Chapter 13: Sexual and Gender Identity Disorders
1. Be able to describe norms and gender differences in sexuality.
2. Be able to define the phases of the sexual response cycle.
3. Be able to explain the symptoms, causes, and treatments for sexual dysfunctions,
gender identity disorder, and paraphilias.
4. Be able to discuss the epidemiology and predictors of rape and sexual coercion, as well
as treatment programs for sexual offenders.
Sexual behavior and attitudes are heavily influenced by culture, and so any
discussion of disorders in sexuality must be sensitive to the idea that norms are
likely to change over time and place. Currently, a great deal of research is focused
on gender differences in sexuality.
The DSM categorizes these disturbances in four groups: sexual desire disorders,
sexual arousal disorders, orgasmic disorders, and sexual pain disorders. Many people
experience brief sexual symptoms, but these are not diagnosable unless they are
recurrent, cause either distress or impairment, or are not explained by medical conditions.
Research on the etiology of sexual dysfunctions is difficult to conduct, as surveys
may be inaccurate and laboratory measures may be difficult to obtain. Researchers have
identified many different variables that can contribute to sexual dysfunctions, including biological variables, previous sexual experiences, relationship issues, psychopathology,
affect and arousal, and negative cognitions.
Many effective interventions for sexual dysfunctions are available, many of them
cognitive behavioral. Sex therapy, aimed at reversing old habits and teaching new skills,
was propelled into public consciousness by the Masters and Johnson work. Their method
hinges on gradual, non-threatening exposure to increasingly intimate sexual encounters
and the sanctioning of sexuality by credible and sensitive therapists. Sex therapists also
aim to educate patients in sexual anatomy and physiology, reduce anxiety, teach
communication skills, and improve attitudes and thoughts about sexuality. Couples
therapy is sometimes appropriate as well. Biological treatments such as Viagra also may
be used, especially when the sexual dysfunction is primarily due to physical rather than
psychological causes, as in many cases of erectile dysfunction.
Gender identity disorder (GID) involves the deep and persistent conviction of the
person that his or her anatomic sexual makeup and psychological sense of self as male or
female are discrepant. Thus, a man with GID is physically male but considers himself a
woman and desires to live as a woman.
Neurobiological models of GID emphasize genes and prenatal hormone exposure.
Research on neurobiology, though, has typically focused on sex-typed behavior and
attitudes, rather than full-blown diagnoses, and even then, neurobiological variables
account for only a certain amount of the variance.Another theory proposes that parents
may have reinforced cross-gender behavior. This theory has been criticized, though, as
most children who show cross-gender behaviors are harshly criticized by peers. The most common treatment for GID is sex-reassignment surgery to bring bodily
features into line with gender identity. There are case reports that behavioral treatment
can help a person minimize cross-gender behavior.
In the paraphilias, unusual imagery and acts are persistent and necessary for
sexual gratification. The principal paraphilias are fetishism, transvestic fetishism,
pedophilia, voyeurism, exhibitionism, frotteurism, sexual sadism, and sexual masochism.
Efforts have also been made to detect hormonal anomalies in people with
paraphilias, but the findings are inconclusive.
According to the psychodynamic view, the person with a paraphilia is fearful of
conventional heterosexual relationships; there is no empirical support for this idea. One
behavioral view is that a fetishistic attraction to objects arises from accidental classical
conditioning of sexual arousal, but this view has not received much empirical support.
Another behavioral hypothesis posits deficiencies in social skills that make it difficult for
the person to interact normally with other adults, but again, there is limited support for
this idea. Cognitive distortions appear to be involved.
The most promising treatments for the paraphilias are cognitive behavioral. One
conditioning procedure is to pair the inappropriate sexual object with painful or aversive
events. Cognitive methods focus on the cognitive distortions of the person with a
paraphilia; social-skills and empathy training are also common.Arange of studies
suggests that psychological treatments do reduce the number of legal offenses. SSRIs and
drugs that reduce testosterone levels have both been found to reduce sex drive and deviant sexual behaviors, but because of the side effects, there are ethical issues involved
in the use of these drugs.
Rape, although it is not separately diagnosed in DSM-IV-TR, results in
considerable psychological trauma for the victim and is far too prevalent. Some estimates
suggest that 20-25% of women will be raped during their lifetime. The nature of rapes
varies a great deal; some people rape strangers, but most rapes are committed by
someone known by the woman. The inclusion of rape in a discussion of human sexuality
is a matter of some controversy, as many theorists regard rape as an act of aggressive
violence rather than of sex.
