HUMAN SEXUAL DEVELOPMENT AND PARAPHILIAS

1
HUMAN SEXUAL DEVELOPMENT AND PARAPHILIAS

• Prof. MUDr. Jirí Raboch, DrSc.
• Department of Psychiatry, First Faculty of
  Medicine, Charles University and General
  University Hospital in Prague

2
(No Transcript)
3
SEXUAL DEVELOPMENT
4
GONADAL DIFERENTIATION
Kucinskas and Just, 2005
5
SEXUAL DEVELOPMENT
6
RATS BRAIN
7
RATS SEXUAL ACTIVITY
8
SEXUAL CENTERS IN THE HYPOTHALAMUS
sex center mating center
Female area praeoptica Hypothalamus ventralis nc. ventromedialis
Male mediobasalis hypothalamus area praeoptica
9
DIFERENTIATION OF HYPOTALAMIC NUCLEI AND
EPITHELIAN OF THE 3rd. BRAIN VENTRICLE
10
FETAL TESTOSTERONE LEVELS
11
HOHLWEGS EFFEKT
Kiss1/kisspeptin system Kiss1 gene expression
and kisspeptin protein levels in anteroventral
periventricular nucleus higher levels in
females Kauffman 2009
12
RESULTS OF HYPOTHALAMOTHOMY
13
SEXUAL DEVELOPMENT
14
SIGMUND FREUD 1856 - 1939

• THEORY OF UNCONSCIOUNESS
• PSYCHOSEXUAL DEVELOPMENT
• CHILDHOOD SEXUALITY
• CONFLICTS, COMPLEXES

15
Consequences of early stress and childhood
maltreatment (child sexual abuse)

• The major structural consequences of early
  stress include reduced size of the mid-portions
  of the corpus callosum and attenuated development
  of the left neocortex, hippocampus, and amygdala
• Early stress alters the development of monoamine
  neurotransmitters and affects their degree of
  laterality

Teicher et al., 2003
16
CUMMULATIVE FREQUENCY OF EXPERIENCES WITH
FORCEFULL SEXUAL ACTIVITY 174 female students
and 137 male students of 1st.
Medical School

age (years)
Raboch, 1996
17
REDUCTION OF BRAIN STRUCTURES DEPENDENT ON AGE OF
THE CHILD
STRUCTURE AGE AT CSA
HIPPOCAMPUS 3 5, 11 13
CORPUS CALLOSUM 9 10
FRONTAL CORTEX 14 16
AMYGDALA No differences
Teicher et al., 2008
18
Plasticity of the brain

• EVOLUTIONARY
• REACTIVE
• ADAPTIVE
• REPARATIVE
• SYNAPTIC LEVEL
• LOCAL CIRCUITS
• DISTANT CIRCUITS

• PROLIFERATION
• MIGRATION
• DIFERENTIATION
• CRITICAL (SENSITIVE) PERIODS

19
HIPPOCAMPUS AND DEPRESSION
Vaidya a Duman, 2001
20
Neuroanatomical sex-specific differences

• MALE BRAIN CONTAINS ON AVERAGE 16 NEURONS MORE
• MALE CORPUS CALLOSUM IS BIGGER
• FEMALE TEMPORAL CORTEX HAS ON AVERAGE 11 GREATER
  DENSITY OF NEURONS
• THE MOST SIGNIFICANT DIFFERENCES - HYPOTHALAMUS
• Sickel a McCarthy, 2000

21
Sexual diferentiation of the brain

• HYPOTHALAMUS
• SDN-POA (sexually dimorphic nucleus of praeoptic
  area) - rats
• INAH 1,2,3,4 (interstitial nuclei of the anterior
  hypothalamus) human beings
• Bed nucleus of stria terminalis

22
DEVELOPMENT OF HYPOTHALOAMIC SDN-POA (INAH)
23
SEXUAL DEVELOPMENT
24
(No Transcript)
25
BED NUCLEUS OF STRIA TERMINALIS DEVELOPMENT
Chung et al., 2002
26
VOLUMES OF BED NUCLEUS OF STRIA TERMINALIS
MTF-T malet to female transsexuals N6
Zhou et al., 1995
27
Criteria of sexual normality

• Adequate gender identity
• PREFERENCE OF
• Heterosexuality (?)
• Mature object
• Mutual contrived (voluntary)
• Adequate interaction technique
• Other

28
F64 Gender identity disorders

• F64.0 Transsexualism
• F64.1 Transvestitism of the double role
• F64.2 Gender identity disorder in childhood

29
F66 Mental and behavioral disorders connceted
with the sexual development and orientation

• F66.0 Sexual maturation disorder
• F66.1 Ego-dystonic sexual orientation
• F66.2 Sexual relationships disorder

30
F65 Disorders of sexual preferences

• F65.0 Fetishism
• F65.1 Transvestic fetishism
• F65.2 Exhibitionism
• F65.3 Voyerism
• F65.4 Pedophilia
• F65.5 Sexual sadism, masochism
• F65.6 Multiple disorders of sexual preferences

31
Treatment of paraphilias

• voluntary
• involuntary
• out-patient
• in-patient
• Psychotherapy
• individual
• group
• CBT
• Sociotherapy

• Pharmacoterapy
• (estrogens)
• antiandrogens
• gestagens
• lithium
• neuroleptics
• LH-RH analogs
• Operations (?)
• hypothalamo-thomy
• castration

32
THANK YOU FOR YOUR ATTENTITION