Sexual

Disorders

Sexual Disorders
These are disorders of sexual functioning that
includes gender identity, paraphilias and sexual
dysfunctions.

Gender Identity
Disorders
GENDER IDENTITY DISORDERS
Are characterized by persistent feelings of discomfort
with ones biological sex or the gender role of ones sex.
SEXUAL OBJECT CHOICE
Persons with gender identity disorder may be :
a. Sexually attracted to males,
b. Sexually attracted to females,
c. sexually attracted to both, or
d. sexually attracted to neither males nor females

 According to DSM-IV (4th edition of Diagnostic and

Statistical Manual of Mental Disorders) , once a
diagnosis of gender identity disorder is made, the object
of sexual attraction should be specified (for example,
male, female, both, or neither).

Gender Identity
Disorder Not
Otherwise Specified

This diagnosis is reserved for persons who cannot be

classified as having a gender identity disorder with the
characteristics described before. Three examples are listed
in DSM-IV: 1) persons with intersex conditions and gender
dysphoria, 2) adults with transcient, stress- related crossdressing behavior, and 3) persons who have a persistent
preoccupation with castration or penectomy without a desire
to acquire the sex characteristics of the other sex.
INTERSEX CONDITION
include a variety of syndromes that produce persons
with gross anatomical or psychological aspects of the
opposite sex.

Turners Syndrome
In Turners syndrome, one sex chromosome is
missing (XO). The result is an absence or minimal
development of the gonads: no significant sex
hormones, male or female, are produced in fetal
life or postnatally.
Because of the second X chromosome, which
seems responsible for full femaleness, is missing,
the girls have an incomplete sexual anatomy and
lacking adequate estrogen.

Symptoms
Girls who have Turner syndrome are shorter than
average. They often have normal height for the
first three years of life, but then have a slow
growth rate.
Non-functioning ovaries. Normally a girl's ovaries
begin to produce sex hormones (estrogenand
progesterone) at puberty. This does not happen in
most girls who have Turner syndrome. They do
not start their periods or develop breasts without
hormone treatment at the age of puberty.

 They are usually of normal intelligence with good

verbal skills and reading skills. Some girls,
however, have problems with math, memory
skills and fine-finger movements.
An especially wide neck.
A broad chest and widely spaced nipples.
Arms that turn out slightly at the elbow.

Klinefelters Syndrome
A person (usually XXY) with Klinefelters
syndrome has a male habitus, under the
influenced of the Y chromosome, but the effect is
weakened by the presence of the second X
chromosome.
Although most boys with Klinefelter Syndrome
grow up to live as men, some do develop atypical
gender identities, and some do develop female
gender identities.

Symptoms
Although the patient is born with testes and penis,
the testes are small (about half of the typical size)
and infertile, and the penis may also be small.
Breast growth (about one-third of teens with KS
have breast growth)
Less facial and body hair
Reduced muscle tone
Narrower shoulders and wider hips
Weaker bones, greater risk for bone fractures
Decreased sexual interest
Lower energy
Reduced sperm production

Congenital Virilizing
Adrenal Hyperplasia
It is results from an excess of androgen acting on a
fetus.
When the condition occurs in females, excessive fetal
androgens from the adrenal gland cause
androgenization of the external genitals, ranging from
mild clitoral enlargement to external genitals that look
like a normal scrotal sac, testes, and a penis; however
behind those external genitals are a vagina and a uterus.

Pseudohermaphroditis
m
Infants may be born with ambiguous genitals.
The genitals appearance at birth determines the
sex assignment, and the core gender identity is
male, female or hermaphroditic.
Male pseudohermaphroditism is incomplete
differentiation of the external genitalia, even
thougha Y chromosome is present. Testes are
present but rudimentary.
Female pseudohermaphroditism is the presence
of virilized genitals in a person who is XX.

Androgen Insensitivity
Syndrome
A congenital X-linked recessive trait disorder also
known as testicular feminization syndrome, results from
an inability of target tissues to respond to androgens.
When a person who is genetically male (who has one X
and one Y chromosome) is resistant to male hormones
(called androgens). As a result, the person has some or
all of the physical traits of a woman, but the genetic
makeup of a man.

