Sexual and Gender Identity Disorders

Sexual and Gender Identity Disorders

* 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

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

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

Gender Differences in Sexual Behavior

* Masturbation
o Males > Females (Primates Too!)
* Causal Premarital Sex
o Males > Females
* No Gender Differences in
o Attitudes About Homosexuality, Sexual Satisfaction, Masturbation
* Big Gap in Views About Sex
o Females (Love); Males (Arousal)
* Are You Born
o Straight
o Homosexual
o Bisexual?
* Nature vs. Nurture

The Development of Sexual Orientation

* Homosexuality
o Runs in Families
o More Common in Monozygotic Twins
o Prenatal Exposure to Hormones
* The Biological Basis Argument
o Promoted by the Media, but Narrow
o The Link is Not That Strong
* Inherit Sexual Predispositions

The Nature of Sexual Arousal and Function

Plateau
Orgasm
Resolution
Arousal - Excitement
Desire Phase
Normal Functioning
Where Problems Arise
* Gender Identity Disorders
* Sexual Dysfunctions
* Paraphilias

Main Classes of Disorders Overview of Sexual and Gender Identity Disorders
Features of Gender Identity Disorders
* Man or Woman?
* Trapped in the Body of the Wrong Sex
* Transexualism
* Transgendered
* Rare

The Nature of Gender Identity Disorders
* Goal is Not Sexual
* No Physical Abnormalities
* Independent of Sexual Arousal Patters
* May be Attracted to People With Desired Identity

The Causes of Gender Identity Disorders

* No Specific Biological Link
* Probably Learned Early in Life

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
* Gender Identity Disorders
* Sexual Dysfunctions
* Paraphilias

Main Classes of Disorders
Overview of Sexual and Gender Identity Disorders
Features of Sexual Dysfunctions

Plateau
Orgasm
Resolution
Arousal - Excitement
Desire Phase
Where Problems Arise
Hypoactive Sexual Desire Disorder
* No Interest in Any Sex Activity
* Common Presenting Problem
* How Much Sex Is Enough?
* Anything Sexual Evokes Fear, Disgust, or Panic
* 10% Males Have Panic Attacks

Sexual Aversion Disorder
The Nature of Sexual Arousal Disorders

Male Erectile Disorder
* Problem is NOT Desire, but Arousal
* Males: “Impotence”
Maintaining /Achieving Erection
* Females: “Frigidity”
Maintain / Achieve Lubrication

Female Sexual Arousal Disorder
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
* Ejaculation Occurs Too Quickly
* Hard to Define “Too Quickly”
* Problem Occurs in About 37% Males
* Perception of Lack of Control Over Orgasm in the Chief Complaint

Premature Ejaculation
Dyspareunia

* Intercourse Associated With Pain
* Rule out Medical Causes of Pain
* Rare Condition in Males
* More Common in Women
Vaginismus “Unhappily Mated as Bedfellows”

Let's Test
Your Sexual IQ
How Often Do Married Couples
Do it (i.e., Have Sex)?
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?
* Medications can Disrupt Sexual Functioning
* Check Vascular Functioning
* Check Hormonal Levels
Thorough Medical Evaluation
* Listen to Audiovisual Erotic Material
* Measure Arousal Directly
* Penile Strain Gauge
* Vaginal Plethysmograph

Thorough Medical Evaluation Psychophysiological Assessment

The Causes of Sexual Dysfunctions
Biological Contributions

* Diabetes and Kidney Disease
* Cardiovascular Diseases
* Chronic Illness
* Prescription Medications
* Using Alcohol and Other Drugs
* More Than Performance Anxiety
* Performance Anxiety Involves
Arousal, Cognition, and Negative Affect
* The Role of Distraction
* Arousal Level is Underestimated
* Learn That Sexuality is Negative
* Traumatic Sexual Experiences
* Poor Interpersonal Relationship
* Inaccurate Beliefs and Myths

Psychological Contributions
Social and Cultural Contributions
Treatment of Sexual Dysfunctions
Providing Education About Sex
* Eliminate Performance Anxiety
Sensate Focus / Nondemand Pleasuring
* Gradual Process of Building Intimacy
* Several Other Available Treatments
* Many Treatments Work!

