Sexual Disorders

 Disorders fall into one of three very broad

categories:
 1) Gender Identity Disorders
 2) Sexual Dysfunction
 3) Paraphilia
 Gender Identity Disorder
 Gender identity disorder exists when the
person’s sense of identity (male vs.
female) is inconsistent with who they are
physically. “I’m a man trapped in a
woman’s body” or vice versa. Has also
been referred to as transexualism.
 Not the same as being gay.
 Not the same as intersex individuals, who
have anatomically ambiguous genitalia.
 Gender Identity Disorder
 Causes are unknown, although one would
assume there is a biological link
 Sexual reassignment surgery
 Sexual Dysfunctions
 The golden age of Viagra….
 MEN: hypoactive sexual desired disorder, sexual
aversion disorder, male erectile disorder,
inhibited male orgasm, premature ejaculation,
dyspareunia
 WOMEN: hypoactive sexual desire disorder,
sexual aversion disorder, female sexual arousal
disorder, inhibited female orgasm, dyspareunia,
and vaginismus.
 Men more commonly have erectile dysfunction
and premature ejaculation, while women have
hypoactive sexual desire.
 Assessment and Treatment
 Thorough assessment is a necessity, and is
comprised of clinical interviews, medical
examination, and psychophysiological
assessment procedures.
 Much of what we know about treatment evolved
out of Masters and Johnson’s work in St. Louis.
 Example of treating erectile
dysfunction/premature ejaculation using sensate
focus and nondemand pleasuring.
 Paraphilias
 When the weird get going, the going gets weird…
 Focus of sexuality is on something or someone other
than a consenting adult.
 Includes the following:
 1) Fetishism
 2) Voyeurism/Exhibitionism
 3) Transvestic Fetishism
 4) Sexual Sadism and Sexual Masochism
 5) Sadistic Rape
 6) Pedophilia and Incest
 Paraphilias
 Fetishism: sexual attraction to nonliving
objects, i.e., shoes and undergarments
 Voyeurism and Exhibitionism: The former
involves observing individuals in a state of
undress without their knowledge
(peeping), while exhibitionism involves
exposing oneself to strangers. Has a thrill-
seeking component.
 Paraphilias
 Transvestic Fetishism: sexual excitement is
related to the act of cross-dressing. Spouses are
often quite supportive.
 Sexual Sadism/Masochism: Sadism involves
sexual excitement when hurting others, while
masochism involves sexual excitement when one
is on the receiving end of the hurt. Wide range
of activities are involved and seems to lie on a
continuum. According to Barlow a subset of
rapists appear to be highly sadistic and meet
criteria for a paraphilia
 Paraphilias
 Pedophilia and Incest: Sexuality is focused
on children, and can involve either or both
sexes. Now aware of the widespread
nature of childhood sexual abuse in our
country, and it’s long term impact on both
women as well as men.
 The majority of perpetrators are men.
Speculation as to why?
 Paraphilias-Causal Factors
 Inability to access “normal” sexual outlets
may result in accessing other sexual
outlets.
 Early sexual fantasies may be repeatedly
reinforced through repeated masturbation,
resulting ultimately in a paraphilia.
 Treatment
 Psychosocial treatments have been largely
unsuccessful; the Barlow text is quite
misleading. The success rates he quotes
have not been found in most clinical
settings.