HUMAN SEXUALITY AND

SEXUAL DISORDERS

Dr. Gemunu Rambukwella

Consultant Psychiatrist
District General Hospital, Chilaw

18/10/2022
Human Sexuality…What is normal?
Cultural Religious

◦ Depends on social
value systems
Political Legal
◦ It’s dynamic

Moral Ethical
Sigiriya Frescos,
480 A.D.
Statue of Tara,
7-8th Century A.D.
Nalanda Gedige,
9-10th Century A.D.
The oil paintings by
Tavik Frantisek Simon (1877-1947)
Some terms….
◦ Biological sex
◦ Assigned at birth
◦ Male, female or
intersex
Some terms….
◦ Gender and gender roles
◦ characteristics of women, men, girls and boys that are socially constructed

◦ Includes norms, behaviors and roles associated with being a woman, man, girl or
boy, as well as relationships with each other.

◦ varies from society to society and can change over time.

Some terms….
◦ Gender expression
◦ How you present yourself
◦ Masculine vs feminine
Some terms….
◦ Gender identity

◦ How you feel inside with regard to gender

◦ Man, woman, transgender, nonbinary

Some terms….
◦ Sexual orientation/identity
◦ enduring pattern of emotional, romantic and sexual attractions
Gender dysphoria/ Gender identity
Disorder
◦ sense of unease that a person may have because of a mismatch between their
biological sex and their gender identity.
◦ can lead to depression and anxiety and have a harmful impact on daily life.
Gender dysphoria management
◦ Detailed assessment
◦ Counselling
◦ Manage secondary psychiatric conditions e.g. depressive disorder
◦ Change gender role, expression
◦ Hormonal treatment
◦ Gender affirmation surgeries
◦ Continuous support
Paraphilias and Paraphilic disorders
◦ Paraphilia refers to patterns of atypical
sexual arousal – object, fantasies and
behaviours
◦ Very common in society – e.g. fetishisms
Paraphilias and Paraphilic disorders
◦ Paraphilic disorders
◦ characterized by persistent and intense patterns of atypical sexual arousal, manifested by sexual thoughts, fantasies, urges,
or behaviors, the focus of which involves others whose age or status renders them unwilling or unable to consent and on
which the person has acted or by which he or she is markedly distressed.
• Exhibitionistic Disorder
• Voyeuristic Disorder
• Pedophilic Disorder
• Coercive Sexual Sadism Disorder
• Frotteuristic Disorder
• Other Paraphilic Disorder Involving Non-Consenting Individuals
Management of Paraphilic disorders
◦ Psychological – cognitive and behavioural

◦ Pharmacological
◦ Antiandrogens, SSRIs, Antipsychotics

◦ Legal
Human Sexual Response
Desire
◦ Human sexual response
occurs in a cycle.
◦ described by Masters and
Resolution Excitement
Johnson in early 1970’s.
◦ Current Classification of
Sexual Dysfunctions and
problems are based on the
sexual response cycle
Orgasm Plateau
Desire

◦ Desire is a strong wanting for sexual stimulation or sexual intimacy that

may cause one to seek sexual satisfaction.

◦ Societal and cultural values influence the range of stimuli that provoke
sexual desire, and ideals about the stimuli considered “sexual” or
“attractive” can vary greatly between cultures and among subsets of a
single culture.

◦ each individual reacts to sets of stimuli that are idiosyncratic—based on

his or her own thoughts, feelings, and experiences.
Excitement
◦ The progression from desire to excitement depends on a wide variety of factors—it may be brought on by
sensory stimulation, thoughts, fantasy, or even the suggestion that desire may be reciprocated.

◦ It generally takes longer for women to achieve full arousal than for men to do so.

◦ During the arousal there is physiological and psychological changes occurring in place.

◦ It prepares the genital organs for copulation.

◦ Excitement may lead to intimacy and sexual activity, but this is not inevitable: for both sexes, initial
physical excitement may be lost and regained many times without progression to the next stage.
Plateau
◦ This occurs during the Copulation.

