Sexual Disorders and

Gender Identity Disorder

Chapter 13
Two General Categories
of Sexual Disorders
• Sexual Dysfunctions
• Problems with sexual responses
• Paraphilias
• Sexual urges and fantasies to
socially inappropriate objects or
situations
Gender Identity Disorder

• Sex-related disorder in which

people feel that they have been
assigned to the wrong sex.
Sexual Dysfunction

• Disorders in which people

cannot respond normally in key
areas of sexual functioning
• As many as 31% of men and 43%
of women in the US
Human Sexual Response
Cycle
• Desire
• Excitement
• Orgasm
• Resolution
Disorders of Desire

• Consists of urge to have sex,

sexual fantasies, and sexual
attraction to others
Hypoactive Sexual
Desire Disorder
• Lack of interest in sex and low
level of sexual activity
• Physical responses may be
normal
• 16% of men; 33% of women
Sexual Aversion
Disorder
• Total aversion to (disgust of)
sex
• Sexual advances may sicken,
repulse, or frighten
• Rare in men; more common in
women
Biological Causes

• Hormones can interact to

produce low sex drive
• Chronic illness, medications,
psychotropic medications,
number of illegal drugs
Psychological Causes

• General increase in anxiety or

anger
• Fear, attitudes, and memories
• Certain psychological disorders
(depression, OCD)
Sociocultural Causes

• Situational Stressors
• Divorce, death, job stress,
infertility
• Cultural standards
• Trauma of sexual molestation or
assault
Disorders of Excitement

• Excitement phase of sexual

response cycle is marked by
changes in heart rate, muscle
tension, blood pressure, and
respiration
• Men – erection of penis
• Women – clitoral swelling and
vaginal lubrication
Female Sexual Arousal
Disorder
• Formerly “frigidity”
• Repeated inability to maintain
proper lubrication or genital
swelling during sexual activity
• Desire and orgasmic disorders
often co-occur
• More than 10% of women
Male Erectile Disorder
(ED)
• Formerly “impotence”
• Characterized by repeated inability
to attain or maintain an adequate
erection during sexual activity
• About 10% of men
• According to surveys, half of adult
men experience erectile difficulty
during intercourse at least
sometimes
Causes of ED

• Interaction of biological,
psychological, and sociocultural
processes
Biological Causes

• Hormonal imbalances
• Vascular problems
• Damage to the nervous system
from various diseases, disorders,
injuries
• Medications and substances
•
Medical Diagnosing

• Biological causes
• Measure nocturnal penile
tumescence (NPT)
• Men typically have erections
during REM sleep; abnormal or
absent erections usually
indicate a physical basis for
erectile failure
Psychological Causes
• As many as 90% of men with severe
depression experience erectile
dysfunction
• Performance anxiety
• Spectator role
• Once ED has begun, men become fearful
and worried during sexual encounters
instead of being a participant, the man
becomes a spectator and judge – Fear of
Failure
Disorders of Orgasm

• During orgasm phase, an

individuals sexual pleasure
peaks and sexual tension is
released as the muscles in the
pelvic region contract
rhythmically
• For men – semen is ejaculated
• For women – the outer third of the
vaginal walls contract
Premature Ejaculation
• Persistent reaching of orgasm and
ejaculation with little sexual
stimulation
• Almost 30% of men experience at
some time
• Typical among young, sexually
inexperienced men
• May also be related to anxiety,
hurried masturbation experiences, or
poor recognition of arousal
Male Orgasmic Disorder

• Repeated inability to reach or a

very delayed orgasm after
normal sexual excitement
• 8% of male population
• Low testosterone, neurological
disease, head and spinal injury
• Medications (SSRIs)
• Performance Anxiety
Female Orgasmic
Disorder
• Persistent delay in or absence
of orgasm following normal
sexual excitement
• Almost 25% of women
• 10% or more have never reached
orgasm
• Additional 10% reach orgasm only
rarely
• Women who are more sexually
assertive and more comfortable with
masturbation tend to orgasm more
regularly
• Female orgasmic disorder appears
more commonly in single women
than married or cohabitating
• Orgasm is not necessary for normal
sexual functioning
Biological Causes