Symptoms
A

person with complete AIS:

appears to be female but has no uterus,
and has very little armpit and pubic hair.
At puberty, female sex characteristics (such as
breasts) develop. However, the person does not
menstruate and become fertile.
Persons with incomplete AIS may have both male
and female physical characteristics. Many have
partial closing of the outer vaginal lips, an
enlarged clitoris, and a short vagina.

There may be:

A vagina but no cervix or uterus
Inguinal herniawith testes that can be felt during
a physical exam
Normal female breasts
Testes in the abdomen or other unusual places in
the body

Cross-Dressing
Some young people and adults with gender
dysphoria problems have an enduring desire to
dress as the opposite sex. Some of them simply
fantasise about it, but others put it into practice.
Crossed- dressing is known as transvestism.
Crossed- dresser as a transvestite.

 It can be classified as:

Transcient
Stress- related
Transcient is having transvestic fetishism. It essential
feature is it produces sexual excitement.
Stress- related cross- dressing sometimes produces
sexual excitement but it reduces tension and anxiety
in the patient.
Cross- dressing differs from transexualism in that the
patients have no persistent preoccupation with
getting rid of their primary and secondary sex
characteristics and acquiring the sex characteristics
of the other sex.

PARAPHILIAS
ARE SEXUAL DISORDERS CHARACTERIZED BY
SPECIALIZED SEXUAL FANTASIES AND INTENSE
SEXUAL URGES AND PRACTICES THAT ARE
USUALLY REPETITIVE AND DISTRESSING TO THE
PERSON. THE SPECIAL FANTASY, WITH ITS
UNCONSCIOUS AND CONSCIOUS COMPONENTS, IS
THE PATHOGNOMONIC ELEMENT, SEXUAL
AROUSAL AND ORGASM BEING ASSOCIATED
PHENOMENA. THE INFLUENCE OF THE FANTASY
AND ITS BEHAVIORAL MANIFESTATION EXTEND
BEYOND THE SEXUAL SPHERE TO PERVADE THE
PERSONS LIFE.

MAJOR FUNCTIONS OF
SEXUAL BEHAVIOR FOR
HUMAN BEING:
TO ASSIST IN BONDING
TO EXPRESS AND ENHANCE LOVE BETWEEN 2
PERSONS.
TO PROCREATE
IS A CONDITION IN WHICH A PERSONS SEXUAL
AROUSAL AND GRATIFICTION DEPEND ON
FANTASIZING ABOUT AND ENGAGNG IN SEXUAL
BEHAVIOR THAT IS ATYPICAL.

EPIDEMIOLOGY
THE BRANCH OF MEDICINE THAT DEALS WITH THE
INCIDENCE, DISTRIBUTION, AND POSSIBLE
CONTROL OF DISEASES AND OTHER FACTORS
RELATING TO HEALTH.
PARAPHILIAS ARE PRACTICED BY A SMALL
PERCENTAGE OF THE POPULATION. HOWEVER,
THE INSIDENT, REPETITIVE NATURE OF THE
DISORDERS RESULT IN THE HIGH FREQUENCY OF
THE COMMISSION OF PARAPHILIAC ACTS; THUS, A
LARGE PROPORTION OF THE POPULATION HAVE
BEEN A VICTIM BY PERSON WITH PARAPHILIAS.

CLASSIFICATIONS
FETISHISM
IS A RECURRENT, INTENSE, SEXUAL URGES, AND
SEXUALLY AROUSING FANTASIES OF AT LEAST 6
MONTHS DURATION, THAT INVOLVE THE USE ON
NON-LIVING OBJECTS SUCH AS BEAUTIFUL
SHOES, SHEER STOCKINGS, GLOVES,
UNDERWEAR, ETC. THEY FONDEL, KISS, SMELL OR
GAZE AT THE ADORED OBJECT AS THEY
MASTUBATE. A FETISHIST IS ALMOST ALWAYS A
MALE.

