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University of Toronto St. George
Stephanie Cassin

PSY240 Sexual Disorders and Dysfunctions 4/14/2011 4:52:00 PM Sexual Disorders and Dysfunctions >>Changing views of Sexual Behaviour  western society has been relatively reserved across time  greek were pretty open about sexuality  homosexuality – e.g. Amsterdam v.s. Alberta >>Sexuality is on a continuum: heterosexual > homosexual most people fall on places in between >>Homosexual Experiences doubled numbers for people who engaged at least once in homosexual exp from those who self-identified themselves as homosexual >>Bisexual might be more difficult for bisexual: sometimes they feel they don’t belong to either homosexual or heterosexual group DSM Disorders sexual disorders - gender identity disorder - paraphilias sexual dysfunction >>Normal Sexual Function Masters and Johnson: first people who took sexual activity research into lab Important: 1. First time experiments; 2. Looked at what’s the difference btw sexual responses during masturbation or actual sexual intercourse: found out it’s actually quite similar; 3. The size of the guys’ penis is not relevant with women’s sexual response; 4. Stages for male and females during intercourse critiques: look into mechanism of sexual intercourse, no emotional factors etc. >>Sex/Porn Addiction a large survey: gender difference: males prefer visual erotica (images); females prefer chat rooms (actual interaction) more than 11hrs/week: impact on daily lives. 60% + are in a relationship, not only single lonely guys 20% of men masturbate daily 80% looked into pornography in the past year; 20% daily >>Sexual Response Cycle Stages (Masters and Johnson) 1. Desire: physiological, behavioral, cognitive 2. Arousal/Excitement: subjective sense of sexual excitement. 3. Plateau: not much change, brief period before orgasm 4. Orgasm: peak of sexual pleasure; heart rate up, breath up 5. Resolution: return to normal conditions, muscular relaxation For men happens more quickly, for women slower. Women’s resolution phase lasts longer that’s why for some they can have multiple orgasms >>Sexual Dysfunctions very common common in terms of sexual desire, arousal, and orgasm. Rarely seen in plateau phase most people report at some point of their life they experiences sexual dysfunction may related to relationship difficulties *research: 100 happily married couple. Males 36% premature ejaculation, 17% disinterested in sex >>Diagnosis - Categorization: depends on the on-set (lifelong, temporary), context (with partner, masturbation), etiological factors (medical conditions directly related, combination of psychological and medical factors) - 6 months, has to interfere with their relationship >>Sexual Desire Disorders about 20% of people have sexual desire disorder don’t have a good benchmark for “normal” “hypoactive” sometimes develops in specific context, no longer attracted, ect. May not be surprised sexual aversion disorder the person really experience aversion to any sexual stimulation, anything that has to do with genitals would be very aversive to them >>Sexual Arousal Disorders female sexual arousal disorder: unable to obtain or maintain the completion of sexual activity male erectile dysfunction: unable to obtain or maintain an erection - primary: nvr been aroused / obtain lubrication (rare) - secondary: occasionally been aroused in men, the primary is really rare, unless have some biological dysfunction for secondary, both gender experience fairly common diabetes, substance abuse/dependence >>Orgasmic Disorders significant delay or complete lack of sexual orgasm during intercourse 20% of women rarely or never experienced orgasm women requires more stimulation, more gradual, takes longer, and also has to be learned. Premature ejaculation: very common, difficult to define. Ejaculation: minimum sexual contact, before intercourse or very shortly after, shorter than the person desires. The person is unable to hold the ejaculation long enough for the partner to experience climax 50% of the time Problem: hard to define what we are looking at. RELATIVE >>Sexual Pain Disorders takes place during all parts of sexual activity Dyspareunia - pain associated with sex - sexually transmitted diseases fall in this category Vaginismus Causes: Attitude about sex, fear of pregnancy >>Factors related to sexual dysfunction Social learning theories (Masters and Johnson) Developed over time. Constantly wondering what they should do, evaluating their performance, hypervigilent, have difficulty to just live in the moment and let everything go by their own way >>Treatment of Sexual Dysfunctions Masters and Johnson - daily for 2 weeks - sexual therapy for both couple. Verbal and non verbal communication between partners - focus on: sensate focus: sexual-retraining techniques. The couple will be actually forbidden to engage in sexual intercourse. May be massage for 1 day, nd kissing for 2 day, and eventually get into intercourse. Because the next stage is forbidden so they can actually embrace the moment. - CBT: relaxation. Examination of beliefs, attitudes, expectations. Also uses the sensate focus. - High success rate: 48% - 90%, most effective for premature ejaculation, which is the most common presented to psychologist - Behavioral therapy for vaginismus: start off with thin diameter rods, oral contact, genital contact. Hierarchy contact scale - Medications: viagra >> Gender Identity social/cultural influence: e.g. fafafina, biologically born male, raised female, considered actually the best gender. Strength of man, and household skills of woman >> Gender Identity Disorder - cross-gender identification: gender identification opposed to biological gender - persistent discomfort about one’s assigned sex - interfere with social, sexual life - exclusion: schizophrenis – they actually believe that they ARE the opposite sex, delusional; hermaphrodites – born with both gender characters differential: transvestism – they don’t actually want to be the opposite sex, they do it just for sexual arousal (diagnosis only for male, because females can be dressed as male in our social context) more for male than female, relatively rare - non-transsexual - transsexual - occurs regardless of the sexual orientation - DSM Specifiers: the sexual orientation is based on the BIOLOGICAL sex. (man changed to woman who is attracted to man = gay?) >>GID in childhood parents are able to detect before age 3 children who has these characters still rarely develops the disorder >> Cause - biological: most empirical support. Androgen (male) deficiency in the prenatal brain in males and androgen excess in females - psychological >>Treatment - sex-reassignment surgery accept the gender identity as right – go thru surgery to change the biological sex have to have lived the opposite gender for 2 years (e.g. for a man: dress as female, go to work as female, etc.) - sexual identity change really really hard. Especially if the person is already in his adolescent or adulthood many negative outcome: person become confused, feeling guilty, etc >>The Paraphilias - have a strong compulsive quality. - Unless the objects are presented, they have difficulty to be aroused. If someone can get sexual gratification through other ways, no diagnosis. - Legal consequences: exposing themselves to other people, voyeurism - Much more common in males - Interfere with normal sexual activities Types of Paraphilias Fetishism (Transvestic Fetishism) develops through classical conditioning Voyeurism They rarely harm
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