SEXUAL DISORDERS
Concept of Sexuality
A central aspect of being human
throughout life encompasses sex, gender
identities and roles, sexual orientation,
eroticism, pleasure, intimacy and
reproduction.
Sexuality is influenced by the interaction
of biological, psychological, social,
economic, political, cultural, legal,
historical, religious and spiritual factors.”
(WHO, 2006)
Concept (Cont’d)
Sexuality is experienced and expressed
in thoughts, fantasies, desires, beliefs,
attitudes, values, behaviours, practices,
roles and relationships.
Sexual behavior is directed by a
complex interplay between hormone
actions in the brain that give rise to
sexual arousal and physical
experiences with a sexual reward.
Kaplan identified four phases in sexual
response cycle.
Desire phase. This stage refers to
sexual interest or desire, often associated
with sexually arousing fantasies or
thoughts.
Excitement phase. During this phase,
men and women experience pleasure and
increased blood flow to the genitalia.
Orgasm Phase. Sexual pleasure peaks.
Resolution phase. This last stage refers
to the relaxation and sense of well-being.
Sexual disorders
Sexuality is of the most personal area of
life.
Each of us is a sexual being with
preferences and fantasies
Usually these are part of normal sexual
functioning.
But when our fantasies or desire begin
to affect other in an unwanted or
harmful ways, they are termed
abnormal.
Two forms of sexual problems: Sexual
dysfunctioning and paraphilias.
Sexual dysfunction
Sexual dysfunctions are disorders in which
people cannot respond normally in key
areas of sexual functioning.
Sexual dysfunctions are distressing, and
often lead to sexual frustration, guilt, loss
of self- esteem, and interpersonal
problems.
The DSM-5 divide sexual dysfunctions into
three categories: those involving (1) sexual
desire, arousal, and interest; (2) orgasmic
disorder; and (3) sexual pain disorders.
Sexual dysfunction (Cont’d)
Sexual Interest, Desire and Arousal:
In women, refers to persistent deficits in
sexual interest (sexual fantasies or urges),
biological arousal or subjective arousal.
In men, hypoactive sexual desire disorder
refers to deficient or absent sexual
fantasies and urges, and erectile disorder
refers to failure to attain or maintain an
erection through completion of the sexual
activity.
Sexual dysfunction (Cont’d)
DSM-5 Criteria in Women Diminish, absent,
or reduced frequency of at least three of the
following for 6 months or more.
Interest in sexual activity
Sexual thoughts or fantasies
Initiation of sexual activity and
responsiveness to partner’s attempts to
initiate
Sexual excitement/pleasure during75
percent of sexual encounters
Sexual interest/arousal elicited by any
internal or external erotic cues
Genital or nongenital sensation during 75%
of sexual encounters.
Sexual dysfunction (Cont’d)
Orgasmic Disorders • Female
orgasmic disorder. Refers to the
persistent absence of orgasm after
sexual excitement.
Two orgasmic disorder for men:
• Early ejaculation disorder. Defined
by ejaculation that occurs too quickly.
• Delayed ejaculation disorder. Define
by persistent difficulty in ejaculating.
Cause of Sexual dyfxn
Biological Factor • e,.g atherosclerosis,
multiple sclerosis, and spinal cord injury;
low level of testosterone or estrogen; heavy
alcohol use before sex; chronic alcohol
dependence; and heavy cigarette smoking
Certain medication, such as antihypertensive
drugs and especially selective serotonin
reuptake inhibitor (SSRI) antidepressant drugs
like Prozac and Zoloft.
Among older men who develop erectile
dysfunction, vascular conditions often
involved.
Cause of Sexual dyfxn
Psychological Factors • Rape, childhood sexual
abuse, or other degrading encounters. •
Depression and anxiety increase the risk the
sexual dysfunctions.
Negative cognitions, such as worries about
pregnancy or AIDS.
Negative attitudes about sex, or concerns about
the partner, interfere with sexual functioning
Variability in sexual performance is common; a
stressful day, a distracting context, a relationship
concern, or any number of other issues may
diminish sexual response when it happens.
Management
Anxiety Reduction. Systematic desensitization
and vivo (real-life) desensitization, combine
with skills training. Psycho education about her
body.
Procedures to Change Attitudes and Thoughts.
Clients are encourage to focus on the pleasant
sensations that accompany even incipient
sexual arousal.
The sensate-focus exercises are way of helping
the person be more aware and comfortable
with sexual feelings.
Skills and Communication Training. Therapist
assign written materials and show clients
explicit videos demonstrating sexual
techniques.
