PSYC 4430 Lecture Notes - Lecture 9: Congenital Adrenal Hyperplasia, Secondary Sex Characteristic, Gender Dysphoria

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10 Jun 2018
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Chapter 9: Sexual Disorders, Gender Dysphoria, Paraphilic Disorders
1. Sexual and gender identity disorder
a. Development of sexual orientation
i. Interaction of bio-psycho-social influences
ii. Example of homosexuality
1. Only small genetic component: 50% of identical twins raised
together (i.e. same genes and environment) do not share the
same sexual orientation
b. DSM-5 disorders of sexuality and gender
i. Gender dysphoria
ii. Sexual dysfunctions
iii. Paraphilia
2. Gender dysphoria
a. Definition
i. Feels out of plae ith oe’s epressed/eperienced gender and assigned
gender
1. Some refer to this as feeling trapped in the wrong body
2. Desire to assume the identity of the desired gender
3. Goal is not sexual
ii. Causes are unclear
1. Gender identity develops between 18 months and 3 years of age
iii. Fluid of cross-gendered identity is not a disorder; it only becomes a
disorder when it causes distress or significant impairment
b. Treatment
i. Hormone treatment
1. Referred to as hormone replacement therapy (HRT)
2. Suppresses production of the hormones associated with the birth
sex
3. Causes secondary sexual characteristics to (develop breasts)
ii. Sex reassignment surgery (SRS)
1. Must be psychologically/socially/financially stable and live as
desired gender for several years first
2. 75% report satisfaction with new identity
3. Female-to-male conversions adjust better
iii. Controversial: psychological treatment of transgender behavior in kids
c. Gender dysphoria and intersexuality
i. When diagnosing gender dysphoria, it is specified if it is with a disorder of
sex development such as a congenital adrenogenital disorder
1. Examples
a. Congenital adrenal hyperplasia
i. Symptoms include ambiguous genitalia in girls and
an enlarged penis in boys
b. Androgen insensitivity syndrome
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i. Has XY chromosomes, but is resistant to androgens
and as a result has the physical traits of a woman
1. Cannot reproduce
ii. Treatment of intersexuality
1. Geitals are geerall oralized durig surger at irth
2. Infertility is common
3. Subsequent gender dysphoria may need to be addressed
4. The Intersex Society of North America was founded to combat the
unnecessary infant surgeries, as well as the shame and secrecy
around ambiguous genitalia
3. Sexual dysfunctions
a. Overview
i. Involve arousal, desire, and/or orgasm
ii. Pain associated with sex can lead to dysfunction
iii. Must now be present for 6 or more months in order to make a diagnosis
iv. Must lead to impairment of distress in order to be considered a disorder
v. Prevalence
1. Sexual difficulties are extremely common and not always
distressing
a. One study: 40% of men had some difficulty with
erection/ejaculation, 63% of women had problems with
arousal/orgasm
2. Males and females usually experience parallel versions of most
dysfunctions
vi. Classification
1. Lifelong vs. acquired
2. Generalized vs. situational
3. Psychological factors
4. Psychological factors combined with medical conditions
b. Types of sexual dysfunction
i. Male hypoactive sexual desire disorder
1. Little or no interest in any type of sexual activity
2. Masturbation, sexual fantasies, and intercourse are rare
3. Accounts for half of all complaints at sexuality clinics
4. Affects 5% of men
ii. Female sexual interest/arousal disorder
1. Lack of or significantly reduced sexual interest/arousal
a. Typically manifesting in:
i. Reduced sexual activity
ii. Reduced sexual interest
iii. Fewer sexual thoughts
iv. Reduced arousal to sexual cues
v. Reduced pleasure or sensations during almost all
sexual encounters
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