Sexual

1
Sexual Gender Identity Disorders

• Not Sexual Abuse - Child or Adult
• Nor Relational Problems

2
Disorders

• Sexual Dysfunctions
• Paraphilias
• Gender Identity Disorders

3
Sexuality

• A most uncomfortable topic
• for beginning counselors
• Next to death
• the most shunned topic in society
• Males
• Less likely to discuss sexual problems
• Females
• Less likely to recognize problems

4
Sexual Dysfunctions

• Typified by inhibitions
• in appetite or psychophysiological changes
  characterizing sexual response cycle
• Must cause marked distress or interpersonal
  difficulty
• Must be both recurrent persistent, although
  some dysfunctions may be short-lived or episodic
• Divided as related to
• Sexual desire
• Sexual arousal
• Orgasm
• Sexual pain

5
Diagnosis of Sexual Dysfunction

• Depends on
• Extent to which it troubles client
• Clinician's judgment
• Adequacy of sexual stimulation
• Sometimes multiple sexual dysfunctions diagnosable

• Desire, arousal, orgasm problems
• correspond to 3 phases of 4 in sexual response
  cycle
• Appetitive/desire
• Excitement
• Orgasm
• Resolution

6
Sexual Disorders

• Hypoactive Sexual Desire disorder
• Sexual Aversion disorder
• Sexual Arousal disorders
• Female Sexual Arousal Disorder
• Male Erectile disorder
• Orgasmic disorder
• Female Orgasmic Disorder
• Male Orgasmic Disorder
• Premature Ejaculation Disorder

7
More Sexual Disorders

• Sexual pain disorders
• Dyspareunia (Not due to GMC)
• Recurrent or persistent genital pain associated
  with sexual intercourse
• Either male or female
• Not caused exclusively by Vaginismus or lack of
  lubrication
• Associated with marital disturbance avoidance
  of sexual situations
• Vaginismus (not to GMC)involuntary spasm of
  muscles
• May include some secual function but not
  intromission
• Could involve past traumaa
• Or young age
• Could also happen with other insertions, tampon,
  etc.
• Sexual Dysfunction due to GMC
• Substance-Induced Sexual Dysfunction
• Sexual Dsyfunction NOS

8
Subtypes Associated Features

• Lifelong vs acquired
• Generalized versus situational
• Due to psychological factors vs to combined
  factors

• Often occur
• with or focus on interpersonal relationship
  problems
• With depression, anxiety, or somatic symptoms
• Anxiety excessively high subjective standards
  for performance

9
Age Cultural Factors

• Advancing age may equal decreased functioning
• Family values stereotypes may play a role
• If Axis I Dx primary cause of sexual problems, do
  not diagnosis sexual dysfunction
• Negative attitudes toward sexuality
• Past experiences
• Internal conflicts
• Inadequate education
• Rigid cultural values
• Severe mental disorders

10
Treatment

• Need extensive training FL licensing law
• Ethics presents referral to expert
• Sexual therapists highly trained know ethics
• Not uncommon to see more than 1 therapist
• Higher rate of success for some sexual
  especially sexual pain disorders

• Concept of accepting responsibility to make
  changes (Adlerian theory)
• Behavior modification, psychotherapy medication
  from Masters Johnson early work
• Meds
• Anti-anxiety agents
• Tricyclic antidepressants to prolong sexual
  response for premature ejaculation
• Meds to Improve sexual desire
• VIAGRA others what must be present
• Testosterone to affect libido for low sexual
  desire

11
Paraphilias

• Conditions in which sexual instincts are
  expressed
• socially prohibited
• unacceptable or
• biologically undesirable
• Sexual arousal is
• In response to sexual objects or situations
• not part of normative arousal-activity patterns
• Essential unusual or bizarre imagery or acts
  necessary fro arousal

12
Pharaphilias acts

• Involve
• Preference for nonhuman objects
• Repetitive activity
• with humans involving real or simulated
  suffering or humiliation
• with nonconsenting partners, statistically
  male-related may have legal significance

• Impairment to being involved in reciprocal
  affectionate relationships
• Psychosexual dysfunctions common
• Often antisocial people
• if behavior is destructive exploitive
• Virtually all reported cases (except SM) are
  males

13
Pharaphilias Needed to achieve sexual excitement

• Exhibitionism
• repetitive act of exposing genitals to
  unsuspecting stranger
• Fetishism
• preferred or exclusive use of nonliving objects
• Frotteurism
• involves touching rubbing nonconsenting person

• Pedophilia
• recurrent, intense, sexual urges sexually
  arousing fantasies
• Involves sexual activity with prepubescent child
• Zoophilia
• use of animals
• Necrophilia
• intercourse with the dead

14
More Paraphilias

• Sexual Sadism
• sexually aroused through infliction of physical
  or psychological suffering on another person
• Must prevail
• Either inflicting suffering on nonconsenting
  partner
• OR With consenting partner, but use of
  humiliation or mild injury
• Or Body injure extensive, permanent, or possibly
  mortal on consenting partner

• Sexual Masochism preferred mode
• beaten, humiliated, bound, or made to suffer
  often participates intentionally in physical harm
  or life threats
• Transvestic Fetishis
• involves cross dressing
• Voyeurism
• repeated viewing of unsuspected people who are
  naked, disrobing, or engaging in sexual activity
• Enjoy thinking of observed as helpless
  humiliated if known seen
• Visual types who may not go beyond showing
  looking

15
Treatment of Paraphilias

• Treatment sought due to negative consequences
• Difficult to treat
• Lack of dysphoria
• High physical gratification
• Prognosis depends on
• Age of onset
• Frequency
• Concurrent substance abuse
• Feelings of guilt or shame
• Outlook best if normal intercourse experienced in
  past
• Outlook good if high motivation to change

• Treatment success rates low
• Psychotherapy alone not usually productive
• Medication therapy together
• Must be therapeutic not punitive
• Many behavior therapies
• Cognitive on faulty beliefs
• Interpretation of childs docility as desire
• Relaxation training
• Group therapy
• Virtually no literature

16
Gender Identity Disorders

• Characterized by feelings of discomfort
• about anatomic sex
• Not same as transvestite
• Code based on current age
• Sufficiently strong persistent cross-gender
  identification
• that one desires to be, or believes one should
  be, a member of opposite sex

17
GID

• Clinically significant distress or impairment in
  social/occupational
• Feeling of discomfort or inappropriateness with
  current sex or sex role
• In children
• strong preference for behaviors activities
  related to opposite sex while avoiding those of
  own sex
• What about tomboys? Others?

• Adults function in opposite-sex role whenever
  possible often alter bodies
• Hormonal treatment
• Surgery
• Including genital-change procedures
• Specify if (for sexually mature individuals)
• Sexually attracted to males
• Sexually attracted to females
• Sexually attracted to both
• Sexually attracted to neither

18
Other features

• Associated features
• Social problems or ostracism, often begun in
  childhood
• Males sometimes have childhood memories of parent
  encouraging cute dressing mimicking female
  mannerisms
• Course
• Most children not continue all criteria as adults
• Although 75 describe homo/bisexual gender
  preference in late adolescence or adulthood

• Differential Diagnosis
• Change in sex solely for perceived
  social/cultural advantage nonconformity
• Chromosomal or congenital abnormality not
  diagnosed here
• No psychotic symptoms to support
• Some men meet both GID Transvestic Fetishism
• could be comorbid yet most do not meet TF