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Disorders of Sex

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Title: Disorders of Sex


1
Disorders of Sex Gender
  • Psych 251
  • October 2, 2003

2
dynamics of sexuality
  • experiences of sex and desire are mediated by
    biology, our personal psychologies, and cultural
    values and norms
  • sexual desire is often construed as unruly
  • our desires may catch us by surprise, differ from
    how we think about our selves consciously
  • social and psychological structures are created
    to keep unruly sex in control
  • designations of disordered sexuality or gender
    may be one such form of control

3
Sexual and Gender Identity Disorders listed in
the DSM-IV
  • Sexual Dysfunctions--problems with desire,
    arousal, and orgasm
  • Sexual Desire Disorders, Sexual Arousal
    Disorders, Orgasmic Disorders, Sexual Pain
    Disorders
  • Paraphilias--problems with whom or what you are
    sexual
  • Exhibitionism, Fetishism, Frotteurism,
    Pedophilia, Sexual Masochism, Sexual Sadism,
    Transvestic Fetishism
  • Gender Identity Disorders--problems with your
    gendered self

4
sexual values
  • before 1973, the DSM listed homosexuality as a
    sexual disorder
  • ones sexual desire may cause individual
    distress, but where do we locate the source of
    this distress?
  • disorders we will discuss today are deemed
    pathological, in part, because of our values
    about what constitutes good and appropriate
    sexual behavior
  • What are contemporary cultural attitudes about
    good and appropriate sex?

5
dominant sexual values expectations
  • sex is important and ought to occur
  • sex should be orgasmic
  • sex should be limited to involvements between 2
    adults
  • not children
  • not inanimate objects or parts of people
  • whatever your assigned gender, you should feel
    like that gender

6
Sexual Dysfunctions
  • disorders in which people can not respond
    normally in key areas of sexual functioning
  • typically very distressing
  • make it difficult or impossible to enjoy sexual
    intercourse
  • often lead to sexual frustration, guilt, loss of
    self-esteem, and interpersonal problems
  • quite common as many as 31 of men and 43 of
    women suffer from such a dysfunction during their
    lives

7
common male sexual dysfunction
  • male erectile disorder
  • definition failure to attain or maintain an
    adequate erection
  • frequency 10 of men increases to 15 at age
    60 1/2 of all men experience some erectile
    difficulty at least some of the time
  • treatment focus on reducing the mans
    performance anxiety, increasing his stimulation,
    or both

8
male erectile disorder
  • treatment techniques
  • sensate focus exercises--partners focus on the
    sexual pleasure that can be achieved by exploring
    and caressing each others bodies, without
    demands to have intercourse or reach orgasm
  • tease technique--partner caresses, but if man
    gets an erection, partner stops caressing him
    until he loses it (reduces pressure to perform)
  • Viagra--biological approach increases blood flow
    to penis

9
common female sexual dysfunction
  • female orgasmic disorder
  • definition inability to achieve orgasm despite
    adequate stimulation
  • frequency 25 of women suffer from 10 or more
    of women today have never had an orgasm (either
    alone or during intercourse) another 10 rarely
    have orgasm
  • half of all women experience orgasm in
    intercourse at least fairly regularly

10
treatment techniques
  • directed masturbation training
  • a woman is taught step-by-step how to masturbate
    effectively and eventually to reach orgasm during
    sexual interactions
  • highly effective over 90 of women learn to have
    an orgasm during masturbation about 80 during
    caressing by their partners about 30 during
    intercourse
  • hormone therapy also being used increasingly

11
theoretical perspectives sexual dysfunctions
  • psychodynamic
  • tend to explain through the presence of
    unresolved sexual issues from childhood
  • will understand manifest problem as representing
    a solution or an attempt to cope with earlier
    difficulty
  • ex male erectile disorder as cure for guilt
  • focus on meanings of sexuality for person
  • particularly unconscious meanings for example,
    conflicts about intimacy, merger or boundary
    issues

12
cognitive behavioral models
  • cognitive
  • focus on the self-talk accompanying sexual
    dysfunction
  • therapist might help patients examine and change
    beliefs about sexuality that are interfering with
    sexual arousal and pleasure
  • behavioral
  • sexual problems as learned through accidental
    pairings or patterns of reinforcement
  • treatment such as pause procedure (for
    premature ejaculation) creates new associations

13
medical views
  • assumption of physiological incapacity unless
    proven otherwise
  • health, age, medications, hormones, etc. may all
    influence sexual desire and arousal
  • ex drop in testosterone can affect sex drive in
    both men and women shifts in estrogen during
    menstrual cycle can cause fluctuations
  • medical assessment will look for possible
    contributing factors such as hormonal
    imbalances, vascular problems, damage to the
    nervous system, effects of medications or
    substance abuse

14
evaluation biological or psychological?
  • measuring sexual arousal during sleep
  • during REM sleep, men typically get erections and
    women lubricate, as many as 2 to 5 times a night
  • snap gauge may be used to assess whether or not
    man experienced an erection during sleep
  • behavioral assessment
  • global--occurs in all contexts (intercourse and
    masturbation)
  • situation-specific--ex occurs with wife, but not
    mistress

15
cultural milieu
  • although we appear, in the media and pop culture,
    to be sexually explicit and obsessed, many people
    are quite reserved when talking about sexual
    issues
  • even with sexual partners or therapists
  • masculinity is often defined in phallic terms
  • when men experience sexual disorders, may feel
    that manhood itself is under attack
  • sexual scripts may place undue pressure on men to
    perform

