Exam 4
Sexual & Gender Dysphoria Disorders
Terms
● Cisgender- described a person whose gender identity aligns in a traditional sense with
the sex assigned to them at birth
● Gender diverse- an umbrella term describing individuals with gender identities and/or
expressions and include people who identify as multiple genders or with no gender at all
● Gender dysphoria- a concept designated in the DSM as clinically significant distress or
impairment related to gender incongruence, which may include desire to change primary
and/or secondary sex characteristics. Not all transgender or gender diverse people
experience gender dysphoria
● Gender expression- the outward manifestation of a person’s gender, which may or may
not reflect their inner gender identity based on traditional expectations. Gender
expression incorporates how a person carries themselves, their dress, accessories,
grooming, voice/speech patterns, and conversational mannerisms, and physical
characteristics
● Gender identity- a person’s inner sense of being a girl/woman, boy/man, some
combination of both, or something else, including having no gender at all. This may or
may not correspond to one’s sex assigned at birth
● Nonbinary- a term used by some individuals whose gender identity is neither girl/woman
nor boy/man
● Sex/gender assigned at birth- traditional designation of a person as “female”, “male”, or
“intersex” based on anatomy (genitalia) and/or other biological factors (sex
chromosomes). “Sex” and “gender” are often used interchangeably, but they are distinct
entities. It is best to distinguish between sex, gender identity, and gender expression and
to avoid making assumptions about a person regarding one of these characteristics
based on knowledge of the others. This is sometimes abbreviated as AFAB (assigned
female at birth) or AMAB (assigned male at birth)
● Sexual orientation- describes the types of individuals toward whom a person has
emotional, physical, and/or romantic attraction
● Transgender- an umbrella term describing individuals whose gender identity does not
align in a traditional sense with the gender they were assigned at birth. It may also be
used to refer to a person whose gender identity is binary and not traditionally associated
with that assigned at birth.
Human Sexual Response
● Desire- ability, interest or willingness to receive sexual stimulation
● Excitement- sexual tension with vasoconstriction & myotonia
● Orgasm- clonic reflex muscular contractions; climax
● Resolution- gradual return of organs & body to the unaroused state
, Successful- Poor-
Psychological Good emotional health Depression or anxiety
Attraction toward partner Focus on performance
Positive attitude toward Poor self esteem
partner Negative attitude toward sex
Positive sexual attitude
Physical Good physical health Smoking
Good nutrition Heavy drinking
Regular exercise Diabetes
Neurological disease
SSRI meds/ antihypertensive
meds
Other drugs
Social and sexual history Positive past sexual Rape or sexual abuse
experience Relationship problems or
Good relationship with poor communication
partner Rushed/hurried sexual
Sexual experience
knowledge/skills/ability to
discuss needs with partner
Sexual Disorders
● Problematic sexual behaviors
● Primary sexual dysfunction: occurs when the appropriate sexual response was never
experienced
● Secondary sexual dysfunction: with a decline or cessation of previously experienced
appropriate response
● In DSM-5 sexual dysfunction is defined as “a clinically significant disturbance in a
person’s ability to respond sexually or to experience sexual pleasure
DSM-5 has 3 Categories of Sexual Dysfunction
1. Sexual desire, arousal, and interest disorder-
● Women: Sexual interest/arousal disorder
, ● Men: Male hyposexual disorder and Erectile disorder
2. Orgasmic Disorders
● Women: Female orgasmic disorder
● Men: Premature Ejaculation and delayed ejaculation
3. Sexual Pain Disorders
● Women: Genito-pelvic pain/penetration disorder
Sexual Desire, Arousal, and Interest Disorders
● Female Sexual Interest/Arousl DIsorder
○ Persistent or recurrent inability to attain or maintain adequate lubrication-
swelling response until completion of sexual activity
○ Psychological factors- past abuse, if something has changed
○ Interventions- Modify negative feedback by sensate focus: provide
lubrication therapy (water- soluble lubrication, no vaseline
● Hyposexual Disorder in Men
○ Persistent or recurrent deficiency or absence of sexual fantasies and
desire for sexual activity
○ Depression, anger, anxiety, fear, anger, religion, sexual abuse, stress
○ Need insight into problem/cause
● Male Erectile Disorder
○ Inability of man to achieve or maintain an erection for completion of
sexual activity
○ Psychological factors- not attracted to partner, physical problem
○ Pumps, implants, Sildenafil, Tadalafil, Yohimbine
○ Modify negative feedback- sensate focus: rebuild trust; identify factors
Orgasmic DIsorders
● Female Orgasmic Disorder
○ A persistent or recurrent delay in, or absence of orgasm following a
normal excitement phase
○ Sometimes referred to as anorgasmia
○ Sexual anxiety or guilt
○ Anger or hostility
○ Indifference
○ Depressive
○ Excessive & intrusive thoughts
● Premature Ejaculation Disorder
○ Tendency to ejaculation during partnered sexual activity within 1 minute
of penile insertion on a least 75% of sexual occasions
○ Causes marked distress or interpersonal problems
○ Not due to a medical illness, another psychological disorder (except
another sexual dysfunction), or the effects of a drug
○ Up to 27% of men (40% at some point in life)
○ Treatment:
■ Behavioral-
