Sex Differences and Defects
Sexual Dysfunctions and Therapies
 Hormones
Sexual Dysfunctions and Therapies
• Statistical definition –
▫ An abnormal sexual behavior is rare or not practiced by many
people.
• Sociological approach –
▫ Sexual behavior that violates the norms of society.
• Psychological approach –
▫ Criteria include discomfort, inefficiency, and bizarreness.
• Medical approach –
▫ The Diagnostic and Statistical Manual of Mental Disorders
recognizes 8 paraphilias.
▫ A paraphilia is a recurring, unconventional sexual behavior that
is obsessive and compulsive.
Sexual Dysfunctions and Therapies
Normal-Abnormal Continuum:
• Normal and abnormal sexual behavior are not two separate
categories, but rather gradations on a continuum.
Sexual Dysfunctions and Therapies
Compulsive Sexual Behavior:
• A disorder in which the individual experiences intense, sexually
arousing fantasies, urges, and associated sexual behaviors.
▫ Intrusive, driven, and repetitive.
▫ Lacking in impulse control.
▫ Often incur social and legal sanctions.
▫ Interfere with personal and occupational functioning.
▫ Create health risks.
Sexual Dysfunctions and Therapies
• Fetishism is characterized by sexual fantasies, urges, or behaviors
involving use of nonliving objects:
▫ To produce or enhance sexual arousal.
▫ With or in the absence of a partner.
▫ Over a period of at least six
months.
▫ Causing significant distress.
Sexual Dysfunctions and Therapies
• Learning theory:
▫ Fetishes result from classical conditioning, in which a learned
association is built between the fetish object and sexual arousal
and organism.
• Cognitive theory:
▫ Fetishists have a serious cognitive distortion in that they perceive
a nonconventional stimulus as erotic.
Sexual Dysfunctions and Therapies
Transvestism:
• Refers to dressing as a member of the other
gender.
• Drag queens are male homosexuals that dress
up as women.
• Female impersonators are men who dress as
women, often as part of an entertainment job.
Transvestite fetishism:
• Refers to a heterosexual man who dresses in
female clothing to produce or enhance sexual
arousal.
• Transvestism is almost exclusively a male sexual
variation and is essentially unknown among women.
Sexual Dysfunctions and Therapies
• Sadist - A person who derives sexual satisfaction from inflicting
pain on another person.
• Masochist - A person who derives sexual satisfaction from
experiencing pain.
• Sadomasochism (S-M) Rare form
of sexual behavior.
▫ Causes are not precisely known.
Sexual Dysfunctions and Therapies
• Bondage and discipline –
▫ Use of physical or psychological restraints to enforce servitude.
• Dominance and submission (D-S) –
▫ The use of power consensually given to control the sexual
stimulation and behavior of the other person.
• Voyeur –
▫ A person who becomes sexually aroused from secretly viewing
nudes.
• Scoptophilia –
▫ A sexual variation in which the person becomes sexually arouse
by observing others’ sexual acts and genitals.
Sexual Dysfunctions and Therapies
Exhibitionism:
• The person derives sexual pleasure from exposing his genitals to
others in situations where this is clearly inappropriate.
• A man who exposes himself is considered offensive, but a women
who reveals most of her breast is likely to be thought of as attractive.
• Causes of exhibitionism are not known.
Sexual Dysfunctions and Therapies
• Nymphomania (women) and Satyriasis (men):
▫ High level of sexual activity.
▫ Excessive sex drive; person is apparently insatiable.
▫ Leads to compulsive behavior; sexuality overshadows all other
concerns
and interests.
Difficult to determine what is “excessive.”
▫ Terms are imprecise; couples may disagree.
• Especially difficult diagnosing women:
▫ One definition for men was seven or more orgasms per week for six
months, but this may not be abnormal for multiorgasmic women,
and hypersexual women may have no orgasms.
Sexual Dysfunctions and Therapies
Asphyxiophilia:
• The desire to induce in oneself a state of oxygen deficiency in order
to create sexual arousal or to enhance excitement and orgasm.
• People engage in asphyxiophilia in the belief that arousal and
orgasm are intensified by reduced oxygen.
Sexual Dysfunctions and Therapies
Cybersex:
• Use of the Internet to access sexually
oriented materials, chat rooms, and
bulletin boards.
▫ Characterized by anonymity,
accessibility, and affordability.
▫ Can become compulsive, addictive
and paraphilic.
Sexual Dysfunctions and Therapies
• Troilism – (triolism) Refers to three people having sex together.
• Saliromania - Disorder found mainly in men; desire to damage or
soil a woman or her clothes.
• Coprophilia - Feces are important to sexual satisfaction.
• Urophilia - Urine is important to sexual satisfaction.
