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Chapter 10

PSYC 235 Chapter Notes - Chapter 10: Premarital Sex, Premature Ejaculation, Sexual Dysfunction


Department
Psychology
Course Code
PSYC 235
Professor
Dean A Tripp
Chapter
10

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Abnormal Psychology - Chapter 10
SEXUAL DYSFUNCTIONS, PARAPHILIC DISORDERS, AND GENDER DYSPHORIA
What is Normal?
Heterosexual behaviour - sex with the opposite sex
Homosexual behaviour - sex with the same sex
Current categories may not fully capture the true range of sexual orientation
Areas of concern for STI and AIDS prevention are the number of sexual partners that some young people
have and the casualness of these interactions
Gender Differences
A much higher percentage of men than women report that they masturbate and the frequency of
masturbation is higher for men than women
Endorsement of many types of sexual fantasy is higher for men than women
Men express a more permissive attitude towards casual sex than women
Men are much more specific and narrow in their patterns of arousal (heterosexual men are only
aroused by heterosexual activity)
No gender differences are apparent in attitudes about homosexuality, the experience of sexual
satisfaction, or attitudes toward masturbation
Slightly more men approve of premarital intercourse and extramarital sex
All existing gender differences have become smaller over time, especially in regard to attitudes
toward premarital sex
Number of sexual partners is decreasing and a tendency to delay sexual intercourse is increasing
among adolescents
Cultural Differences
There are different attitudes concerning premarital sexual behaviour and the engagement in sex
What is normal sexual behaviour in one culture is not necessarily normal in another, even among
cultures in the same country, and the wide range of sexual expression must be considered in
diagnosing the presence of a disorder
An Overview of Sexual Dysfunctions
The three stages of the sexual response cycle (desire, arousal and orgasm) are associated with specific
sexual dysfunctions
Both males and females can experience parallel versions of most disorders, which take on specific forms
determined by anatomy and other gender-specific characteristics - 2 exceptions:
Males - Premature ejaculation
Females - genito-pelvic pain/penetration disorder (difficulties with penetration in intercourse)
Sexual Dysfunctions can have two forms -
Lifelong - a chronic condition that is present during a person’s entire sexual life
Acquired - a disorder that begins after sexual activity has been relatively normal
2 Types of disorders -
Generalized - occurs every time the individual attempts sex
Situational - occurs only with some partners or at certain times
28% of women and 18% of men experience sexual dysfunction
Sexual Desire Disorder
In males - male hypoactive sexual desire disorder

