Sexual fantasies begin to qualify as abnormal when they begin to affect us or others in unwanted or harmful ways. Sexual dysfunctions are persistent disruptions in the ability to experience sexual arousal, desire, or orgasm, or as pain associated with intercourse. Paraphilic disorders are defined as persistent and troubling attractions to unusual sexual activities or objects. Sexual norms and behaviour change with time and culture. Gender dysphoria refers to the idea that one should be the opposite gender.
Men report thinking about sex, masturbating and desiring sex more often as well as desiring more sexual partners and having more partners. Women tend to be ashamed of any flaws in their appearance and this shame can interfere with sexual satisfaction. Sexuality is more closely tied to relationship status for women than for men. Men are more likely to think of their sexuality in terms of power.
Women are more likely to report symptoms of sexual dysfunction, but men are more likely to meet diagnostic criteria for paraphilic disorder. The sexual response cycle consists of four phases:
- Desire phase
Sexual interest or desire. - Excitement phase
Increased blood flow to the genitalia. - Orgasm phase
Sexual pleasure peaks and orgasm occurs. - Resolution phase
Relaxation and a sense of well-being that follows an orgasm.
For women, there is a difference between biological arousal and subjective excitement.
SEXUAL DYSFUNCTIONS
There are three types of sexual dysfunctions. Sexual dysfunctions involving sexual desire, arousal and interest (1), orgasmic disorders (2) and a disorder involving sexual pain (3). All sexual dysfunction disorders must last at least 6 months. Sexual concerns that arise as a consequence of severe relationship distress (e.g: partner abuse) should not be diagnosed as sexual dysfunctions.
Clinical profile female sexual interest/arousal disorder:
Diminished, absent or reduced frequency of AT LEAST three of the following: |
- Interest in sexual activity
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- Erotic thoughts or fantasies
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- Initiation of sexual activity and responsiveness to partner’s attempts to initiate
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- Sexual excitement/pleasure during 75% of sexual encounters
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- Sexual interest/arousal elicited by any internal or external erotic cues
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- Genital or non-genital sensations during 75% of sexual encounters
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Clinical profile male hypoactive sexual desire disorder:
- Sexual fantasies and desires, as judged by the clinician, are deficient or absent.
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Clinical profile erectile disorder:
On AT LEAST 75% of sexual occasions: |
- Inability to attain an erection OR
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- Inability to maintain an erection for completion of sexual activity OR
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- Marked decrease in erectile rigidity interferes with penetration or pleasure
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Clinical profile female orgasmic disorder:
On AT LEAST 75% of sexual occasions: |
- Marked delay, infrequency or absence of orgasm
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- Markedly reduced intensity of orgasmic sensation
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Clinical profile premature ejaculation:
On AT LEAST 75% of sexual occasions: |
- Tendency to ejaculate during partnered sexual activity within 1 minute of penile insertion
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Clinical profile delayed ejaculation:
On AT LEAST 75% of sexual occasions: |
- Marked delay, infrequency or absence of orgasm
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Women are more likely than men to report at least occasional concerns about their level of sexual desire. Occasional symptoms of erectile disorder are the most common sexual concern among men. The prevalence of this is 13% - 28%. The prevalence of erectile disorder increases greatly with age. The prevalence of premature ejaculation is less than 3%. The prevalence of delayed ejaculation is less than 1%.
Clinical profile Genito-pelvic pain/penetration disorder:
Persistent or recurrent difficulties with AT LEAST one of the following: |
- Inability to have (vaginal) penetration during intercourse.
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- Marked vulvar, vaginal or pelvic pain during vaginal penetration or intercourse attempts.
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- Marked fear or anxiety about pain or penetration
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- Marked tensing of the pelvic floor muscles during attempted vaginal penetration
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Vaginismus refers to involuntary muscle spasms of the outer third of the vagina to a degree that makes intercourse impossible. This is common in women with Genito-pelvic pain/penetration disorder.
ETIOLOGY OF SEXUAL DYSFUNCTIONS
There are two immediate causes for sexual dysfunction: fear about performance (1) and the adoption of a spectator role (2). A spectator role refers to begin an observer, rather than a participant in a sexual experience.
A sexual dysfunction disorder diagnosis can only be made in the absence of a medical illness. If heavy alcohol use before intercourse is present, it can also not be labelled a sexual dysfunction disorder. Sexual dysfunction can be caused by either low levels of testosterone or Estrogen or by the high levels induced by supplements.
Psychological factors of sexual dysfunction include rape or sexual abuse. Positive experiences are important. Relationship problems also often interfere with sexual arousal and pleasure. Depression and anxiety increase the risk of sexual dysfunction. Anxiety and depression are comorbid with sexual pain and with female sexual desire/arousal disorder. Stress and exhaustion impede sexual functioning. Negative cognitions also interfere with sexual functioning. People that blame themselves for decreased sexual performance will be more likely to develop recurrent sexual problems. Many negative cognitions about sex are learned through social and cultural surroundings.
