1. Gender and Sexual Disorders
Chapter 8
Psyc 303
Fall 2013

2. Chapter Outline Human Sexuality Gender Identity Disorder
Sexual Dysfunction
Paraphilias
Considered a “taboo” subject and people find it difficult to discuss because of the intimacy factors
Alfred Kinsey
Drs. William Masters and Virginia Johnson

3. Who is the person who engaged in one of the first formal attempts to study human sexuality using interviews of thousands of Americans?
Kinsley
Masters and Johnson’s work – recorded physical responses during sexual intercourse
Alfred Kinsley

4. Sexual Functioning Human sexual response cycle:
Four phases of sexual response
1) Desire phase (response to external and internal cues) 2) Arousal phase (physical and psychological signs of sexual arousal) 3) Orgasm phase (ejaculation of seminal fluids and contractions in the outer third of the vagina) 4) Resolution phase (decrease in arousal followed by refractory “resting” period)

5. Men vs. women when it comes to sexual response
Sex drive – physical and/or psychological craving for sexual activity and pleasure
Exists equally for men and women
Men engage in more frequent sexual activity and tend to think about sex more often than women
Women have a greater capacity for sex (longer duration of sexual activity, no refractory period, multiple orgasms)
Women define sexual desire in a broader way:
Equate desire with a need for emotional intimacy
Effects of age for men observed in genital response, for women in declining sexual desire
Adults of all ages are sexually active – albeit to a different degree

6. Understanding Sexual Behavior
Heterosexuality, bisexuality, and homosexuality
Appears as though 2 to 5% of men & 1 to 2% of women are exclusively same sex attracted
Men are more likely to be exclusively attracted to the same sex, whereas women are more likely to describe themselves as attracted to both sexes – more fluidity in sexual orientation among women….
The need for attachment or pair-bonding could lead to romatic attraction to either sex
There seems to be a greater erotic plasticity among women (more women are identified as bisexual than males). How do you explain that?

7. The development of sexual orientation is biologically based:
Genetic influence
Heritability estimates between % for women, 30% for men
Sex hormones: Androgens during the fetal development
Not clear
Gay men had a greater number of older brothers compared to heterosexual men
There seems to be a greater erotic plasticity among women (more women are identified as bisexual than males). How do you explain that?

8. “Jack” wants to be called “Jill” and “Jill” wants to be called “Jack”: Gender Identity Disorder (GID)
Sex – genes, hormones, genetalia
Gender – defined by culture, developed by ages 3-4
GID
inconsistency between biological sex and gender identity
Strong desire to participate in games of opposite sex, cross-gender roles in pretend plays; persistent fantasies of being the opposite sex; repeated expressions of wanting to be the opposite sex

9. GID, also called Transsexualism
Transgender behavior –
attempts to behave in ways representative of the opposite sex
Transsexualism different from transvestic fetishism (the desire to dress in the clothes of the opposite sex)

10. Functional Impairment of GID
Peer rejection
Social isolation
Negative moods
Distress in parents
Distress in children for being prevented from engaging in the desired behaviors

11. Sex, Race, and Ethnicity Factors Related to GID
Detected between the ages of 2 to 4
Early signs (e.g., persistent cross dressing & play)
Verbal wishes to be of the opposite sex
Prevalence rates prepubescent vs. adolescence
Cultural considerations

12. Etiology of GID
A number of theories exist for the origin of GID, but no empirical data has supported any of these.
Biological
-Brains of transsexual males similar to heterosexual females
-Prenatal hormone imbalances
-Hormonal condition (congenital adrenal hyperplasia, CAH)
-Androgen production
Psychosocial
-Parental rejection (parent-child relationship)

13. Treatment options for GID are: 1
Treatment options for GID are: 1. The most effective treatment for individual’s with GID is sex reassignment surgery (SRS) or commonly referred to as gender reassignment surgery (GRS).
A few steps one must accomplish before surgery is an option
living as the preferred gender for at least two years,
hormone therapy where testosterone is given to biological females and estrogen is given to biological males.
SRS or GRS
Do you think adolescents suffering from GID should have to wait until adulthood before having the sex reassignment surgery (SRS)? Should restrictions be placed on age or extra treatment requirements?
Key Points: It is important to take into consideration that SRS is an irreversible decision. Some studies even indicate that only a minority of children who originally received the diagnosis of GID continued to be expressing these issues into adulthood.