16
cultural milieu female desire
  • desire and pleasure are often left out of our
    formal, approved discourses of sexuality--particul
    arly for girls
  • sexual scripts suggest that males should take the
    lead in sexual acts, that sex is driven by and
    about male sexual desire
  • sexual desire of girls and women presented as
    optional for sexual acts
  • 1/4 of adolescent girls who have had sex say it
    was voluntary, but unwanted

17
not talking about female desire consequences
  • failure to address desire is implicitly shaming
  • females may feel desire, but not know how to
    enact it
  • girls not told anywhere that they might like,
    want, need, seek out, or enjoy sexual activity
  • without recognition of their desire, it is
    difficult for females to become agents of their
    own desire
  • taught to be objects of others desire
  • becomes difficult to recognize and articulate
    what one does and does not want sexually

18
Disorders of Gender Identity
  • degree to which individuals challenge our gender
    categories varies
  • some feel relatively comfortable within existing
    categories, others chafe within societys
    definitions and expectations but do not question
    their core gender identity
  • gender identity disorders are diagnosed when
    individuals feel that they fundamentally do not
    belong in the categories they have been assigned

19
GID DSM-IV diagnostic criteria
  • A. A strong and persistent cross-gender
    identification.
  • B. Persistent discomfort with his or her sex or
    sense of inappropriateness in the gender role of
    that sex.
  • C. The disturbance is not concurrent with a
    physical intersex condition.
  • D. The disturbance causes clinically significant
    distress or impairment.

20
Transsexualism
  • ones psychological experience of gender
    conflicts with ones biological sex
  • may feel that a horrible mistake has been made
    that you were assigned the wrong sex
  • experience is one that is usually psychologically
    and socially quite painful
  • often experience depression and have thoughts of
    suicide
  • may be preoccupied with getting rid of primary
    and secondary sexual characteristics and
    acquiring the characteristics of the other sex

21
  • in order to correct for this mistake,
    transsexuals may attempt to live their lives in
    accord with their internal gender
  • may engage in cross-dressing
  • have a sex change operation, etc.
  • others may become transactivists--fighting for
    the rights of transgendered individuals and/or
    advocating for changes to our dichotomous gender
    system

22
gender sexual orientation
  • more common among males than females
  • FTM--female to male
  • MTF--male to female (men outnumber women by
    around 2 to 1)
  • ideas about why this might be?
  • sexual orientation
  • MTF--substantial numbers are sexually attracted
    to males, females, both, or neither
  • FTM--virtually all are sexually attracted to
    females, although some exceptions exist

23
not to be confused with...Transvestic Fetishism
  • transvestic fetishism--cross-dressing adopted as
    a means of achieving sexual arousal
  • almost always a heterosexual man
  • retains a clear sense of himself as a man
  • excitement is about being a man wearing a womans
    clothing
  • behavior may be secretive or shameful
  • etiology not unusual to find examples in history
    of cross-dressing behavior being encouraged or
    rewarded during childhood

24
controversy transsexualism as disease
  • psychopathology?
  • diagnosis from DSM-IV is necessary for insurance
    reimbursement
  • experience is one that often creates
    psychological pain and difficulty
  • life style?
  • If I want my nose done, its a nose job. If I
    want my breasts done, its a boob job. But if I
    want my groin done, suddenly I have a mental
    disease. (Riki Ann Wilchins)

25
cultural problems with gender?
  • others locate the disease within our cultures
    approach to gender
  • criticize the ways in which
  • gender is overly emphasized
  • gender roles and categories are enforced too
    rigidly
  • categories of gender are falsely constructed as
    binary
  • expectations of congruence between biological
    appearance of sex and gender roles is overly
    valued

26
sex-reassignment surgery
  • some transsexual adults change their sexual
    characteristics by means of hormone treatments
    and feel that this is sufficient
  • for others, this is not enough, and they elect
    for sex-reassignment surgery
  • surgery is usually preceded by
  • one to two years of hormone therapy
    participation in extended counseling or
    psychotherapy taking steps in order to live life
    fully as the opposite of ones biological sex

27
  • approximately 1,000 sex change operations are
    performed each year in the US (top, bottom,
    and face may all be involved)
  • complications
  • surgery and treatment do not often lead to
    cosmetically or functionally adequate genitalia
  • individuals may have
  • scarring
  • on-going need for medical treatment
  • loss of sexual arousal
  • difficulty with orgasm

28
Long-Term Psychological Outcomes
  • results not clear or definitive
  • some studies show improvement in self-esteem
    post-surgery with people functioning well for
    years after
  • other studies show
  • problem outcomes longer term
  • initial acceptance diminished over time
  • psychiatric distress increased following loss of
    ones genitals

29
Is surgery an appropriate treatment for
transsexualism?
  • different positions
  • humane solution giving transsexuals what they
    want
  • drastic nonsolution for a largely psychological
    problem
  • subjecting bodies to mutilation in order to
    conform to cultures rigid gender requirements

30
Gender Identity Disorder in Childhood
  • like adults, feel uncomfortable with assigned sex
    and yearn to be members of the opposite sex
  • developmental course childhood pattern usually
    disappears by adolescence or adulthood
  • research findings for boys
  • about 3/4 of boys with GID report a homosexual or
    bisexual orientation later in development,
    without continuing GID symptoms

31
  • most of the remainder report later heterosexual
    orientation without continuing GID symptoms
  • a small percentage of adolescents and adults
    request sex-reassignment surgery or live as
    transgenderists
  • conclusion transsexual adults may have had a
    childhood gender identity disorder, but most
    children with a gender identity disorder do not
    become transsexual adults
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