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