TRANSVESTISTIC FETISHISM
IS CHARACTERIZED BY A MAN WHO IS SEXUALLY
AROUSED BY WEARING THE CLOTHES OF THE
OPPOSITE SEX WHILE STILL REGARDING HIMSELF
AS A MEMBER OF HIS OWN SEX. TRANSVETISM
SHOULD NOT BE CONFUSED WITH
HOMOSEXUALITY. TRANSVESTITES, WHO ARE
USUALLY MALE, CROSS DRESS EPISODICALLY
RATHER THAN ON A REGULAR BASIS.

 ARE A GROUP OF MENTAL DISORDERS

CHARACTERIZED BY OBSESSION WITH UNUSUAL
SEXUAL PRACTICES OR WITH SEXUAL ACTIVITY
INVOLVING NON-CONSENTING OR INAPPROPRIATE
PARTNERS . THE ESSENTIAL FEATURE OF
TRANSVESTISTIC FETISHISM IS RECURRENT
INTENSE SEXUAL URGES AND SEXUALLY
AROUSING FANTASIES INVOLVING DRESSING IN
CLOTHING ASSOCIATED WITH MEMBERS OF THE
OPPOSITE SEX.
ANOTHER TERM IS CROSS-DRESSING.

INCEST
IS A SEXUAL RELATIONSHIP BETWEEN CLOSE
RELATIVES FOR WHOM MARRIAGE IS FORBIDDEN,
MOST OFTEN BETWEEN DAUGHTER AND FATHER,
AND BETWEEN BROTHER AND SISTER.
EXAMPLE: IN THE BOOK OF GENESIS PORTRAYS
SARAH MARRYING ABRAHAN, HER HALF-BROTHER,
WITHOUT CRITICIZING THE CLOSE GENETIC BETWEEN
THEM.
A RELATED DISORDER, CALLED PARTIALISM,
INVOLVES BECOMING SEXUALLY AROUSED BY A BODY
PART, SUCH AS THE FEET, BREASTS, OR BUTTOCKS.

VOYEURISM OR PEEPING
IS A RECURRENT, INTENSE, SEXUAL URGES AND
SEXUALLY AROUSING FANTASIES INVOLVING THE ACT
OF OBSERVING UNSUSPECTING PEOPLE, USUALLY
STRANGERS WHO ARE EITHER NAKED, IN THE
PROCESS OF DISROBING, OR ENGAGING IN SEXUAL
ACTIVITY FOR THE PURPOSE OF SEXUAL EXCITEMENT
AND GRATIFICATIONS.
IS THE RECURRENT PREOCCUPATION WITH FANTASIES
AND ACTS THAT INVOLVE OBSERVING PEOPLE WHO
ARE NAKED OR ARE ENGAGED IN GROOMING OR IN
SEXUAL ACTIVITY. ALSO KNOWN AS SCOPOPHILIA.

NECROPHILIAS
SEXUAL INTEREST WITH DEAD BODIES.
IS OBSESSION WITH OBTAINING SEXUAL
GRATIFICATION FROM CADAVERS.
AT TIMES, PERSONS MURDER TO SATISFY THEIR
SEXUAL URGES.

ZOOPHILIA
SEXUAL GRATIFICATION WITH ANIMALS.
FOR A NUMBER OF PEOPLE , ANIMALS ARE THE
MAJOR SOURCE OF RELATEDNESS, SO IT IS NOT
SURPRISING THAT A BROAD VARIETY OF DOMESTIC
ANIMALS ARE SENSUALLY OR SEXUALLY USED.
SEXUAL RELATIONS WITH ANIMALS MAY
OCCASIONALLY BE AN OUT-GROWTH OF
AVAILABILITY OR CONVINIENCE , ESPECIALLY IN
PARTS OF THE WORLD WHERE RIGID CONVENTION
PROCLUDES PREMARITAL SEXUALITY AND IN
SITUATIONS OF ENFORCED ISOLATION.

Exhebitionism
Involves the exposure of genitals(usually done by
men) to strangers, usualy women. Sometimes the
person masturbates while exposing his organ.

