HUMAN SEXUALITY

AND
SEXUAL DYSFUNCTIONS
 NORMAL SEXUALITY
 In the classical era: Hippocrates cited the clitoris as the site of female sexual arousal.
 In the middle ages: coitus interruptus recommended as a form of birth control;
 End of Renaissance/beginning of Reformation: linen sheath devised as a condom for
protection against syphilis.
 Victorian era: “sexologist” such as Havelock Ellis and Richard von Kraft-Ebing
presented perspective on sexual behavior.
 Sigmund Freud: theories on libido, childhood sexuality and effects of sexual impulse
on human behavior.
 In modern era: era of sexual liberality
 Alfred Kinsey - masturbation
 William Master and Virginia Johnson
 Development of drugs that prevent contraception, aid erection and replace hormones
 NORMAL SEXUALITY
 PSYCHOSEXUAL

 Used to describe personality development and functioning as these are affected

by sexuality
 Applies to more than sexual feelings and behavior
 Not synonymous to libido
 Freud’s generalization that all pleasurable impulses and activities are originally
sexual has given a distorted view of sexual concept and motivation
 Persons may also use sexual activities for gratification of nonsexual needs, such
as dependency, aggression, power, status.
 NORMAL SEXUALITY
 PSYCHOSEXUAL FACTORS:

1. SEXUAL IDENTITY:
 pattern of a person’s biological sexual characteristics: chromosomes, external
genitalia, internal genitalia, hormonal composition, gonads, and secondary sex
characteristics.; leaves a person no doubt about his or her sex;
 All mammalian embryos are anatomically female during the early stages of
development.
 Differentiation of male from the female results from the action of fetal androgens: 6 th
week to end of 3rd month
 Testis develops as a result of SRY and SOX9 action; ovary develops in absence of such action;
 DAX1 –fetal development of both sexes;
 WNT4 – development of Mullerian ducts in female fetus
 NORMAL SEXUALITY
 PSYCHOSEXUAL FACTORS:

2. GENDER IDENTITY:
 A person’s sense of maleness or femaleness
 Conviction of gender ”I am male” or “I am female” by 2-3 years of age;
 Person must still develop a sense of masculinity or femininity
 Robert Stoller: “connotes psychological aspects of behavior related to
masculinity and femininity
 Results from an almost infinite series of cues derived from experiences with
family members, teachers, friends and coworkers, and from cultural
phenomena
 NORMAL SEXUALITY
 PSYCHOSEXUAL FACTORS:

2. GENDER IDENTITY:
 Sexual identity and Gender Identity are interactive. Genetic influences and
hormones affect behavior, and the environment affects hormonal production
and gene expression.

 GENDER ROLE BEHAVIOR: all things that a person says or does to disclose
himself or herself as having the status of a boy or man, girl or woman
respectively; not established at birth; major factor is learning
 NORMAL SEXUALITY
 PSYCHOSEXUAL FACTORS:

3. SEXUAL ORIENTATION:
 Describes the object of a person’s sexual impulses:
 Heterosexual
 Homosexual
 bisexual
 NORMAL SEXUALITY
 PSYCHOSEXUAL FACTORS:

4. THE CENTRAL NERVOUS SYSTEM AND SEXUAL BEHAVIOR:

 CORTEX- controls sexual impulses and processing sexual stimuli that may lead to
sexual activity. During sexual stimulation, increased activity in orbitofrontal
cortex (emotions) , left anterior cingulate cortex (hormone control and sexual
arousal) and right caudate nucleus (sexual activity follows arousal)
 LIMBIC SYSTEM- penile erection
 BRAINSTEM – inhibitory and excitatory control
o Nucleus paragigantocellularis projects to pelvic efferent neurons in lumbosacral
spinal cord causing them to secrete serotonin which inhibits orgasms.
 NORMAL SEXUALITY
 PSYCHOSEXUAL FACTORS:

4. THE CENTRAL NERVOUS SYSTEM AND SEXUAL BEHAVIOR:

 BRAIN NEUROTRANSMITTERS
o Increased dopamine presumed to increase libido
o Serotonin inhibitory on sexual function
o Oxyctocin released with orgasm and reinforce pleasurable activities

 SPINAL CORD
o Afferents from pudendal, pelvic and hypogastric nerves
 NORMAL SEXUALITY
 MALE SEXUAL RESPONSE CYCLE
ORGAN EXCITEMENT PHASE
Several minutes to several hours
SKIN Sexual flush: maculopapular rash
originates on abdomen and
spreads to ant chest wall, face
and neck; inconsistent
PENIS Erection in 10 to 30 sec caused by
vasocongestion of erectile bodies
of corpus cavernosa of shaft
SCROTUM AND Tightening and lifting of scrotal
TESTES sac; elevation of testes
COWPER’S 2-3 drops of mucoid fluid that
GLAND contain viable sperm
ORGASMIC PHASE
3 to 15 seconds
Well developed flush
Ejaculation : emission phase
marked by three to four 0.8 second 10sec with variable refractory
contractions of vas, seminal
vesicles and prostate
No change
No change
RESOLUTION PHASE
10-15min; if no orgasm. ½ to 1
day
Flush disappears in reverse order
of appearance; inconsistently
appearing film of perspiration on
soles of feet and palms of hands
Erection: partial involution in 5-
period; full detumescence in 5-30
min
Decrease to baseline size;
testicular and scrotal descent
within 5-30 min after orgasm
No change
 NORMAL SEXUALITY
 MALE SEXUAL RESPONSE CYCLE
ORGAN EXCITEMENT PHASE
SCROTUM AND Tightening and lifting of scrotal
TESTES sac; elevation of testes
COWPER’S 2-3 drops of mucoid fluid that
GLAND contain viable sperm
OTHERS Breasts: inconsistent nipple
erection
Myotonia: semispastic
contractions of facial, abdominal
and intercostal muscles;
Tachycardia up to 175 bpm
Rise in blood pressure: systolic 20
to 80; diastolic 10 to 40
Increased respiration
ORGASMIC PHASE
No change
No change
Loss of voluntary muscular control
rectum :rhythmical contractions of
sphincter
Heart rate: up to 180 bpm
BP: 40 to 100 systolic;20 to 50
diastolic;
Respiration up to 40 per minute
RESOLUTION PHASE
Decrease to baseline size;
testicular and scrotal descent
within 5-30 min after orgasm
No change
Return to baseline state in 5 to 10
seconds
A refractory period follows
orgasm, during which time the
male cannot be rearoused to
erection and is unresponsive to
stimulation
 NORMAL SEXUALITY
 FEMALE SEXUAL RESPONSE CYCLE
ORGAN EXCITEMENT PHASE
Several minutes to several hours
SKIN Sexual flush: maculopapular rash
originates on abdomen and
spreads to ant chest wall, face
and neck; inconsistent
BREASTS Nipple erection in 2/3 of women;
venous congestion and areolar
enlargement; size increase to ¼
over normal
CLITORIS Enlargement in diameter of
glands and shaft; just before
orgasm shaft retracts to prepuce
ORGASMIC PHASE RESOLUTION PHASE
3 to 15 seconds 10-15min; if no orgasm. ½ to 1
day
Well developed flush Flush disappears in reverse order
of appearance; inconsistently
appearing film of perspiration on
soles of feet and palms of hands
Breasts may become tremulous Return to normal in about 30
minutes
No change shaft returns to norma position in
5 to 10 seconds; detumescence in
5 to 30 minutes; if no orgasm
detumescence takes several hours
 NORMAL SEXUALITY
 FEMALE SEXUAL RESPONSE CYCLE
ORGAN EXCITEMENT PHASE
LABIA MAJORA Nullipara: elevate and flatten
against perineum
Multipara: congestion and edema
LABIA MINORA Size increase 2 to 3x over normal;
change to pink, red, deep red
before orgasm
VAGINA Color change to dark purple;
vaginal transudate appears 10 to
30 seconds after arousal;
elongation and ballooning of
vagina; lower 1/3 of vagina
constricts before orgasm
ORGASMIC PHASE
No change
Contractions of proximal labia
minora
3 to 15 contactions of lower 1/3 of
vagina at intervals 0.8 secs
RESOLUTION PHASE
Nullipara: decrease to normal size
in 1 to 2 minutes
Multipara: decrease to normal
size in 10to 15 minutes
Return to normal within 5 min
Ejaculate forms seminal pool I
upper 2/3 of vagina; congestion
disappears in seconds; if no
orgasm, in 20 to 30 min
 NORMAL SEXUALITY
 FEMALE SEXUAL RESPONSE CYCLE
ORGAN EXCITEMENT PHASE
UTERUS Ascends into false pelvis; labor-
like contractions begin in
heightened excitement before
orgasm
OTHER Myotonia
A few drops of mucoid secretion
from Bartholin’s gland during
heightened excitement’
Cervix swells slightly and is
passively elevated with uterus
ORGASMIC PHASE
Contractions throughout orgasm
Loss of voluntary muscular control
Rectum: rhythmical contractions of
sphincter
Hyperventilation and tachycardia
RESOLUTION PHASE
Contractions cease; and uterus
descends to normal position
Return to baseline status in
seconds to minutes
Cervix color and size return to
normal and cervix descends into
seminal pool
 NORMAL SEXUALITY
 MASTURBATION