Psychosocial Treatments
Medical Treatments
Main Classes of Disorders
An Overview
Fetishism
* “The Flasher”
o Expose Genitals to Unsuspecting Strangers
o Element of Risk is Important
o Not Harmless (Many Rape / Molest)

Exhibitionism
* “The Peeping Tom”
o Watching Unsuspecting Strangers Naked or Undressing
Voyeurism
* “Cross Dresser”
o Sexual Arousal by Dressing in Clothes of the Opposite Sex
o Most are Male Heterosexuals
o Most are Married

Transvestic Fetishism
Sexual Sadism and Masochism
* Pedophilia
o Sexual Attraction to Children
o More Aroused to Young Children



Pedophilia and Incest
* Incest
o Children Related to Perpetrator
o May be Aroused to Adults
Other Forms of Paraphilia

* Frotteurism -- Rubbing
* Necrophilia -- Corpses
* Klismaphilia -- Enemas
* Coprophilia -- Feces
* Zoophilia -- Animals
* Scatologia -- Obscene Calls

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

Psychosocial Treatments

* Suppression
o Paradoxically Backfires
* Covert Sensitization
* Orgasmic Reconditioning
* Relapse Prevention
* Treatment Works!


Drug Treatments

* Anti-Androgen
o Cyproterone Acetate
o Reduces Testosterone Levels
* Eliminates Sexual Desire / Fantasy
* Use for Sex Offenders
* Only a Temporary Solution

Sexual and Gender Identity Disorders.ppt

Read more...

Orgasm in the Male

Orgasm in the Male
Presentation by: Dr.Li Ming Shun

Frequency of Sex with a Partner:
18-24 yr old Males
Frequency of Masturbation:
Total Population
Masturbation: Males 18-24
* Interesting data: 85 % of men living with a sexual partner masturbated in the previous year. 80% of men with advanced degrees masturbated in the previous year.
“Phallic Fallacies”
* The larger the penis, the more effective the male partner in coital connection with the female. May be valid for anal sex with male partner (b/c of location of prostate)
* Little relation of size erect to size flaccid
* No relation of skeletal stature to penis size

Male Sexual Response Cycle
Variant Arousal in Males
* Too much arousal:
o Priapism
o Premature ejaculation
* Too little arousal:
o Impotence (“ED”)

Priapus: God of Fertility and Gardening
Priapism
* Non-sexual origin
* Usually due to blood vessel pathology or nerve disorders.

Premature Ejaculation

* Male inability to control ejaculation for a sufficient length of time during intravaginal containment to satisfy his partner at least 50% of the time.
* Not a “stopwatch” definition
* Usually psychological in origin
* Treated by “training”
Impotence

* Inability to achieve an erection even with effective sexual stimulation
* Psychological basis
* Physiological basis
Primary Impotence

* Never able to have or maintain a functional erection
* Most often psycho-social basis
* Rarely physiological basis
Secondary Impotence

* History of adequate erections
* Psycho-social basis
o Fear of failure
o Lack of interest
* Physiological basis
o Cardiovascular pathology (e.g., diabetes; arteriosclerosis)
o Nerve damage (injury, stroke)
o Medications

Test for erections during REM sleep
Agents that affect erections
* Viagra: vasodilation (promotes erections)
* Poppers: vasodilation; also relaxation of vagina and anal sphincter
* Alcohol: blocks vasodilation (no NO)
* Nicotine: vasoconstriction
* Ecstasy: decreased libido and agression

The Little Blue Pill
Vasodilation and Constriction
Viagra inhibits Phospho-di-esterase type 5 (PDE5)
PDE5 is only in the penis
“Classical” Popper [for heart attacks]
Rush, Ram, Thrust, Rock Hard, Hix, TNT, Liquid Gold
Chemistry of Nitro-compounds
Subjective Reports of Orgasm
M&J

* Stage I: Sensation of ejaculatory inevitability; 2-3 seconds; “feeling the ejaculation is coming.”
* Stage II: Contractile sensation followed by a specific appreciation of fluid volume as it is expelled along the lengthened and distended penile urethra

Objective Reports of Orgasm
M&J
* Stage I: Rhythmic contractions of accessory organs (epididymis, vas deferens, seminal vesicles, prostate); collection of fluid in the prostatic part of the urethra
* Stage II: Relaxation of external sphincter of bladder; fluid flows into distended bulb and penile urethra; regular contractions of penile urethra and penile muscles forcefully expels semen from penis (12-24 inches); 3-4 major regular contractions (0.8 sec) and several more irregular minor contractions.

Involuntary Myotonia in Orgasm
Brain metabolic scans during penile stimulation
Two main areas are activated
One area is deactivated
Male Brain during Orgasm

* Simulation
* Inject tracer
* Measure signal during orgasm at 10 sec intervals
* Map location of signal (increased blood flow)

Brain activation during ejaculation
Ejaculation signal minus Stimulation signal
Male Brain during Orgasm

* Several parts of the brain known to be involved in reward behavior (e.g. heroin pleasure) were activated (meso-diencephalic junction; cerebellum)
* One part was de-activated (amydala/entorhinal cortex) (these parts are activated during fear)
* Very beginnings of study of brain/mind/sex

Relational Male Anatomy
Multiple Orgasm in Males

* “Many males below the age of 30, but relatively few thereafter, have the ability to ejaculate frequently and are subject to only very short refractory periods during the resolution phase.” One of their subjects could ejaculate 3 times in 10 minutes from the onset of stimulatory activity.
* Not quite the same as in the female.. Where the orgasms originate from the plateau phase rather than the resolution phase as in the male.

