Chapter 11 Disorders Involving Gender & Sexuality
Chapter 11 Disorders Involving Gender & Sexuality
Alice W. Cheng, Ph.D.
University of Hartford
Gender Identity Disorde
Gender identity - One’s psychological sense of being female or being male.
Gender identity disorder (GID) - A type of psychological disorder characterized by conflict between one’s anatomic sex and one’s gender identity.
Gender identity disorder (also refe
ed to as transsexualism) may begin in childhood.
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Gender Identity Disorde
Although the prevalence rate of GID is unknown, the disorder is certainly uncommon.
It is believed to occur about five times more often in boys than girls (Jones &Hill, 2002).
GID takes many paths. It can end by adolescence, with the child’s becoming more accepting of her or his gender identity, or it may persist into adolescence or adulthood
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Gender Identity Disorde
People who undergo sex-reassignment surgery can participate in sexual activity and even reach orgasm, but they cannot conceive or bear children because they lack the internal reproductive organs of their newly reconstructed sex.
Investigators generally find positive postoperative adjustment of transsexuals.
In one study, none of 20 adolescents who underwent sex reassignment surgery later expressed regrets (Smith et al., 2001).
In another recent survey, 85% of male-to-female transsexuals were able to achieve orgasm during sexual activity after reassignment surgery (Lawrence, 2005).
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Theoretical Perspectives
Psychodynamic theorists point to extremely close mother–son relationships, empty relationships with parents, and fathers who were absent or detached (Stoller, 1969).
These family circumstances may foster strong identification with the mother in young males, leading to a reversal of expected gender roles and identity.
Girls with weak, ineffectual mothers and strong masculine fathers may overly identify with their fathers and develop a psychological sense of themselves as “little men.”
GID may develop as the result of an interaction in utero between the developing
ain and the release of male sex hormones (Dennis, 2004).
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The term sexual dysfunction refers to impairment either in
The desire for sexual gratification
The ability to achieve it
The human sexual response has four phases:
Desire phase
Excitement phase
Orgasm
Resolution
Sexual Dysfunctions
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Sexual Dysfunctions
Sexual dysfunctions - Persistent or recu
ent problems with sexual interest, arousal, or response.
Sexual dysfunctions may be classified according to two general categories, lifetime versus acquired and situational versus generalized.
Cases of sexual dysfunction that have existed for the individual’s lifetime are called lifetime dysfunctions.
In situational dysfunctions, the problems occur in some situations (for example, with one’s spouse), but not in others (for example, with a lover or when mastu
ating), or at some times but not others.
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Types Sexual Disorders
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Types of Sexual Dysfunctions
The DSM-IV-TR groups most sexual dysfunctions within the following categories:
1. Sexual desire disorders
2. Sexual arousal disorders
3. Orgasm disorders
4. Sexual pain disorders
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Sexual Desire Disorders
Sexual desire disorders are distu
ances in sexual appetite or an aversion to genital sexual activity.
Hypoactive sexual desire disorder - Persistent or recu
ent lack of sexual interest or sexual fantasies.
Typically there is either a virtual or complete absence of sexual fantasies.
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Sexual Desire Disorders
Sexual aversion disorder - A type of sexual dysfunction characterized by aversion to, and avoidance, of genital sexual contact.
Female sexual arousal disorder - A type of sexual dysfunction in women involving difficulty becoming sexually aroused or lack of sexual excitement or pleasure during sexual activity.
Male erectile disorder - A sexual dysfunction in males characterized by difficulty in achieving or maintaining erection during sexual activity.
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Male erectile disorde
Effects half the male population on at least a temporary basis
May be based on
Anxiety about sexual performance
Physiological dysfunction
Female sexual arousal disorder is in
many ways the female counterpart of erectile disorde
Dysfunctions of Sexual Arousal
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Orgasmic Disorders
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An involuntary spasm of the muscles at the entrance of the vagina (not due to physical disorder) that prevents penetration and sexual intercourse is called vaginismus
Dyspareunia - Persistent or recu
ent pain experienced during or following sexual intercourse.
The pain cannot be explained fully by an underlying medical condition and so is believed to have a psychological component.
Dysfunctions Involving Sexual Pain
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Laumann, Paik and Rosen (1999).
Goal: assess prevalence and risk of experiencing sexual dysfunction
Across various social groups
Examine determinants and consequences of disorders
Sexual Dysfunction in the U.S.
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Analyzed data from an interview study of a national probability sample
1749 women
1410 men
Age 18 to 59
Laumann et al.: Sample
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7 dichotomous items assessing critical syptoms
Lacking desire for sex
Arousal difficulties
Inability achieving climax/ejaculation
Anxiety about sexual performance
Climax/ejaculation too rapid
Physical pain during intercourse
Sex not pleasurable
Sexual Dysfunction Indexed
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Sexual Dysfunction Prevalence
43% for women
31% for men
Social status (deteriorating) associated with dysfunction
Sexual trauma history strongly associated with sexual dysfunction
Sex dysfunction more prevalent than anxiety disorders, mood disorders or substance use disorders
Overall Results
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Male: reduced libido 30%, arousal problem 50%, erectile dysfunction 5% (age XXXXXXXXXX% (age 65+), premature ejaculation 15%, dyspareunia (painful sex) 5%, anorgasmic (delayed ejaculation)2%
Female: vaginal spasm 80%, arousal problem 60%, reduced libido 40%, anorgasmic 35%, dyspareunia 15%, orgasm too soon 10%
Sexual Dysfunction: Rates
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Psychological Perspectives
Physically or psychologically painful sexual experiences may lead the person to respond to sexual contact with anxiety rather than arousal or pleasure.
