Sexual Disorders and Gender Variations

• DSM-5R Categories Related to Sex and Gender

  • Sexual Dysfunctions
  • Paraphilic Disorders
  • Gender Dysphoria
• Sexual Dysfunctions


  Problems with normal sexual functioning
• Paraphilic Disorders


  Unusual sexual urges or fantasies
• Gender Dysphoria


  Discomfort with assigned gender
• Sexual Dysfunctions: Definition


  Persistent inability to function normally in some area of the sexual response cycle
• Diagnostic Criteria for Sexual Dysfunctions

  • Symptoms present most of the time for at least 6 months
  • Cause significant distress or impairment
  • Not due to another psychiatric problem
• Phases of the Sexual Response Cycle

  • Desire: Interest in sexual activity
  • Arousal: Physiological changes (e.g., erection, lubrication)
  • Orgasm: Peak sexual pleasure
  • Resolution: Return to resting state
• Types of Sexual Dysfunctions

  • Lifelong vs. Acquired: Present from the beginning vs. developed later
  • Generalized vs. Situational: Present in all situations vs. tied to specific situations
• DSM-5 Changes: Combined sexual desire disorders and sexual arousal disorders, Renamed "Premature Ejaculation" and "Delayed Ejaculation", "Genito-pelvic Pain/Penetration Disorder" replaces "Dyspareunia" and "Vaginismus"
• Prevalence of Sexual Problems: High prevalence of at least one sexual problem across the population
• Gender Variations


  • Gender Identity: One's sense of being male, female, or non-binary
  • Biological Sex: Assigned sex based on external genitals
  • Gender Expression: How one expresses their gender (clothing, behavior, etc.)
  • Cisgender: Identity aligns with assigned gender
  • Non-Binary: Do not identify as exclusively male or female
  • Gender Fluidity: Gender identity fluctuates
  • Agender: No gender identity
  • Transgender: Gender identity differs from assigned gender
• DSM-5TR Criteria for Gender Dysphoria


  • Contradiction between gender identity and sex characteristics
  • Desire to eliminate sex characteristics
  • Yearning for characteristics of another gender
  • Wish to be a member of another gender
  • Wish to be treated as another gender
  • Belief that one's feelings/reactions are characteristic of another gender
• Controversy: Potential for removal of Gender Dysphoria from DSM in future revisions
• Transgender Functioning


  • Prevalence: 25 million worldwide, 0.15-0.58% in the Netherlands
  • Gender Differences: Transgender women more common than transgender men
  • Development: May emerge in childhood but can change over time
  • Not All Transgender Experience Dysphoria: Many experience gender congruence
• Interventions for Gender Dysphoria

  • Psychological: Address needs/feelings, reduce distress/impairment, improve self-image, develop coping skills
  • Biological: Hormone therapy, gender-affirming surgery
  • Cognitive-Behavioral: Education, support groups
• Explanations for Gender Dysphoria

  • Identical Twin Studies: Higher concordance rates
  • Brain Structure: Differences in brain regions
  • Brain Reactions: Differences in response to stimuli