 Normal precursor of object-related sexual behavior

 Sexual self-stimulation common in infancy and childhood
 15-19 months = genital self stimulation
 Puberty = masturbation increases
 Important emotional difference in presence of coital fantasies in adolescents
 In couples, masturbation serve as adaptive purpose combining sexual pleasure
and tension release
 NORMAL SEXUALITY
 HOMOSEXUALITY

 Often describes a person’s overt behavior, sexual orientation and sense of personal or
social identity.
 HOMOPHOBIA : negative attitude toward, or fear of, homosexuality or homosexuals;
 HETEROSEXISM: belief that a heterosexual relationship is preferable to all others;
implies discrimination against those practicing other forms of sexuality.
 2 to 4 % of population prevalence rate
 FREUD: castration fears and fears of maternal engulfment in the preoedipal phase
 Male homosexual behavior: Strong fixation on the mother; lack of effective fathering;
inhibition of masculine development; fixation at, or regression to, the narcissistic stage
of development; and losses when competing with brothers and sisters
 NORMAL SEXUALITY
 HOMOSEXUALITY
 Genetic and biological components
 Gay men exhibit lower levels of circulatory androgen
 Effective presence of prenatal androgens in prenatal life contribute to sexual
orientation towards female; deficiency lead to sexual orientation toward male
 Preadolescent girls exposed to large amount of androgens before birth are aggressive;
boys exposed to excessive amounts of female hormones in utero are less athletic, less
assertive and less aggressive
 Coming out: a process by which an individual acknowledges his or her sexual
orientation in face of societal stigma and with successful resolution accepts himself or
herself
INTERSEXUAL DISORDERS
  ADRENOGENITAL SYNDROME

-Caused by congenital adrenocortical

hyperplasia
-Excess androgen in fetus with xx
genotype.
- Most common female intersex disorder
- Enlarged clitoris, fused labia, hirsutism
in adolescence

Masculinized external
genitalia of a 46,XX infant
caused by congenital
adrenal hyperplasia
(virilizing form)
Turner’s Syndrome

Absence of second female sex (XO)

Webbed neck, dwarfism, cubitus

valgus, no sex hormones, infertile
Klinefelter’s Syndrome

 Genotype is xxy (47 xxy)