• Diabetes
• Multiple sclerosis
• Medications; illegal substances
• Postmenopausal changes
Psychological Causes

• Memories of childhood trauma

• Relationship distress
Disorders of Sexual Pain
Vaginismus
• Involuntary contractions of the muscles of
the outer third of the vagina
• Severe cases can prevent woman from
having intercourse
• About 20% of women have some
occasional pain with intercourse/ less than
1% experience vaginismus
• Most believe it is a learned fear response
• Anxiety, ignorance, trauma of unskilled partner,
sexual abuse
• Infection or disease may cause “rational”
vaginismus
Dyspareunia

• Severe pain in the genitals

during sexual activity
• Almost 15% of women and
about 3% of men
• In women usually has a physical
cause-usually injury sustained
in childbirth
Paraphilias

• Disorders characterized by unusual

fantasies and sexual urges or
behaviors that are recurrent and
sexually arousing
• Often involve:
• Humiliation of self or partner
• Children
• Nonconsenting people
• nonhumans
Fetishism

• Key features are recurrent intense

sexual urges, sexual arousing
fantasies, or behavior that involves
the use of a nonliving object
• Usually begins in adolescence
• Anything can be a fetish – women’s
underwear, shoes, boots
Transvestic Fetishism
• Cross dressing
• Fantasies, urges, or behaviors
involving dressing in clothes of the
opposite sex as a means of sexual
arousal
• Typical case is heterosexual male
who began cross dressing in
childhood or adolescence
• Often confused with gender identity
disorder (transsexualism)
Exhibitionism

• Flashing
• Arousal from the exposure of
genitals in a public setting
• Sexual contact is neither
initiated nor desired
• Generally begins before 18 and
is most common in males
Voyeurism
• Fantasies, urges, or behaviors
involving the act of observing an
unsuspecting person who is naked,
in the process of disrobing, or
engaging in sexual activity
• Person may masturbate during the
act of observing or while
remembering it later
• Risk of discovery often adds to the
excitement
• Seeking power
Frotteurism
• Person who develops has fantasies, urges,
or behaviors involving touching and
rubbing against a nonconsenting person
• Almost always male
• Person fantasizes during the act that they
are in a caring relationship with the person
• Usually begins as a teenager
• Generally decrease and disappear after 25
Pedophilia
• Fantasizes, urges, or behaviors involving a
sexual activity with a prepubescent child,
usually 13 years or younger
• Some people are satisfied with child
pornography; others are driven to
watching, fondling, or engaging in
intercourse with children
• Victims may be male; 2/3 are female
• Develops in adolescence
• Some were sexually abused as children
• Neglected, excessively punished, deprived of
close relationships
• Most are immature, display
faulty thinking, and have an
additional psychological
disorder
Sexual Masochism

• Fantasies, urges, or behaviors

involving the act or thought of
being humiliated, beaten,
bound, or otherwise made to
suffer
• Most masochistic fantasies
begin in childhood
Sexual Sadism

• Thought or act of psychological or

physical suffering of a victim – find
sexually exciting
• Named for infamous Marquis de Sade
• Imagine they have total control over
a sexual victim
• Fantasies may first appear in
childhood – pattern is long term
Gender Identity Disorder

• Transsexualism
• Feel that they have been assigned to
the wrong biological sex
• Would like to remove their primary
and secondary sex characteristics
and acquire the characteristics of
the opposite sex
• Men with GID outnumber women 2:1
• People with GID may feel
uncomfortable wearing the
clothes of their own sex and
may “cross-dress”
• This is different than transsexual
fetish – there is no sexual arousal
related to this disorder