Sexual Dysfunctions and Therapies
• Frotteurism -Sexual fantasies, urges, or behaviors involving
touching or rubbing one’s genitals against the body of a
nonconsenting person.
• Necrophilia - Sexual contact with a
dead person.
• Zoophilia (bestiality) - Sexual contact
with an animal.
Sexual Dysfunctions and Therapies
Diagnosing:
• Categories for diagnosis are not nearly as clear-cut as the
may seem
• Multiple diagnoses for one person are not uncommon.
Prevention of Sexual Variations:
• Difficult to do primary prevention.
• Interest in developing preventive programs targeting
children has increased.
• Analyze the components of sexual development:
▫ Gender identity
▫ Sexual responsiveness
▫ Formation of relationships with others
Sexual Dysfunctions and Therapies
• Hormonal treatment:
▫ Use of drugs to reduce androgen production or
block effects of androgen.
• Psychopharmacological treatment:
▫ Use of psychotropic medications
to influence psychological
functioning and behavior.
Sexual Dysfunctions and Therapies
Cognitive-Behavioral Therapies:
• Behavior therapy.
• Social skills training.
• Modification of distorted thinking.
• Relapse prevention.
Sexual Dysfunctions and Therapies
Skills Training:
• Programs may include:
▫ How to carry on a conversation.
▫ How to develop intimacy.
▫ Basic sex education.
• Sex surrogates interact socially and sexually with the
client and a therapist.
Sexual Dysfunctions and Therapies
• Sexual Disorder (sexual dysfunction) –
▫ A problem with sexual response that causes
mental distress.
▫ Lifelong –
 Present since the person became sexual.
▫ Acquired –
 Dysfunction appeared after a period of normal
functioning.
Sexual Dysfunctions and Therapies
▫ Sexual desire (libido) - an interest in sexual
activity.
▫ Hypoactive sexual desire - when the person is
not interested in sexual activity.
▫ Discrepancy of sexual desire - when one
partner wants sex considerably less frequently
than the other.
Sexual Dysfunctions and Therapies
Sexual Aversion Disorder:
• Strong aversion to sexual interaction, involving▫ Anxiety
▫ Fear
▫ Disgust
• Avoids any kind of genital contact with a partner.
• Common in persons who have panic disorder.
Sexual Dysfunctions and Therapies
Female Arousal Disorder:
• Lack of response to sexual stimulation, including lack of lubrication.
• Involves psychological and physiological elements.
• Defined partly by a women’s sense that she does not feel aroused
despite adequate stimulation.
Sexual Dysfunctions and Therapies
Erectile Disorder:
• Lifelong erectile disorder -Never been able to have an erection that
is satisfactory for intercourse.
• Acquired erectile disorder - Now has difficulty getting or
maintaining an erection, but has had sufficient erections at other times.
Male Orgasmic Disorder:
• Unable to have an orgasm or it is greatly delayed, despite a solid
erection and adequate stimulation.
• Far less common than premature ejaculation.
Sexual Dysfunctions and Therapies
Female Orgasmic Disorder:
• Lifelong orgasmic disorder - Never experienced an
orgasm.
• Acquired orgasmic disorder - Previously had
orgasms but no longer does so.
• Situational orgasmic disorder - Orgasms in some
situations but not others.
▫ 24 percent of female respondents reported difficulty in
the last 12 months with having orgasms.
▫ Female orgasmic disorder accounts for 25-35 percent
of the cases of women seeking sex therapy.
Sexual Dysfunctions and Therapies
Painful Intercourse:
• Dyspareunia - Pain experienced during intercourse.
• Vaginismus - Spastic contraction of the muscles
surrounding the entrance to the vagina.
Sexual Dysfunctions and Therapies
Causes:
Physical causes:
• Disease and drugs.
• Diseases associated with the heart and circulatory
system.
Hormonal Causes:
• Hypogonadism - Under functioning of the testes,
so that testosterone levels are very low.
• Hyperprolactinemia - Excessive production of
prolactin (associated with lactation).
Sexual Dysfunctions and Therapies
Premature Ejaculation:
• Premature ejaculation is more often caused by psychological than physical
factors.
▫ Physical factors such as a local infection or a nervous system degeneration
may be involved in cases of acquired disorder.
Male Orgasmic Disorder:
• Most commonly associated with psychological factors.
• May be associated with a variety of medical or surgical conditions, such as:
▫ Multiple sclerosis
▫ Spinal cord injury
▫ Prostate surgery
Sexual Dysfunctions and Therapies
Female Orgasmic Disorder:
• Most cases are caused by psychological factors.
