SEXUAL DYSFUNCTION, GENDER DYSPHORIA & PARAPHILLIC DISORDERS
SEXUAL DYSFUNCTIONS:
- Sexual health: state of physical, emotional, mental, and social wellbeing in relation to sexuality
and not merely the absence of disease, dysfunction or infirmity.
- DSM classification does not include sexual difficulties.
- Difficulties are diagnosed as dysfunctional only when they are enduring, cause significant
emotional distress, and interfere with intimate relationships.
- Sexual dysfunction: some inadequacy in functioning at one of the phases of desire, arousal,
and/or orgasm.
- Sexual dysfunctions may occur in people, regardless of their relationship status, sexual
orientation, gender identity, and/or any other such factor.
DSM 5: Sexual dysfunctions in females
- Sexual interest/arousal disorder.
- Female orgasmic disorder.
- Genito-pelvic pain/penetration disorder.
DSM 5: Sexual dysfunctions in males
- Male hypoactive sexual desire disorder
- Erectile disorder.
- Delayed ejaculation.
- Premature ejaculation.
Diagnoses also indicate specifiers
- Lifelong: the person has always had the problem.
- Acquired: new in onset.
- Generalised: experienced in all situations and with all partners.
- Situational: difficulty is experienced in selected situations or with certain partners.
Biological factors that can cause and maintain various sexual dysfunctions:
- Vascular and hormonal abnormalities.
- Undiagnosed diabetes
- The use/or abuse of certain drugs.
- Physiological factors should be excluded before conducting psychological assessments.
Psychological factors that may cause and maintain various sexual dysfunctions:
- Certain psychological disorders.
- Maladaptive attitudes and cognitions.
Sociocultural factors:
- Relationship problems
- Traumatic experiences
- Cultural taboos against sex
- Making a clinical judgement about the presence of a sexual dysfunction: give recognition to an
individual’s ethnic, cultural, religious, and social background.
- Look at how these factors may influence sexual desire, expectations, and attitudes about
performance.
SEXUAL INTEREST/AROUSAL DISORDERS
Three conditions under this category:
- Female sexual interest/arousal disorder.
- Erectile disorder.
- Hypoactive sexual desire disorder.
Female sexual interest/arousal disorder and male hypoactive sexual desire disorder
- Level of interest in sexual activities that is so low it is considered abnormal.
- Person does not imagine sexual activity or fantasise.
- Does not seek out actual sexual relationships.
Hypoactive sexual desire
- Difficult to define in absolute terms.
- Definition emphasises the lack or deficiency of well-accepted markers of desire, such as:
sexual thoughts or fantasies,
absent or deficient receptivity to sexual initiation by a partner.
- Definition also requires that the person be significantly distressed by this deficiency in desire
and/or experience significant interpersonal difficulties due to it.
- Sexual desire disorders that are exclusively physical in origin are not considered psychological
disorders.
- A number of factors are well known to have an impact on men’s and women’s general desire-
libido.
Factors that affect libido Positive factors:
- Good health
- Effective stimulation
- Good body image
- High self-esteem
- Good relationship
- Good communication
Negative factors:
- Disease
- Stress
- Fatigue
- Lactation in women
- Dyspareunia-genital pain with intercourse
- Depression or other psychological difficulties
- Traumatic experience/s
Male hypoactive sexual desire disorder
Diagnosis must be based on two critical aspects:
- Low/absent desire for sex
- Absence of sexual thoughts or fantasies.
SEXUAL AVERSION DISORDER
- A person with sexual aversion disorder may be interested in sex and even enjoy sexual
functioning.
- The person is repulsed by the notion of engaging in the actual sex act.
- Associate sexual thoughts and activities with fear, panic, and/or disgust.
- Characterised by the active dislike and avoidance of genital contact with a sexual partner.
ERECTILE DISORDER
-Experience the recurrent, partial or complete inability to achieve or maintain and erection while
engaging in sexual behaviours.
- May still retain an interest in sexual behaviour
ORGASMIC DISORDER
- recurrent absence of orgasm or the unacceptable delay in orgasm following sexual excitement.
- Anorgasmia: inhibited orgasm or the inability to achieve orgasm despite desire and arousal.
- Female orgasmic disorder: common complaint in women seeking sexual therapy.
- Men: delayed ejaculation and premature ejaculation.
