Sexual and Gender Identity Disorders

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Sexual and Gender Identity Disorders

• RCS 6931
• June 14, 2007
• Steven R. Pruett, Ph.D.

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Overview

• Sexual Dysfunctions
• Low Sexual Desire Disorders
• Sexual Arousal Disorders
• Orgasmic Disorders
• Sexual Pain Disorders
• Secondary Other Sexual Dysfunctions
• Paraphilias
• Gender Identity Disorders

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Sexual Dysfunction

• Four main categories of sexual functioning
• Appetitive
• Excitement
• Orgasm
• Resolution
• Hypersexuality is not defined in DSM-IV yet it
  can occur in other disorders (e.g. Manic
  Episodes, Schizophrenia, cognitive disorders
  personality disorders)
• Sexual dysfunction disorders are frequently
  ignored by clinicians (dont ask dont tell)

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Sexual Dysfunction

• Coding is usually based on
• Cause
• Due to a psychological factor or comorbid
  (general medical involved?)
• Duration
• Lifelong vs. acquired
• Specificity
• Generalized (with all partners and all
  situations)
• Situational (only with certain partners or in
  some situations)

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Sexual Desire Disorders

• Hypoactive Sexual Desire Disorder 302.71
• Desire for and fantasy about sexuality are
  chronically or recurrently deficient
• Causes interpersonal problems or distress

• Sexual Aversion Disorder 302.79
• Individual dislikes or avoids all or nearly all
  genital contact with a sex partner

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Sexual Arousal Disorders

• Female Sexual Arousal Disorder 302.72
• Cannot lubricate enough to complete sexual
  activity
• Often highly correlated with orgasm
• Cannot be related to general medical condition
  (menopause)

• Male Erectile Disorder 302.72
• Cannot get or keep an erection with sufficiency
  to complete sexual activity
• Cannot be related to general medical condition or
  substance use

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Orgasmic Disorders

• Male and Female Orgasmic Disorders
• After normal phase of sexual excitement mans
  (302.74) or womans (302.73) orgasm is
  persistently, repeatedly delayed or absent.
• Not related to a general medical condition or
  substance use

• Premature Ejaculation 302.75
• With minimal sexual stimulation the patient
  ejaculates earlier than he wants to (before,
  during or just after penetration).

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Sexual Pain Disorders

• Dysparenunia 302.76
• Genital pain during intercourse
• Both a diagnosis symptom
• Can occur in both males and females (although
  very rare in males and always associated with a
  medical condition).
• In women cannot be diagnosed if completely due to
  lack of lubrication.
• 1/3 of women who have had gynecological surgery
  have some dysparenunia

• Vaginismus 306.51
• Cramping contraction of vaginal muscles when
  attempting sexual intercourse.

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Secondary Other Sexual Dysfunctions

• Sexual Dysfunction due to a General Medical
  Condition
• Male Erectile 607.84
• Male Dyspareunia 608.89
• Male Hypoactive Sexual Desire 608.89
• Other Male Sexual Dysfunction 608.89
• Female Dysparenunia 625.0
• Female Hypoactive Sexual Desire 625.8
• Other Female Sexual Dysfunction 625.8

• Substance-Induced Sexual Dysfunction
• Alcohol 291.89
• All other substances 292.89
• Impaired desire
• Impaired arousal
• Impaired orgasm
• With sexual pain
• Sexual Dysfunction NOS 302.70
• Absent erotic feelings
• Undiagnosed.

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Paraphilias

• Means abnormal or unnatural sexual attraction
• Individuals with a paraphilia have sexual
  activity that surround
• Objects or nonhuman animals
• Humiliation or suffering of patient or partner
• Nonconsenting persons (including children)

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Paraphilias

• Most common paraphilias are
• Pedophilia
• Exhibitionism
• Voyeurism
• Frotteurism
• The other paraphilias are encountered much less
  frequently

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Paraphilias

• Exhibitionism 302.4
• Repeated for at least 6 months the patient has
  intense sexual desires or behavior about genital
  self-exposure to an unsuspecting stranger
• Either causes some type of distress or patient
  has acted on desires

• Fetishism 302.81
• Repeated for at least 6 months the patient has
  intense sexual desires or behavior about use of
  inanimate objects (e.g. shoes, underwear)
• Not used solely for cross-dressing or stimulation
  of genitalia

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Frotteurism 302.89

• Repeated for at least 6 months the patient has
  intense sexual desires or behavior involving
  touching or rubbing against a person who doesnt
  consent to this behavior.

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Pedophilia 302.2

• Repeated for at least 6 months the patient has
  intense sexual desires or behavior concerning
  sexual activity with sexually immature child
  (usually age 13 or under)

• Coding notes
• Attracted to Males
• Attracted to Females
• Attracted to Both
• Limited to Incest
• Exclusive type (aroused only by children)
• Nonexclusive type

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Sexual Masochism and Sadism

• Sexual Masochism 302.83
• Repeated for at least 6 months the patient has
  intense sexual desires or behavior concerning
  real acts of being beaten, bound, humiliated or
  otherwise made to suffer

• Sexual Sadism 302.84
• Repeated for at least 6 months the patient has
  intense sexual desires or behavior concerning
  real acts of causing physical or psychological
  torment or otherwise humiliating another person

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More Paraphilias

• Transvestic Fetishism 302.3
• Repeatedly for at least 6 months, a heterosexual
  male has intense sexual desires, fantasies, or
  behavior concerning cross-dressing

• Voyeurism 302.82
• Repeatedly for at least 6 months patient has
  intense sexual desires concerning the act of
  watching an unsuspected person who is naked,
  disrobing or having sex

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Paraphilia NOS 302.9

• Partialism
• Preoccupied with portion of the body (e.g. nose,
  breasts, buttocks, feet)
• Telephone Scatologia
• Phone sex
• Zoophilia
• Sex with various animals
• Necrophilia
• Sex with corpses
• Klismaphilia
• Sexual pleasure by giving self enemas

• Coprophilia
• Masturbating with ones own feces
• Urophilia
• Becoming sexually excited by playing or
  masturbating with urine
• Infantilism
• Deriving sexual satisfaction by being treated
  like an baby (e.g. wearing diapers, drinking from
  a bottle)

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Gender Identity and other sexual disorders

• Individual feels intensely uncomfortable with
  their own biological sex.
• Individuals with this disorder wish to live as a
  member of the opposite sex.
• Popularly known as transsexualism
• Rare 3100,000 males 1100,000 females

• Far more common for boys with gender disturbance
  to grow up as homosexual than to develop Gender
  Identity Disorder
• Diagnostic Criteria
• Morrison p. 381-382 DSM-IV-TR p. 581
• GID in Adolescents or Adults 302.85
• GID in Children 302.6

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Gender Identity Disorder NOS 302.6

• Virilizing adrenal hyperplasia (affects females)
• Turners syndrome (only one X chromosome)
• Klinefelters syndrome (XXY)
• Androgen insensitivity (XY)
• Male baby looks like a female (testicular
  feminzation)

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Sexual Disorder NOS 302.9

• Inadequate sexual performance
• Use of lovers
• Other sexual orientation problems
• For those distressed about their sexual
  orientation.