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Sexuality Related Disorders

Anna Josefina Vazquez-Genuino, MD


Psychiatry
2008
What is the lecture about?

Overview of Sexuality in terms of:


Biological
Psychodynamic
Behavioral
Sociocultural

Disorders related to Sexuality


What is the lecture about?

Human Sexual Response Cycle

Sexual Dysfunctions

Sexual Disorders and Paraphilias


What is Human Sexuality?

What do you know?


Human Sexuality

Determined by anatomy, physiology,


psychology, culture and religion in
which one lives, one’s relationship with
others, and developmental
experiences throughout the life cycle
Normal Sexuality
Feelings of desire, behavior, that brings
pleasure to oneself and partner

Stimulation of the primary sex organs


including coitus
Normal Sexuality

Devoid of inappropriate feelings of


guilt or anxiety

Not compulsive
Biological Perspective

Substances that increase dopamine


increase desire

Substances that increase serotonin


decrease desire

Testosterone increases libido in men


and women
Biological Perspective

Estrogen may increase woman’s


sensitivity to stimulation

Progesterone, and excessive levels of


prolactin and cortisol depresses
desire

Oxytocin involve in pleasurable


sensations during sex
Biological Perspective

Genetic and biological components


may contribute to sexual orientation
Psychoanalytic Perspective

Any problems with the development


in psychosexual stages of
development would explain the
sexual symptoms
Behavioral Perspective

Varied ranges of sexual behaviors


are seen in both heterosexuals and
homosexuals
Sociocultural Perspective

Religious values on virginity and


sexual chastity

Cultural values are changing with


regards to sexual behaviors
Psychosexual Factors
Sexual Identity

Gender Identity

Sexual Orientation

Sexual Behavior
Sexual Identity

Female XX genotype

Male XY genotype
Sexual Identity Disorders

XXY Klinefelter’s Syndrome

XO Infertile female

Pseudohermaphrodite
Gender Identity

By 2 to 3 years
old, “I am male”
or “I am female”
Gender Identity

Psychological aspects
of behavior related to
masculinity and
femininity
Gender Identity

Gender role behavior


refers to all things
that disclose the
person is male or
female
Gender IdentityDisorder

Strong & persistent cross-gender Id


Persistent Discomfot with Own Sex
Assignment or Sense of
Inappropriateness in Gender Role of
that Sex
R/O Intersex Condition
Causes Clin Sig Distress or Impaired
Funct
Gender IdentityDisorder

In Child
Repeated Stated Desire to Be or Insist
He is of the Other Sex i.e. Grow up to
be of Opp Sex
Cross- Dress/ Sex Roles- Play, Fantasy
Intense Desire Participate Stereotypical
Games & Pastimes- Opp Sex
Strongly Prefer Playmates of Opp Sex
Gender IdentityDisorder

In Boys: Genitals Disgusting, Will


Disappear Later, Better w/o, Aversion
to Rough & Tumble, Reject Toys,
Games, Activities,

In Girls: Reject Urinating in Sitting , Will


Grow a Penis, Doesn’t Want Breasts/
Mens, Aversion to Dress
Gender Identity Disorder
In Adol & Adult
Born w/ the Wrong Sex
Freq Passing, Desire to Live & Be
Treated as Other Sex
Conviction that He/ She has Typical
Flgs & Rxns of Other Sex
Gender Identity Disorders
In Adol & Adult: TRANSSEXUAL
Freq Request Medical / Surgical Proced
to Alter Physical Appearance
Persistent Preoccupation w/ Getting Rid
of 1ry & 2ndry Sex Char & Acquiring
Sex Char of Opp Sex
Gender Identity Disorders
DIFFERENTIAL DX
Assoc w/ other Psych Dx: Schiz,
Affective, Transvestic Fetishism, PD
Tomboys, Gay- no cross gender ID, no
discontent w/ Sex
Anatomical Intersex Condition
Gender Identity Disorders
ANATOMICAL INTERSEX CONDITION
Congenital Virilizing Adrenal
Hyperplasia- XX
Androgen Insensitivity Syndrome -XY
Turner’s Syndrome - X
Klinfelter’s Syndrome - XXY
5- a Reductase Deficiency
Pseudohermaphroditism
GENDER IDENTITY DISORDER

TREATMENT
In Child: Cope w/ Anatomical Birth
Sex, Dev Social Skills
In Adol: Supportive PsychoTx, Family
Tx & Educ, Cross –Sex Hormones 
Body Changes
In Adult: Hormonal & Surgical Sex
Reassignment
Sexual Orientation

Heterosexual

Homosexual

Bisexual
Sexual Orientation Disorder

Ego-Dystonic Homosexuality

Dissatisfaction w/ Sex Arousal Pattern


Desire to Inc Heterosex Arousal
Strong Neg Flgs Re Being Homosexual
Sexual Behavior

Sexual response =
psychophysiological experience

Human Sexual Response Cycle


What do you know about sex?