 Male habitus; low androgen

production, small penis,
rudimentary testes, weak libido
 Usually assigned as male
Androgen insensitivity syndrome (testicular feminization)

Congenital x-linked recessive disorder;

inability of tissue to respond to
androgens

Ext. genital looks female; cryptochordal

testes
Extreme: breasts, normal ext. genitalia,
short blind vagina, absence of pubic and
axillary hair
ENZYMATIC DEFECTS IN XY GENOTYPE (17-OH- steroid deficiency)

Congenital interruption in production of

testosterone

Ambiguous genitals; female habitus

HERMAPHRODITISM

46 xx; 46 xy; rare

Both testes and ovary present in

the same person;

Internally, Müllerian structures develop (uterus, oviducts, vagina).

Gonadal tissue of both genders is present in various patterns: a
testis on one side and an ovary on the other, a testis on one side
and an ovo-testis (gonad containing both ovary and testis) on the
other, or an ovary on one side and an ovo-testis on the other.
SEXUAL DYSFUNCTIONS
 DESIRE, INTEREST AND AROUSAL DISORDERS
 MALE HYPOACTIVE SEXUAL DESIRE DISORDER
 Characterized by a deficiency or absence of sexual fantasies and desire for sexual
activity for a min duration of approx. 6 months
 It is not better explained by a nonsexual mental disorder or as a consequence of
severe relationship distress or other significant stressors and is not attributable to
the effects of a substance /medicationsor another medical condition
 CAUSATIVE FACTORS:
 Inhibition during phallic phase and unresolved oedipal conflicts
 VAGINA DENTATA: fearful of vagina and believe they will be castrated if they approach it;
unconsciously believed that vagina has teeth
 Chronic stress, anxiety or depression
 Abstinence from sex for a prolonged period of time sometimes result in suppression of sexua
impulses
 Expression of hostility to a partner or sign of a deteriorating relationship
 DESIRE, INTEREST AND AROUSAL DISORDERS
 FEMALE SEXUAL INTEREST/AROUSAL DISORDER

 Women do not necessarily move stepwise from desire to arousal, but often
experience desire synchronously with, or even following, beginning feelings of
arousal.
 Complicating factor is that a subjective sense of arousal is often poorly
correlated with genital lubrication in both normal and dysfunctional women
 Factors: life stresses, aging, menopause, adequate sexual stimulation, general
health, and medication regimen must be evaluated
 Relationship problems relevant; most prevalent etiology is marital discord
 DESIRE, INTEREST AND AROUSAL DISORDERS
 MALE ERECTILE DISORDER
 Impotence – derogatory and negative connotation
 Lifelong : have never been able to obtain erection sufficient for insertion; rare 1% of men
younger than 35
 Acquired : has successfully achieved penetration at some time in his sexual life but is later
unable to do so; reported in 10 to 20 percent
 Situational: able to have coitus in certain circumstances but not in others
 Erectile disorder is the chief complaint of more than 50% of all men treated for
sexual disorders; incidence increases with age
 Usually psychological in young and middle-aged male
 DESIRE, INTEREST AND AROUSAL DISORDERS
 MALE ERECTILE DISORDER

