13.5 PUTTING IT...together
A Private Topic Draws Public Attention
For all the public interest in sexual and gender disorders, clinical theorists and practitioners have only recently begun to understand their nature and how to treat them. As a result of research done over the past few decades, people with sexual dysfunctions are no longer doomed to a lifetime of sexual frustration. At the same time, however, insights into the causes and treatment of paraphilic disorders and gender dysphoria remain limited.
Studies of sexual dysfunctions have pointed to many psychological, sociocultural, and biological causes. Often, as you have seen with so many disorders, the various causes may interact to produce a particular dysfunction, as in erectile disorder and female orgasmic disorder. For some dysfunctions, however, one cause alone is dominant, and integrated explanations may be inaccurate and unproductive. Some sexual pain dysfunctions, for example, have a physical cause exclusively.
Recent work has also yielded important progress in the treatment of sexual dysfunctions, and people with such problems are now often helped greatly by therapy. Sex therapy is usually a complex program tailored to the particular problems of an individual or couple. Techniques from the various models may be combined, although in some instances the particular problem calls primarily for one approach.
CLINICAL CHOICES
Now that you’ve read about disorders of sex and gender, try the interactive case study for this chapter. See if you are able to identify Charles’ symptoms and suggest a diagnosis based on his symptoms. What kind of treatment would be most effective for Charles? Go to LaunchPad to access Clinical Choices.
One of the most important insights to emerge from all of this work is that education about sexual dysfunctions can be as important as therapy. Sexual myths are still taken so seriously that they often lead to feelings of shame, self-
In fact, most people can benefit from a more accurate understanding of sexual functioning. Public education about sexual functioning—
BETWEEN THE LINES
Sexual Self-
A Finnish study of almost 10,000 adults found that half of all male and female participants were satisfied with the appearance of their genitals.
Half of all women were satisfied with the appearance of their breasts.
Higher genital self-
satisfaction was related to better sexual functioning for both genders.
(Algars et al., 2011)
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Eye of the Beholder
In the movie Annie Hall, Annie’s psychotherapist asks her how often she and her boyfriend, Alvy Singer, sleep together. Simultaneously, across town, Alvy’s therapist asks him the same question. Alvy answers, “Hardly ever. Maybe three times a week,” while Annie responds, “Constantly. I’d say three times a week.”
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Tattoos and Sexuality
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31% |
Percentage of people with tattoos who say that their tattoos make them feel sexier |
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39% |
Percentage of people without tattoos who say that people with tattoos are less sexy |
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(Harris Poll, 2008) |
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SUMMING UP
SEXUAL DYSFUNCTIONS The human sexual response cycle consists of four phases: desire, excitement, orgasm, and resolution. Sexual dysfunctions, disorders in which people cannot respond normally in a key area of sexual functioning, make it difficult or impossible for a person to have or enjoy sexual activity. p. 426
DISORDERS OF DESIRE DSM-
5 lists two disorders of the desire phase of the sexual response cycle: male hypoactive sexual desire disorder and female sexual interest/arousal disorder. Men with the former disorder persistently lack or have reduced interest in sex and, in turn, engage in little sexual activity. Women with the latter disorder lack normal interest in sex, rarely initiate sexual activity, and may also feel little excitement during sexual activity or in the presence of erotic cues. Biological causes for these disorders include abnormal hormone levels, certain drugs, and some medical illnesses. Psychological and sociocultural causes include specific fears, situational pressures, relationship problems, and the trauma of having been sexually molested or assaulted. pp. 426– 430 462
DISORDERS OF EXCITEMENT Disorders of the excitement phase include erectile disorder, a repeated inability to attain or maintain an erection during sexual activity. Biological causes of erectile disorder include abnormal hormone levels, vascular problems, medical conditions, and certain medications. Psychological and sociocultural causes include the combination of performance anxiety and the spectator role, situational pressures such as job loss, and relationship problems. pp. 430–
432 DISORDERS OF ORGASM Premature ejaculation has been attributed most often to behavioral causes, such as inappropriate early learning and inexperience. In recent years, possible biological factors have been identified as well. Delayed ejaculation, a repeated absence of or long delay in reaching orgasm, can have biological causes, such as low testosterone levels, neurological diseases, and certain drugs, and psychological causes, such as performance anxiety and the spectator role. The dysfunction may also develop from male hypoactive sexual desire disorder.