Human Sexual Response Cycle


Human Sexual
Response Cycle

Phase I: Desire

Phase II: Excitement

Phase III: Orgasm

Phase IV: Resolution


Sexual Dysfunctions

Sexual Desire Disorders

Hypoactive Sexual Desire Disorder

Sexual Aversion Disorder


Sexual Dysfunctions

Sexual Arousal
disorders

Female Arousal disorder

Male Erectile disorder


Sexual Dysfunctions
Orgasm disorders

Female Orgasm disorders


(Anorgasmia)

Male Orgasmic disorders (retarded


orgasm)

Premature ejaculation
Sexual Dysfunctions

Orgasm disorders

Multiple spontaneous orgasm of


women taking antidepressants when
they yawn
Sexual Dysfunctions NOS
Female Premature Orgasm

Postcoital Headache

Orgasmic Anhedonia

Masturbatory Pain
SEXUAL DYSFUNCTION DUE TO
GENERAL MEDICAL CONDITION
Male Erectile D Due to GMC
Infections, CVD, Renal, Hep, Pulmo,
Endoc, Neuro, Nutritional- Obesity, Rx-
Alc, Pb Poisoning, RadioTx, Surgery
SEXUAL DYSFUNCTION DUE TO
GENERAL MEDICAL CONDITION
Hypoactive Sexual Desire Due to GMC

Surgery Affecting Body Image


Mastectomy, Ileostomy, Hysterectomy, Prostatectomy
Illness Deplete Energy
Drugs Dec Testosterone
SEXUAL DYSFUNCTION DUE TO
GENERAL MEDICAL CONDITION
Male Orgasmic D  S/P Genitourinary
Tract Surgery
Retarded Ejaculation  Anti HPN Rx,
Methyldopa, SSRI
Retrograde Ejaculation  GUT Surg, Rx
w/ Anticholinergic Side Effects e.g
phenothiazine like Thioridazine
SEXUAL DYSFUNCTION DUE TO
GENERAL MEDICAL CONDITION
Female Orgasmic D

Med Condtion: Endoc- Hypothyroidism,


DM, 1ry Hyperprolactinemia
Rx: Anti HPN, CNS stim, SSRI, MAOInh,
SEXUAL DYSFUNCTION
INDUCED BY SUBSTANCES
Substance Intox or W/drawal

Alc, Cocaine, Opioids, Hallucinogen,


Cannabis, Barbiturates
Sed, Hyp, Anxiolytic, Antipsychotic,
AntiDep, Li, Anticholinergics, AntiHist,
A –adrenergic & B –adrenergic Receptor
Antagonist
Sexual Pain Disorders
Dyspareunia

Painful coitus due to tension and


anxiety about sex act-- involuntary
contraction of vaginal muscles
Sexual Pain Disorders
Dyspareunia

Dyspareunia in men - uncommon


& usu assoc with a medical
condition e.g. herpes, prostatitis
or Peyronie’s disease (sclerotic
plaques on penis-- penile
curvature)
Sexual Pain Disorders

Dyspareunia

Chronic pelvic pain- common


complaint of women with hx of rape or
childhood sexual abuse

Often related and coincides with


vaginismus
Sexual Pain disorders
Vaginismus
Involuntary muscle contraction
of the outer third of the vagina
that interferes with penile
insertion and intercourse

No other mental illness


Sexual Pain disorders
Vaginismus
Seen in highly educated women
in high socioeconomic groups

May consciously wish to have


coitus but unconsciously wish to
keep a penis from entering their
bodies
TREATMENT OF SEXUAL
DYSFUNCTION
Dual Sex Tx
Analytically Oriented Sex Tx
HypnoTx
Behavior Tx
Group Tx
Rx- sildenafil (Viagra), Hormone,
AntiAdrogens, Anti Estrogens
TREATMENT OF SEXUAL
DYSFUNCTION
Mechanical Tx Approaches
Vacuum Pump

Surgical Tx
Male Prosthesis
Vascular Surgery
Paraphilias & Other Sexual
Disorders NOS

Paraphilias
Greek words meaning “other
side of” and “love”
unusual sexual fantasies,
urges or behaviors that are
recurrent and sexually
arousing
Paraphilias

Exhibitionism

Fetishism

Transvestic Fetishism

Frotteurism
Paraphilias

Pedophilia
Sexual Masochism

Sexual Sadism
Voyeurism
Paraphilias NOS
Masturbation
Necrophilia
Partialism
Zoophilia
Coprophilia & Klismaphilia
Urophilia
Hypoxyphilia
PARAPHILIA
TREATMENT

Self Help Groups


PsychoTx – Supportive, Insight
Oriented
Cognitive Behavior Tx
Marital or Couples Tx
Rx- SSRI, Antiadrongen
Sexual Disorders NOS
Couple Problems
Unconsummated Marriage

Postcoital Dysphoria:
Depressed, Tense, Anxious,
Irritable, Agitation
Want to Get Away from Partner
Verbally, Physically Abusive
Sexual Disorders NOS
Sex Addiction & Compulsivity
Cant Control Sex Impulse
Entire Life Revolve Sex Seeking Fantasy,
Bvr & Activities
-/ + Guilt – Not Enough to Stop
Tries Stop - Cant b/c Sex Deprive 
Distress
Interfere w/ Funct
Summary

Overview of Sexuality in terms of:


Biological
Psychodynamic
Behavioral
Sociocultural

Disorders related to Sexuality


Summary

Human Sexual Response Cycle

Sexual Dysfunctions

Sexual Disorders and Paraphilias