T10: Disorders Involving Gender and Sexuality

• Paraphilic disorder is a sexual disorder and the relatively new term for sexual deviation in which sexual arousal occurs primarily in the context of inappropriate objects or individuals. Philia refers to a strong attraction or liking, and para indicates the attraction is abnormal. It is associated with distress and impairment or harm the threat of to others.
• Gender dysphoria is a condition in which there is incongruence and psychological distress and dissatisfaction with the gender one has been assigned at birth (boy or girl). The disorder is not sexual but rather a disturbance in the person’s sense of being a male or a female.
• Sexual Response Cycle:

  • Desire Phase
  • Arousal Stage
  • Plateau Phase
  • Orgasm Phase
  • Resolution Phase
• Desire Phase is a phase for sexual response cycle in which sexual urges occur in response to sexual cues or fantasies.
• Arousal Stage is phase of sexual response cycle that is a subjective sense of sexual pleasure and physiological signs of sexual arousal. In males, penile tumescence (increased flow of blood into the penis); in females, vasocongestion (blood pools in the pelvic area) leading to vaginal lubrication and breast tumescence (erect nipples).
• Plateau Phase is a phase of sexual response cycle that occurs before orgasm.
• Orgasm Phase is a phase of sexual response cycle in which in males, feelings of inevitability of ejaculation, followed by ejaculation, while in females, contractions of the walls of the lower third of the vagina.
• Resolution Phase is a phase of sexual response cycle in which the decrease in arousal occurs after orgasm (particularly in men).
• Two disorders for sexual dysfunctions are sex specific: Premature (early) ejaculation occurs only in males, and Genito pelvic pain/penetration disorder —which includes difficulties with penetration during intercourse due in many cases to painful contractions or spasms of the vagina—appears only in females.
• Males with hypoactive sexual desire disorder and females with sexual interest/arousal disorder have little or no interest in any type of sexual activity.
• Erectile Dysfunction is a specific disorder of arousal for men in which desire is not the problem because they still have frequent sexual urges and fantasies and strong desire to have sex. The problem is in becoming physically aroused.
• Female interest and arousal disorder is a specific disorder of arousal in which they have low interest, deficits in arousal are reflected in an inability to achieve or maintain adequate lubrication.
• The old and somewhat derogatory terms for male erectile disorder and female interest and arousal difficulties are impotence and frigidity, but these are imprecise labels that do not identify the specific phase of the sexual response in which the problems are localized.
• Female orgasmic disorder is an orgasm disorder for female who achieve orgasm only with great difficulty or not at all.
• A far more common male orgasmic disorder is premature ejaculation, ejaculation that occurs well before the man and his partner wish it to, defined as approximately 1 minute after penetration in DSM-5.
• Vaginismus is a usual presentation of GPPPD in which the pelvic muscles in the outer third of the vagina undergo involuntary spasms when intercourse is attempted.
• Vascular disease is a major cause of sexual dysfunction, because erections in men and vaginal engorgement in women depend on adequate blood flow. The two relevant vascular problems in men are arterial insufficiency (constricted arteries), which makes it difficult for blood to reach the penis, and venous leakage (blood flows out too quickly for an erection to be maintained).
• Frotteuristic Disorder is a male with an arousal pattern of rubbing against their penis to a woman on a crowded train or bus until he is stimulated to the point of ejaculation.
• Voyeuristic disorder is the practice of observing, to become aroused, an unsuspecting individual undressing or naked.
• Exhibitionistic disorder is achieving sexual arousal and gratification by exposing genitals to unsuspecting strangers. To meet the diagnosis, the behavior must occur repeatedly and be compulsive or out of control.
• Transvestic Disorder is where a sexual arousal is strongly associated with the act of (or fantasies of) dressing in clothes of the opposite sex, or cross-dressing.
• Another specifier for transvestism describes a pattern of sexual arousal associated not with clothing itself but rather with thoughts or images of oneself as a female. This specifier is called “autogynephilia”
• Sexual Sadism Disorder is associated with inflicting pain or humiliation and becoming sexually aroused is specifically associated with violence and injury in these conditions.
• Sexual Masochism Disorder is suffering a pain or humiliation and becoming sexually aroused is specifically associated with violence and injury in these conditions.
• An individual accidentally hangs himself, an event that should be distinguished from the closely related condition called hypoxiphilia, which involves self-strangulation to reduce the flow of oxygen to the brain and enhance the sensation of orgasm.
• The most tragic sexual deviance is sexual attraction to children (or young adolescents generally aged 13 years or younger), called pedophilia. The victims tend to be young children. An important study indicates that being charged with a child pornography offense is one of the best diagnostic indications.
• Incest is a sexual attraction to the children that is a person's relative. Usually, the victims tend to be girls beginning to mature physically.
• Covert Sensitization is a behavior therapy treatment of paraphilic disorder in which patients associate sexually arousing images in their imagination with some reasons why the behavior is harmful or dangerous.
• Disorders of Sex Development (DSD), formerly known as intersexuality or hermaphroditism who are born with ambiguous genitalia associated with documented hormonal or other physical abnormalities.
• In fetishistic disorder, a person is sexually attracted to nonliving objects. Women’s undergarments and shoes are the popular one.