• Sexual Dysfunctions
• Paraphilias
• Sexual Identity Disorder
Sexual Dysfunctions
• Four Primary Categories
– Sexual Desire Disorders
– Sexual Arousal Disorders
– Orgasmic Disorders
– Sexual Pain Disorders
• Can Be Lifelong vs. Acquired
• Generalized vs. Situational
• Due to Psychological Factors vs. Combined
Sexual Desire Disorders
• Hypoactive Sexual Desire Disorder
– Persistently or Recurrently Low or Absent Sexual Interest in and
Desire for Sexual Activity
– Little or No Sexual Fantasy
– Causes Distress to the Individual or Relationship
– Not Better Accounted for by Some Other Axis I Disorder or a Medical
Condition
– Distinguished From Desire Discrepancy
• Sexual Aversion Disorder
– Extreme Aversion to All Genital Sexual Contact
Sexual Arousal Disorders
• Male Erectile Disorder
• Female Sexual Arousal Disorder
Male Erectile Disorder
• Persistent or Recurrent Difficulty Obtaining or Maintaining
Erection Sufficient for Intercourse Male Erectile Disorder
• Causes Distress for the Individual or Relationship (Usually
Both)
– Often Tied to Self-Esteem, Depression, Performance Anxiety
• Increases With Age (> 50% by 70)
• Many Fail to Seek Treatment
• Can Be Secondary to PE
• Etiology of Male Erectile Disorder
– Medical
• Diseases (diabetes, prostate problems)
• Medications (antidepressants, anti- hypertensives)
• Treatments (prostate surgery, dialyses)
– Psychological
• Depression
• Anxiety (including performance anxiety
– Relationship
• Anger
• Loss of sexual interest
Female Sexual Arousal Disorder
• Persistent or Recurrent Inability to Attain/Maintain Adequate
Lubrication-Swelling
• Causes Distress to the Individual or Relationship
• Can Be Secondary to Orgasmic Dysfunction
• Poor Partner Technique Can Play a Role
• Attitudes, Beliefs, Expectations Can Impact
• Feelings Toward Partner May Be Involved
Orgasmic Disorders
• Male/Female Orgasmic Disorder
– Persistent or Recurrent Delay in, or Absence of, Orgasm Following
Adequate Stimulation and a Normal Sexual Excitement Phase
– Distress…: Not Better Accounted for…
• Premature Ejaculation
– Persistent or Recurrent Ejaculation With Minimal Sexual Stimulation
Before, or Soon After Penetration and Before Person Wishes it
– Distress…Not Due to Drugs
Sexual Pain Disorders
• Dyspareunia
– Recurrent or Persistent Genital Pain Associated With Sexual
Intercourse (Male or Female)
– Causes Marked Distress…
– Not Caused Exclusively by Vaginismus, Lack of Lubrication, or Other
Axis I Disorder
• Vaginismus
– Recurrent or Persistent Involuntary Spasm of Vaginal Muscles
Interfering With Intercourse
– Distress…: Not Better Accounted for...
Causes of Sexual Dysfunction
• Medical: Hormonal, Vascular, Neurological
– Diseases
• e.g., Diabetes, MS
– Medications/Treatments
• Antidepressants, Anti-hypertensives, Prostatectomy, Hysterectomy
• Poor Technique
• Relationship Problems
– Anger
– Loss of Sexual Interest in Partner
– Poor Communication
Causes of Sexual Dysfunctions (cont.)
