ABNORMAL

o Marked difficulty in maintaining an erection until the

completion of sexual activity
o Marked decreased in erectile rigidity
 DURATION: 6 months

PSYCHOLOGY  RISK AND PROGNOSTIC FACTORS:

OUTLINE
I SEXUAL DYSFUNCTION
Delayed Ejaculation
Erectile Disorder
Female Orgasmic Disorder
Genito-Pelvic Pain/Penetration Disorder
Male Hypoactive Sexual Desire Disorder
Premature (Early) Ejaculation
Other Specified Sexual Dysfunction
Unspecified Sexual Dysfunction
II GENDER DYSPHORIA
III PARAPHILIC DISORDER
Voyeuristic Disorder
Exhibitionistic Disorder
Frotteuristic Disorder
Sexual Masochism Disorder
Sexual Sadism Disorder
Pedophilic Disorder
Fetishistic Disorder
Transvestic Disorder
SEXUAL DYSFUNCTIONS
 These are heterogeneous group of disorders that are typically
characterized by a clinically significant disturbance in a
person’s ability to respond sexually or to experience sexual
pleasure
 Clinical judgment should be used to determine if the sexual
difficulties are the result of inadequate sexual stimulation
o Lifelong – refers to a sexual problem that has been
present from first sexual experiences
o Acquired – applies to sexual disorder that develop
after a period of relatively normal sexual function
o Generalized – refers to sexual difficulties that are
not limited to certain types of stimulation, situations,
or partners
o Situational – refers to sexual difficulties that only
occur with certain types of stimulation, situations, or
partners
DELAYED EJACULATION
 Either of the following symptoms must be experienced on
almost all occasions (approximately 75%-100%) of partnered
sexual activity (in identified situational contexts or, if
generalized, in all contexts), and without the individual
desiring delay
o Marked delay in ejaculation
o Marked infrequency or absence of ejaculation
 DURATION: 6 months
 RISK AND PROGNOSTIC FACTORS:
o Age-related loss of the fast-conducting peripheral
sensory nerves and age-related decreased sex
steroid secretion may be associated with the
increase in delayed ejaculation in men older than 50
years old
ERECTILE DISORDER
 Either of the following symptoms must be experienced on
almost all occasions (approximately 75%-100%) of partnered
sexual activity (in identified situational contexts or, if
generalized, in all contexts)
o Marked difficulty in obtaining an erection during
sexual activity
o Neurotic personality traits
o Submissive personality traits may be associated with
erectile problems in men age 40 years and older
o Alexithymia (i.e. deficits in cognitive processing of
emotions) is common in men diagnosed with
“psychogenic” erectile dysfunction
o Age, smoking tobacco, lack of physical exercise,
diabetes, and decreased desire
FEMALE SEXUAL INTEREST/AROUSAL DISORDER
 Lack of, or significantly reduced, sexual interest/arousal, as
manifested by at least three of the following:
o Absent/reduced interest in sexual activity
(hypoactive sexual desire disorder)
o Absent/reduced sexual/erotic thoughts or fantasies
o No/reduced initiation of sexual activity, and typically
unreceptive to a partner’s attempts to initiate
o Absent/reduced sexual excitement/pleasure during
sexual activity in almost all or all (approx. 75%-
100%) sexual encounters
o Absent/reduced sexual interest/arousal in response
to any internal/external sexual/erotic cues (e.g.
written, verbal, visual)
o Absent/reduced genital or nongenital sensations
during sexual activity in almost all or all (approx.