Conditioned anxiety resulting from a history of sexual trauma or rape plays a role in many women with sexual arousal disorder, sexual aversion disorder, orgasmic disorder, and vaginismus.
Women with problems becoming sexually aroused may ha
or deep-seated anger and resentment toward their partners.
Other psychologically based causes of sexual arousal disorder, especially in women, include guilt about sex and ineffective stimulation by the partner.
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Risk Factors: Biological
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Psychological disorders
Maladaptive cognitions (e.g., negative expectations)
Cultural factors
Lack of education regarding sexual function
Relationship problems & bad technique
Poor communication
Lack of physical attraction
Restricted sexual repertoire
Risk Factors: Psychosocial
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Sociocultural Perspectives
Investigators find a greater incidence of erectile dysfunction in cultures with more restrictive sexual attitudes toward premarital sex among females, toward sex in ma
iage, and toward extramarital sex.
Men in these cultures may be prone to develop sexual anxiety or guilt that interferes with sexual performance.
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Medications such as Viagra
Serious risks combined with nitrates
16 – 44% of men and up to 82% of postmenopausal women – no benefit
Firm erections and adequate lu
ication don’t necessarily lead to satisfying sexual relationship
Pills don’t teach communication skills
Sexual Dysfunction Treatment
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Evaluate, alleviate or minimize biologic risks
Medication if appropriate
Couples approach
Sensate focusing (get out of “orgasm is goal” mindset) for arousal/orgasmic disorders
Communication training and education– address myths, fears, ability to express needs
Sexual Dysfunction: Treatments
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Paraphilias
The word paraphilia was coined from the Greek roots para, meaning “to the side of,” and philos, meaning “loving.”
Paraphilias - Sexual deviations or types of sexual disorders in which the person experiences recu
ent sexual urges and sexually arousing fantasies involving nonhuman objects (such as articles of clothing), inappropriate or nonconsenting partners (for example, children), or situations producing humiliation or pain to oneself or one’s partner.
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Types of Paraphilias
Some paraphilias are relatively harmless and victimless.
Among these are fetishism and transvestic fetishism.
Others, such as exhibitionism, pedophilia, and voyeurism have unwilling victims.
A most harmful paraphilia is sexual sadism when acted out with a nonconsenting partner.
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Fetishism
Sadism and Masochism
Transvestism
Exhibitionism
Voyeurism
Frotteurism
Pedophilia
Common Varieties
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Zoophilia
Telephone scatologia
Apotemnophilia (the erotic interest in being or looking like an amputee)
Necrophilia
Coprophilia (sexual pleasure from feces)& Urophilia (sexual excitement is associated with the sight or thought of urine or urination)
Less Common Varieties
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Exhibitionism
Exhibitionism - A type of paraphilia almost exclusively occu
ing in males, in which the man experiences persistent and recu
ent sexual urges and sexually arousing fantasies involving the exposure of his genitals to a stranger and either has acted upon these urges or feels strongly distressed by them.
The person may mastu
ate while fantasizing about or actually exposing himself (almost all cases involve men).
The victims are almost always women.
Relatively few cases are reported to the police.
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Fetishism
The French word fétiche is thought to derive from the Portuguese feitico, refe
ing to a “magic charm.”
In this case, the “magic” lies in the object’s ability to arouse sexually.
Fetishism - A type of paraphilia in which a person uses an inanimate object as a focus of sexual interest and as a source of arousal.
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Transvestic Fetishism
Transvestic fetishism - type of paraphilia in heterosexual males involving sexual urges and sexually arousing fantasies involving dressing in female clothing. Also termed transvestism.
Although other men with fetishes can be satisfied by handling objects such as women’s clothing while they mastu
ate; transvestite men want to wear them.
They may wear full feminine attire and makeup or favor one particular article of clothing, such as women’s stockings.
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Voyeurism
Voyeurism - A type of paraphilia involving sexual urges and sexually arousing fantasies focused on acts of watching unsuspecting others who are naked, in the act of undressing, or engaging in sexual activity.
The voyeur usually mastu
ates while watching or while fantasizing about watching.
Peeping may be the voyeur’s only sexual outlet. Some people engage in voyeuristic acts in which they place themselves in risky situations.
The prospects of being discovered or injured apparently heighten their excitement.
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Frotteurism
The French word frottage refers to the artistic technique of making a drawing by ru
ing against a raised object.
Frotteurism - A type of paraphilia involving sexual urges or sexually arousing fantasies involving bumping and ru
ing against nonconsenting persons for sexual gratification.
Frotteurism, also called “mashing,” often occurs in crowded places, such as subway cars, buses, or elevators.
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Pedophilia
The word pedophilia derives from the Greek paidos, meaning “child.”
Pedophilia - A type of paraphilia involving sexual attraction to children.
To be diagnosed with pedophilia, the person must be at least 16 years of age and at least 5 years older than the child or children toward whom the person is sexually attracted or has victimized.
In some cases of pedophilia, the person is attracted only to children. In other cases, the person is attracted to adults as well.
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Effects of Sexual Abuse on Children
An estimated 50,000 children in the United States suffer sexual abuse each year (Villarosa, 2002).
The typical abuser is not the prove
ial stranger lurking in the shadows, but a relative or step-relative of the child, a family friend, or a neighbor—someone who has held and then abused the child’s trust.
Sexual abuse can inflict great psychological harm, whether it is perpetrated by a family member, acquaintance, or stranger.
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Effects of Sexual Abuse on Children
The effects of childhood sexual abuse tend to be