunctions represent disturbances of the normal sexual response cycle • The response cycle comprises 4 phases: • Appetitive involves sexual interest or desire • Excitement is a subjective pleasurable state linked to increased blood flow to the genitals • Orgasm is a peak of sexual pleasure accompanied by ejaculation and/or muscle contraction • Resolution is the restoration after orgasm • Feminists argue that the DSM notion of female sexual dysfunction is limited. • It should include any aspect (emotional, physical, or relational) that impacts the sexual experience Ch 14.13

24. Sexual Desire Disorders • Hypoactive sexual desire disorder refers to deficient or absent sexual fantasies or urges • Sexual aversion disorder involves avoidance of all genital contact with others • Prevalence may be greater than 20% • Causes of low sex drive include • Religious orthodoxy • Fear of loss of control • Depression • Medication side effects (tranquilizers) Ch 14.14

25. The Nature of Sexual Desire Disorders Hypoactive Sexual Desire Disorder • No Interest in Any Sex Activity • Common Presenting Problem • Accounts for half of all complaints at sexuality clinics • 22% of women and 5% of men suffer from this disorder • How Much Sex Is Enough?

26. The Nature of Sexual Desire Disorders Hypoactive Sexual Desire Disorder Sexual Aversion Disorder • Anything Sexual Evokes Fear, Disgust, or Panic • 10% Males Have Panic Attacks

27. Sexual Arousal Disorders • Persons with sexual arousal disorders experience sexual desire, but are unable to maintain arousal during intercourse • Female sexual arousal disorder involves inadequate vaginal lubrication • Male erectile disorder involves failure to maintain an erection during intercourse • Can be induced by disease, drugs or depression • Most common sexual problem for which men consult with specialists (50% of referrals) Ch 14.15

28. Orgasmic Disorders • Female orgasmic disorder refers to the absence of orgasm after a period of normal sexual excitement • Female orgasmic disorder may reflect • Difficulty in learning to become orgasmic • Chronic use of alcohol • Fear of losing control • Male orgasmic disorder refers todifficulty in ejaculation • Premature ejaculation is early ejaculation Ch 14.16

29. Sexual Pain Disorders • Dyspareunia refers to persistent or recurrent pain during sexual intercourse • Associated with depression, anxiety and marital difficulties • Vaginismus refers to an inability to achieve intercourse due to involuntary spasms of the outer third of the vagina • Associated with fear of pregnancy, relationship problems and negative attitudes toward sex Ch 14.17

30. Current Causes of Sexual Dysfunction • Masters & Johnson (1970) model • Fears of performance • Spectator role • No conclusive evidence for these factors • Contemporary views: sexually dysfunctional couples have both sexual and interpersonal problems • Secondary gain may be a “hidden” factor

31. Religious orthodoxy involves negative views of sexuality (procreation only, not for pleasure) Psychosexual trauma Homosexual inclination: sexual desire is impaired if a homosexual engages in sex with a heterosexual Excessive alcohol intake Historical Causes of Sexual Dysfunction

32. The Nature of Sexual Arousal Disorders Male Erectile Disorder Female Sexual Arousal Disorder • Problem is NOT Desire, but Arousal • Males: “Impotence” • Maintaining /Achieving Erection • Females: “Frigidity” • Maintain / Achieve Lubrication

33. The Nature of Orgasm Disorders Inhibited Orgasm • Adequate Arousal and Desire • BUT Unable to Achieve Orgasm • Common in Females; Rare in Males • Only 50% Women Experience Regular Orgasms During Intercourse: 25% report significant difficulty experiencing orgasms; most common referral complaint of women

34. The Nature of Orgasm Disorders Inhibited Orgasm Premature Ejaculation • Ejaculation Occurs Too Quickly • Hard to Define “Too Quickly” • 21% of all adult males meet criteria for premature ejaculation • Perception of Lack of Control Over Orgasm in the Chief Complaint