75%-100%) sexual encounters
 Cause significant distress in the individual
 If a lifelong lack of sexual desire is better explained by one’s
self-identification as “asexual”, then a diagnosis of female
sexual interest/arousal disorder would not be made
 DURATION: 6 months
 RISK AND PROGNOSTIC FACTORS:
o Negative cognitions about sexuality and past history
or mental disorders
o Differences in propensity for sexual excitation and
sexual inhibition may also predict the likelihood of
developing sexual problems
o Relationship difficulties, partner sexual functioning,
and developmental history (early relationship with
caregivers and childhood stressors)
o Diabetes mellitus and thyroid dysfunction
GENITO-PELVIC PAIN/PENETRATION DISORDER
 Persistent or recurrent difficulties with one (or more) of the
following:
o Vaginal penetration during intercourse
o Marked vulvovaginal or pelvic pain during vaginal
intercourse or penetration attempts
o Marked fear or anxiety about vulvovaginal or pelvic
pain in anticipation of, during, or as a result of
vaginal penetration
o Marked tensing or tightening of the pelvic floor
muscles during attempted vaginal penetration
 Cause significant distress in the individual
 DURATION: 6 months
 RISK AND PROGNOSTIC FACTORS:
o Sexual or physical abuse
MALE HYPOACTIVE SEXUAL DESIRE DISORDER
 Persistently or recurrently deficient or (absent) sexual/erotic
thoughts of fantasies desire for sexual activity. The judgment
of deficiency is made by the clinician, taking into account
factors that affect sexual functioning, such as age and general
socio-cultural contexts of the individual’s life
 DURATION: 6 months
 RISK AND PROGNOSTIC FACTORS:
o Mood and anxiety symptoms
o A man’s feelings about himself, his perception of his
partner’s sexual desire towards him, feelings of
being emotionally connected, and contextual
variables may all negatively (as well as positively)
affect sexual desire
o Alcohol use may increase the occurrence of low
desire
PREMATURE (EARLY) EJACULATION
 A persistent or recurrent pattern of ejaculation occurring
during partnered sexual activity within approximately 1 minute
following vaginal penetration and before the individual wishes
it
 DURATION: 6 months
 Causes clinically significant distress in the individual
 RISK AND PROGNOSTIC FACTORS:
o Common in men with anxiety disorders, especially
social anxiety disorders (social phobia)
SUBSTANCE/MEDICATION-INDUCED SEXUAL
DYSFUNCTION
 Developed during soon after substance intoxication or
withdrawal or after exposure to a medication
 Does not occur exclusively during the course of a delirium
 Causes clinically significant distress in the individual
 RISK AND PROGNOSTIC FACTORS:
o Common in men with anxiety disorders, especially
social anxiety disorders (social phobia)
GENDER DYSPHORIA
 Sex – biological indicators or male and female (understood in
the context of reproductive capacity)
 Gender – denote public lived role as a boy or girl, man or
woman, but in contrast to certain social constructionist
theories, biological factors are seen as contributing, in
interaction with social and psychological factors, to gender
development
 Gender assignment – usually assigned at birth, or the “natal
gender”
 Gender atypical – refers to somatic features or behaviors
that are not typical (in a statistical sense) of individuals with
the same assigned gender in a given society and historical
era (gender nonconforming is an alternate form)
 Gender reassignment – denotes an official change of
gender
 Gender identity – a category of social identity and refers to
an individual’s identification as a male, female, or
occasionally, some category other than male or female.
 Transgender – refers to the broad spectrum of individuals
who transiently or persistently identify with a gender different
from the natal gender
 Transsexual – denotes an individual who seeks, or has
undergone, a social transition from male to female or female
to male, which in many, but all cases, also involves a somatic
transition by cross-sex hormone treatment and genital surgery
(sex reassignment surgery)
 Gender dysphoria – refers to the distress that may
accompany the incongruence between one’s experienced or
expressed gender and one’s assigned gender
o Focuses on the dysphoria, not identity per se
PARAPHILIC DISORDERS
 The term paraphilia denotes any intense and persistent
sexual interest other than sexual interest in genital stimulation
or preparatory fondling with phenotypically normal, physically
mature, consenting human partners
 A paraphilic disorder is a paraphilia that is currently causing
distress or impairment to the individual or a paraphilia whose
satisfaction has entailed personal harm, or risk of harm, to
others
 The order of presentation of the listed paraphilic disorders
generally corresponds to common classification schemes for
these conditions
o Anomalous activity preferences – courtship
disorders (which resemble distorted components of
human courtship behavior; voyeuristic,
exhibitionistic, frotteuristic disorder) and algolagnic
disorders (which includes pain and suffering; sexual
masochism and sadism disorders)
o Anomalous target preferences – pedophilic,
fetishistic, transvestic disorders
VOYEURISTIC DISORDER
