You are on page 1of 58

TULBURARI ALE ACTULUI

SEXUAL NORMAL

SUUB, Clinica de Obstetrica si Ginecologie


Dr Monica Fagarasanu
DISORDERS OF NORMAL
SEXUAL ACT

SUUB, Obstetrics and Gynecology Clinic


Dr Monica Fagarasanu
Actul sexual – ce inseamna normal?

ACT SEXUAL – clasificare:


(Diagnostic and Statistical Manual of Mental
Disorders - DSM)
 Normofilic (normal, tipic)
 Parafilic (anormal, deviant)

DSM clasifica actul sexual in doua categorii bine definite, fara zone
gri, clare

Act sexual anormal. Definitie:


= orice forma de comportare sexuala, in afara sexului normal, care
determina unei persoane o safisfactie sexuala
Actul sexual – ce inseamna normal?

SEXUAL ACT – classification:


(Diagnostic and Statistical Manual of Mental
Disorders - DSM)
 Normophilic (normal, typical)
 Paraphilic (abnormal, deviant)

DSM classifies the sexual act in 2 well-defined clear cut categories

Abnormal sexual act. Definition:


= any form of sexual behavior, besides normal sexual act, that
induces a sexual satisfaction to an individual
The Prevalence of Paraphilic Interests and Behaviors in the
General Population: A Provincial Survey

 2016, Universitatea din Montreal


 peste 1000 participanti

• 45% interesati de cel putin un comportament


sexual (fantezie) considerat parafilic
• 33% au aplicat fantezia sexuala

• 35% voyeurism
• 26% fetisism
The Prevalence of Paraphilic Interests and Behaviors in the
General Population: A Provincial Survey

 2016, University of Montreal


 More than 1000 participants

• 45% interested in at least a sexual behavior


(fantasy) considered paraphilic
•33% practiced the fantasy

• 35% voyeurism
• 26% fetishism
DSM – criterii restrictive

 The DSM a mai fost critcat pentru “medicalizarea


naturii umane’ si pentru prejudecati culturale

 De ex: homesexualitatea era considerata o tulburare de


personalitate sociopata in DSM pana in 1952

 Cercetatorii spera sa schimbe criteriile restrictive si


inflexibile ale DSM care nu ia in considerare diversitatea
preferintelor sexuale
DSM – criterii restrictive

 The DSM has been criticized for “medicalization of the


human nature" and for cultural prejudices

 For example: homosexuality was considered a


sociopathic personality disorder by DSM till 1952

 The scientists hope to change the restrictive criteria of


DSM that doesn’t take into consideration the diversity
of sexual preferences
EVALUARE CLINICA
 1. ORIENTAREA SEXUALA

 2. IDENTITATEA SEXUALA

 3. PREFERINTA SEXUALA

 4. COMPORTAMENTUL SEXUAL
EVALUARE CLINICA
 1. SEXUAL ORIENTATION

 2. SEXUAL IDENTITY

 3. SEXUAL PREFERENCE

 4. SEXUAL BEHAVIOUR
1. ORIENTAREA SEXUALA
 Heterosexuala

 Homosexuala

 Bisexuala

 Asexuala
1. SEXUAL ORIENTATION
 Heterosexual

 Homosexual

 Bisexual

 Asexual
2. IDENTITATEA SEXUALA

 nu exista discordanta intre


propria perceptie a sexualitatii si
comportamentul sexual adoptat
= identitate sexuala
neconflictuala

 exista conflict intre identitatea


sexuala adevarata si cea aparenta
= identitate sexuala conflictuala
2. SEXUAL IDENTITY

 No discordance between self-


perception of sexuality and the
sexual behavior
= un- conflictual sexual identity

 Discordance between real sexual


identity and the apparent one
= conflictual sexual identity
3. PREFERINTA SEXUALA
 “Obiectul” sexual preferat
 Sinonim cu orientarea sexuala pentru majoritatea
(barbati, femei, ambele sexe)
 Exista o minoritate care prefera alte
obiecte/situatii/activitati ca surse alternative de
interes sexual
 Exemple: lenjeria intima, materialele din piele,
latex, locurile publice
3. SEXUAL PREFERENCE
 Preferred sexual “object”
 Synonymous with sexual orientation for most
(man, women, both sexes)
 Minority that prefers other
objects/situations/activities as alternative
sources of sexual interest
 Ex: lingerie, leather, latex, public places
4. COMPORTAMENTUL SEXUAL
 Activitatile practicate pentru a experimenta sau
a facilita un raspuns sexual
 Influentat de societate, cultura, religie
 Variaza in timp, schimbandu-se odata cu
societatea
 Unele interzise de lege (pedofilia), altele
dezaprobate de societate (grade diferite de
homofobie, masturbarea)
4. SEXUAL BEHAVIOR
 Practiced activities to experiment or facilitate a
sexual response
 Influenced by de society, culture, religion
 Varies in time, changing with society
 Some forbidden by law (pedophilia), some
disapproved by society (different grades of
homophobia, masturbation)
Atitudinea medicului

