Human Sexuality: Brain and Behavior

Normal Sexual Behavior

• Serves 3 primary functions for human beings: procreation, pleasure/past time, and object relation.

Brain & Sexual Behavior

• Limbic system inside the brain processes and manages emotions, behaviors, memories, and motivations.
• It also manages the autonomic nervous system via the thalamus, hypothalamus, amygdala, and hippocampus.

Brain & Neurotransmitter

• Key neurotransmitters involved in sexual behavior: dopamine, serotonin (upper pons & midbrain), cholinergic innervation, alpha 1 adrenergic, and adrenergic & cholinergic systems.
• Neurotransmitter imbalance can stem from poor dietary choices, toxic consumables, sensory overload, bowel dysfunction, genetics, chronic stress, external & internal environmental factors, and environmental toxins.

Gender Identity Disorders

• Refer to conditions where an individual persistently identifies with the opposite sex, experiencing significant discomfort with their own sex or gender role.

Transsexualism

• Characterized by a feeling that one's gender is inappropriate, leading to a desire to acquire the sexual characteristics of the opposite gender.
• Those experiencing may express feeling trapped in the wrong body.
• These individuals may undergo sexual reassignment surgery to align their physical appearance with their gender identity.

Sexual Orientation

• Relates to whom an individual is attracted to for sexual satisfaction.
• Sexual orientation can be one-person sexual attraction (heterosexual, homosexual (gay), bisexual). Other variations include asexual, aromantic, transgender, and gender fluid.
• Terminology is continually evolving.

DSM IV: Diagnostic Criteria for Gender Identity Disorder

• Strong and persistent cross-gender identification.
• In children, the disturbance is manifested by at least four of the following:
  • Repeated desire to be the other sex.
  • Preference for cross-dressing or simulating female attire in boys, or insistent on wearing only stereotypical masculine clothing in girls.
  • Strong preference for cross-sex roles or persistent fantasies.
  • Intense desire to participate in stereotypical games and pastimes.
  • Preference of playmates of the other sex.
• Persistent discomfort with one's sex or inappropriateness in the gender role to that sex.
• Results in clinically significant distress or impairments in social, occupational, and other areas of functioning.

Treatment for Gender Dysphoria

• Helps individuals explore their gender identity and find a comfortable gender role, easing distress.
• Treatment must be individualized.
• May involve a change in gender expression or modifications to the body.
• Options can include changes in gender expression and role, hormone therapy, surgery, and behavioral therapy, with coping & support and behavioral health treatment.

Sexual Dysfunction

• Involves experiencing difficulties having or enjoying sex.
• These are often recurrent and chronic.
• Can result in problems with sexual arousal/orgasm and cause physical pain.
• Sexual dysfunctions can affect self-esteem, confidence, and intimate relationships.
• Can be caused by emotional factors (depression, sexual fears/guilt, past sexual trauma, anxiety) and physical factors (pain and discomfort during sex).
• Additional factors include Drugs, premenstrual syndrome, pregnancy, postpartum period, and menopause and can affect libido and sexual pleasure.
• Erogenous zones, which when stimulated results in sexual arousal, differs between individuals.

Types of Sexual Dysfunction

• Erectile/Impotence
• Premature Ejaculation
• Pleasure Dissociative Orgasmic behavior
• Frigidity
• Anorgasmia
• Dyspareunia
• Vaginismus
• Nymphomania
• Satyriasis
• Can be categorized by male (hypoactive sexual disorder, sexual aversion disorder, male erectile disorder, inhibited male orgasm, premature ejaculation, dyspareunia) and female (hypoactive sexual desire disorder, sexual aversion disorder, female sexual arousal disorder, female inhibited orgasm, dyspareunia, vaginismus).

Pre Disposing Factors for Sexual Disfunction

• Restrictive upbringing
• Disturbed family behaviors
• Traumatic early sexual experiences
• Poor sex education

Sexual Dysfunctions and Descriptions

• Erectile Disorder: Inability to maintain or achieve an erection.
• Female Sexual Interest/Arousal Disorder: Reduced interest or arousal in sexual activity.
• Female Orgasmic Disorder: Delay or absence of orgasm.
• Male Orgasmic Disorder: Delayed ejaculation or absence of ejaculation.
• Premature Ejaculation: Ejaculation occurring shortly after penetration.
• Genito-Pelvic Pain/Penetration Disorder: Pain during intercourse or fear/anxiety about it.
• Substance/Medication-Induced Sexual Dysfunction: Caused by drugs, alcohol, or medications.

Management of Sexual Dysfunction

• Sensate Focus: Intimate touch exercises to enhance body awareness during sex, done solo or with a partner, lasting 10 minutes to 1 hour
• Sildenafil (Viagra): Used for erectile dysfunction
• Local Anesthetic Sprays
• SSRI's

Paraphilic Disorders

• Involve intense and persistent atypical sexual interests, possibly involving non-consenting parties, suffering, or non-human objects.
• Paraphilias: Persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or atypical situations.

Paraphilic Disorders - Descriptions

• Exhibitionistic Disorder: Sexual arousal from exposing genitals to unsuspecting strangers.
• Voyeuristic Disorder: Arousal from watching others who are naked or engaging in sexual activity.
• Frotteuristic Disorder: Touching or rubbing against a non-consenting person.
• Pedophilic Disorder: Sexual attraction to prepubescent children (must be age 16+ and at least 5 years older than the child).
• Sexual Masochism Disorder: Arousal from being humiliated, beaten, or made to suffer.
• Sexual Sadism Disorder: Arousal from inflicting suffering on another person.
• Fetishistic Disorder: Sexual arousal from non-living objects or non-genital body parts.
• Transvestic Disorder: Sexual arousal from cross-dressing (different from gender identity issues; must cause distress or impairment to be a disorder).
• Zoophilia: Engaging in sexual acts with non-human animals.
• Coprophilia: abnormal interest and pleasure in feces and defecation
• Europhilia's: sexual excitement associated with sight or thoughts of urine or urination.
• Telephone Scatologia: Sexual pleasure by making obscene telephone conversation
• Coprolalia: sexual pleasure in compulsive use obscene language.
• Fetishism: Sexual attraction to non-living objects
• Voyeurism: involves observing individuals in a state of undressing without their knowledge.
• Exhibitionism: Exposing oneself to strangers.
• Transvestic Fetishism: Sexual excitement is related to the act of cross-dressing. Usually supported by the partner.
• Sexual Sadism: Excitement when hurting others.
• Sexual Masochism: Sexual excitement when receiving the end of hurt.
• Pedophilia & Incest: Sexuality is focused on children
• Frotteurism: Characterized by rubbing an erected penis against a buttocks of a women to achieve orgasm.
• Necrophilia: Sexual gratification from cadavers.

Paraphilias Factors

• Inability to access normal sexual outlets may result in accessing other outels.
• Early sexual fantasies may be repeatedly reinforced through repeated masturbation, resulting ultimately in paraphilias