Management
Early Ejaculation: The squeeze technique is
often used, in which a partner is trained to
squeeze the penis in the area where the head
and the shaft meet to rapidly reduce arousal.
Erectile Disorder. The most common
intervention for erectile disorder is a
phosphodiesterase type 5 (PDE-5) inhibitor,
such as sildenafil (Viagra), tadafil (Cialis), or
vardenafil (Levitra), these relax smooth
muscles & thereby allow blood to flow into
penis, creating an erection during sexual
stimulation but not in its absence.
Paraphilias
These are disorder in which arousing has
recurrent intense sexually involving, non
human object, children or other non-
consenting person and suffering or
humiliation of one’s self or partner.
The principal paraphilias in DSM-5 are:
Fetishism Disorder, Pedohebephilic Disorder,
Voyeuristic Disorder, Exhibitionistic
Disorder, Frotteutistic Disorder, Sexual
Sadism and Masochism Disorder.
Fetishistic Disorder
Fetishism: Sexual fascination with
nonliving objects or highly specific body
parts (partialism).
Fetishism are recurrent intense sexual
urges, sexually arousing fantasies
It’s common in men than women and
usually begins in adolescence.
Almost anything can be a fetish e.g
Women’s underwear, shoes, and boots
are especially common
Pedohebephilic Disorder
When adults derive sexual gratification
through sexual contact with pubescent
children or,
when they experience recurrent,
intense and distressing desire for
sexual contact with pubescent children.
Sexual activity with a child that is
prepubescent (usually 13 years old or
younger).
Pedohebephilic Disorder Criteria
Fantasies, urges, or behaviors relating to the
recurrent and intense sexual arousal from
prepubescent or pubescent children.
Equal or greater arousal from such children
than from physically mature individuals, over
a period of at least six months.
Effect on the Child:More disturbed behavior,
Lower self-esteem, Increased tendency for
depression, Increased tendency for anxiety
Voyeuristic Disorder
Voyeurism is the practice of observing
someone else nude or engaging in intimate
behaviors without that person's awareness of
what is going on. • Voyeurism typically begin
in adolescence. – The person may masturbate
during the act of observing or while
remembering it later – The risk of discovery
often adds to the excitement
Exhibitionistic Disorder • Exhibitionism is a
recurrent, intense desire to obtain sexual
gratification by exposing one’s genitalia to an
unwilling stranger, sometimes a child. • The
urge to expose seems overwhelming and
virtually uncontrollable to the exhibitionist
and is apparently trigger by anxiety and
restlessness as well as by sexual arousal.
Frotteuristic Disorder • Frotteurism involves
the sexually oriented touching of an
unsuspected person. • Almost always male,
the person fantasizes during the act that he is
having a caring relationship with the victim
Sexual Sadism and Masochism
Disorder
Sexual sadism is an intense and recurrent
desire to obtain or increase sexual gratification
by inflicting pain or psychological suffering on
another.
The physical or emotional suffering of another
person
Sexual masochism is an intense and recurrent
desire to obtain an intense sexual gratification
through being subjected to pain or humiliation.
Being humiliated, beaten, bound, or otherwise
suffering
Etiology of the Paraphilias
Neurobiological Factors there has
been speculation that
androgens(hormones like
testosterone) play a role.
Androgens regulate sexual desire, and
sexual desire appears to be typically
high among people with paraphilias
Etiology (Cont’d)
Psychological Factor emphasizing classical
conditioning as well as deficiencies in social
skills that make it difficult for the person to
interact normally with other adults.
There is limited support for behavioral risk
factors. Exposure to childhood sexual abuse
may be a risk factor. Alcohol use may
increase the odds acting on sexual urges.
Cognitive distortions appears to be involved.
Treatment for the Paraphilias
The most promising treatment for the paraphilias
are cognitive behavioral.
One conditioning procedure is to pair inappropriate
sexual object with aversive stimuli.
Approaches to improve social skills, empathy and
impulse control and to avoid relapse triggers, are
common.
Drugs that reduce testosterone but because of the
side effects, there are ethical issues involved in the
long-term use of these drugs. SSRI antidepressants
are commonly prescribe to reduce sexual drive of
men with paraphilias.
Strategies to Enhance Motivation
1.Empathize with the offender’s
reluctance to admit that he is an offender
and to seek treatment, thereby reducing
defensiveness and hostility.
2. Point out that treatment might help him
control his behavior better.
3. Emphasize that negative consequences
of refusing treatment (e.g. Transfer to less
attractive incarceration setting if the
person is already in custody) and offending
again (e.g., stiffer legal penalties.)