35. The Nature of Sexual Pain Disorders Dyspareunia • Intercourse Associated With Pain • Rule out Medical Causes of Pain • Rare Condition in Males (1% to 5%) • More Common in Women (10% to 15%) • Vaginismus (involuntary spasms during penetration)

36. Let's Test Your Sexual IQ • How Often Do Married Couples • Do it (i.e., Have Sex)? • 8% < 1 Time / Month • 23% 2-3 Times / Month • 24% Once Per Week • 12% 4-5 Times Week • 1% Daily • 2% Never

37. Assessment of Sexual Behavior and Dysfunction Interviews • How Would You Describe Your Current Interest in Sex? • Do You Have Sexual Fantasies? • How Often Do You Masturbate?

38. Assessment of Sexual Behavior and Dysfunction Interviews Thorough Medical Evaluation • Medications can Disrupt Sexual Functioning • Check Vascular Functioning • Check Hormonal Levels

39. Assessment of Sexual Behavior and Dysfunction Interviews Thorough Medical Evaluation Psychophysiological Assessment • Listen to Audiovisual Erotic Material • Measure Arousal Directly • Penile Strain Gauge • Vaginal Plethysmograph

40. The Causes of Sexual Dysfunctions Biological Contributions • Diabetes and Kidney Disease • Cardiovascular Diseases • Chronic Illness • Prescription Medications • Using Alcohol and Other Drugs

41. The Causes of Sexual Dysfunctions Biological Contributions Psychological Contributions • More Than Performance Anxiety • Performance Anxiety Involves • Arousal, Cognition, and Negative Affect • The Role of Distraction • Arousal Level is Underestimated

42. The Causes of Sexual Dysfunctions Biological Contributions Psychological Contributions Social and Cultural Contributions • Learn That Sexuality is Negative • Traumatic Sexual Experiences • Poor Interpersonal Relationship • Inaccurate Beliefs and Myths

43. Treatment of Sexual Dysfunctions Providing Education About Sex Psychosocial Treatments • Eliminate Performance Anxiety • Sensate Focus / Nondemand Pleasuring • Gradual Process of Building Intimacy • Several Other Available Treatments • Squeeze technique – Premature ejaculation • Masturbatory training – Female orgasm disorder • Use of dilators – Vaginismus • Exposure to erotic material – Low sexual desire problems • Many Treatments Work! (50% to 100% effective)

44. Treatment of Sexual Dysfunctions Providing Education About Sex Psychosocial Treatments Medical Treatments • Medications • Vasodilating Drugs (Viagra) • Surgery and Implants • Vacuum Device Therapy

45. Overview of Sexual and Gender Identity Disorders Main Classes of Disorders • Gender Identity Disorders • Sexual Dysfunctions • Paraphilias

46. The Nature of Paraphilic Disorders An Overview • Para • “Beyond” or “Amiss” • Philia • “Love” Sexual Stimulation Requiring Bizarre or Unusual Acts, Imagery, or Objects

47. The Paraphilias • The paraphilias involve sexual attraction to unusual objects or unusual sexual activities • The fantasies, urges or behaviors must • Endure for at least 6 months • Cause significant distress or impairment (this criterion is arguable) • Prevalence statistics for the paraphilias are unknown, since many of these are illegal activities Ch 14.4

48. Etiology of the Paraphilias • The psychodynamic view argues that the paraphilias are defensive processes • Paraphilias protect against repressed fears • A person with a paraphilia is fearful of heterosexual relationships • Behaviorists argue that the paraphilia represent classical conditioning of sexual arousal that has gone awry • Biological: Role of testosterone is unknown Ch 14.9

49. The Causes of Paraphilic Disorders Psychosocial Contributions • Inability to Develop Adequate Relationships • Early “Unusual” Sexual Experiences • Person’s Early Sexual Fantasies • Excessive Sex Drive & Suppression • Specific Causes are Still Unclear

50. Developmental Model of Paraphilia Figure 10.9 Barlow/Durand, 3rd. Edition. A model of the development of paraphilia