◦ This stage, the highest moment of sexual excitement before orgasm,

may be achieved, lost, and regained several times without the
occurrence of orgasm.
Orgasm

◦ Orgasm can be achieved through mental stimulation and fantasy

alone, but more commonly is a result of direct physical
stimulation or sexual intercourse
◦ Women are capable of multiple orgasms (moving immediately
from orgasm back into the plateau stage and to orgasm again),
whereas men must pass through the resolution stage before
another orgasm can be achieved.
Resolution
◦ The duration of this stage—the period during which the body
returns to its pre-excitement state—varies greatly and generally
increases with age.
◦ Immediately following orgasm, men experience a refractory
period, during which erection cannot be achieved.
◦ Women experience no refractory period—they can either enter the
resolution stage or return to the excitement or plateau stage
immediately following orgasm.
Psychological conditions/Psychiatric disorders.

◦ A number of psychological conditions and psychiatric disorders affect sexual

response.
◦ Stress can reduce desire to have sex
◦ depression is a common cause of sexual dysfunction
◦ dementia causes diminished appetite or inappropriate sexual behaviour.
◦ Many of the drugs used to treat these conditions also affect sexual functions at
various phases.
Prescribed Medications
◦ The effect of drugs on sexual function is often underemphasized by health care providers and medical
researchers.
◦ Providers rarely mention the sexual side effects of the drugs that they prescribe, sometimes out of the
fear that clients will be reluctant to take the medications if they know about the sexual side effects in
advance.
◦ Antihypertensive drugs (drugs used to treat high blood pressure)
◦ Thiazide diuretics
◦ Beta-blockers (Propranol, Atenolol, Pindolol)
◦ Clonidine
◦ Guanethidine
◦ Alpha methyldopa
◦ Prozasin
◦ Hydralazine
◦ Reserpine
◦ Spironolactone
◦ Psychoactive agents (drugs used to treat depression, anxiety, insomnia, and other psychological conditions)
◦ Tricyclic antidepressants
◦ SSRI’s
◦ Major tranquilizers (Chlorpromazine, Butyrophenone, Prochlorperazine, Perpheasine, Trifluoperazine, Thioridazine)
◦ Monoamine oxidase inhibitors (Pargyline, Phenelzine)
◦ Other drugs
◦ Digoxin
◦ Cimetidine
◦ Clofibrate
◦ Blofibrate
◦ Drugs used in cancer chemotherapy
◦ Acetazolamide
◦ Heparin
◦ Estrogen
◦ Anorectic agents
Chronic medical conditions.
◦ Coronary artery disease.
◦ Diabetes Mellitus.
◦ Renal failure.
◦ Prostate Disease.
◦ Stroke disease.
◦ Arthritis.
◦ Parkinson’s disease and other Chronic neurological disorders.
◦ Chronic obstructive pulmonary disease.
◦ Malnutrition, and alcoholism.
Endocrinological Problems
◦ OCP
◦ Hypothyroidism.
◦ Hypogonadism leading to low gonadotrophins.
◦ Low Testosterone.
◦ Other severe Endocrinological disorders.
1. Desire Problems
◦ Hypoactive sexual desire disorder.
◦ Sexual aversion disorder.
◦ Hypoactive sexual desire disorder due to a general medical condition
◦ Substance-induced sexual dysfunction with impaired desire
2. Excitement Disorders
◦ Female sexual arousal disorder.
◦ Male erectile disorder.
◦ Male erectile disorder due to a general medical condition.
◦ Dyspareunia
◦ Majority have combined disorders in this phase due to a general
medical condition and psychological.
◦ Substance-induced sexual dysfunction with impaired arousal
3. Orgasmic disorders
◦ Female orgasmic disorder.
◦ Male orgasmic disorder.
◦ Premature ejaculation.
◦ Sexual dysfunction due to a general medical condition (male or female)
◦ Substance-induced sexual dysfunction with impaired orgasm
4. Disorders in the Resolution
◦ Postcoital dysphoria.
◦ Postcoital headache
Other disorders
◦ Vaginismus
Steps in Management
◦ Psychosexual History
◦ Investigations
◦ Giving essential information and explaining the therapy
◦ Cognitive and Behavioural Therapy
◦ Sex Modified Masters and Johnson's activities.
◦ Specific Therapies
◦ Pharmacotherapy
◦ Invasive Treatment including surgical procedures
Read..
◦ ICD-11
◦ https://icd.who.int/en

◦ Montage of sexuality of Sri Lanka

◦ (Santhushya Fernando, MBBS, MSc, MD (Community Medicine), Senel Wanniarachchi, B.A. Hons. (International
Relations), Janaki Vidanapathirana, MBBS, MSc, MD (Community Medicine))
◦ https://srilanka.unfpa.org/sites/default/files/pub-pdf/Montage%20of%20Sexuality.pdf
THANK YOU