Chapter 11: Sexual Disorders – Flashcards
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Sexual Dysfunctions
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- disorders in which people cannot respond normally in key areas of sexual functioning - problems with sexual responses - Sexual dysfunctions are typically very distressing, and often lead to sexual frustration, guilt, loss of self-esteem, and interpersonal problems - 31% of men and 43% of women
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human sexual response
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- can be described as a cycle with four phases: • Desire • Excitement • Orgasm • Resolution - Sexual dysfunctions affect one or more of the first three phases
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Desire Phase
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- The phase of the sexual response cycle consisting of an urge to have sex, sexual fantasies, and sexual attraction to others
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Hypoactive sexual desire disorder
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- Characterized by a lack of interest in sex and a low level of sexual activity - Disorder of Desire - Physical responses may be normal - Prevalent in about 16% of men and 33% of women
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Sexual aversion disorder
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- Characterized by a total aversion to (disgust of) sex - Disorder of Desire - Sexual advances may sicken, repulse, or frighten - This disorder seems to be rare in men and more common in women
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Biological Causes of Desire Disorders
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- A number of hormones interact to produce sexual desire and behavior - Abnormalities in their activity can lower sex drive - These hormones include prolactin, testosterone, and estrogen for both men and women - Sex drive can also be lowered by chronic illness, some medications, some psychotropic drugs, and a number of illegal drugs
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Psychological causes of Desire Disorders
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- A general increase in anxiety or anger may reduce sexual desire in both women and men - Fears, attitudes, and memories may contribute to sexual dysfunction - Certain psychological disorders, including depression and obsessive-compulsive disorder, may lead to sexual desire disorders
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Sociocultural causes of Desire Disorders
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- Attitudes, fears, and psychological disorders that contribute to sexual desire disorders occur within a social context - Many sufferers of desire disorders are feeling situational pressures -- Examples: divorce, death, job stress, infertility, and/or relationship difficulties - Cultural standards can affect the development of these disorders - The trauma of sexual molestation or assault is also likely to produce sexual dysfunction
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Excitement Phase
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- The phase of the sexual response cycle marked by changes in the pelvic region, general physical arousal, and increase in heart rate, muscle tension, blood pressure, and rate of breathing
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Disorders of Excitement
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- Excitement phase of the sexual response cycle - Marked by changes in the pelvic region, general physical arousal, and increases in heart rate, muscle tension, blood pressure, and rate of breathing --In men: erection of the penis --In women: clitoral swelling and vaginal lubrication - Two dysfunctions affect this phase: Female sexual arousal disorder (formerly "frigidity") - Male erectile disorder - ED (formerly "impotence")
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Female sexual arousal disorder
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- Female dysfunction marked by a persistent inability to attain sexual excitement, including adequate lubrication or genital swelling, during sexual activity
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Male erectile disorder (ED)
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- Recurring inability in some men to attain or maintain adequate penile erection until completion of sexual activity.
