Sexual and Gender Identity Disorders

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Sexual and Gender Identity Disorders

• What Is Normal vs. Abnormal Sexual Behavior?
• Cultural considerations
• Gender differences in sexual behavior and
  attitudes
• Complex interaction of biopsychosocial influences
• Including partners characteristics

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Overview

• Gender Identity Disorder
• Sexual Dysfunctions
• Paraphilias
• Not Sexual Orientation (Homosexuality)

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Gender Identity Disorder

• Difference between sex and gender
• Key feature sense of being trapped in the body
  of the wrong sex
• Assume the identity of the desired sex
• Goal is not sexual
• Causes are unclear
• Gender identity develops between 18 months and 3
  years of age

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Gender Identity Disorder

• Transsexualism
• Goal is Not Sexual
• No Physical Abnormalities
• Independent of Sexual Arousal Patterns
• NOT Transvestism
• Homosexuality
• Unrelated

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Gender Identity Disorder

• Sex-reassignment as a treatment
• Who is a candidate? Basic prerequisites before
  surgery
• 75 report satisfaction with new identity
• Female-to-male conversions adjust better
• Psychosocial treatment
• Realign psychological gender with biological sex
• Few large scale studies

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Sexual Response Cycle
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Sexual Dysfunctions

• Involve desire, arousal, and/or orgasm
• Pain associated with sex can lead to additional
  dysfunction
• Men and Women experience parallel versions of
  most dysfunctions
• Affect about 43 of all women and 31 of men
• Most prevalent class of disorder in the United
  States

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Sexual Dysfunctions

• Desire
• Hypoactive Sexual Desire
• Sexual Aversion Disorder
• Arousal
• Male Erectile Disorder
• Female Sexual Arousal Disorder

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Sexual Dysfunctions

• Orgasm
• Inhibited Orgasm
• Premature Ejaculation
• Pain
• Dyspareunia
• Vaginismus

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Sexual Dysfunctions

• Medical Conditions
• Medications
• Alcohol and Other Drugs
• Traumatic and/or Negative Experiences
• Performance Anxiety and Distraction
• Interpersonal Factors
• Cultural Factors

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Sexual Dysfunctions

• Biological Treatments
• Medications and Injections
• Surgery and Implants
• Vacuum Device Therapy

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Sexual Dysfunctions

• Psychosocial Treatments
• Education
• Eliminate Performance Anxiety (Spectator Effect)
• Relationship Enhancement
• Gradual Building of Intimacy
• Sensate focus and nondemanding pleasuring
• Squeeze technique (Premature ejaculation)
• Masturbation training (Female orgasm disorder)
• Use of dilators (Vaginismus)
• Exposure to erotic material (Desire problems)

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Paraphilias

• Definition
• Often multiple paraphilic patterns of arousal
• High comorbidity with anxiety, mood, and
  substance abuse disorders

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Paraphilias

• Pedophilia
• Fetishism
• Transvestic
• Voyeurism
• Exhibitionism
• Sadism and Masochism
• Frotteurism

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Paraphilias

• Biological Treatments (Medication)
• Anti-Androgen
• Reduces Testosterone Levels
• Reduces Sexual Desire / Fantasy
• Used for Sex Offenders
• Seen as Only a Temporary Solution

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Paraphilias

• Psychosocial Treatment
• Suppression
• Paradoxically Backfires
• Covert Sensitization
• Orgasmic Reconditioning
• Family and Marital Therapy
• Relapse Prevention

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Clarifications

• Homosexuality is not considered a disorder
• Homosexuality is unrelated to gender identity
  disorder
• Cross-dressing could be due to
• Transvestic fetish
• Transsexualism
• Being a Drag Queen