PSYCHOSEXUAL DISORDERS.pptx

This presentation gives you insight into a number of psychosexual disorders that humans can struggle with.

1. PSYCHOSEXUAL DISORDERS Mr Mulundano BSC NS-UNZA KCN

2. WARNING! SENSITIVE SEXUAL INFORMATION

3. INTRODUCTION Sex is an important part of our lives but often much confusion about what is going on during sex. Easy for sex to get less exciting but understanding biological processes can help find ways to avoid this This is a significant contributing factor to marital problems

4. INTRODUCTION The best way to develop a healthy attitude towards sex is to demystify it. Sex is very private but something we all do after a certain age so knowledge is beneficial.

5. At the end of the unit the learner should be able to show an understanding of psychosexual disorders and manage a client with psychosexual disorder. General objective

6. At the end of the unit the learner should be able to: Define psychosexual disorder Explain the different types of psychosexual disorders Describe the specific management of a client with psychosexual disorders Specific objective

7. Definition of psychosexual disorder Psychosexual disorders are defined as the sexual problems that are psychological in origin and occur in absence of any pathological disease. Masters & Johnson’s (1970) observes that the physiological process of sexual intercourse involves increasing levels of vaso congestion and myotonia (tumescence) and the subsequent release of the vascular activity and muscle tone as a result of orgasm (detumescence).

8. Sexual Disorders Disorders fall into one of three very broad categories: Gender Identity Disorders Sexual Dysfunction Paraphilia

9. 1. Gender Identity Disorder The gender identity disorders (GID) are defined as disorders in which an individual exhibits marked and persistent identification with the opposite sex and persistent discomfort (dysphoria) with his or her own sex or sense of inappropriateness in the gender role of that sex.

10. By 2-3yrs old, a sense that “I’m a boy” or “I’m a girl” is firmly set; Sense of masculinity & femininity develop based on biology , parental & cultural attitudes .

11. 1. Gender Identity Disorder Gender identity disorder exists when the person’s sense of identity (male vs. female) is inconsistent with who they are physically . “I’m a man trapped in a woman’s body” or vice versa. Has also been referred to as transsexualism . Not the same as being gay. Not the same as intersex individuals, who have anatomically ambiguous genitalia.

12. 1. Gender Identity Disorder Causes are unknown, although one would assume there is a biological link Ends up undergoing, sexual reassignment surgery.

13. 1 . Gender Identity Disorder Sexual orientation is to do with who an individual is attracted to for sexual satisfaction which includes satisfaction in emotional interest, genitals interest and sexual physiological excitement. Object of person’s sexual attraction - hetero, homo or bi- . Note: sexual orientation is not GID.

14. Figure. 1: shows a young man who underwent sexual reassignment and changed to be female

15. Figure 2: Male sexual reassignment to female

16. DSM-IV-TR Diagnostic Criteria For Gender Identity Disorder A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following:

17. Repeatedly stated desire to be, or insistence that he or she is, the other sex In boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing Strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex

18. 4. intense desire to participate in the stereotypical games and pastimes of the other sex 5.strong preference for playmates of the other sex

19. B. Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. C. The disturbance is not concurrent with a physical intersex condition. D. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

20. Treatment Treatment can help people who have gender dysphoria to explore their gender identity and find the gender role that feels comfortable for them, easing distress. But treatment needs to be individualized.

21. The process might or might not involve a change in gender expression or body modifications. Treatment options might include changes in gender expression and role, hormone therapy, surgery, and behavioral therapy. Coping and support. Behavioral health treatment.

22. 2. Sexual Dysfunctions Sexual dysfunction refers to a problem occurring during any phase of the   sexual response cycle  that prevents the individual or couple from experiencing satisfaction from the sexual activity.

23. 2. Sexual Dysfunctions The sexual response cycle traditionally includes excitement , plateau , orgasm , and resolution . Desire and arousal are both part of the excitement phase of the sexual response.

24. Basic physiological process of sexual responses The two basic physiological processes that occur during these stages are vasocongestion and myotonia . Vasocongestion occurs when great deal of blood flows into the blood vessels in a region, in thisncase the genitals, as a result of dilation of the blood vessels in the region. Myotonia occurs when muscles contract, not only in the genitals but also throughout the body.

