Chapter 12 -- Sexual Disorders

I. Gender and Sexuality

A. Men think more about sex and want more sex than women do
B. Men have more sexual dysfunction as they age
C. Women's desire for sex is more often linked to relationship status and social norms than men’s desire is
D. Women are more likely to report sexual dysfunction

II. Sexual Response Cycle

A.Desire - Thoughts and fantasies
B. Excitement - Experience of blood flow to genitals that is pleasurable
C. Orgasm - Pleasurable muscular contractions in genitals that discharge sexual tension
D. Resolution - Relaxation and release of oxytocin, prolactin, and endorphins

III. Sexual Dysfunctions

A. 43% of women and 31% of men reported dysfunctions with desire, arousal, and orgasm that were distressing
B. 20% of women and 10% of men received help
C. Hypoactive Sexual Desire Disorder in men - persistently deficient or absent sexual fantasies and desires
D. Sexual Interest/Arousal Disorder in women - diminished or absent frequency of 3 of the following for 6 months:
1. Interest in sexual activity
2. Sexual thourghts
3. Initiation or responsiveness to sex
4. Sexual excitement or pleasure during 75% of sexual encounters
5. Sexual interest elicited by erotic cues
6. Genital sensations during 75% of sexual encounters
E. Erectile Disorder - Inabilty to attain or maintain an erection during 75% of sexual occasions for 6 months
F. Female Orgasmic Disorder - Delay or absence of orgasm 75% of sexual occasions for 6 months
G. Early Ejaculation - Within 1 minute 75% of sexual occasions for 6 months
H. Delayed Ejaculation - Delayed, infrequent, or absence of orgasm 75% of sexual occasions for 6 months
I. Genito-pelvic pain/penetration disorder - Persistent difficulties for 6 months with one of the following:
Inability to have vaginal intercourse; marked pain during penetration; marked fear of penetration; marked tensing of the pelvic floor muscles during penetration

IV. Etiology of Dysfunctions

A.Biological Factors
1. Diseases of vascular or nervous system
2. Low testosterone or estrogen
3. Heavy alcohol or cigarette use
4. Anti-hypertensives and anti-depressants
B. Psychosocial Factors
1. Sexual abuse or assault
2. Relationship problems
3. Psychological disorders
4. Stress and exhaustion
5. Negative cognitions

V. Treatment of Sexual Dysfunctions

A. Psychological
1. Sexual history questionnaires
2. Education about body parts and functions
3. Alter cognitions that inhibit desire
4. Directed masturbation in steps to achieve orgasm alone
5. Sensate focus - Progression from nonsexual touching to genital stimulation and intercourse over a number of days
6. Squeeze technique or interruption of stimulation for early ejaculation
B. Biological
1. Medical exams and psychophysiological assessment
2. Medication (Viagra, Cialis, Levitra) given or withdrawn

VI. Paraphilias

A. Recurrent sexual attraction to unusual objects or activities for at least 6 months
B. Causes marked distress or done without consent
C. Fetishistic Disorder - reliance on an object or unsexual body part for sexual arousal
D. Pedohebephilic Disorder - sexual urges, behaviors, or contact with a child where offender is at least 18 and 5 years older than the victim
E. Voyeuristic Disorder - sexually arousing fantasies or behaviors while observing others who are unclothed or engaged in sexual activity
F. Exhibitionistic Disorder - exposure of genitals to unwilling strangers for sexual gratification
G. Frotteuristic Disorder - sexual touching of a nonconsenting person
H. Sexual Sadism Disorder - desire to gain sexual gratification by inflicting pain on another person
I . Sexual Masochism Disorder - desire to gain sexual gratification through receiving pain or humiliation

VII. Etiology of Paraphilias

A.Neurobiological factors - no evidence of unusually high male hormones
B. Classical conditioning does not appear to explain behavior based on current evidence
C. History of physical and sexual abuse is three times greater for sexual offenders
D. Poor social skills are related to pedohebephilic disorder
E. Alcohol and negative affect are triggers
F. Cognitive distortions are common

VIII. Treatment of Paraphilias