Diagnostic Criteria for Exhibitionism

Over a Period of at least 6 months, recurrent,
intense sexually arousing fantasies, sexual urges, or
behaviors involving the exposure of ones genitals
to an unsuspecting stranger.
The fantasies, sexual urges or behaviors cause
clinically significant distress or impairment in social
occupational or other important areas of
functioning

Rape
Is a crime involving sexual intercourse or other
sexual activity on another person. Forcible rape is
the legal term. Statutory rape is a sexual
intercourse between an adult male and someone
who is under the age of consent (18years old).
Rape maybe unplanned, impulsive assault
(opportunistic rape);or enduring sexual
preoccupation(sexual rape); or designed to
degrade and humiliate the victim(vindictive rape).

 Rape is one of the most prevalent forms

ofviolence against women (VAW)in the
Philippines. Reported rape cases ranked third
(13.1%) of the total reported VAW cases in the
country from 1999 to 2009. The hard fact is that
this is not yet the true representation of the
problem. Due to cultural and social stigmatization
associated with rape, many women victims prefer
to maintain their silence and not report their
ordeal to the authorities.

Sexual Sadism
Involves Sexual gratification. In Sadism, it is suexaul
gratification by inflicting pain on other person as a
prelude to sexual intercourse.
Diagnostic Criteria for Sexual Sadism
Over a period of at least 6 months, recurrent,
intense sexually arousing fantasies, sexual urges or
behaviors involving acts (Real not simulated) in
which the psychological or physical Suffering
(including humiliation) of the victim is sexually
exciting to the person.
The fantasies, sexual urges or behaviors cause
clinically significant distress or impairment in social,
occupational or other important areas of functioning

Sexual Masochism
Is marked preference for obtaining or increasing sexual
gratification through subjection to pain as a prelude to
sexual intercourse .
Diagnostic Criteria for Sexual Masochism
Over a period of at least 6 months, recurrent, intense
sexually arousing fantasies, sexual urges or behaviors
involving acts (Real not simulated) of being
humiliated,beaten, bound, or otherwise made to suffer.
The fantasies, sexual urges,or behaviors cause
clinically significant distress or impairment in
social,occupational or other important areas of
functioning

Other Paraphilias
Necrophilias - sexual gratification with dead bodies.
Coprophilia - sexual gratification from handling feces.
Frotteurism - sexual gratification by rubbing against
or fondling an unsuspecting consenting person.
Klismaphilia - sexual excitement by means of an
enema administered by another person.
Zoophilia - sexual gratification with animals.

TREATMENT
INSIGHT-ORIENTED PSYCHOTHERAPY
IS THE MOST COMMON APPROACH TO TREATING THE
PARAPHILIAS. PATIENTS HAVE THE OPPORTUNITY TO
UNDERSTAND THEIR DYNAMICS AND THE EVENTS
THAT CAUSE THE PARAPHILIA TO DEVELOP. IN
PARTICULAR, THEY BECOME AWARE OF THE DAILY
EVENTS THAT CAUSE THEM TO ACT ON THEIR
IMPULSES (FOR EXAMPLE , A REAL OR FANTASIZED
REJECTION). PSYCHOTHERAPY ALSO ALLOWS THE
PATIENTS TO REGAIN SELF-ESTEEM AND TO IMPROVE
THEIR INTERPERSONAL SKILLS AND FIND
ACCEPTABLE METHODS FOR SEXUAL GRATIFICATION.

Homosexuality
Isromanticattraction,sexual attractionorsexual
behaviorbetween members of the
samesexorgender. As anorientation,
homosexuality refers to "an enduring pattern of
or disposition to experience sexual, affectionate,
or romantic attractions" primarily or exclusively to
people of the same sex. "It also refers to an
individual's sense of personal and social identity
based on those attractions, behaviors expressing
them, and membership in acommunity of
otherswho share them."