25. Excitement Phase Sexual desire thinks about sex Fantasizes about having sex Feels attracted to a potential sexual partner

26. Excitement Phase Sexual arousal is part of excitement phase. Sexual arousal- Feels an increasing need to have sex Erotic stimuli - factors in the environment that are sexually arousing.

27. Signs and symptoms Muscle tension, Some increase in heart rate & blood pressure, areas of the body become engorged. It may result in a sex flush – a pink or red rash on the chest and face.

28. Sexual arousal- What turns one person on may be totally ineffective in another person (certain underwear, certain music, certain food, certain smells ) Often all associated with past sexual encounter(s).

29. Sexual arousal- Erotic stimuli possible by all senses touch, vision , hearing , smell , taste. Body is most sexually sensitive in certain areas called erogenous zones Some obvious –> head of penis, clitoris, mons pubis, vagina , labia , nipples (female) Some less obvious –> nipples (male), ear lobes, anus, buttocks (“cheeks”), inner thighs (esp. women) back of knees, soles of feet, eyebrows, lower center of back

30. Erogenous zones

31. Erogenous zones

32. Sexual Arousal – Flirting, kissing, foreplay (petting), seduction MILD pain, gentle biting Extremely important start of the sexual response cycle

33. Excitement disorders Desire- Hypo-active Sexual Desire disorder ; Sexual aversion disorder; hypoactive sexual desire disorder due to a general medical condition (male or female); substance induced sexual dysfunction with impaired desire.

34. Arousal Female sexual arousal disorder; male erectile disorder (may also occur in stage 3 and in stage 4); male erectile disorder due to a general medical condition; substance-induced sexual dysfunction with impaired arousal

35. Men more commonly have erectile dysfunction and premature ejaculation, while women have hypoactive sexual desire.

36. Plateau phase in males During the plateau phase, vasocongestion reaches its peak. In men, the penis is completely erect, although there may be fluctuations in the firmness of the erection.

37. The glans swells. The testes are pulled up even higher and closer to the body. A few drops of fluid (for some men, quite a few), secreted by the Cowper's gland, appear at the tip of the penis. Although they are not the ejaculate, they may contain active sperm.

38. In females, (the most notable change during the plateau phase is formation of the orgasmic platform. This is a tightening of the outer third of the vagina. Thus the size of the vaginal entrance actually becomes smaller, and there may be a noticeable increase in gripping of the penis.

39. ORSGASMIC PHASE Peak of sexual arousal, release of physical, emotional and psychological build-up. In male, it is usually equivalent to ejaculation.

40. In the male. orgasm consists of a series of rhythmic contractions of the pelvic organs at 0.8-second intervals. Actually, male orgasm occurs in two stages. In the preliminary stage. the vas seminal vesicles. and prostate contract, forcing the ejaculate into a bulb at the base of the urethra. Masters and Johnson call the sensation in this stage one of "ejaculatory inevitability" ("coming"); that is, there is a sensation that ejaculation is just about to happen and cannot be stopped.

41. In the second stage, the urethral bulb and the penis itself contract rhythmically, forcing the semen through the urethra and out the opening at the tip of the penis.

42. The process of orgasm in females is basically similar to that in males. It is a series of rhythmic muscular contractions of the orgasmic platform. The contractions generally occur at about 0.8second intervals; there may be three or four in a mild orgasm or as many as a dozen in a very intense, prolonged orgasm. The uterus also contracts rhythmically. Other muscles. such as those around the anus, may also contract.

43. One can almost never get anyone to give a solid definition of what female orgasm is. Instead, people usually fall back on, "You'll know what it is when you have one." This evasiveness is probably related to several factors, most notably that female orgasm leaves no tangible evidence of its occurrence like ejaculation.

44. Also, women often do not reach orgasm as quickly as men do. The main feeling is a spreading sensation that begins around the clitoris and then spreads outward through the whole pelvis. There may also be sensations of falling or opening up. The woman may be able to feel the contraction of the muscles around the vaginal entrance. The sensation is more incense than just a warm glow or a pleasant tingling.

45. Orgasmic disorders Female orgasmic disorder; male orgasmic disorder; premature ejaculation; other sexual dysfunction due to a general medical condition (male or female); substance induced sexual dysfunction with impaired orgasm

46. Numerous psychological factors are associated with female orgasmic disorder. They include fear or guilt concerning sexual impulses, fear of rejection by a sex partner, or hostility toward men.

