Psych - Sexuality Related Disorders

Sexuality Related Disorders

Anna Josefina Vazquez-Genuino, MD Psychiatry 2008

What is the lecture about? Overview of Sexuality in terms of: Biological Psychodynamic Behavioral Sociocultural

Disorders related to Sexuality

What is the lecture about? Human Sexual Response Cycle Sexual Dysfunctions Sexual Disorders and Paraphilias

What is Human Sexuality?

What do you know?

Human Sexuality Determined by anatomy, physiology, psychology, culture and religion in which one lives, one’s relationship with others, and developmental experiences throughout the life cycle

Normal Sexuality Feelings of desire, behavior, that brings pleasure to oneself and partner Stimulation of the primary sex organs including coitus

Normal Sexuality Devoid of inappropriate feelings of guilt or anxiety Not compulsive

Biological Perspective Substances that increase dopamine increase desire Substances that increase serotonin decrease desire Testosterone increases libido in men and women

Biological Perspective Estrogen may increase woman’s sensitivity to stimulation Progesterone, and excessive levels of prolactin and cortisol depresses desire Oxytocin involve in pleasurable sensations during sex

Biological Perspective Genetic and biological components may contribute to sexual orientation

Psychoanalytic Perspective Any problems with the development in psychosexual stages of development would explain the sexual symptoms

Behavioral Perspective Varied ranges of sexual behaviors are seen in both heterosexuals and homosexuals

Sociocultural Perspective Religious values on virginity and sexual chastity Cultural values are changing with regards to sexual behaviors

Psychosexual Factors Sexual Identity Gender Identity Sexual Orientation Sexual Behavior

Sexual Identity Female XX genotype Male XY genotype

Sexual Identity Disorders XXY Klinefelter’s Syndrome XO Infertile female Pseudohermaphrodite

Gender Identity By 2 to 3 years old, “I am male” or “I am female”

Gender Identity Psychological aspects of behavior related to masculinity and femininity

Gender Identity Gender role behavior refers to all things that disclose the person is male or female

Gender IdentityDisorder Strong & persistent cross-gender Id Persistent Discomfot with Own Sex Assignment or Sense of Inappropriateness in Gender Role of that Sex R/O Intersex Condition Causes Clin Sig Distress or Impaired Funct

Gender IdentityDisorder In Child Repeated Stated Desire to Be or Insist He is of the Other Sex i.e. Grow up to be of Opp Sex Cross- Dress/ Sex Roles- Play, Fantasy Intense Desire Participate Stereotypical Games & Pastimes- Opp Sex Strongly Prefer Playmates of Opp Sex

Gender IdentityDisorder In Boys: Genitals Disgusting, Will Disappear Later, Better w/o, Aversion to Rough & Tumble, Reject Toys, Games, Activities, In Girls: Reject Urinating in Sitting , Will Grow a Penis, Doesn’t Want Breasts/ Mens, Aversion to Dress

Gender Identity Disorder In Adol & Adult Born w/ the Wrong Sex Freq Passing, Desire to Live & Be Treated as Other Sex Conviction that He/ She has Typical Flgs & Rxns of Other Sex

Gender Identity Disorders In Adol & Adult: TRANSSEXUAL Freq Request Medical / Surgical Proced to Alter Physical Appearance Persistent Preoccupation w/ Getting Rid of 1ry & 2ndry Sex Char & Acquiring Sex Char of Opp Sex

Gender Identity Disorders DIFFERENTIAL DX Assoc w/ other Psych Dx: Schiz, Affective, Transvestic Fetishism, PD Tomboys, Gay- no cross gender ID, no discontent w/ Sex Anatomical Intersex Condition

Gender Identity Disorders ANATOMICAL INTERSEX CONDITION Congenital Virilizing Adrenal Hyperplasia- XX Androgen Insensitivity Syndrome -XY Turner’s Syndrome - X Klinfelter’s Syndrome - XXY 5- a Reductase Deficiency Pseudohermaphroditism

GENDER IDENTITY DISORDER TREATMENT In Child: Cope w/ Anatomical Birth Sex, Dev Social Skills In Adol: Supportive PsychoTx, Family Tx & Educ, Cross –Sex Hormones  Body Changes In Adult: Hormonal & Surgical Sex Reassignment

Sexual Orientation Heterosexual Homosexual Bisexual

Sexual Orientation Disorder Ego-Dystonic Homosexuality Dissatisfaction w/ Sex Arousal Pattern Desire to Inc Heterosex Arousal Strong Neg Flgs Re Being Homosexual

Sexual Behavior Sexual response = psychophysiological experience Human Sexual Response Cycle

What do you know about sex? Human Sexual Response Cycle

Human Sexual Response Cycle Phase I: Desire Phase II: Excitement Phase III: Orgasm Phase IV: Resolution

Sexual Dysfunctions Sexual Desire Disorders Hypoactive Sexual Desire Disorder Sexual Aversion Disorder

