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PSYC 235Chapter 10.docx

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PSYC 235
Christopher Bowie

Chapter 10: Sexual Disorders and Gender Identity Disorder Gender: psychological condition of being female, male, graduations of both Sex: biological condition of being female or male Gender Role: behaving in a way that is typical of females of males ->Enactment of gender stereotypes, gender schemas, doing gender Gender Identity: sense of maleness/femaleness, graduation of both Gender Dysphoria: Marked incongruence with one’s experienced and expressed Gender and assigned gender -Discontent with biological sex -Desire to live in felt gender role -Desire for physical characteristics of opposite sex Transgender: A person whose gender is different from their biological sex -Adopts the felt gender role Transsexual: Person whose phenotypic sex (physical sexual characteristics) is Altered through surgery and/or hormone treatments to match their Gender identity Intersexed: a person who’s born with a mix of biological traits typical of both sexes -A person having a disorder of sexual development Fa’afafine: Third gender role in Samoan culture -Biological males living in the female role, sexually attracted to men Two-Spirit: Third gender (mixed gender identity) among First Nations People Genderqueer: Person with varying stereotypical gender combinations and chooses Not to adopt either identity 3 Kinds of Sexual Behaviour Disorder: 1. Gender Identity Disorder: experiences psychological dissatisfaction with his or her biological sex. -Not specifically sexual but disturbance in person’s sense of identity 2. Sexual Dysfunction: difficult to function adequately during sex 3. Paraphilia: sexual arousal occurs primarily in the context of inappropriate objects or individuals Transsexuality Characteristics a) Male-to-Female Transsexual (MTF)  Biological male who identifies as a woman  Can be attracted to women (lesbian) or men (heterosexual)  Significant majority of lesbian-identified MTF have a history of autogynephila: sexual attraction to the image of oneself as a woman b) Female-to-Male Transsexual (FTM)  Biological female who identifies as a man  Can be attracted to women (heterosexual) or men (gay) Etiology of Gender Variation -No clear psychological theory of gender incongruity -Extrapolation from hormonal/biological studies in animals and from DSDs/Intersexed to gender variant people  Suggest that gender is associated with early/prenatal hormonal events that shape brain development sexual attractions, and gender congruence Intersexed brain theory: some event causes the brain to develop in male-typical or female-typical ways  Homosexual have a 39% greater chance of being left/mixed handed  Hypothalamic nucleus -> bed of nucleus of the stria terminalis differences in structure volume and neuron count  Smaller in MTFs than natal males  1 FTM greater than natal females Berglund (2008)  MTFs (lesbian) activation to same and opposite-sex pheromones different from natal heterosexual men, more similar to natal heterosexual women Gizewski et al (2009)  Brain activation during erotic stimuli similar in MTFs as natal women Development of Sexual Orientation (Gene & Gender variations) -Studies show that there is a heritability of gender-related behavior and gender dysphoria in child and adolescent twin samples  Possible gene for homosexual orientation = X chromosome  50% of monozygotic twins, 16%-22% dizygotic twins -Environmental factor and biological vulnerability contributes -Variations in genes that code sex hormones, androgens & estrogens (testosterone)  Androgen receptor gene of MTFs impairs androgen utilization  Variations in androgen & estrogen receptor, and related genes in FTMS Gender Differences -Higher reports of men than women who masturbate (80% vs. 48%) -Men endorse more sexual fantasies than women except for erotic garments -Casual premarital sex more permissively acceptable by men (gap is getting smaller)  Women tend to report passionate/romantic feelings as an integral part of their sexuality and openness to sexual experience  Men feel power, independence, and aggression as well as passion and openness and generally do not possess negative beliefs reflecting self- consciousness, embarrassment or inhibition  ½ of adolescent males & ¼ of females report two or more sexual partners in a year  Oral contraceptive use (84%-90%)was more common than condom use (64%-80%)  ->STD rates are rising while pregnancy rates have decreased Cultural Differences a) Sambina, New Guinea: -Believe semen to be an essential substance for growth and development for young boys in the tribe and it is not produced naturally (cannot produce spontaneously) -All young boys in the rive around 7 become semen recipients by engaging exclusively in homosexual oral sex with teenage boys and later on switch roles -Only oral sex is permitted; no masturbation allowed -They are then later expected to marry and become exclusively heterosexual b) Munda, India -Adolescents and children live together (both male and female) -Sexual activity -> mostly of petting and mutual masturbation (heterosexual) Gender Identity Disorder : person’s physical gender is inconsistent with that person’s sense of identity and they feel trapped in their own body. The primary goal is not sexual but rather the desire to live life openly like others with that gender. 