Does volume of ejaculate matter?
* Subjective reports (M&J, etc.) say yes.
* First orgasm is most intense
* After a period of continence, the orgasm is reported to more intense, and the volume of the ejaculate is highest (on average)
* Very little scientific study

Circumcision and Orgasm
* Can the uncircumcised male exercise ejaculatory control more effectively than the circumcised male?.... The exposed glans in the circumcised male is assumed to be more sensitive.
* M&J found in controlled neurological testing that there was no difference in sensitivity of the glans in either case

A G-spot for the Male?
* The prostate is sensitive to sexual stimulation
* Located adjacent to rectum; surrounds urethra
* Urethra can be erogenous zone for males

Vibrators
Prostate/Anal Stimulation
Questions to think about
* Why do humans have orgasms?
* Why do the French call orgasms “La petite mort” ?
* Can males have orgasms without ejaculation?
* What are the variables that can effect orgasmic satisfaction? Same for males and females?

Orgasm in the Male.ppt

Read more...

Hypothyroidism Fetal Brain Development

Hypothyroidism Fetal Brain Development

Thyroid Hormone Action

T4 has the highest levels in the body
T3 has the highest affinity for thyroid receptors
T4 can be metabolized into T3

Thyroid receptor sits on promotor in absence of ligand (corepressor complex)
Ligand binding causes recruitment of the coactivator complex and gene transcription

Hypothyroidism and Development

* Fetal and neonatal hypothyroidism has been correlated with neurological deficits
o Severity of deficits are related to severity of hypothyroidism
o Females may be more sensitive to TH and hypothyroidism than males (shown via gene array data, animal models)
* Studies show that TH has different actions in the brain at different developmental times
o Majority of specific neurodevelopmental events affected by TH are poorly understood

Timing of TH Action

* Fetal thyroid gland is not functional until 12th week of gestation
o Fetus dependent entirely on maternal source of thyroid hormone (1st trimester)
o Reduced maternal supply of TH can occur by maternal hypothyroidism or premature birth
* Fetal thyroid gland increases its role in development during gestation
o TH insufficiency late in development by decreased fetal TH production is referred to as congenital hypothyroidism

Maternal Hypothyroidism

* Nearly 3% of pregnant women have low-normal circulating T4
o Most low-normal hypothyroidism is undiagnosed and/or untreated
o Fetuses exposed to thyroid hormone insufficiency as mother does not produce enough T4 for both her and her fetus
o Severity of fetal thyroid hormone insufficiency is dependent on severity of maternal hypothyroidism
* Offspring are often found to have reduced perceptual and motor abilities, short attention spans, developmental delays, variable reaction times to visual stimuli
* Effect of low TH at specific times results in different developmental deficits
o Before 16 weeks: visual attention abilities
o After 16 weeks: fine and graphomotor skills, reading abilities

Premature Birth

* Premature birth causes a loss of TH from maternal sources before fetal gland is operational
o Provide another model of fetal TH insufficiency
o Low-risk premies (50%) show reduced visuospatial and fine motor skills, selective attention and memory abilities, and reduced math competency

Congenital Hypothyroidism
* Takes place later in development than maternal hypothyroidism or premature birth hypothyroidism
o Children exhibit IQ levels 6 points below expectation as well as visuospatial, motor, language, memory and attention deficits
o Newborn screening for congenital hypothyroidism has allowed treatment, reducing severity of deficits

Hypothyroidism and Development

Experimental Evidence

* Hypothyroid rat dams during pregnancy and the effects on their offspring
o General effects
o Effects on oligodendrocytes
o Changes in phosphorylation of protein kinases
o Effects on HDACs, gene repression

Hypothyroidism
* Female rats made hypothyroid (Tx) prior to mating; offspring were cross-fostered to non-hypothyroid dams at birth
o On PND 80:
+ Offspring exhibited learning deficits (via maze learning), “hyperactivity” (increased open-field exploration), less cautious during emotionality testing
+ Gender difference on learning
# Females more sensitive to TH insufficiency than males in terms of learning


Oligodendrocyte Accumulation
* Hypothyroidal animals demonstrate:
o Decreased number of myelinated axons in commissures
o HOWEVER, no difference in the total number of axons; suggests hypothyroidism interferes with myelination of the axons
o Decreased thickness of myelin sheath surrounding those axons that are myelinated

