Module 9: Sexual Dysfunctions & Paraphilic Disorders PDF

Sexual Dysfunctio ns & Paraphilic Disorders Mariya Nasim [email protected] Outline 01. 02. Sexual Paraphilic Types of Paraphilic Dysfunctions Types of Sexual Disorders Di...

Sexual Dysfunctio ns & Paraphilic Disorders Mariya Nasim [email protected] Outline 01. 02. Sexual Paraphilic Types of Paraphilic Dysfunctions Types of Sexual Disorders Disorders Dysfunction Disorders Causes of Explanations of Sexual Paraphilias Dysfunctions Diagnosing Diagnosing Sexual Paraphilias Dysfunctions Treatment for Treatment for Sexual Paraphilias Dysfunctions  01. Sexual Dysfuncti ons  What are Sexual Dysfunctions? Persistent or recurrent problems with sexual interest, arousal, or response Affect 40% to 45% of adult women sometime in their life Affect 20% to 30% percent of adult men sometime in their life Lifetime Disorder vs Acquired Disorder Situational Disorder vs Generalized Disorder The Human Sexual Response  The Human Sexual Response Desire Phase Sexual urges occur in response to sensual cues or fantasies Resolution Phase Arousal Phase Decrease in arousal occurs after orgasm A subjective sense of sexual pleasure (particularly in men) and physiological signs of sexual arousal: In males, penile tumescence; In females, vasocongestion, leading to vaginal lubrication and breast Orgasm Phase tumescence In males, feelings of the invincibility of ejaculation, followed by ejaculation; In females, contraction of the walls of the Plateau Phase lower third of the vagina Brief period occurs before orgasm  Categories of Sexual Dysfunctions Sexual Sexual Desire Arousal Orgasmic Sexual Disorders Disorders Disorders Pain Disorders  Sexual Desire Disorders Male Hypoactive Sexual Female Sexual Desire Disorder Interest/Arousal Interest Deficient or absent sexual Disorder fantasies and urges Low sexual interest with Little or no interest in sex diminished ability to 20% to 30% of general become aroused by erotic adult population cues or sexual activities Hypersexuality? 20% prevalence rate Cuts across BOTH desire and arousal phases  Sexual Arousal Disorders Male Erectile Disorder Problems surrounding becoming aroused Still have frequent sexual urges and fantasies (Desire Phase is functional) 7% to 70% prevalence Age dependent ○ More common in aging populations  Orgasmic Disorders Female Orgasmic Male Orgasmic Disorders Disorders Delayed Ejaculation Absence of orgasm Marked delay, infrequency, or after period of absence of ejaculation normal sexual 3% to 8% prevalence excitement Premature Ejaculation 16% to 46% Recurrent/persistent pattern of prevalence ejaculation with minimal sexual As many as 10% of stimulation women have never Affects up to 40% of men experienced an sometime in their life  Sexual Pain Disorders Genito-Pelvic Pain/Penetration Disorder Vaginismus Involuntary spasm of the outer third of the vagina to a degree that makes intercoure impossible Normal sexual arousal or orgasms possible with manual or oral stimulation Dyspareunia (Genito-Pelvic Pain) Persistent or recurrent pain during sexual intercourse/penetration Associated with lower sexual desire and  Assessing Sexual Behavior Interviews Talking to a clinician about your sexual problems Can also include questionnaire Medical Examination Will help rule out medical causes for the dysfunction Psychophysiological Assesses the ability to become aroused in a variety of different conditions to determine if issue is psychological I.e., penile strain gauge, vaginal  Explanations Biological Psychological SocioCultural  Biological Explanations Hormone Imbalances Deficient Testosterone and Estrogen production and over or underactivity of thyroid ○ Testosterones is major hormone involved in sexual desire and activity in BOTH men and women Medical Conditions Temporal physical conditions, nerve damaging conditions (i.e., multiple sclerosis), diabetes, lung disorders, kidney disease, circulatory problems, and sexually transmitted infections (STIs) Medications Antihypertensive medications, antiandrogens, antidepressants and antianxiety medications (i.e., SSRIs) Illicit drugs  Psychological Explanations Cognitive Interference Irrational beliefs and attitudes (i.e., “we must be perfect at everything we do”) Performance Anxiety: excessive concern about the ability to perform successfully Mental Health Depression, Anxiety, and stress Poor body image Traumatic sexual experiences Communication and Relationship Problems Marital or relationship problems Long simmering resentments and conflicts Dysfunctional Arousal  SocioCultural Explanations Sexual Scripts Theory There are guidelines for appropriate sexual behaviours and encounters Gendered ○ Men expected to be enthusiastic about sex, more so than women (masculinity vs femininity) ○ Stereotypes that sexual pleasure is exclusively a male preserve Sociocultural Beliefs (i.e., Religion) Sexual Taboos (i.e., Paraphilias) Early Traumatic Sexual Events Current Life and/or Relationship Difficulties  Treatments for Sexual Dysfunctions PsychoSo Medicati Physical Surgery cial on  PsychoSocial Treatments Human Sexual Inadequacy Anxiety reduction (Psychotherapy, CBT) Directed masturbation Procedures to change attitudes and thoughts Sensory-awareness procedures Skills and communication training Couples therapy  Sexual Dysfunction Treatments Physical Surgery Medication Treatment of Penile prosthesis Testosterone gel underlying and/or vacuum patch physical problems devices Sildenafil (Viagra) (i.e., Sexually Vaginal dilators Birth Control Transmitted Unblock blood Injection of Infection (STI), vessels Vasodilators Urinary Tract SSRIs Infection (UTI))  02. Paraphilic Disorders  What are Paraphilic Disorders? Para: deviance; Philia: attraction Group of conditions involving sexual attraction to atypical objects and/or sexual behaviours that are unusual/deviant in nature Can involve