Sexual & Gender Dysphoria Disorders
Terms
● Cisgender- described a person whose gender identity aligns in a traditional sense with
the sex assigned to them at birth
● Gender diverse- an umbrella term describing individuals with gender identities and/or
expressions and include people who identify as multiple genders or with no gender at all
● Gender dysphoria- a concept designated in the DSM as clinically significant distress or
impairment related to gender incongruence, which may include desire to change primary
and/or secondary sex characteristics. Not all transgender or gender diverse people
experience gender dysphoria
● Gender expression- the outward manifestation of a person’s gender, which may or may
not reflect their inner gender identity based on traditional expectations. Gender
expression incorporates how a person carries themselves, their dress, accessories,
grooming, voice/speech patterns, and conversational mannerisms, and physical
characteristics
● Gender identity- a person’s inner sense of being a girl/woman, boy/man, some
combination of both, or something else, including having no gender at all. This may or
may not correspond to one’s sex assigned at birth
● Nonbinary- a term used by some individuals whose gender identity is neither girl/woman
nor boy/man
● Sex/gender assigned at birth- traditional designation of a person as “female”, “male”, or
“intersex” based on anatomy (genitalia) and/or other biological factors (sex
chromosomes). “Sex” and “gender” are often used interchangeably, but they are distinct
entities. It is best to distinguish between sex, gender identity, and gender expression and
to avoid making assumptions about a person regarding one of these characteristics
based on knowledge of the others. This is sometimes abbreviated as AFAB (assigned
female at birth) or AMAB (assigned male at birth)
● Sexual orientation- describes the types of individuals toward whom a person has
emotional, physical, and/or romantic attraction
● Transgender- an umbrella term describing individuals whose gender identity does not
align in a traditional sense with the gender they were assigned at birth. It may also be
used to refer to a person whose gender identity is binary and not traditionally associated
with that assigned at birth.
Human Sexual Response
● Desire- ability, interest or willingness to receive sexual stimulation
● Excitement- sexual tension with vasoconstriction & myotonia
● Orgasm- clonic reflex muscular contractions; climax
● Resolution- gradual return of organs & body to the unaroused state
, Successful- Poor-
Psychological Good emotional health Depression or anxiety
Attraction toward partner Focus on performance
Positive attitude toward Poor self esteem
partner Negative attitude toward sex
Positive sexual attitude
Physical Good physical health Smoking
Good nutrition Heavy drinking
Regular exercise Diabetes
Neurological disease
SSRI meds/ antihypertensive
meds
Other drugs
Social and sexual history Positive past sexual Rape or sexual abuse
experience Relationship problems or
Good relationship with poor communication
partner Rushed/hurried sexual
Sexual experience
knowledge/skills/ability to
discuss needs with partner
Sexual Disorders
● Problematic sexual behaviors
● Primary sexual dysfunction: occurs when the appropriate sexual response was never
experienced
● Secondary sexual dysfunction: with a decline or cessation of previously experienced
appropriate response
● In DSM-5 sexual dysfunction is defined as “a clinically significant disturbance in a
person’s ability to respond sexually or to experience sexual pleasure
DSM-5 has 3 Categories of Sexual Dysfunction
1. Sexual desire, arousal, and interest disorder-
● Women: Sexual interest/arousal disorder
, ● Men: Male hyposexual disorder and Erectile disorder
2. Orgasmic Disorders
● Women: Female orgasmic disorder
● Men: Premature Ejaculation and delayed ejaculation
3. Sexual Pain Disorders
● Women: Genito-pelvic pain/penetration disorder
Sexual Desire, Arousal, and Interest Disorders
● Female Sexual Interest/Arousl DIsorder
○ Persistent or recurrent inability to attain or maintain adequate lubrication-
swelling response until completion of sexual activity
○ Psychological factors- past abuse, if something has changed
○ Interventions- Modify negative feedback by sensate focus: provide
lubrication therapy (water- soluble lubrication, no vaseline
● Hyposexual Disorder in Men
○ Persistent or recurrent deficiency or absence of sexual fantasies and
desire for sexual activity
○ Depression, anger, anxiety, fear, anger, religion, sexual abuse, stress
○ Need insight into problem/cause
● Male Erectile Disorder
○ Inability of man to achieve or maintain an erection for completion of
sexual activity
○ Psychological factors- not attracted to partner, physical problem
○ Pumps, implants, Sildenafil, Tadalafil, Yohimbine
○ Modify negative feedback- sensate focus: rebuild trust; identify factors
Orgasmic DIsorders
● Female Orgasmic Disorder
○ A persistent or recurrent delay in, or absence of orgasm following a
normal excitement phase
○ Sometimes referred to as anorgasmia
○ Sexual anxiety or guilt
○ Anger or hostility
○ Indifference
○ Depressive
○ Excessive & intrusive thoughts
● Premature Ejaculation Disorder
○ Tendency to ejaculation during partnered sexual activity within 1 minute
of penile insertion on a least 75% of sexual occasions
○ Causes marked distress or interpersonal problems
○ Not due to a medical illness, another psychological disorder (except
another sexual dysfunction), or the effects of a drug
○ Up to 27% of men (40% at some point in life)
○ Treatment:
■ Behavioral-
