Paraphilias Gender Identity Disorders Sexual Dysfunctions Paraphilias Gender Identity Disorders Sexual Dysfunctions Main Classes of Disorders

An Overview Para –“Beyond” –Philia –“Love” Para –“Beyond” –Philia –“Love” Sexual Stimulation Requiring Bizarre or Unusual Acts, Imagery, or Objects

Fetishism Sexual Attraction to Nonliving Objects –Inanimate Objects –Tactile Stimulation –Parts of the Body Sexual Attraction to Nonliving Objects –Inanimate Objects –Tactile Stimulation –Parts of the Body

“The Flasher” –Expose Genitals to Unsuspecting Strangers –Element of Risk is Important –Not Harmless (Many Rape / Molest) “The Flasher” –Expose Genitals to Unsuspecting Strangers –Element of Risk is Important –Not Harmless (Many Rape / Molest) Exhibitionism

“The Peeping Tom” –Watching Unsuspecting Strangers Naked or Undressing “The Peeping Tom” –Watching Unsuspecting Strangers Naked or Undressing Voyeurism

“Cross Dresser” –Sexual Arousal by Dressing in Clothes of the Opposite Sex –Most are Male Heterosexuals “Cross Dresser” –Sexual Arousal by Dressing in Clothes of the Opposite Sex –Most are Male Heterosexuals Transvestic Fetishism

Sexual Sadism and Masochism The “Sadist” –Sexual Arousal by Inflicting Pain / Humiliation Domination, Beatings The “Masochist” –Suffers the Pain / Humiliation –Helps the Sadist The “Sadist” –Sexual Arousal by Inflicting Pain / Humiliation Domination, Beatings The “Masochist” –Suffers the Pain / Humiliation –Helps the Sadist

Pedophilia –Sexual Attraction to Children –More Aroused to Young Children Pedophilia –Sexual Attraction to Children –More Aroused to Young Children Pedophilia and Incest Incest –Children Related to Perpetrator –May be Aroused to Adults Incest –Children Related to Perpetrator –May be Aroused to Adults

Psychosocial Contributions Inability to Develop Adequate Relationships Early “Unusual” Sexual Experiences Person’s Early Sexual Fantasies Excessive Sex Drive Specific Causes are Still Unclear Inability to Develop Adequate Relationships Early “Unusual” Sexual Experiences Person’s Early Sexual Fantasies Excessive Sex Drive Specific Causes are Still Unclear

Psychosocial Treatments Covert Sensitization Orgasmic Reconditioning Relapse Prevention Victim Empathy Training Covert Sensitization Orgasmic Reconditioning Relapse Prevention Victim Empathy Training

Drug Treatments Anti-Androgen –Cyproterone Acetate –Reduces Testosterone Levels Eliminates Sexual Desire / Fantasy Use for Sex Offenders Anti-Androgen –Cyproterone Acetate –Reduces Testosterone Levels Eliminates Sexual Desire / Fantasy Use for Sex Offenders

Rare Trapped in the Body of the Wrong Sex Transexualism (former name) Rare Trapped in the Body of the Wrong Sex Transexualism (former name)

No Physical Abnormalities Independent of Sexual Arousal Patterns May be Attracted to People With Desired Identity No Physical Abnormalities Independent of Sexual Arousal Patterns May be Attracted to People With Desired Identity

No specific biological link has been discovered to this point (but probably a major factor) Gender identity is usually established between 18 mos. and 3 years of age No specific biological link has been discovered to this point (but probably a major factor) Gender identity is usually established between 18 mos. and 3 years of age

Sex Reassignment Surgery High cost ($$) Female-to-Male Adjust Better (most are happy) Psychosocial Treatment (an attempt to change the gender identity) Sex Reassignment Surgery High cost ($$) Female-to-Male Adjust Better (most are happy) Psychosocial Treatment (an attempt to change the gender identity)

PlateauOrgasm Resolution Arousal - Excitement Desire Phase Sexual Desire Disorders Sexual Arousal Disorders Orgasm Disorders Sexual Pain Disorders

Hypoactive Sexual Desire Disorder No Interest in Any Sex Activity Common Presenting Problem How Much Sex Is Enough? No Interest in Any Sex Activity Common Presenting Problem How Much Sex Is Enough?

Hypoactive Sexual Desire Disorder Anything Sexual Evokes Fear, Disgust, or Panic Sexual Aversion Disorder

Male Erectile Disorder Problem is NOT Desire, but Arousal Males: “Impotence” Maintaining /Achieving Erection Females: “Frigidity” Maintain / Achieve Lubrication Problem is NOT Desire, but Arousal Males: “Impotence” Maintaining /Achieving Erection Females: “Frigidity” Maintain / Achieve Lubrication Female Sexual Arousal Disorder

Inhibited Orgasm Adequate Arousal and Desire BUT Unable to Achieve Orgasm Common in Females; Rare in Males Only 50% Women Experience Regular Orgasms During Intercourse Adequate Arousal and Desire BUT Unable to Achieve Orgasm Common in Females; Rare in Males Only 50% Women Experience Regular Orgasms During Intercourse

Ejaculation Occurs Too Quickly Define “Too Quickly / Premature” Problem Occurs in About 37% Perception of Lack of Control Over Orgasm in the Chief Complaint Ejaculation Occurs Too Quickly Define “Too Quickly / Premature” Problem Occurs in About 37% Perception of Lack of Control Over Orgasm in the Chief Complaint Premature Ejaculation

Dyspareunia Intercourse Associated With Pain Rule out Medical Causes of Pain Rare Condition in Males More Common in Women Vaginismus Intercourse Associated With Pain Rule out Medical Causes of Pain Rare Condition in Males More Common in Women Vaginismus

Interviews Listen to Audiovisual Erotic Material Measure Arousal Directly Penile Strain Gauge Vaginal Plethysmograph Listen to Audiovisual Erotic Material Measure Arousal Directly Penile Strain Gauge Vaginal Plethysmograph Thorough Medical Evaluation Psychophysiological Assessment

Biological Contributions Diabetes and Kidney Disease Cardiovascular Diseases Chronic Illness Prescription Medications Using Alcohol and Other Drugs Diabetes and Kidney Disease Cardiovascular Diseases Chronic Illness Prescription Medications Using Alcohol and Other Drugs

Biological Contributions Couple problems Performance Anxiety Involves Arousal, Cognition, and Negative Affect The Role of Distraction Arousal Level is Underestimated Couple problems Performance Anxiety Involves Arousal, Cognition, and Negative Affect The Role of Distraction Arousal Level is Underestimated Psychological Contributions

Biological Contributions Learn That Sexuality is Negative Traumatic Sexual Experiences Poor Interpersonal Relationship Inaccurate Beliefs and Myths Learn That Sexuality is Negative Traumatic Sexual Experiences Poor Interpersonal Relationship Inaccurate Beliefs and Myths Psychological Contributions Social and Cultural Contributions

Providing Education About Sex Reconditioning Eliminate Performance Anxiety Sensate Focus / Nondemand Pleasuring Gradual Process of Building Intimacy Reconditioning Eliminate Performance Anxiety Sensate Focus / Nondemand Pleasuring Gradual Process of Building Intimacy Psychosocial Treatments

Providing Education About Sex Medications Vasodilating Drugs (Viagra) Surgery and Implants Vacuum Device Therapy Medications Vasodilating Drugs (Viagra) Surgery and Implants Vacuum Device Therapy Psychosocial Treatments Medical Treatments