 Madonna-putana complex :inability to reconcile feelings of affection towards a

woman with feelings of desire for her; they can function only with women
whom they see as degraded
 Other factors: punitive superego, an inability to trust, feelings of inadequacy or
sense of being undesirable as partner
 Fear, anxiety, anger or moral prohibitions
 ORGASM DISORDERS
 FEMALE ORGASMIC DISORDER
 Inhibited female orgasm or anorgasmia
 Recurrent or persistent inhibition of female orgasm, as manifested by the
recurrent delay in, or absence of orgasm after a normal sexual excitement phase
 Lifelong: never experience orgasm by any kind of stimulation;
 Acquired: previously experienced at least one orgasm
 Women who can achieve orgasm by one of these methods ( coitus or
masturbation) are not necessarily categorized as anorgasmic
 Some are not distressed by the lack of climax and derive pleasure from sexual
activity
 5 percent of married women over 35 years of age had never achieved orgasm by
any means
 ORGASM DISORDERS
 FEMALE ORGASMIC DISORDER
 first orgasm occurs during adolescence in about 50 percent of women as a result
of masturbation or genital caressing with a partner
 Psychological factors: fears of impregnation, rejection by a sex partner, and
damage to the vagina; hostility toward men; and feelings of guilt about sexual
impulses; Cultural expectations and social restrictions
 Other symptoms: lower abdominal pain, itching, and vaginal discharge, as well
as increased tension, irritability, and fatigue
 Post-menopausal.
 ORGASM DISORDERS
 DELAYED EJACULATION
 retarded ejaculation
 Lifelong or acquired; occur in 8% of the population
 Orgasmic anhedonia - ejaculate but complain of a decreased or absent subjective
sense of pleasure during the orgasmic experience
 Lifelong - rigid, puritanical background; perceive sex as sinful and the genitals as dirty;
and he may have conscious / unconscious incest wishes or guilt; may be aggravated by
ADD
 Acquired – reflects interpersonal difficulties; more common among OCDs.
 plans for pregnancy about which the man is ambivalent, the loss of sexual attraction to
the partner, or demands by the partner for greater commitment as expressed by
sexual performance
 inability to ejaculate reflects unexpressed hostility toward a woman
 ORGASM DISORDERS
 PREMATURE (EARLY) EJACULATION
 When a man regularly ejaculates before or within approx. 1 minute after
penetration
 Mild: if ejaculation occurs w/in approx. 30 sec to 1 min of penetration
 Moderate: if within approx. 15 to 30 seconds of penetration
 Severe: when ejaculations occurs at the start of sexual activity or w/in approx. 15 sec

 FACTORS THAT AFFECT DURATION OF EXCITEMENT PHASE

 Age
 Novelty of partner
 Frequency of coitus
 ORGASM DISORDERS
 PREMATURE (EARLY) EJACULATION
 more commonly reported among college-educated men than among men with less
education
 two groups: those who are physiologically predisposed to climax quickly because
of shorter nerve latency time and those with a psychogenic or behaviorally
conditioned cause
 anxiety regarding the sex act, with unconscious fears about the vagina, or with
negative cultural conditioning;
 Men whose early sexual contacts occurred largely with prostitutes who demanded
that the sex act proceed quickly or whose sexual contacts took place in situations
in which discovery would be embarrassing (e.g., in the back seat of a car or in the
parental home) might have been conditioned to achieve orgasm rapidly;
 Stressful marriage/relationship
 SEXUAL PAIN DISORDERS
 GENITO-PELVIC PAIN/PENETRATION DISORDER

 Dyspareunia or vaginismus
 One or more of the ff complaints, of which any two or more may occur
together:
 Difficulty having intercourse
 Genito-pelvic pain
 Fear of pain or penetration
 Tension of the pelvic floor muscles
 SEXUAL PAIN DISORDERS
 GENITO-PELVIC PAIN/PENETRATION DISORDER
DYSPAREUNIA
 recurrent or persistent genital pain
occurring in either men or women
before, during, or after intercourse
 Causative factors; history of rape or
childhood sexual abuse (chronic pelvic
pain); anxiety or tension, infection
 In women, common physical cause in
injury from childbirth
 In men, usually associated with an
organic condition, such as herpes,
prostatitis, or Peyronie's disease, which
consists of sclerotic plaques on the penis
that cause penile curvature
VAGINISMUS
 constriction of the outer third of the
vagina due to involuntary pelvic floor
muscle tightening or spasm that
interferes with penile insertion and
intercourse;
 Diagnosis may occur during a
gynecological exam
 Learned fear response
 Sexual trauma (rape), psychosexual
conflict, nonverbal protest, anticipation
of pain
 Less than 1% of women has vaginismus
 SOME MEDICAL CONDITIONS THAT CAUSES SEXUAL DYSFUNCTION:

Male erectile d/o Dyspareunia Hypoactive sexual desire Male orgasmic disorder
Infectious: Surgical procedure Surgery: mastectomy, Surgery of
elephantiasis/mumps ileostomy, prostatectomy GUT
Hydrocoele/ varicocoele Bartholin’s gland Chronic conditions Parkinson’s dse.
infection
Klinefelter’s syndrome Endometriosis Retrograde ejaculation
Malnutrition/ vitamin def. Menopause Surgery, meds:
Thioridazine
DM/ hyperthyroidism Vulvar vestibulitis Female orgasmic disorder
Parkinson’s dse Interstitial Cystitis Hypothyroidism
Respiratory failure Diabetes mellitus
Cardiac failure Primary
hyperprolactinemia
Cirrhosis
 SUBSTANCE/MEDICATION-INDUCED SEXUAL DYSFUNCTION

ANTIPSYCHOTICS Chlorpromazine (Thorazine), thioridazine, and trifluoperazine (Stelazine) are potent

anticholinergics and they impair erection and ejaculation; rare cases of priapism

ANTIDEPRESSANTS  Tricyclics/Tetracyclics – interfere with erection; delays ejaculation

 Clomipramine, Selegiline, buprorion – increase sex drive
 Trazodone – priapism
 MAOIs - impaired erection, delayed or retrograde ejaculation, vaginal dryness, and
inhibited orgasm

LITHIUM Reduce hypersexuality in manic states; impaired erection reported

SYMPATHOMIMETICS Psychostimulants inc libido however with prolonged use, men may experience a loss or desire
and erections
ALPA AND BETA Impotence, decrease the volume of ejaculate, produce retrograde ejaculation; changes in libido
ADRENERGIC ANTAGONISTS
ANTICHOLINERGICS Dryness of vaginal mucosa; impotence
Amantadine – reverses SSRI-induced orgasmic dysfunction
 SUBSTANCE/MEDICATION-INDUCED SEXUAL DYSFUNCTION

ANTIHISTAMINES Cyproheptadine - block the serotonergic sexual adverse effects produced by SSRIs, such as
delayed orgasm and impotence;
BENZODIZEPINES Decrease plasma epinephrine concentrations: improve sexual functions in persons inhibited by
anxiety
ALCOHOL Can produce erectile disorders in men; has gonadal effect that decreases testosterone in men;
Paradoxical increase testosterone in women that increase their libido;
Long term use reduces ability of liver to metabolize estrogenic compounds that produce signs of
feminization in men (gynecomastia as a result of testicular atropy)
OPIODS erectile failure and decreased libido
HALLUCINOGENS Some reports enhanced sexual experience; but anxiety, delirium or psychosis interferes with
sexual function
CANNABIS enhance sexual pleasure; prolonged use decreases testosterone level