Sexuality and Identity

Kinsey scale
TheKinsey scale, also called the HeterosexualHomosexual Rating Scale,attempts to describe a
person's sexual history or episodes of his or her
sexual activity at a given time. It uses a scale
from 0, meaning exclusivelyheterosexual, to 6,
meaning exclusively homosexual. In both the
Male and Female volumes of theKinsey Reports,
an additional grade, listed as "X", was used for
asexuality.

Sexual Orientation and

Behavior
Sexual orientation is commonly discussed as a characteristic of
the individual, like biological sex, gender identity, or age. This
perspective is incomplete because sexual orientation is always
defined in relational terms and necessarily involves relationships
with other individuals. Sexual acts and romantic attractions are
categorized as homosexual or heterosexual according to the
biological sex of the individuals involved in them, relative to each
other. Indeed, it is by actingor desiring to actwith another
person that individuals express their heterosexuality,
homosexuality, or bisexuality. This includes actions as simple as
holding hands with or kissing another person. Thus, sexual
orientation is integrally linked to the intimate personal
relationships that human beings form with others to meet their
deeply felt needs for love, attachment, and intimacy. In addition
to sexual behavior, these bonds encompass nonsexual physical
affection between partners, shared goals and values, mutual
support, and ongoing commitment.

 Coming out(of the closet) is a phrase referring to one's

disclosure of their sexual orientation or gender identity,
and is described and experienced variously as a
psychological process or journey.Generally, coming out is
described in three phases. The first phase is that of
"knowing oneself", and the realization emerges that one is
open to same-sex relations.This is often described as an
internal coming out. The second phase involves one's
decision to come out to others, e.g. family, friends, or
colleagues. The third phase more generally involves living
openly as an LGBT person.In the United States today,
people often come out during high school or college age. At
this age, they may not trust or ask for help from others,
especially when their orientation is not accepted in society.
Sometimes their own families are not even informed.

Same Sex
Relationships
People with a homosexual orientation can express
their sexuality in a variety of ways, and may or
may not express it in theirbehaviors.Many have
sexual relationships predominately with people of
their owngender identity, though some have
sexual relationships with those of the opposite
gender,bisexualrelationships, or none at all
(celibate).

Sexual Dysfunctions
Sexual dysfunction or sexual malfunction is
difficulty experienced by an individual or a couple
during any stage of a normal sexual activity,
including physical pleasure, desire, preference,
arousal or orgasm.

Sexual Desire Disorder

Sexual Desire Disorder

Sexual Desire Disorders are divided into two classes:
Hypoactive Sexual Desire Disorder a deficiency or
the absence of sexual fantasies and desire for sexual
activity.
estimated 20% of total population have hypoactive
sexual desire disorder
more common among women than among men
Causes are chronic stress, anxiety and depression
Abstinence
Deteriorating relationship

Sexual Desire Disorder

Sexual Aversion Disorder an aversion to and
avoidance of genital sexual contact with a sexual partner.
Less common than hypoactive sexual desire disorder
Causes are:
inhibition in phallic stage of development
unresolved oedipal conflicts
vagina dentata

Sexual Desire Disorder

Vagina Dentata
Some men, fixated at the phallic
state of development, are fearful of
the vagina, believing that they will
be castrated if they approach it, a
concept Freud called vagina
dentata, because they believe
unconsciously that the vagina has
teeth. Hence, they avoid contact
with the female genitalia entirely.

Sexual Arousal
Disorders
Female Sexual Arousal Disorder the persistent or
recurrent partial or complete failure to attain or maintain
the lubrication-swelling response of sexual excitement
until the completion of the sexual act.
caused by many psychological factors (anxiety, guild,
fear), lack of desire, dyspareunia, different hormonal
patterns and antihistaminic/anticholinergic medications.

Sexual Arousal
Disorders
Male Erectile Disorder (impotence)

Sexual Arousal
Disorders
Male Erectile Disorder

the persistent or recurrent partial or complete failure to

attain or maintain an erection until the completion of the
sex act.
A man with lifelong male erectile disorder has never been
able to obtain an erection sufficient for vaginal insertion.
In acquired male erectile disorder the man has
successfully achieved vaginal penetration at some time in
his sexual life but is later unable to do so.
In situational male erectile disorder the man is able to
have coitus in certain circumstances but not in others; for
example a man may function effectively with a prostate
but be impotent with his wife.

