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Overview of Psychosexual Disorders

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Clayton Sewell

on 15 March 2013

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Transcript of Overview of Psychosexual Disorders

MOB ATTACKS 'PEEPING TOM'
“Cops on Tuesday had to prevent residents of Clonis district, Manchester, from burning down the house with a man they accused of being a 'peeping Tom'. Peeping Tom caught - Found lurking in women's bathroom A MAN ACCUSED of being a pervert because he was allegedly spying on women inside a female bathroom at the University of the West Indies (UWI), Mona campus, was fined $50,000 when he appeared in the Corporate Area Resident Magistrate's Court on Tuesday. FREMONT MUSIC TEACHER CHARGED WITH VOYEURISM A Fremont music teacher accused of taking "up-skirt" photos of a woman on an escalator last month at a Seattle airport has been charged with one count of voyeurism. EXCITEMENT Engorgement of the sexual organs (vasocongestion).
Increases in muscle tension (myotonia) resulting in erect nipples and penis.
Increases in heart rate and blood pressure. PLATEAU Sexual tension continues to mount.
Changes that began in 1st phase continue (increased muscle tension, heart rate, blood pressure and vasocongestion). ORGASMIC The climax of the cycle.
In women consists of muscular contractions of the lower third of the vagina and the pelvic floor muscles.
Uterus undergoes top to bottom contractions. RESOLUTION The final phase in which the sexual systems return to their non-excited state.
Males have a variable refractory time period during which they cannot experience another erection or orgasm. Sexual Dysfunctions - Phases Excitement and Plateau
Hypoactive sexual desire disorder
Sexual aversion disorder
Hypoactive sexual desire disorder due to a general medical condition (male or female)
Substance-induced sexual dysfunction with impaired desire FETISHISM Use of an inanimate object (the fetish) as the preferred method of producing sexual excitement, usually beginning in adolescence.
Common fetishes include aprons, shoes, leather or latex items, and women’s underclothing. Clayton A. Sewell
Consultant Forensic Psychiatrist
clayton.sewell02@uwimona.edu.jm SEXUAL DYSFUNCTIONS Disturbances in the sexual response cycle or pain associated with sexual arousal or intercourse.
Proper sexual functioning depends on the sexual response cycle which consists of desire/excitement, plateau/arousal, orgasm and resolution phases. SEXUAL RESPONSE CYCLE The sequence of events that occur physiologically when we become sexually aroused and engage in sexually stimulating activities.
William Masters and Virginia Johnson (1966) conducted studies to determine what happens to the body during sexual arousal and activity. PLATEAU (cont’d.) Enlargement of outer third of vagina and change in color of the vaginal wall.
Clitoral retraction
Testes withdrawn into scrotum. MALE RESPONSE Emission phase: seminal fluid is gathered in the urethral bulb. This process is accompanied by a subjective feeling that an orgasm is inevitable.
Expulsion phase: semen is expelled out of the penis by muscular contractions. Typically takes longer for women and some women may be able to respond with multiple orgasms with further sexual stimulation. Men typically reach orgasm first when engaging in intercourse.
Women may take a variable length of time to reach orgasm which makes the likelihood of simultaneous orgasm a rare event. SEXUAL DESIRE DISORDERS Hypoactive Sexual Desire Disorder – a disorder in which sexual fantasies and desire for sexual activity are persistently or recurrently diminished or absent, causing marked distress or interpersonal difficulties.
It may be lifelong or acquired, generalised or situational . TREATMENT Aimed at removing the underlying cause when possible.
The choice of behavioural or psychodynamic psychotherapy depends on the diagnostic issues.
Marital therapy is indicated if the cause is interpersonal.
Anxiety states can be treated with antidepressants. SEXUAL AROUSAL DISORDERS Includes male erectile disorder and female arousal disorder.
Difficulty in maintaining excitement can reflect psychological conflicts such as anxiety or physiology changes.
Alteration in levels of hormones have been implicated in arousal disorders as well as medications e.g. antihistamines.
