Sexual Disorders

Natia Badridze,MD
The Phases of the Sexual Response Cycle –
Regulated by sex hormones

 Phase 1: Excitement

 Phase 2: Plateau

 Phase 3: Orgasm

 Phase 4: Resolution
The Sexual Response Cycle
 Gender Identity, Gender Role, and Sexual Orientation
Term Definition Presumed Etiology Comments

Gender identity Sense of self as being Differential exposure May not agree with
male or female to prenatal sex physiological
hormones sex (i.e., gender
identity disorder)
Gender role Expression of one’s Societal pressure to May not agree with
gender identity in conform to sexual gender identity
society norms or physiological sex
(e.g., choice
of opposite gender’s
clothing)
Sexual orientation Persistent and Differential True bisexuality is
unchanging exposure to uncommon;
preference for people of most people have a
the same sex
prenatal sex
sexual preference
(homosexual) or the hormones
Homosexuality is
opposite sex Genetic influences considered a normal
(heterosexual)
variant of sexual
for love and sexual
expression
expression
 a. Individuals with gender identity disorder
Gender (transsexual or transgender individuals) have
Identity, a pervasive psychological feeling of being born
into the body of the wrong sex despite
Gender Role,
a body form typical of their physiological sex.
and Sexual
Orientation b. School-age children with gender identity
disorder prefer to dress like and have playmates
of the opposite sex. Since gender identity is
permanent, the most effective management of this
situation is to help parents accept the child as he
or she is.

c. In adulthood, these individuals commonly take

the hormones of their preferred sex in
order to better assume that gender role and may
seek surgery to change their genital sex.
 THE BIOLOGY OF SEXUALITY IN ADULTS
In adults, alterations in circulating levels of gonadal hormones (estrogen,
progesterone, and testosterone) can affect sexual interest and expression.
Hormones and behavior in women
Because estrogen is only minimally involved in
libido, menopause (i.e., cessation of ovarian
estrogen production) and aging do not reduce
sex drive if a woman’s general health is good
Testosterone is secreted by the adrenal glands
(as well as the ovaries and testes) throughout
adult life and is believed to play an important
role in sex drive in both men and women.
Hormones and behavior in men
Testosterone levels in men generally are
higher than necessary to maintain normal
sexual functioning; low testosterone levels are
less likely than relationship problems, age,
alcohol use, or unidentified illness to cause
sexual dysfunction.
Psychological and physical stress may
decrease testosterone levels.
Medical treatment with estrogens,
progesterone, or anti-androgens (e.g., to treat
prostate cancer) can decrease testosterone
availability via hypothalamic feedback
mechanisms, resulting in decreased sexual
interest and behavior.
 Homosexuality (i.e., gay or lesbian sexual orientation
Etiology
 The etiology of homosexuality
is believed to be related to
alterations in levels of prenatal
sex hormones (e.g., increased
androgens in females and
decreased androgens in males)
resulting in anatomic changes
in some hypothalamic nuclei;
 sex hormone levels in
adulthood are
indistinguishable from those of
heterosexual people of the
same biological sex
 Evidence for involvement of
genetic factors includes markers
on the X chromosome and
higher concordance rate in
monozygotic than in dizygotic
twins.
 Social factors, such as early
sexual experiences, are not
associated with the etiology of
homosexuality.
 People who are uncomfortable
with their sexual orientation
may benefit from psychological
intervention to help them
become more comfortable.
 Homosexuality (i.e., gay or lesbian sexual orientation
 By most estimates, at
least 5%–10% of the
population has an
exclusively homosexual
sexual orientation;
many more people have
had at least one sexual
encounter leading to
arousal with a person of
the same sex.
Occurrence
 There are no significant
ethnic differences in the
occurrence of
homosexuality.
 Many people with gay and
lesbian sexual orientations
have experienced
heterosexual sex and have
had children.
Characteristics SEXUAL DYSFUNCTION
Sexual dysfunction can result from
biological, psychological, or
interpersonal causes, or
from a combination of causes.
a. Biological causes include an
unidentified general medical
condition (e.g., diabetes can cause
erectile dysfunction; pelvic
adhesions can cause dyspareunia),
side effects of medication (e.g.,
selective serotonin reuptake
inhibitors [SSRIs] can cause
delayed orgasm), substance abuse
(e.g., alcohol use can cause erectile
dysfunction), and hormonal or
neurotransmitter alterations.
b. Psychological causes include
current relationship problems,
stress, depression, and anxiety. In
men with erectile disorder, the
presence of morning erections,
erections during masturbation, or
erections during rapid eye
movement (REM) sleep suggests a
psychological rather than a
physical cause.
2. Dysfunctions may always have
been present (primary sexual
dysfunctions), or, more commonly,
they occur after an interval when
function has been normal
(secondary sexual dysfunctions).

1. The physician must
understand the patient’s
sexual problem before
proceeding with treatment
(e.g., clarify what a patient
means when he says, “I have
a problem with sex.”).
2. The physician should not
assume anything about a
patient’s sexuality (e.g., a
middle-aged married male
patient may be having an
extramarital homosexual
relationship).
Managment
3. There is a growing
tendency for physicians to
manage the sexual problems
of heterosexual and
homosexual patients rather
than to refer these patients to
sex therapists.
4. Management of sexual
problems may be behavioral,
medical, or surgical.
 PARAPHILIAS

Paraphilias involve the preferential use of

unusual objects of sexual desire or
engagement in unusual sexual activity To fit
DSM-IV-TR criteria, the behavior
must continue over a period of at least 6
months and cause impairment in
occupational or social functioning.
 Sexual Paraphilia The Preferential Means of Obtaining Sexual
Pleasure is By

Exhibitionism Revealing one’s genitals to unsuspecting women so

that they will be shocked

Fetishism Contact with inanimate objects (e.g., women’s shoes,

rubber sheets)

Transvestic fetishism Wearing women’s clothing, particularly

underclothing (exclusive to heterosexual men)
Frotteurism Rubbing the penis against a clothed woman who is
not consenting and not aware (e.g., on a crowded
train)
Necrophilia Engaging in sexual activity with corpses

Pedophilia Engaging in fantasies or actual behaviors with

children under age 14 yrs, of the opposite or
same sex; is the most common paraphilia
Sexual masochism Receiving physical pain or humiliation

Sexual sadism Giving physical pain or humiliation

Telephone scatologia Engaging unsuspecting women in telephone

conversations of a sexual nature (obscene phone calls)
Voyeurism Secretly watching other people (often by using
binoculars or cameras) undressing or engaging in
sexual activity
Sexual Paraphilias-Occurrence and
Management

1. Paraphilias occur almost exclusively in

men.

2. Pharmacologic management includes

anti-androgens and female sex hormones
for paraphilias that are characterized by
hypersexuality.
THANK YOU