47. Resolution phase Following orgasm is the resolution phase, during which the body returns physiologically to the unaroused state. Orgasm triggers a massive release of muscular tension and of blood from the engorged blood vessels. Resolution then represents a reversal of the processes that build up during the excitement and plateau stages.

48. Resolution disorders Postcoital dysphoria; postcoital headache. Postcoital dysphoria   [sometimes called  postcoital   tristesse (French for sadness) or the “ post -sex blues”] refers to feelings of deep sadness or agitation after consensual sex, even if the encounter was loving, satisfying, or enjoyable. In some cases, people become tearful or depressed after orgasm

49. Orgasm without discharge of it brings about repeated buildups of vasocongestion . The result is a chronic vasocongestion in the pelvis. A mild version of this occurs in some women who engage in sex but are not able to have orgasms, and it can be quite uncomfortable.

50. One of the most common complaints women bring to sex therapists is a socially defined dysfunction: they reach orgasm only through manual or oral stimulation of the clitoris, or only when the intercourse is combined with such direct stimulation. In fact, this is normal.

51. TYPES OF SEXUAL DYSFUNCTIONS Erectile dysfunction or impotence : This is characterized by an inability to achieve or maintain an erection sufficient for successful sexual intercourse. In primary impotence the man is not able to have erection at all in his sexual life. In secondary impotence, the man has successfully achieved vaginal penetration at some time in his sexual life but is later unable to do so. But In selective impotence, the man is unable to do so in certain circumstances but not in others.

52. Premature ejaculation : This occurs when the man recurrently achieves orgasm and ejaculation before he wishes to do so. It is more common today among college educated men than among men with less education and it is thought to be related to their concern for partner satisfaction. About 40% of men treated for sexual disorders have premature ejaculation as the chief complaint.

53. There are three types of premature ejaculation known as: a. Habitual premature ejaculation b. Acute onset premature ejaculation c. Insidious onset premature ejaculation

54. Pleasure dissociative orgasmic disorder , is a condition in which an individual cannot feel pleasure from an orgasm. It is thought to be a variant of hypoactive sexual desire disorder. Aka Orgasmic anhedonia.

55. Frigidity (inhibited sexual excitement ) in female: This is characterized by the inability of the female to express sexual satisfaction. Its chief physical manifestation is a failure to produce the characteristic lubrication of the vulva and vaginal tissue during sexual stimulation, a condition that may make coitus uncomfortable.

56. Inhibited Female orgasm (anorgasmia ): This is characterized by a recurrent and persistent inhibition of the female orgasm as manifested by a delay in or absence of orgasm following a normal sexual excitement phase during sexual activity, It refers to the inability of the women to achieve orgasm by masturbation or coitus.

57. Dyspareunia: This is a recurrent and persistent pain during coitus in either the man or the women. It often coincides with vaginismus. It is due to physical factors like trauma, inflammation, endometritis. It can also result from psychological cause.

58. Vaginismus : This is an involuntary constriction of the outer one third of the vagina that prevents penetration, insertion and coitus. It is less prevalent than anorgasmia. It often affects highly educated women and those in higher socioeconomic groups. Sexual trauma as rape may result in vaginismus.

59. Nymphomania : This is excessive sexual derive or desire in females. Satyriasis : This is excessive sexual drive or desire in males.

60. Summary of Sexual Dysfunctions MEN : Hypoactive sexual disorder, Sexual aversion disorder, Male erectile disorder, Inhibited male orgasm, Premature ejaculation, Dyspareunia-sexual pain

61. WOMEN : hypoactive sexual desire disorder, sexual aversion disorder, female sexual arousal disorder, inhibited female orgasm, dyspareunia, and vaginismus.

62. Predisposing factors Restrictive upbringing Disturbed family relations Traumatic early sexual experiences Poor sex education

63. Etiological factors Psychologic issues such as depression or drug addiction, or by Physiologic issues such as high levels of prolactin, low levels of testosterone, use of Medications such as SSRI antidepressants and oral contraceptives, or Chronic medical problems such as spinal cord injury and chronic fatigue syndrome.

64. Drugs can lead to the following sexual dysfunctions: Impaired ejaculation - Guanathidine - Bethamedine - Thioridazine ( Melleraril ) .