• Emotional Problems
– Fear, Anxiety, or Depression
– Performance Anxiety
• Developmental Problems
– Physical/Sexual Abuse; Negative Messages
Treatment of Sexual Dysfunctions
• Usually Couple-Oriented
• Education
– Learning What’s Normal
• Communication
– Learn About Each Other (e.g., Desires/Fears)
• Cognitive Therapy
– Identifying and Challenging Irrational Beliefs
• Behavioral Techniques
– Sensate Focus
• Medication
Paraphilias
• Recurrent, Intense Sexually Arousing Fantasies, Sexual Urges,
or Behaviors Generally Involving:
– Nonhuman Objects
– Own or Partner’s Suffering or Humiliation
– Children or Other Nonconsenting Persons
• Occurring Over a Period of at Least 6 Months
• Lead to Significant Distress or Impairment
– e.g., Are Obligatory, Result in Impairment, Legal or Relationship
Problems
Types of Paraphilias
• Exhibitionism
– Intense Sexually Arousing Fantasies, Urges, or Behaviors Involving
Exposure of One’s Genitals to an Unsuspecting Stranger
• Fetishism
– …Involving the Use of Nonliving Objects
• Female Undergarments, Shoes, Leather
• Frotteurism
– …Involving Touching and Rubbing Against a Nonconsenting Person
• Pedophilia
– Intense Sexual Urges, Fantasies, Behaviors Involving Sexual Activity
With a Prepubescent Child or Children (Usually 13 or Younger)
– Person is at Least 16 Years and at Least 5 Years Older Than the Child
• Sexual Masochism
– Intense Sexual Urges, Fantasies, Behaviors Involving the Act (Real,
Not Simulated) of Being Humiliated, Bound, Beaten, Made to Suffer
• Sexual Sadism
– …Involving the Psychological or Physical Suffering of Another
• Transvestic Fetishism
– Intense Sexual Urges, Fantasies, Behaviors Involving Cross-Dressing
Treatment of Paraphilias
• Does It Always Require Treatment?
• Psychotherapy
– Psychodynamic
– Cognitive
• Wants vs. Needs
– Behavioral
• Aversion Therapy
• Orgasmic Reorientation
– Relapse Prevention
Gender Identity Disorder
• Feel “Trapped” in the Wrong Body
• Also Called Transexualism
• M to F vs. F to M = 2:1
• vs. Transvestism
• Much More Common in Childhood
• Both Biology and Learning Implicated
• Treatment is Controversial
– Psychotherapy vs. Hormones + Surgery
• Paraphilias
• Sexual Identity Disorder
Sexual Dysfunctions
• Four Primary Categories
– Sexual Desire Disorders
– Sexual Arousal Disorders
– Orgasmic Disorders
– Sexual Pain Disorders
• Can Be Lifelong vs. Acquired
• Generalized vs. Situational
• Due to Psychological Factors vs. Combined
Sexual Desire Disorders
• Hypoactive Sexual Desire Disorder
– Persistently or Recurrently Low or Absent Sexual Interest in and
Desire for Sexual Activity
– Little or No Sexual Fantasy
– Causes Distress to the Individual or Relationship
– Not Better Accounted for by Some Other Axis I Disorder or a Medical
Condition
– Distinguished From Desire Discrepancy
• Sexual Aversion Disorder
– Extreme Aversion to All Genital Sexual Contact
Sexual Arousal Disorders
• Male Erectile Disorder
• Female Sexual Arousal Disorder
Male Erectile Disorder
• Persistent or Recurrent Difficulty Obtaining or Maintaining
Erection Sufficient for Intercourse Male Erectile Disorder
• Causes Distress for the Individual or Relationship (Usually
Both)
– Often Tied to Self-Esteem, Depression, Performance Anxiety
• Increases With Age (> 50% by 70)
• Many Fail to Seek Treatment
• Can Be Secondary to PE
• Etiology of Male Erectile Disorder
– Medical
• Diseases (diabetes, prostate problems)
• Medications (antidepressants, anti- hypertensives)
• Treatments (prostate surgery, dialyses)
– Psychological
• Depression
• Anxiety (including performance anxiety
– Relationship
• Anger
• Loss of sexual interest
Female Sexual Arousal Disorder
• Persistent or Recurrent Inability to Attain/Maintain Adequate
Lubrication-Swelling
• Causes Distress to the Individual or Relationship
• Can Be Secondary to Orgasmic Dysfunction
• Poor Partner Technique Can Play a Role
• Attitudes, Beliefs, Expectations Can Impact
• Feelings Toward Partner May Be Involved
Orgasmic Disorders
• Male/Female Orgasmic Disorder
– Persistent or Recurrent Delay in, or Absence of, Orgasm Following
Adequate Stimulation and a Normal Sexual Excitement Phase
– Distress…: Not Better Accounted for…
• Premature Ejaculation
– Persistent or Recurrent Ejaculation With Minimal Sexual Stimulation
Before, or Soon After Penetration and Before Person Wishes it
– Distress…Not Due to Drugs
Sexual Pain Disorders
• Dyspareunia
– Recurrent or Persistent Genital Pain Associated With Sexual
Intercourse (Male or Female)
– Causes Marked Distress…
– Not Caused Exclusively by Vaginismus, Lack of Lubrication, or Other
Axis I Disorder
• Vaginismus
– Recurrent or Persistent Involuntary Spasm of Vaginal Muscles
Interfering With Intercourse
– Distress…: Not Better Accounted for...
