Chapter 8 - Gender Identity and Sexual Disorders

I.  Important Definitions

A.  gender identity

B.  sex roles/gender roles

C.  sexual orientation

D.  normal vs. abnormal sexuality

              1.  lack of choice

              2.  lack of others’ consent

              3.  harm to others

              4.  mismatch with partner’s desire

              5.  other distress/interference

II.  Gender Identity Disorder (aka transsexualism)

A.  psychological issues AND political issues in dx

              1.  IS it a disorder? 

              2.  does NOT apply to intersex individuals

B.  etiology:  some evidence for role of biology?

C.  treatment

              1.  sex-reassignment

              2.  alternative:  sex-reassignment minus surgery (full or part)

              3.  behavioral tx to alter gender identity

III.  Sexual Response Cycle Disorders (Sexual Dysfunction)

       A.  Sexual desire disorders

              1.  hypoactive

              2.  aversion

       B.  Sexual arousal disorders

              1.  women:  lubrication problems (female sexual arousal d/o)

              2.  men:  erectile problems (male erectile d/o)

       C.  Orgasmic Disorders

              1.  women:  not obtaining orgasm given “sufficient” sexual stimulation

a. preorgasmic vs. anorgasmic

              2.  men: 

a.  lack of orgasm/ejaculation (male orgasmic d/o): less common

b.  premature ejaculation:  much more common

       D.  Sexual Pain Disorders

              1.  dyspareunia

              2.  vaginismus

       E.  Etiological and Related Factors in Sexual Dysfunction

1.  biological:  disease, hormone, meds, etc

2.  sole focus on intercourse

              3.  performance anxiety/ spectatoring

4. alcohol/drug use, past and present  

              5.  other mood problems (e.g., depression)

6.  partner of nonpreferred gender (or other demog)

7.  sexual trauma

8.  sociocultural (e.g. strict or negative beliefs about sex)

9.  masking other problems/secondary gain

       F.  Treatment for Sexual Dysfuntions

              1.  addressing anxiety/relational concerns

              2.  sensate focus

              3.  “stop-squeeze” method

              4.  masturbatory training

              5.  dilator use

              6.  biological approaches:  hormones, erectile aids (pump/meds), psych meds

IV. Paraphilias

A.  sexual attraction TO objects, or needing the objects in the situation to become aroused, or  attraction to specific sexual situations

       B.  Inc. fetishes, tranvestic fetishism, voyeurism, exhibitionism, s/m, etc

       (C.  pedophilia/incest and possibly rape)

       D. Etiology

              1.   conditioned associations?

              2.   biology?

       E.  Treatment

1.  castration, anti-androgen medication

              2.  aversive conditioning; satiation

              3.  cognitive therapy

4.  orgasmic reorientation (reconditioning)

5.  social skills training, sex ed