TREATMENTS OF SEXUAL DYSFUNCTIONS
Type of treatment | Treatment | How it works |
Psychological | Exposure | Gradual and systematic exposure to anxiety-provoking aspects of the sexual situation. |
Psychological | Psychoeducation | Education about sex and the body in order to reduce anxiety |
Psychological / biological | Sensate-focus exercises | Touch the partner without touching the genitals and be very clear when something becomes uncomfortable. This promotes contact. |
Psychological | Cognitive intervention | Challenge the self-demanding, perfectionistic thoughts that often cause sexual dysfunction. |
Psychological | Communication training | Encourage partners to communicate their likes and dislikes more clearly. It also has an exposure element. |
Psychological / biological | Directed masturbation | The women has to find out through directed masturbation what she likes and what she does not like. |
Psychological / biological | Sex position treatment | Couples are taught specific sexual positions that increase the amount of clitoral stimulation. |
Biological | Medication | Antidepressant drugs are helpful when depression contributes to diminished sex drive. Buproprion counteracts the libido problems caused by SSRIs. PDE-5 inhibitors (Viagra) can help with erectile dysfunctions. |
PARAPHILIC DISORDERS
Most people with paraphilic disorders are male and heterosexual. Onset of paraphilic disorders typically begins during adolescence. The onset of sexual sadism disorder and sexual masochism disorder tends to occur by early adulthood. Paraphilic disorders are highly comorbid with mood disorders, anxiety and substance use disorders.
Clinical profile fetishistic disorder:
For AT LEAST six months: |
- Recurrent and intense sexually arousing fantasies, urges or behaviours involving the use of non-living objects or non-genital body parts
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- Causes significant distress or impairment in functioning
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- The sexually arousing objects are not limited to articles of clothing used in cross-dressing or to devices designed to provide tactile genital stimulation
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A fetish refers to the object of these sexual urges. The attraction in fetishistic disorder is experiences as involuntary and irresistible.
Clinical profile pedophilic disorder:
For AT LEAST six months: |
- Recurrent and intense, sexually arousing fantasies, urges or behaviours involving sexual contact with a prepubescent child.
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- Person has acted on these urges or the urges and fantasies cause marked distress or interpersonal problems.
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- Person is at least 16 years old and 5 years older than the child.
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Overt physical force is seldom used in pedophilic disorder. About half of the children who are exposed to childhood sexual abuse will develop symptoms, such as depression, low self-esteem or other disorders. The odds that childhood sexual abuse will produce clinically significant symptoms are increased when a perpetrator threatens the child, the child blames himself or when the family is unsupportive. Negative outcomes are also more pronounced when there is sexual intercourse. Symptoms are also more likely if the victim is younger.
Incest is a subtype of pedophilic disorder. Incest refers to sexual relations between close relatives for whom marriage is forbidden.
Clinical profile voyeuristic disorder:
For AT LEAST six months: |
- Recurrent and intense sexually arousing fantasies, urges or behaviours involving the observation of unsuspecting others who are naked, disrobing or engaged in sexual activity.
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- The person has acted on these urges with a nonconsenting person OR the urges and fantasies cause marked distress or interpersonal problems.
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More men than women are diagnosed with voyeuristic disorder.
Clinical profile exhibitionistic disorder:
For AT LEAST 6 months: |
- Recurrent, intense and sexually arousing fantasies, urges or behaviours involving showing one’s genitals to an unsuspecting person.
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- The person has acted on these urges to a nonconsenting person, or the urges and fantasies cause clinically significant distress or interpersonal problems.
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Clinical profile frotteuristic disorder:
For AT LEAST six months: |
- Recurrent and intense sexually arousing fantasies, urges or behaviours involving touching or rubbing against a nonconsenting person.
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- The person has acted on these urges with a nonconsenting person or the urges and fantasies cause clinically significant distress or interpersonal problems.
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Clinical profile sexual sadism disorder:
For AT LEAST 6 months: |
- Recurrent, intense and sexually arousing fantasies, urges or behaviours involving the physical or psychological suffering of another person
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- The person has acted on these urges with a nonconsenting person or the urges and fantasies cause clinically significant distress or interpersonal problems.
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Clinical profile sexual masochism disorder:
For AT LEAST six months: |
- Recurrent, intense and sexually arousing fantasies, urges or behaviours involving the act of being humiliated beaten, bound or made to suffer
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- It causes marked distress or impairment in functioning
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Asphyxiophilia refers to sexual arousal by restricting breathing.
ETIOLOGY OF PARAPHILIC DISORDERS
Androgens are a neurotransmitter that regulate sexual desire. It is hypothesized that androgens play a role. The majority of people with paraphilic disorders have a history of childhood sexual abuse. Incidents with the paraphilic disorders often occurs with alcohol use, as it makes people act more impulsively. Negative moods may also play a role, because the act of the disorder may be a mean to escape the negative affect. Cognitive distortions and attitudes also play a role in the paraphilic disorders. People diagnosed with paedophilia have a lower IQ and higher rates of neurocognitive problems than the general population.
TREATMENTS OF PARAPHILIC DISORDERS
Type of treatment | Treatment | How it works |
Psychological | Enhance motivation | Enhance motivation to change illegal behaviour and motivation to continue treatment. |
Psychological | Cognitive behavioural treatment | Change beliefs about inappropriate sexual desires. It also includes training in empathy. |
Biological | Hormonal treatment | Medication that reduces androgens. SSRIs are also use because they reduce arousal to deviant objects. |
Wrong summary kuqelis contributed on 25-05-2021 10:26
Hey, this is the summary for eating disorders, not sexual disorders
@kuqelis JesperN contributed on 25-05-2021 10:32
Hi!
Thanks for letting me know, I've changed it.
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