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Biological causes of ED
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- The same hormonal imbalances that can cause hypoactive sexual desire can also produce ED - Most commonly, vascular problems are involved - ED can also be caused by damage to the nervous system from various diseases, disorders, or injuries - The use of certain medications and substances may interfere with erections - Medical devices have been developed for diagnosing biological causes of ED - One strategy involves measuring nocturnal penile tumescence (NPT) [at home with stamps/like Charlotte and Trey] - Men typically have erections during REM sleep; abnormal or absent nighttime erections usually indicate a physical basis for erectile failure
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Psychological causes of ED
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- Any of the psychological causes of hypoactive sexual desire can also interfere with erectile function - For example, as many as 90% of men with severe depression experience some degree of ED - One well-supported cognitive explanation for ED emphasizes performance anxiety and the spectator role - Once a man begins to have erectile difficulties, he becomes fearful and worried during sexual encounters; instead of being a participant, he becomes a spectator and judge --This can create a vicious cycle of sexual dysfunction where the original cause of the erectile failure becomes less important than the fear of failure
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Orgasm Phase
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- The phase of the sexual response cycle during which an individual's sexual pleasure peaks and sexual tension is released as muscles in the pelvic region contract rhythmically
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Disorders of Orgasm
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- Affects orgasm phase of the sexual response cycle - There are three disorders of this phase: --Premature ejaculation --Male orgasmic disorder --Female orgasmic disorder
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Male orgasmic disorder
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- Characterized by a repeated inability to reach orgasm or by a very delayed orgasm after normal sexual excitement -- Occurs in 8% of the male population - Biological causes include low testosterone, neurological disease, and head or spinal injury -- Medications, including certain antidepressants (especially SSRIs) and drugs that slow down the CNS, can also affect ejaculation
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Female orgasmic disorder
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- Characterized by persistent delay in or absence of orgasm following normal sexual excitement - Female orgasmic disorder is more common in single women than in married or cohabiting women - Almost 25% of women appear to have this problem - 10% or more have never reached orgasm - An additional 10% reach orgasm only rarely - Women who are more sexually assertive and more comfortable with masturbation tend to have orgasms more regularly
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Biological causes of Female orgasmic disorder
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- A variety of physiological conditions can affect a woman's arousal and orgasm - These conditions include diabetes and multiple sclerosis - The same medications and illegal substances that affect erection in men can affect arousal and orgasm in women - Postmenopausal changes may also be responsible
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Psychological causes of Female orgasmic disorder
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- The psychological causes of hypoactive sexual desire and sexual aversion may also lead to female arousal and orgasmic disorders - Memories of childhood trauma and relationship distress may also be related - Researchers suggest that unusually stressful events, traumas, or relationships may produce the fears, memories, and attitudes that characterize these dysfunctions - Research has also linked certain qualities in a woman's intimate relationships (such as emotional intimacy) to orgasmic behavior
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Disorders of Sexual Pain
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- Two sexual dysfunctions do not fit neatly into a specific phase of the sexual response cycle -These are the sexual pain disorders: -- Vaginismus -- Dyspareunia
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Vaginismus
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- condition marked by involuntary contractions of the muscles around the outer third of the vagina, preventing entry of the penis - Most clinicians agree with the cognitive-behavioral theory that it is a learned fear response - A variety of factors can set the stage for this fear, including anxiety and ignorance about intercourse, trauma caused by an unskilled partner, and childhood sexual abuse - Some women experience painful intercourse because of infection or disease, leading to "rational" vaginismus - Many women with vaginismus also have other sexual disorders
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Dyspareunia
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- Characterized by severe pain in the genitals during sexual activity - Affects about 14% of women and about 3% of men - Dyspareunia in women usually has a physical cause, most commonly from injury sustained in childbirth - Although relationship problems or psychological trauma from abuse may contribute to dyspareunia, psychosocial factors alone are rarely responsible
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Treatments for Sexual Dysfunctions
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- Sex Therapy - 1970: Human Sexual Inadequacy This book, written by William Masters and Virginia Johnson, revolutionized treatment of sexual dysfunctions - This original "sex therapy" program has evolved into a complex, multidimensional approach - Modern sex therapy is short-term and instructive - Therapy typically lasts 15 to 20 sessions - It is centered on specific sexual problems rather than on broad personality issues
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Modern Sex Therapy
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- Assessing and conceptualizing the problem - Assigning "mutual responsibility" for the problem - Education about sexuality - Attitude change - Elimination of performance anxiety and the spectator role - Increasing sexual and general communication skills - Changing destructive lifestyles and marital interactions - Addressing physical and medical factors