Causes of Sexual Dysfunction
• Medical: Hormonal, Vascular, Neurological
– Diseases
• e.g., Diabetes, MS
– Medications/Treatments
• Antidepressants, Anti-hypertensives, Prostatectomy, Hysterectomy
• Poor Technique
• Relationship Problems
– Anger
– Loss of Sexual Interest in Partner
– Poor Communication
Causes of Sexual Dysfunctions (cont.)
• Emotional Problems
– Fear, Anxiety, or Depression
– Performance Anxiety
• Developmental Problems
– Physical/Sexual Abuse; Negative Messages
Treatment of Sexual Dysfunctions
• Usually Couple-Oriented
• Education
– Learning What’s Normal
• Communication
– Learn About Each Other (e.g., Desires/Fears)
• Cognitive Therapy
– Identifying and Challenging Irrational Beliefs
• Behavioral Techniques
– Sensate Focus
• Medication
Paraphilias
• Recurrent, Intense Sexually Arousing Fantasies, Sexual Urges,
or Behaviors Generally Involving:
– Nonhuman Objects
– Own or Partner’s Suffering or Humiliation
– Children or Other Nonconsenting Persons
• Occurring Over a Period of at Least 6 Months
• Lead to Significant Distress or Impairment
– e.g., Are Obligatory, Result in Impairment, Legal or Relationship
Problems
Types of Paraphilias
• Exhibitionism
– Intense Sexually Arousing Fantasies, Urges, or Behaviors Involving
Exposure of One’s Genitals to an Unsuspecting Stranger
• Fetishism
– …Involving the Use of Nonliving Objects
• Female Undergarments, Shoes, Leather
• Frotteurism
– …Involving Touching and Rubbing Against a Nonconsenting Person
• Pedophilia
– Intense Sexual Urges, Fantasies, Behaviors Involving Sexual Activity
With a Prepubescent Child or Children (Usually 13 or Younger)
– Person is at Least 16 Years and at Least 5 Years Older Than the Child
• Sexual Masochism
– Intense Sexual Urges, Fantasies, Behaviors Involving the Act (Real,
Not Simulated) of Being Humiliated, Bound, Beaten, Made to Suffer
• Sexual Sadism
– …Involving the Psychological or Physical Suffering of Another
• Transvestic Fetishism
– Intense Sexual Urges, Fantasies, Behaviors Involving Cross-Dressing
Treatment of Paraphilias
• Does It Always Require Treatment?
• Psychotherapy
– Psychodynamic
– Cognitive
• Wants vs. Needs
– Behavioral
• Aversion Therapy
• Orgasmic Reorientation
– Relapse Prevention
Gender Identity Disorder
• Feel “Trapped” in the Wrong Body
• Also Called Transexualism
• M to F vs. F to M = 2:1
• vs. Transvestism
• Much More Common in Childhood
• Both Biology and Learning Implicated
• Treatment is Controversial
– Psychotherapy vs. Hormones + Surgery