 Consulta si asculta fara sa judece


 Respecta diversitatea in exprimarea sexuala
 Nu se lasa influentat de propriile convingeri
morale in ingrijirea unui pacient cu orientare
diferita
ATTITUDE

 Consults and listens without judging


 Respects diversity in sexual expression
 Not influenced by his own moral convictions in
caring for a patient with a different sexual
orientation
Adaptarea la lumea moderna
 Globalizarea – pacientii si medicii provin
din medii socio-culturale diverse
Modern World - Adaptation
 Globalization – patients and doctors come
from diverse socio-cultural backgrounds
Atitudinea medicului

 Termenii “deviatie sexuala”


sau “perversiune” nu isi
gasesc locul in practica
moderna
 Implica aplicarea unei
etichete negative
ATTITUDE OF THE DOCTOR

 Terms “sexual deviation” or


“perversion” do not belong
in modern practice
 It implies a negative
connotation
Unde e limita?

= pacientul isi provoaca suferinta lui sau altora


= devine nefunctional social
= pacientul nu poate experimenta un raspuns
sexual decat in prezenta preferintei sexuale

PARAFILIE = tulburare a preferintei sexuale


Where Do We Draw the Line?

= patient hurts himself or hurts others


= becomes un-functional socially
= the patient can’t experience a sexual response
unless he/she is in the presence of sexual
preference

PARAPHILIA = disorder of sexual preference


Parafiliile

 Origine si natura incerta


 Exista teorii ca fetisismul se dezvolta in copilarie
ca urmare a educatiei sexuale anormale,
inconstienta, inainte de stabilirea unui concept
matur despre sex
 Mai frecvente la barbati
PARAPHILIAS

 Uncertain nature and origin


 Theories suggest that fetishism develops in
childhood as a result of abnormal sexual
education, unconscious, before establishing a
mature concept about sex
 More frequent in men
PARAFILIILE. Definitie
 Fantezii/senzatii/comportamente sexuale
intense si recurente
 Implica: 1. obiecte non-umane
2. suferinta/umilire a individului in
cauza sau a partenerului
3. copii sau persoane care spun NU
 durata de minim 6 luni
 Provoaca stres semnificativ
clinic/social/ocupational
PARAFILIAS. Definition
 Intense and recurrent fantasies/sensations/sexual
behaviors
 Involves: 1. non-humane objects
2. suffering/humiliation of the
individual or of its partner
3. children or un-consenting persons
 Lasts 6 months minimum
 Provokes significant clinical/social/occupational
stress
PARAFILIILE

 Spectru larg de surse ce provoaca un raspuns


sexual parafilic – articol ce enumera 549

 Lista oficiala din Manualul de Diagostic


Psihiatric American include:
exhibitionism, fetisism, frotteurism, pedofilia,
masochism, sadism, travestism, voyeurism,
narcisism
PARAFILIAS

 Large spectrum of sources that provoke a sexual


paraphilic response– a paper lists more than 549
sources

 Official list from the Manual of Psychiatric


Diagnostics include:
exhibitionism, fetishism, pedophilia, masochism,
sadism, travestism, voyeurism, narcissism
EXHIBITIONISM

 Fantezii/senzatii/comportamente sexuale intense si


recurente
 Expunerea organelor genitale in fata unui strain
 practica exhibitionismului sau fanteziile de a practica
exhibitionismul provoaca un stres marcant in relatiile
interpersonale
 Cel putin 6 luni
EXHIBITIONISM

 Intense and recurrent


fantasies/sensations/sexual behaviors
 Exposing the genitals in front of a stranger
 Practicing exhibitionism or fantasies provokes a
significant stress in interpersonal relations
 For at least 6 months
FETISISM

 Fantezii/senzatii/comportamente sexuale intense si


recurente
 Obiecte non-umane sau parti ale corpului non-sexuale
 Stres social, ocupational, perturba activitatea cotidiana
 Cel putin 6 luni
FETISISM

 Intense and recurrent fantasies/sensations/sexual


behaviors
 Non-humane objects or non-sexual parts of the body
 Social stress, occupational, alters daily activity
 For at least 6 months
TRAVESTISM

 Cel putin 6 luni


 Fantezii/senzatii/comportamente
sexuale intense si recurente
 Imbracaminte feminina pt barbati

 Stres social, ocupational,

perturba activitatea cotidiana


TRAVESTISM

 For at lest 6 months


 Intense and recurrent
fantasies/sensations/sexual behaviors
 Feminine clothes for men
 Social stress, occupational, perturbs daily
activity
VOYEURISM

 Cel putin 6 luni


 Fantezii/senzatii/comportamente sexuale
intense si recurente
 Priveste pe ascuns o persoana dezbracata sau
care intretine activitati sexuale
 Stres social, ocupational, perturba activitatea
cotidiana
VOYEURISM