fantasies, urges, or behaviours Preferred way of seeking sexual gratification Must last at least 6 months MUST cause significant impairment or distress OR the behaviour places the individual or others at harm (i.e., non-  Paraphilic Disorders 4 Distinguishing Features of Paraphilias Paraphilias are more common in men ( 3% to 1. Uncommon and atypical from a statistical and sociocultural perspective 5%) than women (1% to 6%) There is high comorbidity 2. Involves an intense interest in sexual activities that do not involve physically mature, consenting, across paraphilias or human partners Individuals with one paraphilia may often 3. Recurrent and persistent (must last at least 6 meet criteria for months) another paraphilia Some paraphilias also 4. The sexual fantasy or activity is the person’s referred to as Courtship preferred and primary way of obtaining sexual gratification Disorders  Paraphilic Disorders in the DSM-5 Sexual Exhibitionsism Transvestism Frotteurism Sadism Sexual Fetishism Voyeurism Pedophilia Masochism  Paraphilic Disorders in the DSM-5 Sexual Sadism Sexual Masochism Sexual arousal from Sexual arousal from inflicting pain or humiliation experiencing pain or Can be practiced with humiliation consenting parties (i.e., Most common paraphilia in BDSM) women Only small subset Infibulation commit stranger sexual Harming one's own assaults body for sexual pleasure Coercive Paraphilic Disorder (i.e., autoerotic now falls under Sexual asphyxiation)  Paraphilic Disorders in the DSM-5 Transvestism Fetishism Sexual arousal from cross- Sexual excitement in dressing response to a non-sexual Wearing clothes from object or body part opposite sex May include body parts MUST be about sexual (i.e., feet), objects (i.e., pleasure, not related to shoes), body features (i.e., gender identity piercings), materials (i.e., (transgender), for fun etc. latex), costumes (i.e., furries), or stimulation  Paraphilic Disorders in the DSM-5 Voyeurism Frotteurism Sexual arousal Sexual arousal Exhibitionism from non- from touching or Sexual arousal consensually rubbing one’s from exposing watching genitals against oneself or others naked or non-consenting performing engage in individuals sexual acts for sexual acts Rubbing non-consenting Peeping against individuals Tom vs others on the Flasher vs watching bus Stripper porn Relatively  Paraphilic Disorders in the DSM-5 Pedophilia Sexual attraction to prepubescent children Physical and Emotional/Romantic Pedophilia vs Hebephilia (no longer in DSM) Not an act, considered a (deviant) sexual orientation Not everyone who sexually offends a child is a Pedophile (only about half) Pedophiles vs Child Molestors Many individuals never act on their sexual attraction to children Distribution  Other Paraphilic Disorders Somnophilia Sexual urge to have sex with a sleeping person Necrophilia Sexual urge to have sex with a dead person Zoophilia Sexual attraction to animals (Bestiality) Telephone Scatologia Sexual urge to make obscene phone calls Urophilia Sexual excitement from urine Coprophilia Sexual excitement from feces  Causes of Paraphilic Disorders Behavioural and Cognitive Perspectives Multifactorial causes: childhood sexual abuse, disturbed family relations, insecure attachment style Inadequate social skills, cognitive distortions Early sexual experiences Learning Theories: Classical & Operant Conditioning, Modelling Biological and Neurological Perspectives Possible role of Androgen (principal male hormone) High sex drive (hypersexual) Disturbances in hormonal fetal development  Diagnosing Paraphilic Disorders DSM-5 differentiates between harmless and harmful/distressing (DSM-4) Paraphilia vs (DSM-5) Paraphilic Disorder Two Prong Assessment For Paraphilia Self-report, Indirect measures (Viewing time, Implicit Association Test, Eyetracking), Physiological measures (Penile Plethysmography (PPG), Vaginal Photoplethysmography (VPG))  Paraphilia Treatments Medication PsychoSocial Antiandrogens Focus on changing problematic thoughts/behaviors (“Chemical Specific techniques to eliminate paraphilic Castration”) behaviours and strengthen appropriate sexual SSRIs behaviours Aversion Therapy (Covert Sensitization) Masturbatory Satiation Orgasmic Reorientation Relapse Prevention CBT Risk/Need/Responsivity (RNR) Model Good Lives Model (GLM) Stigma can greatly affect whether individuals reach out for help CAMH Talking for Change Talking For Change Advertisement  Key Points 1. Four categories of sexual dysfunctions are identified: sexual desire disorders (hypoactive sexual desire disorder and its more severe form, sexual aversion disorder; sexual aversion disorder is no longer included in the DSM-5, Sexual arousal disorders (female sexual arousal disorder and male erectile disorder), orgasm disorders (female orgasm disorder, male orgasm disorder, and premature ejaculation), and sexual pain disorders (dyspareunia and vaginismus) - now referred to as genito-pelvic pain/penetration disorder. 2. Adopting a spectator role and fears of performance are the primary current variables maintaining sexual dysfunctions. Historical antecedents are often important as well. 3. Therapies for sexual dysfunctions include gradual, nonthreatening exposure to sexual encounters, education, anxiety reduction, couples therapy, and sometimes medical procedures. 4. In paraphilias, unusual imagery and acts are persistent and necessary for sexual gratification. These include fetishism, transvestic fetishism, pedophilia and incest, voyeurism, exhibitionism, sexual sadism, and sexual masochism. Theories of the etiology of paraphilias include fixations at an immature psychosexual stage, accidental classical conditioning, and social skills deficits. 5. The most promising treatments for paraphilias involve behaviour therapies such as attempts to reorient sexual arousal to more conventional targets and social skills training.