Chapter 10 - Sexual Disorders

I. LEVELS OF SEXUALITY
Sexual Identity
Sexual Orientation
Sexual Interest
Sex Role
Sexual Performance
A. Sexual Identity
- male or female
- usually consistent with biology
1. 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
2. Etiology: prenatal hormonal influences
- Masculine hormones => masculine sex organs & male sex identity;
- Absence => female organs & identity
3. Treatment
a) Therapy to deal with feelings
- often severe adjustment problems
- ineffective in changing sexual identity
b) Sexual-reassignment surgery & hormone treatment
- Fairly successful
B. Sexual Orientation
- What sex you fall in love with
- Orientation is NOT a choice
- Continuum
1. Disorder: None
- Most homosexuals are well-adjusted
- Some = unhappy, want to be heterosexual
- Women more accepting of homosexuals than men
- Prevalence = < 10%
2. Etiology of Homosexuality
- Prenatal hormones -> predisposition
- Also influenced by later events
- Evidence of different brain structure & genetic data from twin studies
- Research is based on males
3. Treatment: None
- If ego-dystonic, treat either homosexuality or dystonicity
- < 60% success in changing orientation via Aversive Therapy
C. Sexual Interest
- Objects of arousal
- Most men = female body; women = male body
1. 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
Categories
a) Nonhuman objects
- fetishes
- transvestic fetishism
b) Humiliation/pain
- sadism
- masochism
c) Children or nonconsenting adults
- pedophilia - exhibitionism
- voyeurism
- frotteurism
2. Etiology
Classical conditioning
- The paraphilic object/situation (CS) is paired with sexual arousal (US)
and sexual pleasure (UR)
- Person subsequently strengthens bond between CS & CR
- No arousal to normal adult stimuli
- Maybe deficient social skills
- Preparedness
3. Treatment
- Rarely diminish on own
- But can be treated
- Rationale for tx:
A learned/conditioned paraphilia can be unlearned
a) Aversion therapy
electrical shock or 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
D. Sex Role
- Public expression of sexual identity
- Parents/society/peers
- Fetal hormones
- Disorder: None
but previously thought non-sex-typed -> problems
E. Sexual Performance
- Adequacy of performance in sexual situations
1. Disorders (4 categories)
- Decreased sexual desire or response
a) Sexual Desire
* Hypoactive Sexual Desire
- no interest in sex, often regarding a particular partner
* Sexual Aversion Disorder
- extreme dislike of sexual activity
b) Sexual Arousal
* Female Sexual Arousal Disorder
* Male Erectile Disorder
- difficulty experiencing or maintaining arousal
- very common
- reaction heightens problem
c) 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
d) Pain disorders (mostly women)
* Dyspareunia
- painful intercourse
* Vaginismus
- muscle spasms rendering intercourse painful/impossible
2. Etiology
Physical Causes (minority of cases)
a) aging
b) alcohol/drugs/antidepressants
c) medical problems
Psychological Causes
a) Hostility toward partner
b) Cognitions (performance anxiety)
c) Traumatic early sexual experience
- condition fear/shame to sexual encounters
3. Treatment: quick & easy
Direct Sexual Therapy Masters/Johnson
- with couple
- explicit instruction & then practice
via Sensate Focus = primary technique
- anxiety blocks excitement & pleasure
- reduce anxiety via sensuous exercises
with no performance (intercourse)
II. 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
Date Rape as type of Acquaintance Rape
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 re sex until arises; woman may then be easily influenced
Social norms re game playing
Media
much sexual violence
increase acceptance of rape myths
decrease sensitivity to victims
This document was created with Win2PDF available at http://www.daneprairie.com.
The unregistered version of Win2PDF is for evaluation or non-commercial use only.