• May be caused by physical factors, such as:
▫
▫
▫
▫
A severe illness
General ill health
Extreme fatigue
Injury to the spinal cord
Dyspareunia:
• Painful intercourse in women is often caused by organic factors:
▫ Disorders of the vaginal entrance
▫ Disorders of the vagina
▫ Pelvic disorders
• Painful intercourse in men can often be caused by a variety of organic
factors:
▫ For an uncircumcised man, poor hygiene may be the cause.
▫ Prostate problems may cause pain on ejaculation.
Sexual Dysfunctions and Therapies
• Some drugs may have side effects that cause sexual disorders.
• Effects of alcohol vary considerably.
Marijuana:
• Many respondents report that marijuana increases sexual
desire.
• Chronic users report decreased sexual desire.
Cocaine:
• Said to increase sexual desire.
• Chronic use is associated with▫ Loss of desire
▫ Orgasmic disorders
▫ Erectile disorders
Sexual Dysfunctions and Therapies
Stimulants:
• Stimulant drugs such as amphetamines are associated
with increased sexual desire, but in some cases, orgasm
becomes impossible or difficult.
• People high on crystal methamphetamine (ice) have a
tendency to engage in risky sexual behaviors.
Opiates:
▫ Morphine
▫ Heroin
▫ Methadone
• Have strong suppression effects on sexual desire and
response.
• Long-term use of heroin leads to decreased testosterone
levels in males.
Sexual Dysfunctions and Therapies
Psychiatric Drugs:
• Psychiatric drugs alter functioning of the central
nervous system which, in turn, affects sexual
functioning.
• Some antidepressants are associated, in both
men and women, with
▫ Arousal problems.
▫ Delayed orgasm problems.
Sexual Dysfunctions and Therapies
Sexual Dysfunctions and Therapies
Psychological Causes:
• Immediate causes –
▫ Various things that happen in the act of lovemaking itself that
inhibit the sexual response.
• Prior learning –
▫ Things people learned earlier (childhood, adolescence, earlier
adulthood), which now inhibit their sexual response.
• Cognitive interference –
▫ Thoughts that distract the person from focusing on erotic
experience.
• Spectatoring –
▫ When the person behaves like a judge of his or her own sexual
performance.
• Failure of the partners to communicate –
▫ One of the more important and immediate causes of sexual
disorders.
Sexual Dysfunctions and Therapies
• Emotional factors▫ Such as depression, anger, sadness, and anxiety can
interfere with sexual responding.
• Behavioral or lifestyle factors▫ Such as smoking, alcohol consumption,
and obesity all are associated with
higher rates of sexual disorders.
Sexual Dysfunctions and Therapies
Sexual Dysfunctions and Therapies
• Interpersonal factors-
▫ Disturbances in a couple’s relationship.
▫ Anger or resentment toward one’s
partner.
▫ Fear of intimacy can cause a person to
draw back from a sexual relationship
before it becomes truly fulfilling.
Sexual Dysfunctions and Therapies
• Behavior therapy –
▫ Eliminates goal-oriented sexual performance.
▫ Sensate focus exercises –
 Gradually increase the sexual component as the couple
successfully complete assignments.
• Couple therapy ▫ Sexual and performance anxiety reduction.
▫ Education and cognitive intervention.
▫ Script assessment and modification.
▫ Conflict resolution and relationship enhancement.
▫ Relapse prevention training.
Sexual Dysfunctions and Therapies
• Stop-start technique - Used in the treatment of
premature ejaculation.
• Kegel exercises - Strengthen the pubococcygeal
muscle (PC muscle) along the sides of the vagina.
• Bibliotherapy - Using self-help books to treat a
disorder.
Sexual Dysfunctions and Therapies
• Viagra (sildenafil), Cialis (tadalafil), and
Levitra (vardenafil)
▫ Treat erectile disorders
▫ Do not seem to cause priapism
(an erection that won’t go away)
• Intrinsa –
▫ A testosterone patch for post menopausal women
experiencing low sexual desire, is in clinical trials.
Sexual Dysfunctions and Therapies
• Suction devices ▫ A tube is placed around the penis until a reasonably
firm erection is present.
▫ Can be helpful in combination with
cognitive-behavioral couple therapy.
• Surgical therapy ▫ Inflatable penis –
 Involves implanting a prosthesis into the penis.
 This is radical treatment that should
be reserved for cases that have not been
cured by sex or drug therapy.
Sexual Dysfunctions and Therapies
Inflatable Penis
Sexual Dysfunctions and Therapies
Sexual Dysfunctions and Therapies
• Masters and Johnson
▫ Failure rate of 20%
▫ Success rate of 80%
• There is a lack of carefully controlled studies that
investigate the success of various therapies compared
with other therapies.
• Disorders may be given a quick fix with drugs while the
patient’s anxieties and relationship problems are
ignored.
• We must be sensitive to the values expressed in labeling
something as being, or someone as having, a “disorder.”