Although there is no single profile that fits all rapists, variables that appear to
distinguish rapists include high levels of hostility towards women, antisocial and
impulsive personality traits, and high rates of sexual dysfunction. Social skills do not
seem to be poor, except for in convicted rapists. Many have emphasized that the
likelihood of rape is likely to be higher in societies that condone interpersonal violence.
Psychological treatment programs focus on increasing empathy for victims, anger
management, self-esteem, and substance abuse. Biological treatments, like those used for
paraphilias, are used to decrease sex drive by lowering male hormone levels. Treatment
has been shown to reduce the rate of recidivism.A major concern is that most rapes do
not get reported to police, and so few rapists are convicted.
1. In contrast to the general Victorian view, the contemporary Western world believes that
___________ of sexual expression contributes to problems.
a. an excess
b. inhibition c. the amount
d. the type
Answer: B Type: Factual Page: 413
2. Research suggests that gender differences in sexuality are
a. consistent across cultures.
b. vary greatly by culture.
c. are more of a result of culture than biology.
d. have changed greatly over the centuries.
Answer:AType: Factual Page: 415
3. Which of the following is NOT a phase in the sexual response cycle?
Answer C Type: Factual Page: 416
4. In the human sexual response cycle, what is the name of the phase in which blood
flows to the genitalia and pleasurable sensations build?
Answer: B Type: Factual Page: 416
5. Which of the following lists the correct order for the four responses in the human
sexual response cycle?
a. appetitive, excitement, orgasm and resolution
b. appetitive, excitement, resolution and climax
c. excitement, appetitive, orgasm and resolution
d. appetitive, orgasm, excitement and resolution
Answer:AType: Factual Page: 416
6. Elizabeth is slipping into her nightgown and watching her husband get into bed. She is
fantasizing about what they will soon be doing together. In which phase of the human
sexual response cycle is Elizabeth at this moment? a. resolution
Answer: C Type:Applied Page: 416
7. Barbara is concerned about her husband's premature ejaculation, which occurs before
she reaches orgasm. Which of the following phases of the sexual response cycle is
problematic in Barbara's husband?
Answer:AType:Applied Page: 416
8. Occasional symptoms of sexual dysfunctions
a. are fairly common.
b. typically cause marked distress.
c. are only labeled if they reoccur.
d. require immediate treatment.
Answer:AType: Factual Page: 418
9. Hannah reports that she has a low sex drive and sometimes has trouble reaching
orgasm. However, when asked by her doctor, she does not report distress or impairment
from these symptoms. The most likely diagnosis for Hannah would be
a. female orgasmic disorder.
b. sexual aversion disorder.
c. Hannah would not receive a clinical diagnosis.
Answer: C Type:Applied Page: 418
10. Jane is finding that her interest in sex has diminished greatly. She not only avoids
having sexual contact with her husband, but has even stopped fantasizing and
masturbating. Jane would be diagnosed as having which of the following DSM-IV-TR
a. female orgasm disorder
b. female sexual arousal disorder c. hypoactive sexual desire disorder
d. None of the above are correct.
Answer: C Type:Applied Page: 419
11. People usually receive the diagnosis of hypoactive sexual desire disorder because
a. they are concerned about their inability to enjoy sexual fantasies.
b. they come for treatment of an orgasmic disorder which is found to have a basis in
hypoactive sexual desire disorder.
c. someone else wants them to be more active sexually.
d. they wish to have children and recognize that their sexual problem must first be
Answer: C Type: Factual Page: 419
12. Male orgasmic disorder
a. is the most common sexual disorder in men.
b. is associated with childhood sexual abuse.
c. is a problem that is situationally bound.
d. is defined as persistent difficulty in ejaculating.
Answer: D Type: Factual Page: 420
13. Female orgasmic disorder is defined as
a. lack of orgasm during intercourse.
b. lack of orgasm without direct clitoral stimulation.
c. lack of orgasm despite normal sexual excitement and stimulation.
d. orgasm during masturbation only, if at all.
Answer: C Type: factual Page: 420
14. When Sheila attempts to have sexual intercourse, the outer part of her vagina has an
involuntary spasm, and it becomes impossible for her to have intercourse. Which of the
following DSM-IV diagnoses would fit Sheila's problem?
c. female orgasmic disorder
d. sexual aversion disorder
Answer:AType:Applied Page: 421 15. Joan experiences pain during sexual intercourse. The frequency of pain has been so
great that she now dreads the prospect of possible sexual encounters despite experiencing
sexual arousal while observing films depicting sexual acts other than intercourse. Joan
most likely is suffering from
a. female orgasmic disorder.
c. imperferate hymen.
d. major depression.