 DURATION: 6 months
 Recurrent and intense sexual arousal from observing an
unsuspecting person who is naked, in the process of
disrobing, or engaging in sexual activity, as manifested by
fantasies, urges, and behaviors
 The individual has acted on these sexual urges with a
nonconsenting person, or the sexual urges or fantasies cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning
 The individual is at least 18 years of age
 There should be a report of distress, demonstrated by
anxiety, obsessions, guilt, or shame, about these paraphilic
impulses
 PREVALENCE: Male-to-female ratio is 3:1
 RISK FACTORS:
o Voyeurism
o Childhood sexual abuse, substance misuse and
sexual preoccupation/hypersexuality have been
suggested as risk factors, although the casual
relationship to voyeurism is uncertain and the
specificity unclear
EXHIBITIONISTIC DISORDER
 DURATION: 6 months
 Recurrent and intense sexual arousal from the exposure of
one’s genitals to an unsuspecting person, as manifested by
fantasies, urges, or behaviors
 The individual has acted on these sexual urges with a
nonconsenting person, or the sexual urges or fantasies cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning
 There should be a report of distress, demonstrated by
anxiety, obsessions, guilt, or shame, about these paraphilic
impulses, however, nondisclosing individuals can be also
diagnosed with the disorder
 PREVALENCE: Male > Female
 RISK FACTORS:
o Exhibitionism, AsPD, alcohol use disorder,
pedophilic interest
FROTTEURISTIC DISORDER
 DURATION: 6 months
 Recurrent and intense sexual arousal from touching or
rubbing against a nonconsenting person, as manifested by
fantasies, urges, or behaviors
 The individual has acted on these sexual urges with a
nonconsenting person, or the sexual urges or fantasies cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning
 There should be a report of distress, demonstrated by
anxiety, obsessions, guilt, or shame, about these paraphilic
impulses, however, nondisclosing individuals can be also
diagnosed with the disorder
 PREVALENCE: Male > Female
 RISK FACTORS:
 o Nonsexual antisocial behavior and sexual  The individual has acted on these sexual urges with a
preoccupation/hypersexuality might be nonspecific nonconsenting person, or the sexual urges or fantasies cause
risk factors, although the causal relationship to clinically significant distress or impairment in social,
frotteurism is uncertain, and the specificity unclear occupational, or other important areas of functioning
SEXUAL MASOCHISM DISORDER  There should be a report of distress, demonstrated by
 DURATION: 6 months anxiety, obsessions, guilt, or shame, about these paraphilic
 Recurrent and intense sexual arousal from the act of being impulses, however, nondisclosing individuals can be also
humiliated, beaten, bound, or otherwise made to suffer, as diagnosed with the disorder
manifested by fantasies, urges, or behaviors  PREVALENCE: Male > Female
o Asphyxiophillia – if the individual engages in the
practice of achieving sexual arousal related to
restriction of breathing
 The fantasies, sexual urges, or behaviors cause clinically
significant distress or impairment in social, occupational, or
other important areas of functioning
 There should be a report of distress, demonstrated by
anxiety, obsessions, guilt, or shame, about these paraphilic
impulses, however, nondisclosing individuals can be also
diagnosed with the disorder
 PREVALENCE: Male > Female
 RISK FACTORS:
o Exhibitionism, AsPD, alcohol use disorder,
pedophilic interest
PEDOPHILIC DISORDER
 DURATION: 6 months
 Recurrent and intense sexually arousing fantasies, sexual
urges, or behaviors involving sexual activity with a
prepubescent child or children (generally 13 years or
younger)
 The individual has acted on these sexual urges with a
nonconsenting person, or the sexual urges or fantasies cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning
 The individual is at least age 16 years and at least 5 years
older than the child or children
 There should be a report of distress, demonstrated by
anxiety, obsessions, guilt, or shame, about these paraphilic
impulses
 PREVALENCE: Male > Female
 RISK FACTORS:
o Antisociality
o Sexually abused as a child
FETISHISTIC DISORDER
 DURATION: 6 months
 Recurrent and intense sexual arousal from either the use of
nonliving objects or a highly specific focus on nongenital body
part(s), as manifested by fantasies, urges, or behaviors
 The individual has acted on these sexual urges with a
nonconsenting person, or the sexual urges or fantasies cause
clinically significant distress or impairment in social,
occupational, or other important areas of functioning
 The fetish object are not limited to articles of clothing used in
cross-dressing (as in transvestic disorder) or devices
specifically designed for the purpose of tactile genital
stimulation (e.g. vibrator)
o Body part
o Nonliving object
 PREVALENCE: Male > Female
TRANSVESTIC DISORDER
 DURATION: 6 months
 Recurrent and intense sexual arousal from cross-dressing, as
manifested by fantasies, urges, or behaviors
o With fetishism – if sexually aroused by fabrics,
materials, or garments
o With autogynephilia – if sexually aroused by
thoughts or images of self as female