Chapter Introduction

CHAPTER
13

Disorders of Sex and Gender

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TOPIC OVERVIEW

Sexual Dysfunctions

Disorders of Desire

Disorders of Excitement

Disorders of Orgasm

Disorders of Sexual Pain

Treatments for Sexual Dysfunctions

What Are the General Features of Sex Therapy?

What Techniques Are Used to Treat Particular Dysfunctions?

What Are the Current Trends in Sex Therapy?

Paraphilic Disorders

Fetishistic Disorder

Transvestic Disorder

Exhibitionistic Disorder

Voyeuristic Disorder

Frotteuristic Disorder

Pedophilic Disorder

Sexual Masochism Disorder

Sexual Sadism Disorder

Gender Dysphoria

Explanations of Gender Dysphoria

Treatments for Gender Dysphoria

Putting It Together: A Private Topic Draws Public Attention

Robert, a 57-year-old man, came to sex therapy with his wife because of his inability to get erections. He had not had a problem with erections until six months earlier, when they attempted to have sex after an evening out, during which he had had several drinks. They attributed his failure to get an erection to his being “a little drunk,” but he found himself worrying over the next few days that he was perhaps becoming impotent. When they next attempted intercourse, he found himself unable to get involved in what they were doing because he was so intent on watching himself to see if he would get an erection. Once again he did not, and they were both very upset. His failure to get an erection continued over the next few months. Robert’s wife was very upset and frustrated, accusing him of having an affair, or of no longer finding her attractive. Robert wondered if he was getting too old, or if his medication for high blood pressure, which he had been taking for about a year, might be interfering with erections. When they came for sex therapy, they had not attempted any sexual activity for over two months.

Sexual behavior is a major focus of both our private thoughts and public discussions. Sexual feelings are a crucial part of our development and daily functioning, sexual activity is tied to the satisfaction of our basic needs, and sexual performance is linked to our self-esteem. Most people are fascinated by the abnormal sexual behavior of others and worry about the normality of their own sexuality.

Experts recognize two general categories of sexual disorders: sexual dysfunctions and paraphilic disorders. People with sexual dysfunctions have problems with their sexual responses. Robert, for example, had a dysfunction known as erectile disorder, a repeated failure to attain or maintain an erection during sexual activity. People with paraphilic disorders have repeated and intense sexual urges or fantasies in response to objects or situations that society deems inappropriate, and they may behave inappropriately as well. They may be aroused by the thought of sexual activity with a child, for example, or of exposing their genitals to strangers, and they may act on those urges. In addition to the sexual disorders, DSM-5 includes a diagnosis called gender dysphoria, a pattern in which people persistently feel that they have been born to the wrong sex, identify with the other gender, and experience significant distress or impairment as a consequence of these feelings.

As you will see throughout this chapter, relatively little is known about racial and other cultural differences in sexuality. This is true for normal sexual patterns, sexual dysfunctions, and paraphilic disorders alike. Although different cultural groups have for years been labeled hypersexual, “hot blooded,” exotic, passionate, submissive, and the like, such incorrect stereotypes have grown strictly from ignorance or prejudice, not from objective observations or research (McGoldrick et al., 2007). In fact, sex therapists and sex researchers have only recently begun to attend systematically to the importance of culture and race.

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