14. Treatment options for GID are…
2. Psychological
-Attention and reinforcement of same-sex activities
-Behavioral approach with rewards and punishment

15. Sexual Dysfunction
Absence or impairment of some aspect of sexual response that causes distress or impairment
Factors that contribute to sexual performance (age, sex, culture, life circumstances, illness, or separation from sexual partner)
Classification (disorders of sexual desire, sexual arousal, orgasm, and pain)

16. To Desire or Not: Sexual Desire Disorders
Sexual desire – interest in sexual activity or objects, or wishes to engage in sexual activity
Diminished or absent interest in sexual activity
Two subtypes:
-Hypoactive sexual desire disorder
-Sexual aversion disorder
Factors associated with decreased sexual desire

17. Sexual Arousal Disorders
Female sexual arousal disorder
-Psychological reasons vs. Physiological reasons or both
-75% of women report sexual arousal disorder to their gynecologist
Male erectile disorder
-Persistent and recurrent inability to maintain an adequate erection until completion of sexual activity
-Significant distress and/or interpersonal difficulty

18. Orgasmic Disorders Female orgasmic disorder Male orgasmic disorder
-Persistent and recurrent delay or absence of orgasm following the normal excitement phase
-Important to consider age, adequacy of sexual stimulation, and sexual experience
Male orgasmic disorder
-Delayed ejaculation or the delay of or inability to achieve orgasm, not as common as “premature ejaculation”
Premature ejaculation
-Consistent ejaculation with minimal sexual stimulation, 30% of men, also known as rapid ejaculation

19. Sexual Pain Disorders
Dyspareunia (consistent genital pain associated with sexual intercourse)
3 to 5% of men report this
14% of gay men report this
Vaginismus (unwanted involuntary spasms of the vaginal muscles that interfere with intercourse or any attempt at vaginal insertion)
72% of women report pain with sex

20. How do sexual disorders impact individuals?
Both individuals sexual well-being is affected
Sexual functioning vs. overall functioning
Sexual difficulties are common
Impacts self-esteem, sexual relationship, but not always “overall relationship”
Only less than 19% of people seek treatment

21. Sex, Race, and Ethnicity Occurs across all race and ethnicities
Developmental factors – premature ejaculation
African American women reported lower levels of sexual desire and pleasure
White women are more likely to have pain
Both African American and white women reported more difficulties than Hispanic women

22. Etiology of sexual disorders
Biological
-Hormonal imbalances (hypothyroidism or hypogonadism)
-Menopause (decreased levels of estrogen)
-Decrease in testosterone levels (beginning in the 30 to 40s)
-Physical disorders (cardiovascular disease, hypertension, diabetes, kidney failure, & cancer)
-Androgens
-Alcohol and drugs
-Antidepressants (SSRIs)

23. Etiology of sexual disorders
Psychosocial
-Depression
-Anxiety
-Stress
-“Performance anxiety”
-Classical conditioning (repeated experiences involving the need to ejaculate quickly)
-Couple distress and negative life events
-Environmental factors
-Aging

24. Treatment of sexual disorders
-Media and advertisements (Viagra, Levitra, and Cialis) -Penile implants -Vacuum devices
Biological
-Testosterone replacement therapy (injection, patch, or gel)
-SSRIs (increase sexual desire but impair sexual performance)

25. Treatment of sexual disorders
Psychosocial
-Sex therapy (4 steps)
-“Stop-Squeeze” technique
-Directed masturbation
-Systematic desensitization (with the use of different-sized vaginal dilators) -CBT to challenge irrational beliefs