 For at least 6 months


 Intense and recurrent
fantasies/sensations/sexual behaviors
 Secretly watches a naked person or a person that
engages in sexual activity
 Social stress, occupational, alters daily activity
MASOCHISM

 Cel putin 6 luni


 Fantezii/senzatii/comportamente
sexuale intense si recurente
 durere fizica, umilinta, bataie sau legare
corporala
 Stres social, ocupational, perturba activitatea
cotidiana
MASOCHISM

 For at least 6 months


 Intense and recurrent
fantasies/sensations/sexual behaviors
 To accept pain, humiliation, physical violence
 Social stress, occupational, alters daily activity
Leopold von Sacher-Masoch

 scriitor si jurnalist austriac,


care si-a castigat renumele mai
ales datorită romanului său,
Venus învesmântată în blană
(Venus im Pelz, 1870) care l-a
condus pe psihiatrul Krafft-
Ebing să creeze termenul de
“masochism”
Leopold von Sacher-Masoch

 Austrian writer and journalist,


that earned its fame in
particular because of its novel,
Venus in fur (Venus im Pelz,
1870) that led the psychiatric
doctor Krafft-Ebing to create
the term “masochism”
“Venus învesmântată în blană ”

 “Sacher-Masoch si metresa sa,


baroana Fanny Pistor, semnează
un contract prin care el devine
sclavul ei pe o perioadă de sase
luni, stipulându-se în act ca
baroneasa să poarte blănuri cât
mai des, în special când era într-o
stare sufletească proastă si dornică
de cruzime”.
“Venus in Fur ”

 “Sacher-Masoch and its mistress,


baroness Fanny Pistor, sign a
contract stipulating he will become
her slave for 6 months, the
baroness being obliged to wear
furs as often as possible, especially
when in a bad mood”.
SADISM

 Cel putin 6 luni


 Fantezii/senzatii sau
comportamente sexuale
intense si recurente
 durere fizica, umilinta, bataie
sau legare corporala
 Stres social, ocupational,
perturba activitatea cotidiana
SADISM

 For at least 6 months


 Intense and recurrent
fantasies/sensations/sexual
behaviors
 To cause physical pain,
humiliation, violence
 Social stress, occupational,
alters daily activity
Marchizul de Sade

 Nascut in Paris in anul 1740


 aristocrat francez care a devenit celebru prin activitatea
sa sexuală libertină, perversă si exceptional de violentă
precum si prin scrierile sale apologetice despre acest
subiect
 a fost încarcerat în total 32 de ani din viată, în mai
multe închisori pentru “desfrau scandalos”
Marquis de Sade

 Born in Paris 1740


 French aristocrat that become famous for its liberal
sexual activity, perverse and extremely violent, as well as
his writings about the subject
 He was incarcerated in total 32 years of his life in many
prisons and an insane asylum, in the end, for
“scandalous orgies”
SADISM
 Teoria: deoarece femeile pot mima orgasmul dar
nu si durerea, aceasta este forma suprema de
activitate sexuala
 A scris despre experientele lui in inchisoare
 Sade a negat sistematic legea, religia si morala,
prin satisfacerea propriei plăceri prin intermediul
unei alte persoane, exercitând violentă
 A sfarsit sarac si alienat mintal intr-un azil
SADISM
 Theory: because women may mimic orgasm but
not pain, this is the ultimate form of sexual
activity
 He wrote about his adventures in prison
 Sade has systematically challenged the law, the
religion and morality by satisfying his own
pleasure through another person, exercising
violence
 Ended poor and insane in an asylum
NARCISISM

 Termenul narcisism a fost dezvoltat de


Freud în cartea din 1914 “Despre
narcisism” după Narcis
NARCISISM

 The term narcisism has been created by


Freud in his book in 1914 “About
narcisism” after Narcis
NARCIS
 Narcis era un tânăr frumos,
conform mitologiei grecesti,
fiul nimfei Liriope si al râului
Cephios
 Narcis era un tânăr care s-a
îndrăgostit patologic de
propria reflexie din apă
 Freud credea că o parte a
narcisismului este parte
esentială a tuturor dintre noi
de la nastere
NARCIS
 Narcis was a beautiful man, as
ancient green mythology
mentions, the son of nymph
Liriope and of the river
Cephios
 Narcis fell in love with
himself after seeing his own
reflection in water
 Freud believed a moderate
narcissism is essential for all
of us at birth
SCATOLOGIA
TELEFONICA
 Cel putin 6 luni
 Fantezii/senzatii sau comportamente sexuale intense
si recurente
 Telefoane obscene catre straini
 Stres social, ocupational, perturba activitatea
cotidiana
 Raspunsul sexual este proportional cu reactia
negativa a victimei
PHONE
SCATOLOGY
 At least 6 months
 Intense and recurrent fantasies/sensations/sexual
behaviors
 Obscene phone calls to strangers
 Social stress, occupational, alters daily activity
 Sexual response is proportional with the victim’s
negative reaction

You might also like