Oligodendrocyte Accumulation

* TH Actions on oligodendrocytes:
o Initiation of oligodendrocyte maturation
+ In absence of TH, precursor O-2A cells proliferate indefinitely; in presence of TH, O-2A cells terminate cell division, mature
o Enhance oligodendrocyte survival
+ Protection from apoptosis (shown in vitro)
o Regulate myelin production in developing oligodendrocyte via MBP (myelin basic protein)
+ MBP levels are reduced in hypothyroid states
Oligodendrocyte Accumulation

* Cortical areas of mammalian brain hemispheres are reciprocally connected via intrahemispheric commissures
o Critical for information transfer in higher brain function
o Arise embryonically in rat and develop post-natally
o TH is required for normal commissure development

Oligodendrocyte Accumulation

* MBP levels are reduced in hypothyroid animals compared to control
* T3 treatment showed no effect on MBP mRNA levels
* Anterior commisure (AC) is reduced in hypothyroid state
* Reduction of cell number
* Similar in Corpus collosum (CC)

Phosphorylation of ERK in Hippocampus

* Congenital hypothyroidism
* Shown previously that ERK phosphorylation and LTP were decreased in the hippocampus of Tx adult rats
o Hypothyroidal neonatal rats were analyzed for ERK phosphorylation in the hippocampus

* Hypothyroidism increased pERK1/2
* Hypothyroidism decreased p38/MAPK
* Changes occurred in the absence of a change in the phosphorylation state of JNK

Phosphorylation of ERK in Hippocampus

* Changes in phosphorylation of ERK and p38 in hypothyroidism may mediate changes in the hippocampus common to hypothyroidism such as:
o synaptic transmission
o migration of dentate granule cells
o decreases in cell number
o Reduction of dendritic arbors of dendrites and pyramidal cells

TH and Hairless

* Hairless (hr) is a direct target of TH in the developing brain
o Originally identified in mice with congenital hair loss
o Analogous phenotype in humans
o Hr mutant mice show altered neuronal morphology, inner ear defects, abnormal retinal cytoarchitecture
o Hr (protein) interacts with unliganded TR to enhance transcriptional repression
+ Binds to TR via two independent domains and has multiple repression domains
+ Known to associate with histone deacetylases (HDACs), suggesting hr and TR form repression complex with HDAC

TH and Hairless

* Hr is able to be co-immunoprecipitated by TR
* Hr co-immunoprecipitates with HDACs
* Hr expression is controlled by TRα

TH and Hairless

* In situ hybridization demonstrates hr and hdac expression overlaps in neonatal rat brain cerebellum forebrain

TH and Hairless

* Expression of hr is regulated during development by TH
* Expression occurs rapidly following treatment with TH

Why do we care?
* PCBs in environment
o Polychlorinated biphenyls bioaccumulate through the food chain and are found in high concentrations in samples of human tissues
o Children exposed to PCBs in utero exhibit neuropsychological deficits such as a lower full-scale IQ, reduced visual recognition memory, attention deficits, and motor deficits
o Developmental deficits overlap with those following developmental TH insufficiency

Activation of HES

* Maternal thyroid status affects the expression of HES1 and HES5 (TH-responsive genes; bHLH regulated by Notch receptor)
o Inhibits neurogenesis while favoring gliogenesis
o Therefore, TH may have role in fate specification of cells in early cortex by enhancing HES activation
o PCBs mimic affects of elevated T4 on HES1/5
o Possible that PCB exposure exerts effects on brain development by interfering with TH action
+ dysregulation of HES expression may be a mediating factor of PCB exposure
ADHD and Hypothyroidism

* Children born to mothers from iodine-deficient area have a higher incidence of ADHD
o Syndrome previously reported to be associated with resistance to TH by receptor mutations
* Study performed in Northeastern Sicily to identify long-term effects of maternal hypothyroxinemia
o Two groups (one normal iodine intake (11#), one low iodine intake (16#)); age-matched mothers and their children
o TSH levels remained normal in mothers, while all 11 identified ADHD children were born to mothers in iodine deficient area

Summary

* TH is required for a number of neuropsychological abilities
o Type of deficit dependent on timing of TH deficiency
* General:
o Prenatal TH loss
+ Visual processing
+ Motor and visuomotor abilities
o Early Neonatal TH loss
+ visuospatial
o Late Neonatal TH loss
+ Sensorimotor
+ Language
o Late Late TH loss
+ Language
+ Fine motor skills
+ Auditory processing
+ Attention
+ Memory skills

What’s Next?

* Though the morphological changes due to hypothyroidism in fetal brain development are well-described, underlying molecular mechanisms have yet to be fully understood
* Potential sex differences in TH action in developing brain may provide insight into some of the mechanisms
* Determine better ways to identify and treat fetal hypothyroidism
* Maternal treatment with either T4 or PCB results in an increase in HES (via in situ hybridization)

Hypothyroidism

Read more...