Premature ejaculation
- persistent or recurrent onset of orgasm and ejaculation with minimal sexual stimulation before,
upon, or shortly after penetration and before the person wishes it.
Delayed ejaculation
- Unable to reach ejaculation, or in cases they do, this is often delayed.
Sexual pain disorders
Genito-pelvic pain/penetration disorder
- Persistent or recurrent experience of genital pain before, or after engaging in sex.
- Pain usually disrupts sexual behaviour.
Gender Dysphoria / Gender Incongruence
- Psychological dissatisfaction with one’s gender assigned at birth.
- Refers to the distress that may accompany the incongruence between one’s experiences or
expressed gender and one’s assigned gender.
- People with gender dysphoria may dress in the clothes of the opposite gender simply in order to
wear the clothes of the gender to which they feel they truly belong.
-
Gender role: how they believe they should behave in society as either a male or female
Sexual orientation: the emotional, romantic, and/or sexual attraction for either a male or female sexual
partner.
DSM-5: different criteria for different developmental groups
Gender dysphoria in children
a. Marked incongruence between ones expressed gender & assigned gender – 6 month duration;
strong desire to be of the other gender or insistence that one is of the other gender, strong
preference for cross-gender role, strong preference for playmates of the other gender, strong
dislike for one’s sexual autonomy.
b. Condition associated with clinically significant distress or impairment in school, social
environments.
Gender dysphoria in adolescents
a. Marked incongruence between one’s expressed gender & assigned gender – 6 month duration;
strong desire for primary and sex characteristics of the other gender, strong desire to be treated
as the other gender
b. Condition associated with clinically significant distress or impairment in social / occupational
settings.
Issues with gender identity
- LGBTIQA+-affirmative therapists: believe that transgender identity is not a mental illness and
that there is no need for psychotherapeutic treatment for transgender people per se.
- South Africa: the law allows allows a person to change, under certain conditions, their sex as
recorded in the population registry.
- Transgender people have been misunderstood and misdiagnosed by their caregivers.
- Overall goal of therapy: for people with gender dysphoria is lasting personal comfort with the
gendered self
PARAPHILIC DISORDERS
Paraphilia: term used to describe sexual interests in which sexual arousal, behaviours, and satisfaction
can occur in the context of unusual or inappropriate objects, including either non-human objects, and/or
non-consenting adults or children.
DSM-5: uses the term paraphilic disorders to designate those atypical sexual behaviours that are
considered to be disorders.
1. Fetishism • The use of inanimate objects as the preferred or exclusive source of sexual arousal.
People with fetishism do not impose their desires on other people and may go unnoticed. •
Fetish behaviours commonly include fondling, smelling, and licking the objects.
2. Transvestic Fetishism • Sexual arousal in heterosexual men is associated with the act of cross-
dressing in women’s clothes. • Cross-dressing ranges from using only one item of women’s
clothing to completely dressing as a woman with make-up and a wig. Condition indicates a
sexual attraction to the clothing of the opposite sex, but once orgasm occurs, sexual arousal
typically declines.
3. Sexual sadism • Involves the recurrent urge or behaviour to inflict pain or humiliation on a
sexual partner for sexual arousal.
4. Sexual masochism • Involves the recurrent urge or behaviour of wanting to be made to suffer
pain of humiliation for sexual arousal.
5. Voyeurism • Refers to the act of watching an unsuspecting individual undressing, naked,
engaging in sex, or bath, in order to become sexually aroused. • The watching is done in secret.
6. Exhibitionism • The recurrent urge or behaviour to gain sexual arousal from shocking others by
exposing one’s genitals.
7. Frotteurism • The recurrent urge to or behaviour of touching or rubbing against a non-
consenting person.
8. Paedophilic disorder • Synonymous with child molestation, involves sexual attraction to
prepubescent or peri-pubescent children, most often girls. • People with paedophilic disorder
are sexually attracted to children. Victim: required to be 13 years and at least 5 years younger
than the perpetrator.
AETIOLOGY
Biological factors
- Biological factors play a role in predisposing or triggering these conditions
- Organic factors such as diabetes, , depression, fatigue and use of other substances cause the
trigger
Psychological factors
- Anger, stress and anxiety are implicated in sexual dysfunctions
- Sexual traumas
- Body image problems