1) A strong and persistent cross-gender identification (more than a desire)  Repeated state of desire to be, or insisting that they are the opposite sex  Boys -> preference to cross –dress or simulate female attire Girls -> insisting on wearing stereotypical masculine clothing  Strong/persistent preferences for cross-sex roles in make-believe play or fantasies of being the other sex  Intense desire to participate in the stereotype activities of other sex  Strong preference for playmates of the other sex  Adults/Adolescents: symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to life or be treated as the other sex, or the conviction of having the typical feelings/reactions of the other sex 2) Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex (want to get rid of physical characteristics)  Boys: penis/testes are disgusting or will disappear or better without them, avoid rough and tumble play and rejection of male stereotypes  Girls: rejection of urinating in a sitting position, assertion that she has or will grow a penis, she does not want to grow breasts or menstruate or avoid female clothing  Adults: preoccupation with getting rid of primary/secondary sex characteristics (request for hormones, surgery, physical altercations) or belief that they were born in the wrong sex 3) The disturbance is not concurrent with a physical intersex condition  EX: hermaphrodites: born with ambiguous genitalia 4) Disturbance causes clinically significant distress or impairment in social, occupational or other important areas of functioning Gender identity is independent of sexual arousal patterns EX: heterosexual women before surgery become gay men after surgery “Treatment” of Gender Dysphoria -Focuses on ways to resolve gender dysphoria counseling/support process -Follows World Professional Association for Transgender Health Standards of Care  Psychological & physical evaluation: ->Rule out mental disorder, physical factors  Real-life experience  Hormone replacement therapy  Sex reassignment surgery/adjunct surgeries ->No longer required in Ontario for gender change on birth certificate -During counseling, explore possibilities of:  Occasional living in the felt gender role  Full-time living  Hormone therapy  Sex reassignment surgeries  DOESN’T focus on accepting gender role associated with biological sex Sexual dysfunction : difficulty-achieving arousal during sexual interactions  Due to a) psychological factors b) combination with medical condition  Can be either lifelong or acquired  Generalized (occurring every time) or Situational (certain partners or times)  28% of women and %18 men experience sexual dysfunction Sexual Desire Disorders Hypoactive Sexual Desire Disorder: little/no interest in any sexual activity a. Persistently or recurrently deficient/absent sexual fantasies and desire for sexual activity. b. Disturbance cause marked distress or interpersonal difficulty c. Dysfunction is not better accounted for but another disorder and is not due exclusively to the direct physiological effects of a substance or a general medical condition -50% of patients complain of hypoactive sexual desire with more frequency found in women while men more often reported for erectile dysfunction -Patients with this disorder rarely have sexual fantasies, seldom masturbate and hardly engage in intercourse Sexual Aversion Disorder: thought of sex or touch may evoke fear, panic, disgust a. Persistent/recurrent extreme aversion to, and avoidance of almost or all genital sexual contact with a sexual partner b. Disturbance causes marked distress or interpersonal difficulty c. The sexual dysfunction is not better accounted for by another disorder Sexual Arousal Disorders Female sexual arousal disorder/Male erectile disorder: although having frequent sexual urges and fantasies and a strong desire to have sex, their problem is in become physically aroused a. Persistent/recurrent inability to attain or maintain adequate lubrication or erection as a response of sexual excitement until completion of sex b. Disturbance causes marked distress or interpersonal difficulty c. Dysfunction is not better accounted for but another disorder and is not due exclusively to the direct physiological effects of a substance or a general medical condition -In women, arousal and lubrication may decrease at any time but for men, such problems tend to accompany aging -Situations where: full erections are possible during masturbation and a partial erection during attempted intercourse but with insufficient rigidly to allow penetration -40% of 40 year-old men and 70% of 70 year-old men have impairment Criticism of the current definition of female arousal disorder  Focuses too much on genital events (ex: lubrication difficulties) and instead should focus on women’s subjective arousal  Studies show that women with arousal disorders often show normal vaginal responding to erotic movies which reporting low subject excitement Orgasm Disorders Inhibited Orgasm: inability to achieve an orgasm despite adequate sexual desire and arousal is commonly seen in women but rare in men  25% of women report difficulty reaching orgasm  Only 50% of all women experience reasonably regular orgasms during sexual intercourse  Globally, 5% of men report the inability to achieve orgasms Premature Ejaculation: ejaculation that occurs well before the man and partner want it to  9% of all men report a sexual dysfunction involving premature ejaculation  Typically climax no more than 1-2 minutes after penetration  Behavioral (ex: regularity of premature ejaculation, Emotional (ex: worry or concern for), Efficiency (ex: perceiving that they have little control  Appears more often to inexperienced women with less education and lower frequency of intercourse Sexual Pain Disorders Dyspareunia: high sexual desire/drive but pain of intercourse is extremely severe a. Persistent or recurrent genital pain associated with sexual intercourse in either a male and female b. Disturbance causes marked distress or interpersonal difficulty c. Dysfunction is not caused exclusively by vaginismus or lack of lubrication, is not better accounted for but another disorder and is not due exclusively to the direct physiological effects of a substance or a general medical condition -Only diagnosed if no medical reasons for pain can be found -Degree of pain found in women similar to depressive/anxious symptoms and can be associated with marital adjustment problems, hostility and psychotic symptoms -Rarely seen in clinics but estimates range from 1-5% of men and 10-15% in women Treatment:  Should be approached from a pain-management perspective  Focus on the patient’s chronic pain, impact of the dyspareunia on the couple’s relationship and any associated psychological effects Vaginismus: spasm reaction of vagina occurs during sexual intercourse a. Persistent/recurrent involuntary spasm of the musculature of the outer third vagina that interferes with sexual intercourse b. Disturbance causes marked distress or interpersonal difficulty c. Dysfunction is not better accounted for but another disorder and is not due exclusively to the direct physiological effects of a substance or a general medical condition Assess
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