Sexual Dysfunctions, Gender
Dysphoria and Paraphilic Disorders
- All sexual dysfunctions require a duration of 6 months to be diagnosed
- Lifelong- sexual problem that has been present from first sexual
encounter
- Acquired- sexual difficulties that develop after a period of a relatively
normal sexual function
- Generalized- sexual difficulties that are not limited to certain types of
stimulation, situations, or partners
- Situational- sexual difficulties that only occur with certain types of
stimulation, situations or partners
- Diagnosis of sexual dysfunction is not appropriate when factors such as
sever relationship problems, other mental disorders, or significant
stressors play a key role in the sexual difficulties
Normal Sexual Behavior
- Take into account culture and religion
- As long as it does not harm the society
The Sexual Response Cycle
- Appetitive phase
o Person’s interest in sexual activity
o Thoughts or feelings about sex
o Feels attracted to another person
- Arousal phase
o Heightened and intensified arousal resulting from a specific and
direct sexual stimulation
o Males- blood flow increases in penis resulting in erection,
o Females- breasts swell, nipples become erect, blood engorges
genital region, clitoris expands
- Orgasm phase
o Involuntary muscular contractions throughout body and eventual
release of sexual tension
o Males- muscles at the base of the penis contract, propelling semen
through the penis
o Females- outer third of the vagina contracts rhythmically
- Resolution phase
o Relaxation of the body after orgasm
o Males enter refractory period during which they are unresponsive
to sexual stimulation
o Females capable of multiple orgasms with continued stimulation
,Sexual Interest/Arousal Disorders
- Problems with sexual excitement, including difficulties with feelings of
sexual pleasure or the physiological changes associated with the
appetitive and arousal phases
- Male hypoactive sexual desire disorder- little or no interest in sexual
activities, either actual or fantasized
- Female sexual interest/arousal disorder- little or no interest in sexual
activities, either actual or fantasized, and/or lack of or diminished arousal
to sexual cues during nearly all sexual activities
- Rare for men to have libido issues in isolation, they are likely to result
from a medical condition
- Women- difficulties with sexual interest or arousal often result from
negative attitudes about sex or early sexual experiences
Erectile Disorder
- Inability to attain or maintain an erection sufficient for sexual intercourse
or other sexual activity on almost all occasions
- Can be due to limited blood flow (vascular problems)
- Check nocturnal penile tumescence to evaluate if it is a psychological or
physical problem
Orgasmic Disorder
- Difficulty or an inability to achieve a satisfactory orgasm after entering
the excitement phase and receiving adequate sexual stimulation
Female orgasmic disorder
- Persistent delay or inability to achieve an orgasm or a markedly reduced
intensity of orgasmic sensations
- Most women require clitoral stimulation to reach orgasm, if still don’t
then orgasmic disorder
Delayed ejaculation
- The persistent delay or absence of ejaculation after the excitement phase
has been reached and sexual activity has been adequate in focus, intensity
and duration
- Must have occurred 75-100% of the time for at least 6 months
- Usually able to ejaculate when masturbating
Premature ejaculation
- Distressing and recurrent pattern of having an orgasm with minimal
sexual stimulation before, during or shortly after vaginal penetration
- Ejaculation must occur within approximately 1 minute of penetration
, Genito-Pelvic Pain/Penetration Disorder
- When a women experiences distress and difficulty associated with:
vaginal penetration during intercourse, pain in the genital or pelvic region
during intercourse (dyspareunia), fear of pain or vaginal penetration, or
tension in the pelvic muscles
- Can experience reduced sexual arousal
Etiology of Sexual Dysfunctions
Biological Dimension
- Lower levels of testosterone and higher levels of estrogens have been
associated with lower sexual interest and erectile difficulties
- Use of drugs, alcohol use and antidepressant medications associated with
sexual dysfunctions
- Penile hypersensitivity to physical stimulation
Psychological Dimension
- Predisposing or historical factors can influence sexual dysfunction
- Stressful situation and anxiety disorders can inhibit sexual responding
and functioning
- Guilt, anger or resentment toward partner
- Partner with a sexual dysfunction increases the risk of sexual difficulties
in the other partner
- Fear of failing sexually or anxiety over size of genitals, become “spectator”
and make problem worse
- Frequency of intercourse- premature ejaculation- less often= more
excited, more likely to ejaculate quicker
- Emotional factors for women, self-consciousness
Social Dimension
- Attitudes parents display toward sex and their expression of affection
toward each other
- Strict religious upbringing associated with sexual dysfunction
- Traumatic sexual experiences as child or adolescent such as rape or
molestation can lead to sexual dysfunctions in women
- Relationship issues usually main cause
Sociocultural Dimension
- Gender differences in sexual response cycle
- Women more likely to experience sexual interest/arousal disorders
- Sexual potency sign of masculinity in some cultures
