Sexual Disorders
Levels of Sexuality
• Sexual Identity
• Sexual Orientation
• Sexual Interest
• Sex Role
• Sexual Performance
Sexual Identity
• Male or female
• Usually consistent with biology
Disorder: Gender Identity Disorder
(Transsexualism)
• Belief that you are opposite sex from
biology
• Many cross-dress, live as opposite sex
• Actions are not sexually arousing
• 1 in 100,000 – Men
• Usually begins in childhood
• Chronic course
Etiology
• Prenatal hormonal influences
• Masculine hormones => masculine sex
organs & male sex identity
• Absence => female organs & identity
Treatment
1.Therapy to deal with feelings
- Often severe adjustment problems
- Usually ineffective in changing sexual
identity
2.Sexual-reassignment surgery & hormone
treatment
- Fairly successful
Sexual Orientation
• What sex you fall in love with
• Orientation is NOT a choice
• Continuum
Disorder: None
• Most homosexuals are well-adjusted
• Some = unhappy, want to be heterosexual
• Women more accepting of homosexuals
than men
• Prevalence = < 10%
Etiology of Homosexuality
• Prenatal hormones -> predisposition
• Also influenced by later events
• Evidence of different brain structure &
genetic data from twin studies
• Most research is based on males
Treatment
• None
• If ego-dystonic, treat either homosexuality
or dystonicity
• Some success in changing orientation
via aversive therapy
• Probably would also need orgasmic
reconditioning
Sexual Interest
• Objects of arousal
• Most men = female body
• Women = male body
Disorders: Paraphilias
• Unusual sexual interests that impair
“normal” erotic relations
• Paraphilic fantasies are common
Disorder
a) person acts on fantasy
b) object becomes necessary
c) person is distressed
or object replaces human partners
Paraphilic Categories
a)Nonhuman objects
• Fetishes
• Transvestic fetishism
b)Humiliation/pain
• Sadism
• Masochism
c) Children or nonconsenting adults
pedophilia
exhibitionism
voyeurism
frotteurism
Etiology
• Classical conditioning
• Paraphilic object/situation (CS) is paired with
sexual arousal (US) and sexual pleasure (UR)
• Person then strengthens bond between CS & CR
• No arousal to “normal” adult stimuli
• Maybe deficient social skills
• Preparedness
Treatment
• Rarely diminish on own
• But can be treated
• Rationale for tx:
A learned/conditioned paraphilia can be
unlearned
a)Aversion therapy
• electrical shock
• chemical nauseants
b)Covert sensitization
• Aversive stimulus is imagined
• Focus on negative consequences
c)Orgasmic Reconditioning
• Teach link between sexual pleasure and
“normal” stimuli
• Treatment is mildly effective
• 40% flashers reoffend (vs. 60% untreated)
• Cognitive component improves rates
(25% reoffend)
• Cannot change underlying desire but can
change some behavior
Sex Role
• Public expression of sexual identity
• Parents/society/peers
• Fetal hormones
• Disorder: None
• Previously thought non-sex-typed
-> problems
Sexual Performance
• Adequacy of performance in sexual
situations
• Disorders (4 categories)
- Decreased sexual desire or response
1. Sexual Desire
* Hypoactive Sexual Desire
- No interest in sex, often regarding a
particular partner
* Sexual Aversion Disorder
Extreme dislike of sexual activity
2. Sexual Arousal
* Female Sexual Arousal Disorder
* Male Erectile Disorder
- difficulty experiencing or maintaining
arousal
- very common
- reaction heightens problem
3. Orgasmic Disorders
* Female & Male Orgasmic Disorders
- inability to reach orgasm (women)
- premature ejaculation in men
(most common male problem)
- can lead to Male Erectile Disorder
- men also have retarded ejaculation
4. Pain disorders (women)
* Dyspareunia
- painful intercourse
* Vaginismus
- muscle spasms rendering intercourse
painful/impossible
Etiology
Physical Causes (minority of cases)
a)aging
b)alcohol/drugs/antidepressants
c)medical problems
Psychological Causes
a) Anger
b) Cognitions (performance anxiety)
c) Traumatic sexual experience
- condition fear/shame
Treatment
Direct Sexual Therapy Masters/Johnson
• With couple
• Explicit instruction & then practice
Sensate Focus = nondemand pleasuring
• Anxiety blocks excitement & pleasure
• Reduce anxiety via sensuous exercises
with no performance (intercourse)
Rape
Rape is not a Paraphilias because
1) Most rapists usually do not need rape to
become aroused
2) Calling rape a “disorder” reduces
person’s responsibility
What factors may lead to date rape?
• Double standard
Hidden norms that may condone sexual
aggression in men
• Changing sexual values
Lack of accepted standards about how
people should behave
Alcohol/drugs
• Impair judgment, decrease inhibitions,
render women more vulnerable
Miscommunication
• Wait to make decision
• Woman may then be easily influenced
• Social norms re game playing
Media
• Sexual violence
• Increase acceptance of rape myths
• Decrease sensitivity to victims