Sexual Disorders

Ms. Kanika Kumar

 Sex

Def: Sum of the structural, functional,

and behavioural characteristics of
organisms that are involved in
reproduction marked by the union of
gametes and that distinguish males
and females.
 Sexual Abnormality
• Sexual Behaviour
• Destructive to oneself or others
• But cannot be directed towards partners
• Exclude stimulation of 10 sex organ
 Orientation to sexuality
• Birth through age 1-
• 2 and 2 ½ years –children know what they are ,they know
that they are like the parents of same gender and different
from the parents of opposite gender.
• By the age of 4-5 children engage in heterosexual play.
• Playing doctors can be popular game at this age.
• Late child hood and preadolescence may be characterized by
heterosexual and homosexual play.Girls at this age became
self conscious about their
• Bodies and are concerned with physical attractiveness
• 10- 12 year- are preoccupied with pubertal changes and
beginning of romatic interest in opposite gender
 Adolescence
• Adolescence represent an acceleration in term of
biological changes and psychological and sexual
development
• Psychological task- are issue relating to sexuality
,sexuality feeling, sexual behavior, age- appropriate sex
role
• Sexuality is slower to develop in the female than in men
• Women show steady increases sexual response in their
20s
• Men is usually reached in late teens, but remain high
through young adulthood
• More adolescence are engaged in premarital
intercourse
• The incidence of premarital intercourse for
girls has increased
• The average age at first intercourse is
decreasing
 Adulthood
• The period of life cycle begins at 20 years of age
and continues to age of 65
• Marital sex-choosing a marital partner or
developing a sexual relationship with another
individual is one of major task in the early years
of the life cycle
• American couple has coitus about two or three
times per week at 20s
• Gradually decreased to about once weekly for
aged 45 and over
• Extramarital sex- about half of married men
and women have engaged in extramarital sex at
some times during their marriages
• Incidence of extra marital sex for men seems to
be holding constant
• Attitude towards premarital sex have changed
• Most men and women say that they believe
sexual exclusive should be goal in marriage
• Sex and the single person- Attitude about
sexual intimacy among single never married ,
divorced, or widowed
• Some single person will settle for any kind of
relationship , causal, or committed,
• Other deny any desire for marriage or sexual
intimacy
• Other may desperately search for a spouse with
the desperation increasing as the years wear on
• Most divorced men and women return to their
normal life
• The middle years 40 – 45- decreased in hormonal
changes, and change in sex organ. The average age
of onset of menopause for women is around 50
The decreased in the amount of estrogen can
result in loss of vaginal lubrication, making
intercourse painful, other symptom are
insomnia, headache, depression, hot flushes
Decreased amount of androgen – amount of
ejaculation decreased, ejaculation may be less
forceful, the testes decreased in size ,erection
may be less frequent, refractory period
increased
 Classification
ICD-10 Classifies as:
• F64-Gender identity disorder
• F65-Paraphilia
• F66-Psychological &Behavioural disorder
associated with sexual development&
orientation
 Gender Identity disorder
• Def: Are characterized by disturbance in
gender identity-
E.g.- The sense of one’s masculinity and femininity is
disturbed.
 Classification
3rd Revised Edition -4
Gender Identity disorders

Gender
Transsexualism identity Disorder of
Non specific
disorder of Adolescence
Child hood
 TRANSEXUALISM
• The severest form of gender identity disorder
chararacterized by

Sense of
Normal discomfort
anatomical regarding
sex ones own
sex

Wish to get Diagnosis

rid of ones made after
sex puberty
 Differential diagnosis
• Fetishistic transvestism- cross dressing is
wearing or using clothes traditionally of the
sex for the purpose of sexual excitement
• Almost seen in males
Gender identity disorder-Children
• This disorder start with very early age of onset 2-4 yrs of age

Desire to
other sex

Traditional
activities Children
&clothing
patterns
Strong denial
of anatomical
Onset sex
before
puberty
Gender identity disorder –Non specific
• The diagnosis is reserved for person who cannot classified as
a being a gender identity disorder

Inter sex
Transient condition
stress

Castration
&
penectomy

Diagnostic criteria
 Paraphilias
• Definition- paraphilias are divergent behavior
that are concealed by their participant appear
to exclude or harm other and disrupt the
potential for bonding person.
 Pedophilia

Voyeuris Transvectic
m fetishism

Non
Sadism specific
Classification

Exhibitio
Masochism nism

Frotteurism Fetishism
Fetishism
Fetishism
 Fetishism
• Fetishism
– Sexual attraction – Nonliving objects
– Objects can be inanimate and/or tactile
– Examples include rubber, hair
– Usually many objects of fetishistic arousal, fantasy,
urges
 Diagnostic Criteria
• A-Over a period of 6months,recurrent intense
sexually behaviour involved use of Non living
object.
• B-Significant distress or impairment in social,
occupational or other important area of
functioning.
• C-Use of device designed for the purpose of
tactile genital stimulation like vibrator.
Frotteurism
 Characteristics

