2. Multiple Partners Mostly Heterosexual Mostly Monogamous Condom Use Has Increased Older Populations are Still Active Multiple Partners Mostly Heterosexual Mostly Monogamous Condom Use Has Increased Older Populations are Still Active

3. Are You Born – Straight – Homosexual – Bisexual? Nature vs. Nurture Are You Born – Straight – Homosexual – Bisexual? Nature vs. Nurture

4. Homosexuality –Runs in Families –More Common in Monozygotic Twins –Prenatal Exposure to Hormones The Biological Basis Argument –Promoted by the Media, but Narrow –The Link is Not That Strong Inherit Sexual Predispositions Homosexuality –Runs in Families –More Common in Monozygotic Twins –Prenatal Exposure to Hormones The Biological Basis Argument –Promoted by the Media, but Narrow –The Link is Not That Strong Inherit Sexual Predispositions

5. Gender Dysphoria (Gender Identity Disorder) Sexual Dysfunctions Paraphilias vs Paraphilic Disorders Gender Dysphoria (Gender Identity Disorder) Sexual Dysfunctions Paraphilias vs Paraphilic Disorders Main Classes of Disorders

6. Man or Woman? Trapped in the Body of the Wrong Sex Transexualism Transgendered Rare Man or Woman? Trapped in the Body of the Wrong Sex Transexualism Transgendered Rare

7. Goal is Not Sexual No Physical Abnormalities Independent of Sexual Arousal Patterns May be Attracted to People With Desired Identity Goal is Not Sexual No Physical Abnormalities Independent of Sexual Arousal Patterns May be Attracted to People With Desired Identity

8. No Specific Biological Link, but… Probably Developed Early in Life No Specific Biological Link, but… Probably Developed Early in Life

9. Sex Reassignment Surgery Costs ? Double $ for Female to Male Female-to-Male Adjust Better Psychosocial Treatment Sex Reassignment Surgery Costs ? Double $ for Female to Male Female-to-Male Adjust Better Psychosocial Treatment

10. PlateauOrgasm Resolution Arousal - Excitement Desire Phase Normal Functioning

11. PlateauOrgasm Resolution Arousal - Excitement Desire Phase Where Problems Arise

12. PlateauOrgasm Resolution Arousal - Excitement Desire Phase Can be Either –Lifelong or Acquired –Generalized or Situational Can be Either –Lifelong or Acquired –Generalized or Situational Specify as Due to –Psychological Factors Alone –Psych Factors Plus Medical Condition Specify as Due to –Psychological Factors Alone –Psych Factors Plus Medical Condition

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

14. 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?

15. 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

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

17. Inhibited Orgasm Ejaculation Occurs Too Quickly Hard to Define “Too Quickly” but 1 min Problem Occurs Commonly, esp. in Younger Males Perception of Lack of Control Over Orgasm is the Chief Complaint Ejaculation Occurs Too Quickly Hard to Define “Too Quickly” but 1 min Problem Occurs Commonly, esp. in Younger Males Perception of Lack of Control Over Orgasm is the Chief Complaint Premature Ejaculation

18. 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

19. Interviews How Would You Describe Your Current Interest in Sex? What Behaviors do You Engage In? Describe Your Sexual Fantasies... How Often Do You Masturbate? How Would You Describe Your Current Interest in Sex? What Behaviors do You Engage In? Describe Your Sexual Fantasies... How Often Do You Masturbate?

20. Interviews Medications can Disrupt Sexual Functioning Check Vascular Functioning Check Hormonal Levels Medications can Disrupt Sexual Functioning Check Vascular Functioning Check Hormonal Levels Thorough Medical Evaluation

21. 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

22. Biological Contributions:

23. More Than Performance Anxiety Performance Anxiety Involves Arousal, Cognition, and Negative Affect The Role of Distraction Arousal Level is Underestimated More Than Performance Anxiety Performance Anxiety Involves Arousal, Cognition, and Negative Affect The Role of Distraction Arousal Level is Underestimated Psychological Contributions

24. Providing Education About Sex Eliminate Performance Anxiety Sensate Focus / Nondemand Pleasuring Gradual Process of Building Intimacy Other Specific Techniques Many Treatments Work Eliminate Performance Anxiety Sensate Focus / Nondemand Pleasuring Gradual Process of Building Intimacy Other Specific Techniques Many Treatments Work Psychosocial Treatments

25. 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

26. Gender Dysphoria Sexual Dysfunctions Paraphilic Disorders Gender Dysphoria Sexual Dysfunctions Paraphilic Disorders Main Classes of Disorders

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

28. Fetishism Sexual Attraction to: –Inanimate Objects –Tactile Stimulation –Parts of the Body Sexual Attraction to: –Inanimate Objects –Tactile Stimulation –Parts of the Body

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

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

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

32. 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 What About Sadistic Rape? What About Sadistic Rape?

33. 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 Incest –Children Related to Perpetrator

34. Other Forms of Paraphilia Frotteurism -- Rubbing Necrophilia -- Corpses Klismaphilia -- Enemas Coprophilia -- Feces Zoophilia -- Animals Scatologia -- Obscene Calls Frotteurism -- Rubbing Necrophilia -- Corpses Klismaphilia -- Enemas Coprophilia -- Feces Zoophilia -- Animals Scatologia -- Obscene Calls

35. Psychosocial Contributions

36. Anxiety/S-E Management Strategies? Paraphilias Nonparaphilic Compulsive Sexual Behaviors: (not in DSM) Compulsive Cruising & Multiple Partners Fixation on Unattainable Partner Compulsive Autoeroticism Multiple Love Relationships (obsessed with finding intense feeling of a new relationship) Paraphilias Nonparaphilic Compulsive Sexual Behaviors: (not in DSM) Compulsive Cruising & Multiple Partners Fixation on Unattainable Partner Compulsive Autoeroticism Multiple Love Relationships (obsessed with finding intense feeling of a new relationship)

37. Psychosocial Treatments Suppression Covert Sensitization Orgasmic Reconditioning Relapse Prevention Treatment Can Work But… follow-up issues are a concern Suppression Covert Sensitization Orgasmic Reconditioning Relapse Prevention Treatment Can Work But… follow-up issues are a concern

38. Drug Treatments Anti-Androgen –Cyproterone Acetate; Depo-Provera –Reduces Testosterone Levels Eliminates Sexual Desire / Fantasy Use for Sex Offenders Only a Temporary Solution Anti-Androgen –Cyproterone Acetate; Depo-Provera –Reduces Testosterone Levels Eliminates Sexual Desire / Fantasy Use for Sex Offenders Only a Temporary Solution