Discussion: Sexual Addiction

1
Discussion Sexual Addiction

• What, if anything, is disordered?
• Sexaholics Anonymous

2
Addiction criteria

• Overuse or other misuse of a substance
• Continued use despite significant adverse
  personal consequences
• Legal problems
• Employment difficulties
• Damage to relationships
• Subjective sense of compulsion or loss of
  control Inability to limit the behavior
• Preoccupation with the substance

3
Is sexual addiction a myth?

• Do addiction criteria apply to sexuality?
• Is the idea of sexual addiction an example of
  using psychiatry to categorize a current social
  concern?
• Is it helpful to consider sexual addiction
  pathological? Helpful to whom?
• Does the idea of sexual addiction oversimplify a
  complex issue?

4
Arguments about sexual addiction

• It punishes people for normal behavior (Henkin,
  1991)
• It absolves people from responsibility for
  inappropriate, even harmful behavior
• It acknowledges the role of brain chemistry in
  behavioral problems
• It is co-morbid with psychiatric conditions like
  eating disorders and compulsions

5
Sexuality as differences

• Did Western culture hold that there was only one
  sex, as Laqueur (1992) argues?
• Why do we think that there are two sexes?
• Anatomical distinctions
• Reproductive roles
• Social roles Gender and the division of labor

6
What determines sexuality?

• Genetics
• Embryonic and fetal hormones
• Maternal and environmental hormones
• Society and culture

7
History of sex-determination theories

• Homer (8th C. B.C. ?) Conception is influenced
  by the wind, north for males and south for
  femalesat least in sheep goats
• Aristotle added the influence of male semen
  molding the embryo from the menstruum
• Galen (130-200A.D.) Semen from left testis makes
  females, right makes males. A mixture produces
  hermaphrodites.

8
More history

• Avicenna or Ibn Sina (11th C) Gender depends on
  the side of the uterus to which the placenta
  attaches
• Anton van Leeuwenhoek, 1677 sperm
• Albrecht von Haller, 18th C., reported a man with
  one testis having children of both genders, and a
  woman with no right fallopian tube having a boy
  and a girl.
• Carl Ernst von Baer, 1827 ovum

9
Sex determination vs. sex differentiation

• Sex determination includes the triggering events
  that determine gonadal tissue development as
  testes or ovaries
• Sex differentiation includes the following events
  producing the male or female phenotype.
• Gonadogenesis precedes sex determination
• Steroidogenic factor 1 (SF-1)
• WT-1 (after Wilms tumor) on 4 autosomes

10
Chromosomal determination

• C.I. McClung (1902) discovers the Accessory
  chromosome
• Barr Bertram (1949) discover Barr bodies
• Drosophila studies link the X-chromosome/
  autosome ratio to sex determination
• Welshons Russell (1959) The role of the Y
  chromosome

11
Genetics Testis determining factor

• H-Y Antigen?
• Zinc-Finger Proteins (ZFY) (Page et al., 1987)
• SRY (Goodfellow and Lovell-Badge, 1993)
• Found in testes, midbrain, and hypothalamus of XY
  mice
• Translatable linear form in brain (Lahr et al,
  1995) May directly masculinize brain
• SRY triggers Mullerian Inhibiting Substance
• SRY is the rate-limiting factor for other
  sex-differentiating genes, like SOX-9

12
DSS and DAX-1

• Dosage-sensitive sex reversal (DSS)
• DSS, adrenal hypoplasia, X-linked (DAX-1)
• A locus on the X chromosome. If there are two of
  these loci, female development occurs. Effects
  opposite to SF-1.
• May be duplicated on one X chromosome, making
  possible an X-Y karyotype with female
  differentiation

13
Genetics and sexual differentiation

• 46,XX Double DSS or 46,XY TDF/SRY
• 46,XX with translocated TDF/SRY
• 46,XY with missing or mutated TDF/SRY or doubled
  DSS 1/20,000
• 46,XY females without SRY mutation Downstream
  mutations
• 46,XX males with no Y-derived gene sequences

14
More genetic abnormalities

• 45,XO or Turners syndrome 1/2,500
• 45, YO Not viable
• 47,XXX
• 47,XXY or Klinefelters syndrome 1/500
• 47,XYY Supernumerary Y or Super-male
• 48,XXYY 48,XXXY 49,XXXXY
• Mosaicism eg. 46,XX/47,XXY

15
Intersexuality

• Hermaphroditism
• True hermaphrodites
• Pseudohermaphrodites
• Sexual neutrality

16
Embryonic and fetal hormones

• Fetal gonadal anlage
• SRY ---gtTestosterone at six weeks
• 10X higher than in females from 12-17 weeks
• By 7th month, identical levels until pubescence
• Mullerian Inhibiting Substance from Sertoli cells
• Wolffian tissue stimulated by androgens from
  Leydig cells

17
Maternal and environmental hormones

• Diethylstilbesterol (DES)
• Fetal androgenization
• Environmental estrogen-like compounds (?)
• Dioxins, PCBs, DDT Banned in the West
• Current suspects a phthalate, endosulfan, and
  bisphenol-A synergistic effects of 1000x
• Morphology and sperm counts
• Phytoestrogens and menopausal complaints

18
Hormone-based abnormalities

• Congenital Adrenal Hyperplasia (CAH) or
  Adrenogenital (not androgenital) syndrome
• Induces masculinization in girls
• Precocious puberty in boys
• Androgen Insensitivity syndrome
• Complete or partial
• 5-a reductase or DHT-deficiency syndrome
  Machihembra
• Dominican Republic Syndrome in textbook

19
Society and culture

• North American Anglo views of intersexuality
• Defined as abnormal
• Forced choice scenario
• Native North American views
• Some Plains Indians The berdache
• A social role for non-aggressive males
• Sometimes shamanistic

20
Other cultural views

• Ulrichs and the Uranians
• Myanmar Manguedon and acaults
• India Hijra
• Samoa Faafine
• Castrati and eunuchs