• Males rubbing their penis against the

buttocks or other body parts of fully clothed
women.
• He may use hand to rub unsuspecting victim.
• The act usually occur in crowded places.
• They are extremely passive and isolated.
 Diagnostic Criteria
• Atleast 6months and recurrence involving
touching and rubbing against a non
consenting person.
• Significant distress and impairment in social,
occupation or other important area of
functioning.
Voyeurism
 Voyeurism and Exhibitionism
• Voyeurism
– Observing an unsuspecting individual undressing
or naked
– Risk associated with “peeping” is necessary for
arousal
• Exhibitionism
– Exposure of genitals to unsuspecting strangers
– Element of thrill and risk are necessary for sexual
arousal
 Diagnostic criteria
• 6months involving act of observing an
unsuspecting person who is naked , or in the
process of disrobing or engage in sexual
activity.
• Significant distress and impairment in social,
occupation or other important area of
functioning.
Transvectic Fetishism
 Transvestic Fetishism
• Is marked by fantasies and sexual urge by
heterosexual men to dress in female clothes
for the purpose of arousal as an adjunct to
masturbation or coitus.
– Sexual arousal with the act of cross-dressing
– Males may show highly masculine compensatory
behaviors
– Most do not show compensatory behaviors
– Many are married and the behavior is known to
spouse
Sexual Sadism & Masochism
 Sexual Sadism and Sexual Masochism
• Sexual Sadism
– Inflicting pain or humiliation to attain sexual
gratification
• Sexual Masochism
– Suffer pain or humiliation to attain sexual gratification
• Relation Between Sadism and Rape
– Some rapists are sadists
– Most rapists do not show paraphilic patterns of
arousal
– Sexual arousal to violent sexual and non-sexual
material
Pedophilia
Pedophilia
 Pedophilia
• Overview
– Pedophiles – Sexual attraction to young children.
– Incest – Sexual attraction to one’s own children
– Victims are typically children or young adolescents
– Pedophilia is rare, but not unheard of, in females
• Associated Features
– Most pedophiles and incest perpetrators are male.
– Incestuous males may be aroused to adult women.
– Pedophiles are not aroused by adult women.
– Most rationalize the behavior.
 Paraphilia –Non specific
• Telephone Scatological
-Obscene phone calling ,
arousal begin in anticipation
of phoning.

• Necrophilia-Gratification from
cadavers.

• Zoophilia-From animals
Coprophilia-
To desire to defecate on partner

Urophilia
Desire to urinate on partner.
Abnormal sexuality and sexual dysfunction

• In DSM-IV –TR- a sexual dysfunction is defined as

disturbance in sexual response cycle or as pain with
sexual intercourse
• Sexual desire disorder
• Sexual arousal disorder
• Orgasm disorder
• Sexual pain disorder
• Sexual dysfunction general medical condition
• Sexual – induced sexual dysfunction
 Sexual Desire disorder

Hypoactive sexual disorder- characterized by a

deficiency or absence of sexual fantancies and
desire for sexual activity
Sexual aversion disorder - characterized by an
aversion and avoidance of genital sexual
contact with sexual partner or by
masturbation
 Sexual Arousal disorder
• Female sexual arousal disorder- female sexual arousal
disorder is identified as a persistent or recurrent inability
to attain or to maintain completion of sexual activity ,an
adequate lubrication swelling response of sexual
excitement
• Male erectile disorder- inability to attain or maintain
adequate erection
• Primary erectile dysfunction- man has never been able
to have intercourse
• Secondary erectile dysfunction- man has difficulty
getting or maintaining an erection , but able to have
vaginal anal intercourse at once
 Orgasmic disorder
• Female orgasmic disorder- persistent or recurrent
delay in or absence of orgasm following a normal
sexual excitement phase. This condition is known as
agorgasmia
• Primary orgasmic dysfunction- she has never
experienced orgasm by any kind of stimulation
• Secondary orgasmic – women has experienced at
least one orgasm regardless of the means of
stimulation but no longer does so
• Male orgasmic disorder- it is also known as
retarded ejaculation. It is characterized by
persistent or recurrent delay or absence of
,orgasm following a normal sexual excitement
phases during sexual activity.
• Premature ejaculation- persistent or recurrent
ejaculation with minimal sexual stimulation
before, on or shortly after penetration and
before the person wishes it.
 Sexual pain disorder
• Dyspareunia- is recurrent or persistent pain
associated with sexual intercourse in either
man or woman
• In women the pain may felt in the vagina,
around the vaginal entrance and clitoris or
deep in the pelvic,
• In men the pain felt in the penis
• Prevalence dyspareunia is estimates of 15
percent and male 3percent
 Vaginismus
• It is an involuntary constriction of outer one
third of the vagina that prevent penile
insertion and intercourse
• The disorder most afflicts highly educated
women and those in high economic group
 Sexual dysfunction due to general medical condition