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Directed Masturbation Training
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- A sex therapy approach that teaches women with female arousal or orgasmic disorders how to masturbate effectively and eventually reach orgasm during sexual interactions
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Paraphilias
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- These disorders are 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 -- Nonhuman objects
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Fetishism
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- recurrent intense sexual urges, sexually arousing fantasies, or behaviors that involve the use of a nonliving object - The disorder usually begins in adolescence - Almost anything can be a fetish -- Women's underwear, shoes, and boots are especially common - Behaviorists propose that fetishes are learned through classical conditioning
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Treatment for Fetishism
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- Fetishes are sometimes treated with aversion therapy, covert sensitization, or imaginal exposure - Another behavioral treatment is masturbatory satiation, in which clients masturbate to boredom while imagining the fetish object - An additional behavioral treatment is orgasmic reorientation, a process which teaches individuals to respond to more appropriate sources of sexual stimulation
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Transvestic Fetishism
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- Also known as transvestism or cross-dressing - Characterized by fantasies, urges, or behaviors involving dressing in the clothes of the opposite sex to achieve sexual arousal - The typical person with transvestism is a heterosexual male who began cross-dressing in childhood or adolescence - Transvestism is often confused with gender identity disorder (transsexualism), but the two are separate patterns - The development of the disorder seems to follow the behavioral principles of operant conditioning
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Exhibitionism
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- Characterized by arousal from the exposure of genitals in a public setting - Also known as "flashing" - Sexual contact is neither initiated nor desired - Usually begins before age 18 and is most common in males - Treatment generally includes aversion therapy and masturbatory satiation - May be combined with orgasmic reorientation, social skills training, or psychodynamic therapy
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Voyeurism
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- Characterized by repeated and intense sexual desires to observe people in secret as they undress or to spy on couples having intercourse; may involve acting upon these desires - The person may masturbate during the act of observing or while remembering it later - The risk of discovery often adds to the excitement
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Frotteurism
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- A person who has fantasies, urges, or behaviors involving touching and rubbing against a non-consenting person - Almost always male, the person fantasizes during the act that he is having a caring relationship with the victim - Usually begins in the teenage years or earlier - Acts generally decrease and disappear after age 25
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Pedophilia
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- Characterized by fantasies, urges, or behaviors involving sexual activity with a prepubescent child, usually 13 years of age or younger - Some are satisfied with child porn - Others are driven to watching, fondling, or engaging in intercourse with children - Two-thirds of victims are female - They develop the disorder in adolescence - Some were sexually abused as children - Many were neglected, excessively punished, or deprived of close relationships in childhood - Most are immature, display faulty thinking, and have an additional psychological disorder - Some theorists have proposed a related biochemical or brain structure abnormality
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Sexual Masochism
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- Characterized by fantasies, urges, or behaviors involving the act or the thought of being humiliated, beaten, bound, or otherwise made to suffer - Most masochistic fantasies begin in childhood and seem to develop through the behavioral process of classical conditioning
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Sexual Sadism
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- Finding fantasies, urges, or behaviors involving the thought or act of psychological or physical suffering of a victim sexually exciting - Named for the infamous Marquis de Sade - People with sexual sadism imagine that they have total control over a sexual victim - Sadistic fantasies may first appear in childhood - Pattern is long-term - May be related to classical conditioning and/or modeling - Psychodynamic and cognitive theorists view them as having underlying feelings of sexual inadequacy
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Gender identity disorder
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- Also known as transsexualism - People with this disorder persistently feel that they have been assigned to the wrong biological sex and would like to remove their primary and secondary sex characteristics and acquire the characteristics of the opposite sex - Men outnumber women 2 to 1 - Often experience anxiety or depression and may have thoughts of suicide - Usually feel uncomfortable wearing the clothes of their own sex and may cross-dress - Distinctly different from a transsexual fetish; there is no sexual arousal related to this disorder
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Causes of Gender Identity Disorder
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- Some clinicians suspect biological - perhaps genetic - factors - Abnormalities in the hypothalamus are a potential link - The disorder sometimes emerges in childhood and disappears with adolescence - In some cases it develops into adult gender identity disorder - Some adults with this disorder change their sexual characteristics by way of hormones; others opt for sexual reassignment (sex change) surgery
