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Chapter 16

Chapter 16.notes by farnaz.docx

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Chapter 16: Sexual disorders : - Extraordinary people : David Reimer- the boy who was rasied as a girl - As a baby being born his penis was accidently destroyed during a circumcision and could not be restored and was told that he could never function as a normal male - So doctors like doctor money offered them a solution which was to raise bruce as a girl and have him undergo a sex reassignment therapy thinking that the environment in which bruce is raised in is important and not the genes or genitals - Money wanted to show his theory is correct by taking bruce who also had a twin brother and making Bruce go through surgery to make him a girl and raise him as a girl too and if he did end up accepting himself while his brother came into his normal male identity then this would show his theory to be correct - Bruces parents renamed him as Branda and began dressing him in girl clothing and took this child to get both of his testicals removed at 22 months - Her parents tried to reinforce her into a girl in any way possible however Brenda resisted by ripping her girl clothes, walking like a guy, did everything a guy would do - As Brenda grew up she became more convinced that she is not a girl while parents reinforcing her femininity and refused surgery for vagina and when she turned 14 her parents told her the truth and made her become relieved to feel the way she did - So Brenda decided to go back to her biological roots calling herself a boy by the name of david and began taking testosterone injections and went a surgery to remove breasts and created a simple penis but being a boy was rough but he was sexually attracted to girls but scared of sex didnt want girl to know the truth because his genitals would become blocked making him go do more surgeries - Over few years David tried suicide so then after being 22 years old he went through a more advanced surgery to create a more functional penis and went to marry a girl who loved everything about him Sexual disorders fall into 3 categories: sexual dysfunction which is problems in experiencing sexual arousal or carrying out sexual act, paraphilias which involves sexual activities that are focused on non human objects such as children or rape, and gender identity disorder which is the belief that one is born with body of the wrong gender, feeling trapped, and wishing to be the other gender Sexual Dysfunctions: - people have trouble engaging in and enjoying sexual relationships with other ppl - 5 phases of sexual response cycle - 1) desire - 2)excitement/arousal - vasocogestion: filling of blood vessels and tissues with blood - mytonia: muscular tension - 3)plateau - also a pleasureable state - physiological arousal - 4) orgasm - discharge of neuromuscular tension - refractory period for men but not women (few minutes -> few hours) - 5)resolution - state of deep relaxation N DSM diagnosis on pg. 579 table 16.1 - The sexual dysfunctions are set of disorders in which people have trouble engaging in and enjoying sexual relationships - The sexual response cycle: - masters and Johnson have reported that there can be divided into 5 phases. - 1 being the sexual desire which is the urge to engage in any sexual activity, 2)the arousal phase or excitement phase consists which includes psychological experience of arousal and pleasure and physiological changes known as vascongestion and myotonia. Vasocongestion is the filling of blood vessels and tissues with blood also known as engorgement. In males erection is caused by a flow of blood into arteries of penis and a decrease in the outflow of blood from the penis thorough the veins. In females vascongestion causes clitoris to enlarge, the libia to swell, and the vagina to moisten. Myotonia is muscular tension, and during the arousal phase many muscles in the body becomes tense, culminating in muscular contractions known as orgasm. - Following the arousal phase is the 3) Plateau phase in which excitement remains in a high but stable level and many try to extend this phase anyway they can before orgasm. - During the arousal and plateau phase the person may feel very tense all over , the skin being flushed, heart pounds, and after this phase comes the 4)orgasm-which is the discharge of Sexual Desire Disorders - people have trouble engaging in and enjoying sexual relationships with other ppl - DSM III included sexual disorders as a category - Hypoactive Sexual Desire Disorder - Little or no desire for sex - Do not initiate in sexual activity or fantasy - Not due to physiological problems - Generalized sexual desire disorder: lack desire for all ppl. - Situational sexual dersire disorder: lack desire only for their own partners - Sexual aversion disorder - Actively avoid sexual contact b/c it is anxiety inducing - Hypoactive sexual disorder: sometimes the individual used to enjoy sex but lost intreast in it sometimes because being too tired or overworked and for these reasons there are no diagnosis for it and is also not given a diagnosis if the person is having pain during pain - Generalized sexual desire disorder : a person lacks the desire for sexual activity almost all their lives - Situational sexual desire disorder: the person who lacks the desire to have sex with their partener but has fantasies about others - 22 percent of women and 5 percent men reported low desire but men with this disorder tend to be older than women - Women with hypoactive are more likely than men to report anxiety, depression, and life stress - Sexual Aversion disorder:- these are not passive type of lack of sex but these are people who just avoid sexual activities and when they do engage in it they may feel disgusted or experience acute anxiety and some experience sexual aversion even to kissing and touching - Sexual aversion in women is usually tied to experience in sexual assault like in the case of norma- norma and gray were having sex once every one month and norma always had aversion to looking at or touching her husbands penis and said this came on at uncles eulogy when she became mad , because e uncle was respected bu then she suddenly remembered being molested by him as a child. She was sared as a child to tell anyone, and refused to be given lessons by him by age 12 until eventuall forgetting what he did to her Sexual Arousal Disorder -Female: inability to attain or maintain the swelling lubrication response of sexual excitement - 20% prevalence rate of difficulty for lubrication for women - Male: recurrent inability to maintain an erection until completion of sexual activity (impotence). Men with lifelong erectile disorder have never been able to sustain eractions for a desire period of time - men with the acquired form were able to sustain eractions in the past but no longer can - eractional problems are only a disorder if they are persistent and start to effect relationships -Life long form: never been able to sustain and maintain -Acquired form: could in the past but can no longer now - 4-9% prevalence rate for men who have this disorder - Much less is known about female sexual arousal disorder than male Paul and Gerdaline had this problem that Paul couldnt keep eraction so they go to sex therapy and therapist Orgasm Disorder- female (anorgasmia):- recurrent delay in or the complete absence of orgasm after having reached the excitement phase - most common among post-menstrual women - N male (pre mature ejaculation): persistently ejaculate with minimal sexual stimulation - before they wish to ejaculate - N male orgasmic disorder: recurrent delay or the absence of orgasm following - excitement phase - 8% prevalence rate for men who have this disorder - Women should be diagnosed only when they receive stimulation and and no orgasim - One problem with premature ejaculation is that weather the ejaculation is premature depends In how quickly the mans partner becomes aroused to orgasm and because of difficulty defining premature the disorder is often referred to as rapid ejaculation - Men with this problem try to put creams, wear more condoms, distract themselves doing hard math, not aloowing partners to touch them but this tactic goes unsuccessful shutting out their partners - Like Bill and Margret who had same problem their communication was disappearing - Male with male orgasmic disorder experience delay or absence of orgasm following following the excitement phase of the sexual response cycle , sometimes a man cannot ejaculate during intercourse but can with manual or oral stimulation Sexual Pain Disorders - Dyspareunia: genital pain associated with sex, occur more frequently for women due to dryness in the vagina caused by antihistamines or other drugs, infection of the clitoris, or vulva area , wheaears in men its painful eractions or pain during thrusting - Vaginismus: muscle spasm around the vagina 5-17% prevalence rate for women. Its the involuntary contraction of the muscles surrounding the outer third of the vagina when vaginal penetration with a male, finger, ta,pons - Women with vaginismus may get sexual arousal when clitiros is stimulated,, however when penis is inserted their muscles conta
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