Impotence in men may be medical or psychological and may reflect relationship difficulties between partners. Dyspareunia in women maybe due to a medical cause such as endometriosis, vaginitis, cervicitis and other pelvic disorders. SEXUAL DYSFUNCTION DUE TO A GENERAL MEDICAL CONDITION. Clinically significant sexual dysfunction that causes personal distress or interpersonal problems and is most likely fully explained by direct physiologic effects of a physical disorder e.g. diabetes mellitus.
Resolution of the underlying physical disorder often results in the resolution or amelioration of the sexual dysfunction. SUBSTANCE INDUCED SEXUAL DYSFUNCTION Sexual dysfunction that causes personal distress or interpersonal problems and is fully explained by substance abuse or develops during or within a month of substance intoxication. SEXUAL DYSFUNCTION NOT OTHERWISE SPECIFIED This includes sexual dysfunctions that do not meet the criteria for any specific dysfunction.
Examples include orgasmic anhedonia and compulsive sexual behaviour. Transsexualism A gender identity disorder in which the person believes he is the victim of a biologic accident, cruelly imprisoned in a body incompatible with his subjective gender identity.
Their primary objective in seeking help is not to obtain psychologic treatment but to obtain hormones and genital surgery that will make their physical appearance approximate their gender identity. TREATMENT Long-term group or individual psychotherapy is usually necessary and may be especially helpful when it is part of multimodal treatment that includes social skills training, treatment of comorbid physical and psychiatric disorders and hormonal treatment. PEDOPHILIA a preference for repetitive sexual activity with prepubertal children.
Pedophiles may limit their sexual activities to their own children or close relatives or may victimise other children.
Predatory pedophiles may use force and threaten to physically the children or even their pets if they disclose the sexual abuse. EXHIBITIONISM Achieving sexual excitement via repetitive acts of genital exposure to an unsuspecting stranger.
Actual sexual contact is never sought. VOYEURISM Achieving sexual arousal by observing unsuspecting persons who are naked, disrobing or engaging in sexual activity.
Spend considerable time seeking out viewing opportunities.
The voyeur does not seek sexual contact with those he is observing. SEXUAL MASOCHISM Intentional participation in an activity in which one is humiliated, beaten, bound or otherwise abused to experience sexual excitement.
Activity tends to be ritualised and chronic.
Some masochists increase the severity of their activity as time goes on, potentially leading to serious injury or death, e.g. autoerotic partial asphyxiation (hypoxyphilia). SEXUAL SADISM Infliction of physical or psychologic suffering (humiliation, terror) on the sexual partner to stimulate sexual excitement and orgasm. 12 Key Sexuality Questions On a scale of 1 to 10, how would you rate your sex life? (1 is very poor and 10 is the best it could be.) For it to be a 10, what would have to change?
How would you describe your level of sexual desire?
[Women] Do you lubricate?
[Men] Do you have difficulty getting and keeping an erection? Do you have morning/nocturnal erections?
Is achieving orgasm difficult for you? When you have sex, what proportion of the time do you achieve orgasm? PSYCHOSEXUAL DISORDERS SEXUAL DYSFUNCTIONS.
disturbance of sexual arousal or sexual performance
GENDER IDENTITY DISORDERS.
dissatisfaction with one’s biological sex; a desire to become a member of the opposite sex
PARAPHILIAS.
culturally inappropriate or dangerous pattern of sexual arousal Determined that there at least 4 different stages that humans go through. From the beginning of arousal to the time after orgasm.
The phases are Excitement, Plateau, Orgasmic and Resolution.
Both men and women go through these stages but the timing is usually different. Disorders of sexual response may involve one or more of the cycle’s phases.
Generally the subjective components of desire, arousal and pleasure and the objective components of performance, vasocongestion and orgasm are disturbed, although any maybe affected independently Female sexual arousal disorder
Male erectile disorder (may also occur in stage 3 and in stage 4)
Male erectile disorder due to a general medical condition
Dyspareunia due to a general medical condition (male or female)
Substance-induced sexual dysfunction with impaired arousal Orgasm
Female orgasmic disorder
Male orgasmic disorder