Female orgasmic disorder, which is often accompanied by arousal difficulties, has been tied to biological causes such as medical diseases and changes that occur after menopause, psychological causes such as memories of childhood traumas, and sociocultural causes such as relationship problems. Most clinicians agree that orgasm during intercourse is not critical to normal sexual functioning, provided a woman can reach orgasm with her partner during direct stimulation of the clitoris. pp. 433–
437 SEXUAL PAIN DISORDERS Genito-
pelvic pain/penetration disorder involves significant pain during intercourse. In one form of this disorder, vaginismus, involuntary contractions of the muscles around the outer third of the vagina prevent entry of the penis. In another form, dyspareunia, the person has severe vaginal or pelvic pain during intercourse. This form of the disorder usually occurs in women and typically has a physical cause, such as injury resulting from childbirth. pp. 437– 438 TREATMENTS FOR SEXUAL DYSFUNCTIONS In the 1970s, the work of William Masters and Virginia Johnson led to the development of sex therapy. Today sex therapy combines a variety of cognitive, behavioral, couple, and family systems therapies. It generally includes features such as careful assessment, education, acceptance of mutual responsibility, attitude changes, sensate-
focus exercises, improvements in communication, and couple therapy. In addition, specific techniques have been developed for each of the sexual dysfunctions. The use of biological treatments for sexual dysfunctions is also increasing. pp. 438– 445 
Grand Theft Auto: The sexual controversy With 15 different titles, Grand Theft Auto is one of today’s most popular video game series. But it was almost derailed in 2004 with the release of one of the titles, Grand Theft Auto: San Andreas. Fearing that the sexual material in this game was too graphic for children, parents and politicians pressured the producer to develop enhanced security measures and, eventually, to remove the sexual material.PARAPHILIC DISORDERS Paraphilias are patterns characterized by recurrent and intense sexual urges, fantasies, or behaviors involving objects or situations outside the usual sexual norms—
for example, nonhuman objects, children, nonconsenting adults, or experiences of suffering or humiliation. When an individual’s paraphilia causes great distress, interferes with social or occupational functioning, or places the individual or others at risk of harm, a diagnosis of paraphilic disorder is applied. Paraphilic disorders are found primarily in men. The paraphilic disorders include fetishistic disorder, transvestic disorder, exhibitionistic disorder, voyeuristic disorder, frotteuristic disorder, pedophilic disorder, sexual masochism disorder, and sexual sadism disorder. 463
Fetishistic disorder consists of recurrent and intense sexual fantasies, urges, or behaviors that involve the use of a nonliving object or nongenital part. Transvestic disorder, also known as transvestism or cross-
dressing, is characterized by repeated and intense sexual fantasies, urges, or behaviors that involve dressing in clothes of the opposite sex. Exhibitionistic disorder features repeated and intense sexual fantasies, urges, or behaviors that involve exposing one’s genitals to others. In voyeuristic disorder, a person has repeated and intense sexual fantasies, urges, or behaviors that involve secretly observing unsuspecting people who are naked, undressing, or engaging in sexual activity. In frotteuristic disorder, a person has repeated and intense sexual fantasies, urges, or behaviors that involve touching or rubbing against a nonconsenting person. In pedophilic disorder, a person has repeated and intense sexual fantasies, urges, or behaviors that involve watching, touching, or engaging in sexual acts with children. Sexual masochism disorder is characterized by repeated and intense sexual fantasies, urges, or behaviors that involve being humiliated, beaten, bound, or otherwise made to suffer. Sexual sadism disorder is characterized by repeated and intense sexual fantasies, urges, or behaviors that involve inflicting suffering on others. Although various explanations have been proposed for paraphilic disorders, research has revealed little about their causes. A range of treatments have been tried, including aversion therapy, masturbatory satiation, orgasmic reorientation, and relapse-
prevention training. pp. 445– 456 GENDER DYSPHORIA People with gender dysphoria persistently feel that they have been born the wrong gender and, along with this, experience significant distress or impairment. Gender dysphoria in children usually disappears by adolescence or adulthood, but in some cases it develops into adolescent and adult forms of gender dysphoria. The causes of this disorder are not well understood. Hormone treatments, facial surgery, speech therapy, and psychotherapy have been used to help some people adopt the gender role they believe to be right for them. Sex-
change operations have also been performed, but the appropriateness of surgery as a form of treatment has been debated heatedly. pp. 456– 461
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