1. Gender and Sexual Disorders Chapter 8 Copyright © 2012 by Pearson Education, Inc. All rights reserved.

2. Let’s talk about sex… Considered a “taboo” subject and people find it difficult to discuss because of the intimacy factors Alfred Kinsey Drs. William Masters and Virginia Johnson Copyright © 2012 by Pearson Education, Inc. All rights reserved.

3. 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) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

4. Understanding Sexual Response Figure 8.1 The Human Sexual Response Cycle Copyright © 2012 by Pearson Education, Inc. All rights reserved.

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 equate sexual desire with a need for emotional intimacy Copyright © 2012 by Pearson Education, Inc. All rights reserved.

6. Thoughts on sex… Figure 8.3 Frequency With Which Men and Women of Various Ages Think About Sexual Activity From "Sexual activity, sexual disorders and associated help-seeking behavior among mature adults in five Anglophone countries from the Global Survey of Sexual Attitudes and Behaviors (GSSAB)," by A. Nicolosi, et al., Journal of Sex & Marital Therapy, 32, 331-342. Copyright © 2006 Taylor & Francis Group, reprinted by permission of the publisher (Taylor & Francis Group, http://www.informaworld.com). Copyright © 2012 by Pearson Education, Inc. All rights reserved.

7. Understanding Sexual Behavior Heterosexuality vs. 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 Women are more likely to describe themselves as attracted to both sexes The development of sexual orientation is biologically based (genetic and prenatal hormone influences) There seems to be a greater erotic plasticity among women (more women are identified as bisexual than males). How do you explain that? Copyright © 2012 by Pearson Education, Inc. All rights reserved.

8. “Jack” wants to be called “Jill” and “Jill” wants to be called “Jack”: GID Sex Gender Gender Identity Disorder (GID) Transgender behavior Transsexualism Sex Reassignment Surgery (SRS) or Gender Reassignment Surgery (GRS) Reports estimate that 1 in 7,400 to 12,800 men, and 1 in 30,000 to 1 in 52,100 women suffer from GID. Copyright © 2012 by Pearson Education, Inc. All rights reserved.

9. 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 Copyright © 2012 by Pearson Education, Inc. All rights reserved.

10. 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 Copyright © 2012 by Pearson Education, Inc. All rights reserved.

11. Etiology of GID 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) A number of theories exist for the origin of GID, but no empirical data has supported any of these. Which do you think plays the primary role in the development of GID? Copyright © 2012 by Pearson Education, Inc. All rights reserved.

12. Treatment options for GID are… Three phases of treatment -Living as desired gender for at least two years -Hormone therapy -Sex reassignment surgery (SRS) also known as Gender reassignment surgery (GRS) Surgery M to F, F to M and surgical outcomes Psychological -Attention and reinforcement of same-sex activities -Behavioral approach with rewards and punishment Copyright © 2012 by Pearson Education, Inc. All rights reserved.

13. 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) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

14. To Desire or Not, That Is the Question: 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 Copyright © 2012 by Pearson Education, Inc. All rights reserved.

15. 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 Copyright © 2010 by Pearson Education, Inc. All rights reserved.

16. Orgasmic Disorders Female 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 Copyright © 2012 by Pearson Education, Inc. All rights reserved.

17. 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 Copyright © 2012 by Pearson Education, Inc. All rights reserved.

18. 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 Copyright © 2012 by Pearson Education, Inc. All rights reserved.

19. Sex, Race, and Ethnicity Occurs across all race and ethnicities Developmental factors 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 Men, erectile dysfunction Copyright © 2012 by Pearson Education, Inc. All rights reserved.

20. Etiology of sexual disorders Biological -Hormonal imbalances (hypothyroidism or hypogonadism) -Androgens -Menopause (decreased levels of estrogen) -Decrease in testosterone levels (beginning in the 30 to 40s) -Physical disorders (cardiovascular disease, hypertension, diabetes, kidney failure, & cancer) -Alcohol and drugs -Antidepressants (SSRIs) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

21. 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 Copyright © 2012 by Pearson Education, Inc. All rights reserved.

22. Treatment of sexual disorders Biological -Testosterone replacement therapy (injection, patch, or gel) -SSRIs (increase sexual desire but impair sexual performance) -Media and advertisements (Viagra, Levitra, and Cialis) -Penile implants -Vacuum devices Copyright © 2012 by Pearson Education, Inc. All rights reserved.

23. 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 Copyright © 2012 by Pearson Education, Inc. All rights reserved.

24. Paraphilias Intense, persistent, and frequently occurring sexual urges, fantasies, or behaviors that involve unusual situations, objects, or activities Association with criminal activity Considered unusual or “out of the norm” Three categories (sexual arousal: toward nonhuman objects, children and nonconsenting individuals, and involving suffering or humiliation of oneself or others) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

25. Sexual Arousal toward Nonhuman Objects Fetishism (fantasies, urges, or behaviors, that involve nonliving objects, not limited to female clothing used in cross- dressing) Most common (female underwear, stockings, footwear, or other apparel) Transvestic Fetishism (sexual arousal in men that results from wearing women’s clothing and is accompanied by distress and impairment) Occurs only among heterosexual men Copyright © 2012 by Pearson Education, Inc. All rights reserved.

26. Sexual Arousal Involving Suffering or Humiliation of Oneself or Others Sexual masochism (sexual arousal as a result of being humiliated, beaten, bound, or otherwise made to suffer pain) Examples Sexual Sadism (infliction of pain or humiliation, but in this case the physical or psychological suffering is inflicted on another person Found primarily in males 20 males to 1 female Copyright © 2012 by Pearson Education, Inc. All rights reserved.

27. People usually have more than one There is no cookie-cutter profile They are described as well-adjusted, successful, and above the norm on assessments of mental health Men with transvestic fetishism are happy with their biological sex Erotica asphyxiation occurs at the same rate Paraphilias and the facts… Copyright © 2012 by Pearson Education, Inc. All rights reserved.

28. Most people with paraphilias are male Sexual masochism is found in women, but males attribute to 20 to 1 ratio Women prefer less pain during sexually masochistic activities Onset begins from age 7 to 38 with 16 being the average age for paraphilias Cultural implications The facts about sex, ethnicity, and development… Copyright © 2012 by Pearson Education, Inc. All rights reserved.

29. The Causes of Paraphilias Unknown Behavioral component with conditioning (one engages in a paraphilia and achieves sexual release; therefore, the behavior is likely to be reinforced due to experience of pleasure) Lack of data to support biological or psychosocial reasons How would you explain the lack of research related to the etiology of paraphilias? Can you come up with your own explanations of why this occurs in people, especially males? Copyright © 2012 by Pearson Education, Inc. All rights reserved.

30. Biological treatment options to consider… Past treatment of surgical castration, although is no longer used Medications (SSRIs and antiandrogens) Examples of testosterone-lowering medications (Depo-Provera & Depo-Lupron) Copyright © 2012 by Pearson Education, Inc. All rights reserved.

31. Psychosocial treatment options to consider… Behavioral and cognitive-behavioral treatments Satiation Covert sensitization Olfactory aversion Social skills training (SST) Couples therapy Sex education Copyright © 2012 by Pearson Education, Inc. All rights reserved.