Sexual Arousal
Disorders
Male Erectile Disorder

episodes of impotence are reinforcing, with the man

becoming increasingly anxious before each sexual
encounter
Causes are lack of desire, punitive superego, inability to
trust, sense of being undesirable, medical condition or
pharmacological substance

Orgasmic Disorders
Female Orgasmic Disorder the inability of a woman to
achieve orgasm by masturbation or coitus.
Lifelong female orgasmic disorder exists when the woman
has never experienced orgasm by any kind of stimulation.
Acquired orgasmic disorder exists if the woman has
previously experienced at least one orgasm, regardless of
the circumstances or means of stimulation, whether by
masturbation or during sleep while dreaming.
Causes are fear of impregnation, rejection by sexual
partner, or damage to the vagina; hostility toward men; and
feelings of guilt regarding sexual impulses; and cultural
expectations and social restrictions are also relevant.

Orgasmic Disorders
Male Orgasmic Disorder a man achieves ejaculation
during coitus with great difficulty, if at all.
A man suffers from lifelong orgasmic disorder if he has
never been able to ejaculate during coitus. This disorder
is diagnosed as acquired if it develops after previous
normal functioning.
The incidence of male orgasmic disorder is much lower
than premature ejaculation or impotence.
Lifelong male orgasmic disorder is indicative of severe
psychopathology. The man often comes from rigid,
puritanical background; he may perceive sex as sinful
and the genitals as dirty.

Orgasmic Disorders
Male Orgasmic
Disorder

Causes are interpersonal difficulties such as unwanted

plans for pregnancy, loss of sexual attraction to partner,
demands of partner for greater sexual commitment and
unexpressed hostility towards women.
This problem is more common among men with
obsessive-compulsive disorder than among others.

Orgasmic Disorders
Male Premature Ejaculation a man persistently or
recurrently achieves orgasm and ejaculation before he
wishes to. The diagnosis is made when the man
regularly ejaculates before or immediately after entering
the vagina.
30 to 40 percent of men treated for sexual disorders
have premature ejaculation as the chief complaint.
Causes are anxiety regarding sex act or with
unconscious fears about the vagina, negative cultural
conditioning, stressful marriage. In situation in which
discovery would be embarrassing may become
conditioned to achieve orgasm rapidly.

Sexual Pain Disorders

Dyspareuniathe recurrent or persistent genital
pain occurring before, during, or after intercourse
in either the man or the woman.
Vaginismus an involuntary muscle constriction
of the outer third of the vagina that interferes
with penile insertion and intercourse.
Causes:
dynamic factors (sexual trauma)
religious/cultural inhibition
denial

Sexual Dysfunction Not

Otherwise Specified
Postcoital Headache characterized by headache
immediately after coitus and may last for several hours. It
is usually described as throbbing, and is localized in the
occipital or frontal area. The cause is unknown.
Orgasmic Anhedonia a condition in which the person
has no physical sensation of orgasms, even though the
physiological component (for example, ejaculation)
remains intact.
Psychological cause is extreme guilt about experiencing
sexual pleasure. Those feelings produce a type of
dissociative response that isolates the affective component
of the orgasmic experience from consciousness.

Sexual Dysfunction Not

Otherwise Specified

Masturbatory Pain pain during masturbation

Causes:
organic
compulsive masturbation
Autoerotic asphyxiation

Sexual Dysfunction Not

Otherwise Specified
Autoerotic asphyxiation, these practices may involve
masturbating while hanging oneself by the neck to
heighten erotic sensation and the intensity of the orgasm
through the mechanism of mild hypoxia.
Although the persons intend to release themselves from
the noose after orgasm, an estimated 500 to 1000 persons
a year accidentally kill themselves by hanging. Most who
indulge in this practice are male; transvetism is often
associated with the habit, and the majority of deaths occur
among adolescents. Such masochistic practices are
usualy associated with severe mental disorders, such as
schizophrenia and major mood disorders.