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Lecture 10

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Psychology 2030A/B
David Vollick

Abnormal  Psychology  Chapter  10:   Sexual  Disorders  and  Gender  Identity  Disorder  (pp.340-­‐383)     Sexual  Disorders  and  Gender  Identity  Disorder:  An  Overview  (pp.341-­‐345)   • What  Is  “Normal”  vs.  “Abnormal”  Sexual  Behaviour?   o Cultural  considerations  (e.g.  only  about  50%  of  societies  accept   premarital  sex)   o Sexuality  and  the  elderly   o Gender  differences  in  sexual  behaviour  and  attitudes  –  no  differences   between  males  and  females  re:  number  of  sexual  partners  in  the  past   year   • Development  of  Sexual  Orientation   o Complex  interaction  of  bio-­‐psychosocial  influences  –  no  single  factor   can  account  for  orientation     The  Nature  of  Gender  Identity  Disorder  (pp.345-­‐350)   • Clinical  Overview   o Trapped  in  the  body  of  the  wrong  sex   o Assume  the  identity  of  the  desired  sex,  but  the  goal  is  not  sexual   • Causes  are  Unclear   o Biological  –  testosterone/estrogen??   o GI  develops  between  18months  and  3  years  of  age   • Sex-­‐Reassignment  as  a  Treatment  of  Gender  Identity  Disorder   o Candidates?  –  some  basic  prerequisites  before  surgery   o 75%  report  satisfaction  with  new  identity   o Female-­‐mal  adjust  better  than  male-­‐female   • Psychosocial  Treatment  of  Gender  Identity  Disorder   o Realigning  the  persons  psychological  gender  with  their  biological  sex   o Few  large  scale  studies   o Enza  Anderson  one  of  the  best  known  Canadian  cases  of  male-­‐female   transsexualism  in  Canada   o Ran  for  mayor  of  Toronto  in  2000  and  came  in  3  and  ran  for   municipal  council  in  2003  and  came  in  2       Sexual  Dysfunctions:  An  Overview  (pp.  351)   • Figure  10.2  –  Normal  Cycle   • Sexual  dysfunctions  involve  desire,  arousal,  and/or  orgasm   • Males  and  females  experience  parallel  versions  of  most  dysfunctions   o Affects  about  43%  of  females  and  31%  of  males   o Most  prevalent  class  of  disorder  in  the  US   • Most  persons  suffer  from  more  than  one  dysfunction   • Classification  of  Sexual  Dysfunctions   o Lifelong  vs.  acquired   o Generalized  vs.  specific   o Dues  to  psychological  factors  alone  or  in  combination  with  medical   condition   Sexual  Desire  Disorders  (pp.  351-­‐353)   • Hypoactive  Sexual  Desire  Disorder   o Little  or  no  interest  in  any  type  of  sexual  activity   o Masturbation,  sexual  fantasies,  and  intercourse  are  rare  in  this   disorder   o Accounts  for  half  of  all  complaints  at  sexuality  clinics   o 11%  of  women  and  5%  of  men  suffer  from  this  disorder   • Sexual  Aversion  Disorder   o Little  interest  in  sex   o Extreme  fear,  panic,  or  disgust  related  to  physical  or  sexual  contact   o 25%  of  patients  met  criteria  for  panic  attacks     Sexual  Arousal  Disorder  (pp.353-­‐354)   • Male  Erectile  Disorder   o Difficulty  achieving  and  maintaining  an  erection   • Female  Sexual  Arousal  Disorder   o Difficulty  achieving  and  maintaining  adequate  lubrication    Current  definition  focuses  too  much  on  “genital  events”  (such   as  lubrication  difficulties)  –  not  enough  on  subjective  arousal   • Study  –  women  with  arousal  disorder  often  show   normal  vaginal  responding  to  erotic  movies  despite   reporting  low  subjective  arousal   • Associated  Features  of  Sexual  Arousal  Disorders   o Problem  is  arousal,  not  desire   o Problem  affects  about  5%  of  males,  14%  of  females  (hard  to  estimate   –  lack  of  arousal  often  considered  a  problem)   o Males  are  more  troubled  by  the  problem  than  females   o Erectile  problems  are  the  main  reason  males  seek  help     Orgasm  Disorders:  An  Overview  (pp.  355-­‐357)   • Inhibited  Orgasm:  Female  and  Male  Orgasmic  Disorder   o Inability  to  achieve  orgasm  despite  adequate  sexual  desire  and   arousal   o Rare  in  adult  males  (also  retarded  and  retrograde  ejaculation)   o Most  common  complaint  of  adult  females   o 25%  of  adult  females  report  significant  difficulty  reaching  orgasm   o 50%  of  adult  females  report  experiencing  regular  orgasms  during   intercourse   • Premature  Ejaculation   o Ejaculation  occurring  before  the  man  or  partner  wishes  it  to   o 9%  of  all  Canadian  adult  males  meet  criteria   o Most  prevalent  sexual  dysfunction  in  adult  males   o Most  common  in  younger,  inexperienced  males,  and  declines  with  age   o How  soon  it  too  soon?  Perhaps  perceptions  of  lack  of  control  better   criterion   • Dyspareunia   o Extreme  pain  during  intercourse   o Adequate  sexual  arousal  desire,  and  ability  to  attain  arousal  and   orgasm   o Must  rule  out  medical  reasons  for  pain   o Affect  1%  to  %  of  men  and  about  10%  to  15%  of  women   • Vaginismus   o Outer  third  of  the  vagina  undergoes  involuntary  spasms   o Complaints  include  feeling  of  ripping,  burning,  or  tearing   o Prevalence  rates  are  higher  in  more  conservative  countries  and   subgroups     Assessing  Sexual  Behaviour  and  Sexual  Dysfunction  (pp.359)   • Comprehensive  Interview   o Include  a  detailed  history  of  sexual  behaviour,  lifestyle  and  associated   factors   • Medical  Examination   o Must  rule  out  potential  medical  causes  of  sexual  dysfunction   • Psychophysiological  Evaluation   o Exposure  to  erotic  material   o Males  –  penile  strain  gauge   o Females  –  vaginal  photoplethysmograph   o Determine  extent  and  pattern  of  physiological  and  subjective  sexual   arousal   o Nocturnal  erections  (REM)     Causes  of  Sexual  Dysfunctions  (pp.  359-­‐363)   • Biological  Contribution   o Physical  and  medical  illnesses  –  cautious   o Prescription  medications   o Use  and  abuse  of  alcohol  and  other  drugs   • Psychological  Contributions   o The  role  of  “anxiety”  vs.  “distraction”   o The  cognitive  and  emotional  components  of  performance  anxiety   (determines  blood  flow)   • Social  and  Cultural  Contributions   o Erotophobia  –  learned  –  ‘ve  attitudes  about  sexuality   o Negative  or  traumatic  sexual  experiences   o Deterioration  of
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