• Type of medical condition

• neurological-Multiple sclerosis, Neuropathy
Endocrine -diabetes mellitus thyroid dysfunction
• vascular – atherosclerosis
• genitourinary- testicular diseases, vaginal
infection,
• Substance abuse- alcohol, amphetamines,
cocaine, opioids, sedative, anxiolytics,
antidepressant , anti hypertensive
 Predisposing factors

• Biological factors-
Sexual desire disorder=decreased levels of serum
testosterone
Elevated level of prolactin
Antihypertensive
Antipsychotic
Antidepressants
Anticonvulsants
Alcohol and cocaine
 Sexual Arousal disorder
Women-
• post menopausal women
• antihistamine and anticholinergic
Male
• Arteriosclerosis
• Diabetes mellitus
• temporal epilepsy , trauma, spinal cord injury,
pelvic cancer
• medication- antihypertensive, antipsychotics,
antidepressant, anxiolytics, alcohol,
 Orgasmic disorder
Female
hysterectomy
selective serotonin reuptake medicine
depression, hypothyroidism, diabetes mellitus.
Male – surgery of genitourinary tract
neurological disorder( Parkinson's)
diabetes mellitus
Antihypertensive , antidepressant, antipsychotic
Alcohol intake
Premature ejaculation- local infection( prostatitis) , degenerative
changes neural multiple sclerosis
 Sexual pain disorder
• Female- intact hymen, episiotomy scar, vagina
or urinary tract infection, ligament injuries,
endometriosis ovarian cyst, tumors
• Male- infection in foreskin
• Phimosis
• allergic reaction vaginal spermicide, irritation
caused by vaginal infection
• prostate problem
 Psychological factors

• Sexual desire disorder- religious orthodoxy

• sexual identity conflict
• past sexual abuse
• financial , family, job problem
• depression, interpersonal conflict
• physical, verbal, sexual abuse,
extramarital affairs
 Sexual Arousal disorder
• Female- doubt, guilt, fear, anxiety, shame, conflict,
embarrassment, tension, irritation, grief, hostility toward
partner moralistic upbringing

• Male- anxiety and depression,

• inadequate ,distrust
• Lack of attraction towards partner
• Anger towards partner
• Impotence
• Anxious about next sexual encounter
• Sense of being unloving
 Orgasmic disorder
• Women-it include-fear of became pregnant, rejection
from sexual partner, damage to vagina, hostility
towards men's, feeling of guilt regarding sexual
impulse, negative culture conditions
• Male- rigid puritanical background ,perceives sex as
sinful genital as dirty, interpersonal difficulties,
ambivalent about commitment, fear of pregnancy
,unexpressed hostility
• Premature ejaculation-the man aware of the sensation
and learn to delay the point of ejaculation, stress ful
marriage, anxiety over intimacy , lack of comfort in the
sexual ralationship
 Treatment

• Hypoactive sexual desire disorder-

• administration of testosterone
• Combination with cognitive therapy
• Exercise to enhance sexual pleasuring,
communication and relationship therapy
• Sexual aversion disorder-systematic
desensitization, tricyclic medication,psysexual
therapy
 Sexual arousal disorder
• Female sexual arousal disorder-the goal to
reduce anxiety associated with sexual activiy
• Behaviourally oriented sensate focus exercise

• Male erection disorder-sensate focus has been

used
• Group therapy, hypnotherapy, systematic
desensitization
• Psychodynamic intervention
• Medication- testosterone, yohimbine,
• Injection- papavarine, prostaglandin
• Medication – sildenafil- side effect- headache,
facial flushing, indigestion, nasal congestion,
visual changes
• Apomorphine and phentolamine
• Surgery- penile prostheses- bendable silicone
inflated device
 Orgasmic disorder
• Female – sensate focus
•
• Male – sensate focus and masturbatory training

• premature ejaculation- sensate focus

genital stimulation
squeeze technique
 Sexual pain disorder
• Physical and gynecological examination
• Systematic desensitization

• Vaginismus- education regarding anatomy and physiology

• Systematic desensitization
• Tensing and relaxing exercise
• Relaxation of pelvic muscles
• Systematic insertion of dilators
• Physical therapy's