Sexual Dysfunctions Sexual Arousal disorders Female Arousal disorder Male Erectile disorder

Sexual Dysfunctions Orgasm disorders Female Orgasm disorders (Anorgasmia) Male Orgasmic disorders (retarded orgasm) Premature ejaculation

Sexual Dysfunctions Orgasm disorders Multiple spontaneous orgasm of women taking antidepressants when they yawn

Sexual Dysfunctions NOS Female Premature Orgasm Postcoital Headache Orgasmic Anhedonia Masturbatory Pain

SEXUAL DYSFUNCTION DUE TO GENERAL MEDICAL CONDITION Male Erectile D Due to GMC Infections, CVD, Renal, Hep, Pulmo, Endoc, Neuro, Nutritional- Obesity, RxAlc, Pb Poisoning, RadioTx, Surgery

SEXUAL DYSFUNCTION DUE TO GENERAL MEDICAL CONDITION Hypoactive Sexual Desire Due to GMC Surgery Affecting Body Image Mastectomy, Ileostomy, Hysterectomy, Prostatectomy Illness Deplete Energy Drugs Dec Testosterone

SEXUAL DYSFUNCTION DUE TO GENERAL MEDICAL CONDITION Male Orgasmic D  S/P Genitourinary Tract Surgery Retarded Ejaculation  Anti HPN Rx, Methyldopa, SSRI Retrograde Ejaculation  GUT Surg, Rx w/ Anticholinergic Side Effects e.g phenothiazine like Thioridazine

SEXUAL DYSFUNCTION DUE TO GENERAL MEDICAL CONDITION Female Orgasmic D Med Condtion: Endoc- Hypothyroidism, DM, 1ry Hyperprolactinemia Rx: Anti HPN, CNS stim, SSRI, MAOInh,

SEXUAL DYSFUNCTION INDUCED BY SUBSTANCES Substance Intox or W/drawal Alc, Cocaine, Opioids, Hallucinogen, Cannabis, Barbiturates Sed, Hyp, Anxiolytic, Antipsychotic, AntiDep, Li, Anticholinergics, AntiHist, A –adrenergic & B –adrenergic Receptor Antagonist

Sexual Pain Disorders Dyspareunia Painful coitus due to tension and anxiety about sex act-- involuntary contraction of vaginal muscles

Sexual Pain Disorders Dyspareunia Dyspareunia in men - uncommon & usu assoc with a medical condition e.g. herpes, prostatitis or Peyronie’s disease (sclerotic plaques on penis-- penile curvature)

Sexual Pain Disorders Dyspareunia Chronic pelvic pain- common complaint of women with hx of rape or childhood sexual abuse Often related and coincides with vaginismus

Sexual Pain disorders Vaginismus

Involuntary muscle contraction of the outer third of the vagina that interferes with penile insertion and intercourse No other mental illness

Sexual Pain disorders Vaginismus Seen in highly educated women in high socioeconomic groups May consciously wish to have coitus but unconsciously wish to keep a penis from entering their bodies

TREATMENT OF SEXUAL DYSFUNCTION Dual Sex Tx Analytically Oriented Sex Tx HypnoTx Behavior Tx Group Tx Rx- sildenafil (Viagra), Hormone, AntiAdrogens, Anti Estrogens

TREATMENT OF SEXUAL DYSFUNCTION Mechanical Tx Approaches Vacuum Pump Surgical Tx Male Prosthesis Vascular Surgery

Paraphilias & Other Sexual Disorders NOS Paraphilias Greek words meaning “other side of” and “love” unusual sexual fantasies, urges or behaviors that are recurrent and sexually arousing

Paraphilias Exhibitionism Fetishism Transvestic Fetishism Frotteurism

Paraphilias Pedophilia Sexual Masochism Sexual Sadism Voyeurism

Paraphilias NOS Masturbation Necrophilia Partialism Zoophilia Coprophilia & Klismaphilia Urophilia Hypoxyphilia

PARAPHILIA TREATMENT Self Help Groups PsychoTx – Supportive, Insight Oriented Cognitive Behavior Tx Marital or Couples Tx Rx- SSRI, Antiadrongen

Sexual Disorders NOS Couple Problems Unconsummated Marriage Postcoital Dysphoria: Depressed, Tense, Anxious, Irritable, Agitation Want to Get Away from Partner Verbally, Physically Abusive

Sexual Disorders NOS Sex Addiction & Compulsivity Cant Control Sex Impulse Entire Life Revolve Sex Seeking Fantasy, Bvr & Activities -/ + Guilt – Not Enough to Stop Tries Stop - Cant b/c Sex Deprive  Distress Interfere w/ Funct

Summary Overview of Sexuality in terms of: Biological Psychodynamic Behavioral Sociocultural

Disorders related to Sexuality

Summary Human Sexual Response Cycle Sexual Dysfunctions Sexual Disorders and Paraphilias