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In females - low sexual interest is almost always accompanied by a diminished ability to become
excited or aroused by erotic cues or sexual activity- Female sexual interest/arousal disorder
Male Hypoactive sexual desire disorder and Female Sexual Interest/Arousal Disorder
Males and females with these disorders have little or no interest in any type of sexual activity
Patients with this disorder rarely have sexual fantasies, seldom masturbate and attempt
intercourse once a month or less
Sexual Arousal Disorders
Erectile disorder - frequent sexual urges/fantasies and a strong desire to have sex but cannot get
aroused
Female deficits in arousal are reflected in an inability to achieve or maintain adequate lubrication
A man typically feels more impaired by his problem than a woman does by hers
Inability to achieve and maintain an erection makes intercourse difficult or impossible
May occur at any time in women but generally occurs with age in men
It is very unlikely for a man to be completely unable to achieve an erection - more typical to be
able to achieve a partial erection during intercourse and a full erection during masturbation
Occasional dysfunction does not necessarily detract from overall sexual satisfaction - symptoms
must cause clinically significant distress in the individual
Many women do not consider absence of arousal to be a problem, let alone a disorder
Women with arousal disorder often show normal vaginal responding to erotic movies while
reporting low subjective excitement (may be more psychological than genital)
Orgasm Disorders
Inhibited Orgasm
Delayed ejaculation and Female orgasmic disorder - achieve orgasm only with great difficulty
or not at all
Unmarried women are more likely than married women to experience orgasm disorder
Only 50% of women reach orgasm regularly during sexual intercourse
Retarded ejaculation - usual pattern ejaculation is delayed
Retrograde ejaculation - ejaculatory fluids travel backward into the bladder rather than forward -
usually due to certain drugs or medical condition
Premature ejaculation - ejaculation that occurs well before the man and his partner want it to
A perception of lack of control over orgasm may be the more important psychological
determinant of the complaint of premature ejaculation
3 parts to premature ejaculation - behavioural (regularity), emotional (stress) and efficiency
(control)
Occurs in inexperienced men with less education who have a lower frequency of intercourse
Sexual Pain Disorders
Genito-pelvic pain/penetration disorder - difficulties with penetration during attempted
intercourse or significant pain during intercourse - specific to women
Most usual presentation of this disorder is vaginismus (the pelvic muscles in the outer third of
the vagina undergo involuntary spasms when intercourse is attempted) - may occur during any
attempted penetration (tampon)
Assessing Sexual Behaviour
Three major aspects to the assessment of sexual behaviour -
Interviews - supported by questionnaires
A thorough medical evaluation - to rule out medical conditions
Psychophysiological assessment - to measure the physiological aspects of sexual arousal
Interviews
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Clinicians must demonstrate that they are comfortable talking about these issues and clinicians
must be prepared to use the terms comfortable to the patient
A clinician must be careful to ask questions in a manner that puts the patient at ease
Patients may volunteer some information in writing that they are not ready to talk about so are
usually given a variety of questionnaires
Medical Examination
A variety of drugs often disrupt sexual arousal and functioning
Recent surgery or medical conditions must be evaluated for their impact on sexual functioning
Gynecologists/Urologists may check levels of sexual hormones necessary for adequate sexual
functioning and evaluate vascular functioning necessary for an erectile response (in males)
Psychophysiological Assessment
In men, penile erection is measured directly using a penile strain gauge (as the penis expands, the
penile strain gauge picks up the changes which are then recorded by a computer)
For women, use a vaginal photoplethysmograph - inserted by the woman into her vagina - a light
source at the tip of the instrument and light-sensitive photoreceptors on the sides of the
instrument measure the amount of light reflected back from the vaginal walls (amount of light
going through walls decreases as blood flows to the vaginal walls during arousal)
Sexual response is measured psychophysiologically and subjectively verbally during exams
Erections most often occur during REM sleep in men, so nocturnal penile tumescence was used
frequently in the past to determined a man’s ability to obtain normal erectile response - if he
could reach normal erection then disorder is psychological however, not reaching erection during
sleep may also be caused by psychological problems
Causes of Sexual Dysfunction
Biological Contributions
Neurological diseases and other conditions that affect the nervous system may directly interfere
with sexual functioning by reducing sensitivity (erectile dysfunction)
Vascular disease - arterial insufficiency (constricted arteries) and venous leakage (blood flows
too quickly to maintain erection)
Chronic illness can also affect sexual functioning
Prescription medications - antihypertensive medications (beta-blockers), SSRIs, antidepressant
medications and other antidepressant and antianxiety drugs interfere with sexual desire/arousal
Alcohol and most other drugs of abuse (cocaine and heroin) produce sexual dysfunction -
oAlcohol produces social disinhibition and physical suppression
oChronic alcoholism can cause sexual problems in both men and women
Psychological Contributions
Performance anxiety - can be broken into arousal, cognitive processes and negative affect
Sexual arousal is strongly determined by psychological factors that are powerful enough to
determine whether blood flows to the appropriate areas of the body
Premature ejaculation - excessive physiological arousal in the sympathetic nervous system may
lead to rapid ejaculation
Social and Cultural Contributions
Erotophobia - the belief that sexuality can be negative and threatening - learned from families,
religious authorities or others and predicts sexual difficulties later in life
Traumatic sexual acts have long-lasting effects on subsequent sexual functioning, sometimes
lasting decades beyond the original event - these events may initiate negative affect, causing
people to loose control over their sexual response cycle
Deterioration in close interpersonal relationship may also be associated with sexual dysfunction
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