BARBITURATES May enhance sexual responsiveness in a person who are sexually unresponsive; no direct
effect on sex organs
Methaqualone acquired a reputation as sexual enhancer but has no biological basis in fact
TREATMENT FOR SEXUAL DYSFUNCTIONS
DUAL SEX THERAPY
 Originated and developed by Masters and Johnson
 Based on the concept that the couple must be treated when a dysfunctional
person is in a relationship.
 Both must participate in the therapy program
 Entire relationship is treated: sexual problem often reflects other area of
disharmony or misunderstanding
 Four way session: round table discussion
 Sensate focus exercises
 Aim of therapy is to establish or reestablish communication within the partner unit
 Treatment is short term and behaviorally oriented
DUAL SEX THERAPY
 Short-term and instructive
 Centers on specific sexual problems
 Includes :
 Assigning “mutual responsibility” to the problem
 Education about sexuality
 Attitude change
 Elimination of performance anxiety and the spectator role
 Changing destructive lifestyle and marital interactions
 Addressing physical and medical factors
SPECIFIC TECNIQUES AND EXERCISES:
DISORDER
VAGINISMUS/DYSPAREUNIA
PREMATURE EJACULATION
SEXUAL DESIRE/MALE ERECTILE
DISORDER
DELAYED EJACULATION
FEMALE ORGASMIC DISORDER
TECNIQUE/EXERCISES
Dilate vaginal openings with fingers or with size-graduated dilators
Sometimes treatment is coordinated with specially trained physiotherapist wo work with
the patients to help them relax perineal muscles
Squeeze technique: stimulates the erect penis until the earliest sensation of impending
ejaculation are felt; the woman forcefully squeezes the coronal ridge of the glans, the
erection is diminished, and ejaculation is inhibited; eventually raises the threshold of the
sensation of ejaculatory inevitability and allows the man to focus on the sensations of
arousal w/o anxiety and develop confidence
Stop-start technique: the woman stops all stimulation of the penis when the man first
senses and impending ejaculation; no squeeze
Masturbation
Extravaginal ejaculation initially then gradual vaginal entry after stimulation to a point near
ejaculation
Masturbation; dilator
PHARMACOTHERAPY:

SILDENAFIL Nitric oxide enhancer that facilitates the inflow of blood to the penis;1 hour after ingestion;
not effective in the absence of sexual stimulation
A/E: headache, flushing, dyspepsia
C/I: persons taking organic nitrates
IV METHOHEXITAL SODIUM Desensitization therapy
(BREVITAL)
SSRI AND TCACS Side effect used to treat premature ejaculation;PTSD from rape;
TRAZODONE Nocturnal erections
BROMOCRIPTINE Improve sexual dysfunction cause by hyperprolactinemia
PARAPHILIC DISORDERS
FETISHISM
 Recurrent intent sexual urges ,
sexually arousing fantasies, or
behaviors that involve a non-living
object, often to the exclusion of all
other stimuli;
 Many fetishes are
 extensions of the human body, such as
articles of clothing or footwear
 some particular textures such as rubber,
plastic or leather
 Fetish objects vary in their
importance to the individual. In
some cases they simply serve to
enhance sexual excitement achieved
in ordinary ways
EXHIBITIONISM
 a recurrent or persistent tendency to
expose the genitalia to strangers
(usually of the opposite sex and to
children) without inviting or
intending closer contact.

 There is usually, but not invariably,

sexual excitement at the time of the
exposure and the act is commonly
followed by masturbation.
 Treatment generally includes aversion

therapy and masturbatory satiation

 May be combined with orgasmic
reorientation, social skills training and
cognitive behavioral therapy.
VOYEURISM
 a recurrent or persistent tendency to look at
people engaging in sexual or intimate behaviour
such as undressing.

 This is carried out without the observed people

being aware, and usually leads to sexual
excitement and masturbation

 the risk of discovery often adds to the

excitement

 Seeking power

 Primal scene
FROTTEURISM

 Involves touching and rubbing

against a non-consenting
person
 Almost always male, the person

fantasizes during the act that

he has a caring relationship
with the victim
 Usually appears during the teen

years or earlier, and generally

the act disappears after age 25
PEDOPHILIA
 a sexual preference for children, boys
or girls or both, usually of prepubertal
or early pubertal age
 An isolated incident, especially if the

perpetrator is himself an adolescent,

does not establish the presence of the
persistent or predominant tendency
required for the diagnosis.
 Child pornography, watching, fondling

 Victims may be male, 2/3 are females

 History of abuse
SEXUAL MASOCHISM

 Involving the act or the thought of

being humiliated , beaten, bound
or otherwise made to suffer.

 Begins in childhood ; developed

through classical conditioning
 SEXUAL SADISM

 Act or thought of physical suffering of victim

 They imagine they have control over the sexual victim

 Underlying feelings of sexual inadequacies

 Possible abnormalities in the endocrine system

 Primary treatment is aversion therapy

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