Premature ejaculation
Other sexual dysfunction due to a general medical condition (male or female)
Substance-induced sexual dysfunction with impaired orgasm Resolution
Postcoital dysphoria
Postcoital headache The acquired form is commonly caused by boredom or unhappiness in a longstanding relationship, depression, dependence on alcohol or psychoactive drugs, side effects from prescription drugs or hormonal deficiencies.
The lifelong form is sometimes related to traumatic events in childhood or adolescence, the suppression of sexual fantasies, a dysfunctional family or deficient levels of androgens. TREATMENT Directed at removing or alleviating the underlying cause.
Changing drugs and in the occasional case of androgen deficiency, administering intramuscular testosterone may be required. SEXUAL AVERSION DISORDER Persistent or recurrent aversion to and avoidance of all or almost all genital sexual contact with a sexual partner, causing marked distress or interpersonal difficulties.
It occurs occasionally in males and much more often in females.
It may result from sexual trauma such as incest, sexual abuse, or rape; or from a very repressive atmosphere in the family; from initial attempts at intercourse that resulted in moderate to severe dyspareunia. ORGASMIC DISORDERS A persistent or recurrent delay in or the absence of orgasm after normal sexual intercourse may be due to physical disorder or the use of a substance.
Depression is a common cause of orgasmic difficulty as well as decreased desire and arousal.
Premature ejaculation – orgasm and ejaculation with minimal stimulation that persistently or recurrently occurs before, during or shortly after penetration and before the man desires.
The disorder is probably due to a combination of psychologic and physiologic factors. SEXUAL PAIN DISORDERS Sexual pain (dyspareunia) in men, when present, usually occurs during coitus and rarely during arousal.
The leading causes are prostatitis and neurologic damage.
Vaginismus is an involuntary constriction of the outer third of the vagina that interferes with penile insertion and intercourse.
Sexual trauma such as rape or childhood sexual abuse can be the cause. GENDER IDENTITY DISORDERS Characterised by a strong, persistent cross-gender identification and by continuous discomfort about one’s anatomic sex or by a sense of inappropriateness in the gender role of that sex. PARAPHILIAS Disorders characterised by long-standing, intense, sexually arousing fantasies, urges, or behaviours that involve inanimate objects, actual or imagined suffering or humiliation of oneself or one’s partner, or non-consenting partners and that are associated with clinically important distress or disability.
Considered deviant because they are often obligatory for sexual functioning, may involve inappropriate partners and cause significant distress or impairment in functioning. Transvestic Fetishism Dressing in women’s clothing by heterosexual males, generally beginning in late childhood and at least initially associated with sexual arousal. Very few females have exhibitionism, although society sanctions some exhibitionist tendencies in females (through media and entertainment venues).
“Women exhibit everything but the genitals; men, nothing but.” Taking a Sexual History Do so without shame or embarrassment.
Patients will detect your anxiety, which will only increase their own.
Don’t apologise for asking intimate questions.
Particularly with couples, how they behave sexually is important to assess. When taking a sexual history, the clinician has four tasks:
To put the patient at ease,
To find out what the problem is,
To learn something about the patients sexual background and clinical history, and
To arrive at a plan to manage the problem Questions about sexual satisfaction can easily be incorporated into inquiries about gynaecologic and prostate health.
‘‘What sexual concerns do you have?’’ - This implies that it is common for patients to have sexual concerns and that they can discuss them with their health care practitioner. How pleasurable are your orgasms?
[Men] Is ejaculating too soon during intercourse a problem for you?
Approximately how long does it take you do achieve orgasm?
Do you have pain or discomfort during intercourse?
How long have you had this problem?
Does anything make it better or worse?
How frequently do you have sexual intercourse/other forms of sex? Thank you!

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