Sexual Disorders

• Sexual norms


  Definitions of what is normal or desirable in human sexual behavior
• In contemporary Western worldviews, inhibition of sexual expression is seen as a problem, contrasting with 19th and early 20th century views that excess was the culprit
• The AIDS epidemic in the 1980s changed the perceived risks associated with sexual behavior
• In some cultures, sexuality is viewed as an important part of well-being and pleasure, whereas in others, sexuality is seen as relevant only for procreation
• In the United States, the DSM contained a diagnosis for homosexuality as recently as 1973
• Gender identity


  A person's inherent sense of being male or female, distinct from sexual orientation
• The DSM-5 includes a diagnosis of gender dysphoria for people who experience a strong and persistent identification with the opposite sex
• There are several reasons why the diagnosis of gender dysphoria is debated, including that cross-gender behavior is universal, the diagnosis is philosophically incongruent with the positive outcomes of sex-reassignment surgery, and it might foster more stigma and social ostracism
• Women are much more likely to report symptoms of sexual dysfunction than are men, but men are much more likely to meet diagnostic criteria for paraphilic disorder
• On many dimensions, men and women may be more similar than stereotypes suggest, such as women's primary motivation for having sex being sexual attraction and physical gratification rather than just promoting relationship closeness
• Many gender differences in sexuality have decreased over time, and are less apparent in cultures with more empowered attitudes toward women
• Men continue to endorse engaging in more masturbation and using more pornography than women, though there is a lot of overlap between the genders
• Gender differences in sexuality

  • Many gender differences in sexuality have decreased over time
  • Gender differences are less apparent in cultures with more empowered attitudes toward women
• In recent surveys across a broad range of countries, men continue to endorse engaging in more masturbation and using more pornography than women
• About 67 percent of men and women were in the same range for masturbation and pornography use
• Reporting gender differences in sexual behavior

  Could reflect respondents' attempts to match cultural expectations
• Sexual response cycle


  Phases: Desire, Excitement, Orgasm, Resolution
• Kaplan's sexual response cycle phases for women

  • Desire and excitement phase may not be distinct stages
  • Kaplan's definition of excitement phase may be overly biological
• Female Sexual Interest/Arousal Disorder

  Diminished, absent, or reduced frequency of at least three of the following: Interest in sexual activity, Erotic thoughts or fantasies, Initiation of sexual activity and responsiveness to partner's attempts to initiate, Sexual excitement/pleasure during 75 percent of sexual encounters, Sexual interest/arousal elicited by any internal or external erotic cues, Genital or nongenital sensations during 75 percent of sexual encounters
• Erectile Disorder


  On at least 75 percent of sexual occasions: Inability to attain an erection, or Inability to maintain an erection for completion of sexual activity, or Marked decrease in erectile rigidity interferes with penetration or pleasure
• Robert, a very bright 25-year-old graduate student in physics at a leading university, sought treatment for what he called "sexual diffidence" toward his fiancée
• Robert had little interest in sex—either with men or with women—for as far back as he could remember, even when work pressures were not present
• Among people seeking treatment for sexual dysfunctions, more than half complain of low desire
• Women are more likely than men to report at least occasional concerns about their level of sexual desire
• Postmenopausal women are more likely than women in their 20s to report low sexual desire and low levels of arousal, but they are less likely to be distressed by these symptoms
• Female sexual interest/arousal disorder


  Biologically or subjectively low arousal or desire
• Women tend to be more concerned by a lack of subjective desire than by a lack of biological arousal
• Women with subjective lack of desire often have normative levels of biological response to erotic stimuli
• The sexual interest and desire disorders, often colloquially referred to as low sex drive, are the most subjective of the DSM-5 diagnoses
• Among women with low sexual desire in the last month, American women are more likely to report distress about the symptom than are European women
• Occasional inability to attain or sustain an erection is the most common sexual concern among men
• The prevalence of erectile disorder increases sharply with age, with as many as 50 percent of men age 60 and older reporting at least occasional erectile dysfunction
• Female orgasmic disorder


  Persistent absence or reduced intensity of orgasm after sexual excitement
• About one-third of women report that they rarely or never experience orgasms during intercourse with their partners
• Women become more likely to have orgasms as they age, which may reflect a greater knowledge of their bodies and sexual needs
• Women are more likely to have orgasms in close relationships than they are in casual, short-term relationships
• About two-thirds of women report that they have faked an orgasm, and most say that they did so to try to protect their partner's feelings
• Premature (early) ejaculation


  Ejaculation that occurs too quickly, defined as less than 1 minute after the penis is inserted
• Less than 3 percent of men report symptoms of premature ejaculation lasting 6 months or more
• Delayed ejaculation disorder


  Persistent difficulty in ejaculating