1. CHAPTER 8 SEXUAL DISORDERS
-Two major categories of sexual disorders: Paraphilia & sexual dysfunction. *Paraphilia: Arousal in response to sexual objects or situations that are not part of normative arousal activity for reciprocal, affectionate sexual activity. *Sexual dysfunction: Impairment or disturbance in any of the phases of the sexual response cycle. These include disorders of desire, arousal, orgasm, & disorders that relate to experience of genital pain during intercourse.

2. I. Paraphilias: 1.Exhibitionism: Recurrent, intense sexual urges & sexually arousing fantasies, of at least 6 month’s duration, involving, exposing of one’s genitals to a stranger. -Masturbation may occur during exhibitionism. -Only occurs in men, victims are women in 99% of cases.

3. 2.Fetishism: Recurrent, intense sexual urges & sexually arousing fantasies, of at least 6 months duration, involving the use of nonliving objects. -Common fetish objects include bras, women’s under pants, stocking shoes, boots or other wearing apparel. -The fetish object is generally used during masturbation or incorporated into sexual activity with another person to produce sexual excitation.-When the fetish involves cross-dressing, the disorder is called transvestite fetishism.

4. 3.Fotteurism: Involves touching or rubbing against a non-consenting person. Sexual excitement is derived from the actual touching or not from the coercive nature of the act.

5. 4.Sexual sadism: involves acts (real not simulated in which the psychological or physical suffering (including humiliation) of the victim sexually exciting.
-The sadistic activities may be fantasized or acted on with a consenting or non-consenting partner.
-In all instances, sexual excitation occurs in response to the suffering of the victim.
-Examples include rape, beating, torture, or even killing.

6. 5.Voyeurism: involves the act of observing unsuspecting people, usually strangers, who are either naked, disrobing, or engaging in sexual activity. -Sexual excitement is achieved through the act of looking and no contact with person is attempted. -Masturbation usually accompanies the window peeping but may occur later when the individual fantasizes about the voyeuristic act.

7. 6.Pedophilia: Involves sexual activity with a prepubescent characteristic. -The age of the molester is 16 years old, & is at least 5 years older than the child. -This category of paraphilia is the most common of sexual assaults.

8. 7.Sexual masochism: Involves the act (real, not simulated) of being humiliated, beaten, bound, or otherwise made to suffer.
-In all instances, sexual excitation occurs in response to the suffering of the victim.
-Examples include rape, beating, torture, or even killing.

9. II. Sexual dysfunction -May occur in any phase of the sexual response cycle. *Types of sexual dysfunction: 1.Sexual desire disorders: a. Hypoactive sexual desire disorder: persistent or recurrent deface or absence of sexual fantasies and desire for sexual activity. -The complaint is more common among women than men.

10. b. Sexual aversion disorder: persistent or recurrent extreme aversion to, and avoidance of, all or almost all, genital sexual contact with a sexual partner.

11. 2. Sexual Arousal disorders a
2.Sexual Arousal disorders a. Female sexual arousal disorder: -One of the following should be present for diagnosis: 1.Persistent or recurrent partial or completed failure to attain or maintain the lubrication-swelling response of sexual excitement until completion of the sexual activity. 2.Persistent or recurrent lack of a subjective sense of sexual excitement and pleasure in a woman during sexual activity.

12. b. Male sexual arousal disorder: (erectile dysfunction or impotence)
Either of the following criteria may be present to make this diagnosis:
-Persistent or recurrent partial or complete failure in a man to attain or maintain erection until completion of sexual activity.
-Persistent or recurrent lack of a subjective sense of sexual excitement and pleasure in a man during sexual activity.

13. c. Orgasm disorder
1. Inhibited female orgasm (Anorgasmia):
-Recurrent and persistent inhibition of the female orgasm after a period of sexual excitement judged adequate in intensity and duration to produce such a response.
2. Inhibited male orgasm (Retarded Ejaculation):
-The man is unable to ejaculate; even he has a firm erection and has had more than adequate stimulation.
-The severity of the problem may range from only occasion problems ejaculating to a history of never having experience of orgasm.

14. 3.Premature ejaculation:
-Persistent or recurrent ejaculation minimal sexual stimulation or before, on, or shortly after penetration and before the person wishes it.

15. d. Sexual pain disorder
1.Dyspareunia
Recurrent or persistent genital pain in either a man or woman before, during, or after sexual intercourse that is not associated with vaginismus or with lack of lubrication.
2.Vaginismus:
-An involuntary constriction of the outer on the of the vagina that prevents intercourse.

16. Treatment for sexual disorders:
1. Pharmacologic:
Depo-provera (Medroxyprogesterone Acetate):
Side Effects: Testosterone levels and sperm production, patient may not be able to father a child, weight gain, hypertension, fatigue.
Depo-lupron (leuprolide)
Side effects: Decrease Libido, Hair growth, Dizziness, Phlebitis

17. 2. Psychotherapy/ psycho-education groups: the purpose:
-To address cognitive distortions.
-To provide education to client population regarding identification of trigger relapse prevention strategies, importance treatment compliance, self-esteem appropriate coping strategies and problem-solving skills.
-Recreational and occupational therapy.
-Family /couples therapy.