- Homophobia
Dysphoria and Paraphilic Disorders
- All sexual dysfunctions require a duration of 6 months to be diagnosed
- Lifelong- sexual problem that has been present from first sexual
encounter
- Acquired- sexual difficulties that develop after a period of a relatively
normal sexual function
- Generalized- sexual difficulties that are not limited to certain types of
stimulation, situations, or partners
- Situational- sexual difficulties that only occur with certain types of
stimulation, situations or partners
- Diagnosis of sexual dysfunction is not appropriate when factors such as
sever relationship problems, other mental disorders, or significant
stressors play a key role in the sexual difficulties
Normal Sexual Behavior
- Take into account culture and religion
- As long as it does not harm the society
The Sexual Response Cycle
- Appetitive phase
o Person’s interest in sexual activity
o Thoughts or feelings about sex
o Feels attracted to another person
- Arousal phase
o Heightened and intensified arousal resulting from a specific and
direct sexual stimulation
o Males- blood flow increases in penis resulting in erection,
o Females- breasts swell, nipples become erect, blood engorges
genital region, clitoris expands
- Orgasm phase
o Involuntary muscular contractions throughout body and eventual
release of sexual tension
o Males- muscles at the base of the penis contract, propelling semen
through the penis
o Females- outer third of the vagina contracts rhythmically
- Resolution phase
o Relaxation of the body after orgasm
o Males enter refractory period during which they are unresponsive
to sexual stimulation
o Females capable of multiple orgasms with continued stimulation
,Sexual Interest/Arousal Disorders
- Problems with sexual excitement, including difficulties with feelings of
sexual pleasure or the physiological changes associated with the
appetitive and arousal phases
- Male hypoactive sexual desire disorder- little or no interest in sexual
activities, either actual or fantasized
- Female sexual interest/arousal disorder- little or no interest in sexual
activities, either actual or fantasized, and/or lack of or diminished arousal
to sexual cues during nearly all sexual activities
- Rare for men to have libido issues in isolation, they are likely to result
from a medical condition
- Women- difficulties with sexual interest or arousal often result from
negative attitudes about sex or early sexual experiences
Erectile Disorder
- Inability to attain or maintain an erection sufficient for sexual intercourse
or other sexual activity on almost all occasions
- Can be due to limited blood flow (vascular problems)
- Check nocturnal penile tumescence to evaluate if it is a psychological or
physical problem
Orgasmic Disorder
- Difficulty or an inability to achieve a satisfactory orgasm after entering
the excitement phase and receiving adequate sexual stimulation
Female orgasmic disorder
- Persistent delay or inability to achieve an orgasm or a markedly reduced
intensity of orgasmic sensations
- Most women require clitoral stimulation to reach orgasm, if still don’t
then orgasmic disorder
Delayed ejaculation
- The persistent delay or absence of ejaculation after the excitement phase
has been reached and sexual activity has been adequate in focus, intensity
and duration
- Must have occurred 75-100% of the time for at least 6 months
- Usually able to ejaculate when masturbating
Premature ejaculation
- Distressing and recurrent pattern of having an orgasm with minimal
sexual stimulation before, during or shortly after vaginal penetration
- Ejaculation must occur within approximately 1 minute of penetration
, Genito-Pelvic Pain/Penetration Disorder
- When a women experiences distress and difficulty associated with:
vaginal penetration during intercourse, pain in the genital or pelvic region
during intercourse (dyspareunia), fear of pain or vaginal penetration, or
tension in the pelvic muscles
- Can experience reduced sexual arousal
Etiology of Sexual Dysfunctions
Biological Dimension
- Lower levels of testosterone and higher levels of estrogens have been
associated with lower sexual interest and erectile difficulties
- Use of drugs, alcohol use and antidepressant medications associated with
sexual dysfunctions
- Penile hypersensitivity to physical stimulation
Psychological Dimension
- Predisposing or historical factors can influence sexual dysfunction
- Stressful situation and anxiety disorders can inhibit sexual responding
and functioning
- Guilt, anger or resentment toward partner
- Partner with a sexual dysfunction increases the risk of sexual difficulties
in the other partner
- Fear of failing sexually or anxiety over size of genitals, become “spectator”
and make problem worse
- Frequency of intercourse- premature ejaculation- less often= more
excited, more likely to ejaculate quicker
- Emotional factors for women, self-consciousness
Social Dimension
- Attitudes parents display toward sex and their expression of affection
toward each other
- Strict religious upbringing associated with sexual dysfunction
- Traumatic sexual experiences as child or adolescent such as rape or
molestation can lead to sexual dysfunctions in women
- Relationship issues usually main cause
Sociocultural Dimension
- Gender differences in sexual response cycle
- Women more likely to experience sexual interest/arousal disorders
- Sexual potency sign of masculinity in some cultures
- Homophobia