65. II) Decreased libido and impotency - Oral contraceptive - Sedatives - Major tranquilizers (e.g. Chlorpromazine ( Largactil ). - Lithium - Methyldopa - Clamidine

66. Treatment Proper diagnosis: Psychotherapy: Different psychotherapeutic methods are used. Behavioral and cognitive behavioral psychotherapies are the most widely used techniques. Pharmacological treatment:

67. Thorough assessment is a necessity, and is comprised of clinical interviews, medical examination, and psychophysiological assessment procedures. Much of what we know about treatment evolved out of Masters and Johnson’s work in St. Louis. Example of treating erectile dysfunction/premature ejaculation using sensate focus and non demand pleasuring.

68. Sensate focus   is a series of intimate touch exercises that teach one how to be fully in the body during sex. The exercises can be done solo or with a partner and can last from 10 minutes to one hour.  Sensate  uses  non - demand  touching, which means you are touching with no particular outcome or expectation in mind.

69. Sildenafil (Viagra) for erectile dysfunction Local anesthetic sprays for premature ejaculation SSRIs are used for premature ejaculations, no controlled studies are available Pharmacological treatment of any underlying psychiatric disorders: depression, generalized anxiety, phobia

70. Psychologic approaches to improving orgasmic function focus on the woman exploring psychologic factors such as hypoactive sexual desire disorder, depression, poor arousal, anxiety, fatigue, emotional concerns, past trauma and abuse history, cultural and religious prohibitions feeling excess pressure to have sex, or a partner’s sexual dysfunction such as erectile dysfunction or premature ejaculation.

71. Sex therapy includes teaching the use by couples of manual or vibrator stimulation during intercourse, or using the female-above position as it may allow for greater stimulation of the clitoris and it allows the woman better control of movement.

72. Sex therapy may focus on mindfulness strategies and yoga exercises. Sex therapy also assist the woman examine and realign expectations of orgasm. Emotional intelligence, or knowledge of one’s own mood or sense of being is important for orgasm function.

73. NEXT PARAPHILIAS

74. PARAPHILIAS When the weird get going, the going gets weird… Focus of sexuality is on something or someone other than a consenting adult.

75. Paraphilias Includes the following: 1) Fetishism 2) Voyeurism/Exhibitionism 3) Transvestic Fetishism 4) Sexual Sadism and Sexual Masochism 5) Sadistic Rape 6) Pedophilia and Incest

76. Paraphilias Zoophilia - performing sex acts with non-human animals Coprophilia- abnormal interest and pleasure in feces and defecation. Urophilia - Urolagnia  (also  urophilia ,  golden shower  and  watersports ) is a paraphilia in which sexual excitement is associated with the sight or thought of urine or urination.

77. Telephon scatologia -   an individual obtains sexual pleasure by making obscene telephone calls. See scatophilia . Scatologia - deviant sexual practice in which sexual pleasure is obtained through the compulsive use of obscene language aka (coprolalia).

78. Paraphilias Fetishism : sexual attraction to nonliving objects, i.e., shoes and undergarments. Voyeurism( scopophilia): involves observing individuals in a state of undress without their knowledge (peeping), while Exhibitionism involves exposing oneself to strangers. Has a thrill-seeking component.

79. Paraphilias Transvestic Fetishism : sexual excitement is related to the act of cross-dressing. Spouses are often quite supportive. Sexual Sadism Sadism involves sexual excitement when hurting others, while Sexual Masochism involves sexual excitement when one is on the receiving end of the hurt. Wide range of activities are involved and seems to lie on a continuum. According to Barlow a subset of rapists appear to be highly sadistic and meet criteria for a paraphilia

80. Paraphilias Pedophilia and Incest : Sexuality is focused on children, and can involve either or both sexes. Now aware of the widespread nature of childhood sexual abuse in our country, and it’s long term impact on both women as well as men. The majority of perpetrators are men. Speculation as to why?

81. Frotteurism is usually characterized by a man's rubbing his penis against the buttocks or other body parts of a fully clothed woman to achieve orgasm Necrophilia is an obsession with obtaining sexual gratification from cadavers. Most persons with this disorder find corpses in morgues, but some have been known to rob graves or even to murder to satisfy their sexual urges.

82. Paraphilias -Causal Factors Inability to access “normal” sexual outlets may result in accessing other sexual outlets. Early sexual fantasies may be repeatedly reinforced through repeated masturbation, resulting ultimately in a paraphilia.