Answer: B Type:Applied Page: 421
16. The traditional psychoanalytic theory about sexual dysfunctions views them as
a. excessive masturbation in childhood.
b. a deep-seated fear of intimacy.
c. repressed conflicts which are incompatible with sexual pleasure.
d. lack of gratification of oral needs in infancy.
Answer: C Type: Factual Page: 421
17. According to traditional psychoanalytic theory about sexual dysfunctions, a woman
a. is trying to frustrate her partner.
b. is frigid.
c. is probably fixated at the oral stage of development.
d. may be expressing hostility toward men.
Answer: D Type: Factual Page: 421
18. It used to be widely believed that ___________ reduced an 'excessive' sex drive.
a. a bland diet
b. reduction in physical exertion
c. tight, restrictive trousers
Answer:AType: Factual Page: 413, 415
19. Which of the following is a current or proximal cause of sexual dysfunctions,
according to Masters and Johnson?
a. psychosexual trauma
b. fear of performance c. excessive intake of alcohol
d. homosexual inclinations
Answer: B Type: Factual Page: 423
20. Sexual contact with an adult during childhood is most associated with which of the
b. premature ejaculation
c. female orgasm disorder
d. male orgasm disorder
Answer: C Type: Factual Page: 422
21. Sexual desire is mediated in part by
a. anger towards one’s partner.
b. communication problems.
c. certain medications such as SSRI’s.
d. All of the above are correct.
Answer: D Type: Factual Page: 421-423
22. Which of the following psychological disorders are associated with an increased risk
of sexual dysfunction?
a. borderline personality disorder and specific phobias
b. bipolar disorder and antisocial personality disorder
c. depression and anxiety
d. generalized anxiety disorder and dependent personality disorder
Answer: C Type: Factual Page: 423
23. Studies indicate that __________ can interfere with specific sexual arousal.
a. erotic films
b. low general physiological arousal
c. low blood pressure
Answer: B Type: Factual Page: 423
24. In a study of the role of self-blame and erectile dysfunction, men who were given an
internal explanation for their low arousal after watching erotic films a. reported and showed less physiological arousal.
b. reported and showed more physiological arousal.
c. reported more, but showed less physiological arousal.
d. believed they had an erectile dysfunction.
Answer:AType: Factual Page: 423-424
25. Masters and Johnson found that many individuals who have sexual dysfunction
a. were college-educated.
b. had low socio-economic status.
c. had negative views of sexuality.
d. were encouraged to express their sexuality at a young age.
Answer: C Type: Factual Page: 424
26. Bill and Deborah are in sex therapy. One exercise that they are directed to practice
involves touching each other and feeling comfortable with contact, but without any
sexual intercourse. This intervention is called
a. sensate focus.
b. sensuality training.
c. physical redirecting.
d. cognitive restructuring.
Answer:AType:Applied Page: 425: Focus on Discovery 13.2
27. During the first few days of Masters and Johnson's sex therapy,
a. couples are instructed to have sex as often as possible and to practice the techniques
they are being taught.
b. couples are instructed not to make any changes in their sexual relationship until the
assessment period is over.
c. couples are instructed not to engage in any sexual activity.
d. instructions about sexual activities vary depending on the particular dysfunction being
Answer: C Type:Applied Page: 425: Focus on Discovery 13.2
28. In sex therapy, the sensate focus exercise involves
a. having sexual intercourse without taking on the spectator role.
b. engaging in intercourse as often as possible to sensitize each other's bodies.
c. nonsexual touching.
d. caressing without engaging in intercourse. Answer: D Type: Factual Page: 425: Focus on Discovery 13.2
29. Directed masturbation is often used
a. to train individuals who have difficulty achieving orgasm.
b. as a means for re-directing attention from inappropriate sexual stimuli.
c. for excessive sexual appetite.
d. as part of a program of treatment for sex offenders.
Answer:AType: Factual Page: 426
30. The squeeze technique is used in the treatment of
b. male orgasmic disorder.
d. premature ejaculation.
Answer: D Type: Factual Page: 427
31. Surgical procedures to treat erectile dysfunction
a. have increased in recent years.
b. have shown to be very effective in long-term follow-up studies.
c. are less commonly performed since drugs like Cialis and Viagra have been made
d. are generally preferred by men over taking drugs like Cialis or Viagra.
Answer: C Type: Factual Page: 427
32. Viagra, a medication that medically allows for improved erectile function, acts
a. increasing the level of dopamine, which is associated with sexual arousal.
b. relaxes smooth muscles allowing increased blood flow to the penis.
c. stimulating the amygdala in the limbic system.
d. inhibiting the response of the serotonin system.
Answer: B Type: Factual Page: 427
33. The sense of being either male or female is referred to as
a. sexual orientation.
b. sex role stereotype.