Psychosexual disorders Three categories of sexual disorders ...

Psychosexual disordersDept.of Psychiatry andPsychotherapyPécsKrafft-Ebing(1840-1902)Sigmund FreudThree categories of sexualdisorders• Sexual dysfunctions - disturbance of sexualarousal or sexual performance• Paraphilias - culturally inappropriate or dangerouspattern of sexual arousal e.g.exhibicionism –• „sexual deviation”• Sexual identity disorders - dissatisfaction withown’s biological sex, a desire to become a memberof the opposite sex (e.g. transsexualism)Phases• Desire• Excitement• Orgasm• ResolutionSexual dysfunctionsDysfunctionHypoactive sexual desire disorder; sexual aversiondisorder; hypoactive sexual desire disorder due to ageneral medical condition (male or female); substanceinducedsexual dysfunction with impaired desireFemale sexual arousal disorder; male erectile disorder(may also occur in stage 3 and in stage 4); male erectiledisorder due to a general medical condition; dyspareuniadue to a general medical condition (male or female);substance-induced sexual dysfunction with impairedarousalFemale orgasmic disorder; male orgasmic disorder;premature ejaculation; other sexual dysfunction due to ageneral medical condition (male or female); substanceinducedsexual dysfunction with impaired orgasmPostcoital dysphoria; postcoital headache1

Sexual Dysfunction Not Correlated withPhases of the Sexual Response CycleDiagnostic Criteria for Sexual DysfunctionDue to a General Medical ConditionCategory• Sexual paindisorders• OtherDysfunctionsVaginismus (female) Dyspareunia (femaleand male)Sexual dysfunctions not otherwise specified.Examples:1. No erotic sensation despite normalphysiological response to sexual stimulation(e.g., orgasmic anhedonia)2. Female analogue of prematureejaculation3. Genital pain occurring duringmasturbationA. Clinically significant sexual dysfunction thatresults in marked distress or interpersonaldifficulty predominates in the clinical picture.B. There is evidence from the history, physicalexamination, or laboratory findings that thesexual dysfunction is fully explained by the directphysiological effects of a general medicalcondition.C. The disturbance is not better accounted for byanother mental disorder (e.g., major depressivedisorder).Diagnostic Criteria for Sexual DysfunctionNeurotransmitter Effects on Sex FunctionFemale hypoactive sexual desire disorder : if deficient orabsent sexual desire is the predominant feature.• Male hypoactive sexual desire disorder if deficient orabsent sexual desire is the predominant feature.• Male erectile disorder if male erectile dysfunction is thepredominant feature.• Female dyspareunia : if pain associated with intercourse isthe predominant feature.• Male dyspareunia : if pain associated with intercourse isthe predominant feature.• Other female sexual dysfunction : if some other feature ispredominant (e.g., orgasmic disorder) or no featurepredominates.• Other male sexual dysfunction if some other feature ispredominant (e.g., orgasmic disorder) or no featurepredominates.Dopamine Serotonin Adrenergic CholinergicErection ++ +/- α, β +/-- +Ejaculation +/- + + +/-and orgasm α 1Etiological factorsParaphilias• Biological, medical illnesses• general medical conditions• Substances use dependency• Psychological (learning, analytical, -traumas, communication failure)• drugs – side effects• E.g• Pedophilia• Exhibitionism• Voyeurism• Frotteurism• Sexual masochism• Transvesticfetishism• Sexual sadism• Fetishism• Zoophilia•Coprophilia•Urophilia•Telephon scatologia•Computer scatologia•Necrophilia2

Gender identity disorders I.Gender identity disorders II.• Gender identity disorder– Transsexualism– Adolescent/adult gender identity disorder– Childhood gender identity disorder• Gender identity disorder NC– Intersexual disorders (etc.: androgenresistency, congenital adrenal hyperplasia)and related discomfort– Transient, stress-related cross-dressingSome aspects of the therapy• Drugs – if needed /symptomatology, general th, viagra.cialis, anxiolytics e.g./• Dual sex therapy – both partners• Review of the psychological and psyciological aspects ofsexual functioning and an evalution of the couple’sattitudes about sexual• ability to communicate• suggestion are made for specific sexual activity• sexual relations are emphasized as natural and healthy• relatively briet sex therpay (i.e.,8-12)• focuses correcting dysfunctional behavior, not oninterpreting• exersises may focus on increasing sensory awarenessof erogenuos zones, so that couples can leart to giveand receive bodily pleasure (i.e.”sensate focus”).3

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