Sexual/Identity Disorders

Sexual Dysfunction is a disruption in sexual response cycle or by pain associated with sexual intercourse. The sexual response cycle can be divided into four phases: desire (fantasies about sexual activity); excitement (sense of sexual pleasure and accompanying physical changes); orgasm (peaking of sexual pleasure with release of tension and rhythmic contraction) and resolution (sense of muscular relaxation and well-being).

Sexual Desire Disorders

Premature Ejaculation is the constant onset of orgasm and ejaculation by men with very little stimulation before or shortly after penetration and before the man wishes it. In most cases, delayed orgasm can occur during self-masturbation and last considerably longer than during sexual intercourse.

Vaginismus is the involuntary contraction of the outer muscles of the vagina when penetration (by penis, finger, tampon, speculum, or other object) is attempted. Sometimes just the thought of vaginal insertion can result in muscle spasms. These contractions can range from mild, causing some tightness, to severe, preventing penetration or causing pain. Often the diagnosis is made during routine gynecological checks, although there cases in which Vaginismus occurs during sexual activity, but not during a gynecological exam. The disorder is more common found in younger than older women, in women with a negative attitude toward sex, and in those with a history of being sexually abused or traumatized.

Hypoactive Desire Disorder is when the sexual fantasies and desire for the fantasies do not occur. The individual does not usually initiate sexual activity or may be reluctant to engage in it when it is initiated by a partner.

Sexual Aversion Disorder is the active avoidance of genital contact with a sexual partner. It is usually accompanied by fear or disgust when confronted by a sexual opportunity. Some people are even revolted by kissing or touching. In severe cases, panic attacks, faintness, nausea, palpitations, dizziness, and breathing difficulties can occur.

Sexual Arousal Disorders

Female Sexual Arousal Disorder is a recurrent inability to maintain an adequate lubrication-swelling response during sexual activity. Individuals with this disorder may have little or no sense of sexual arousal and the result can be painful intercourse, sexual avoidance, and dysfunction in a relationship.

Male Erectile Disorder is a recurrent inability to maintain an adequate erection during sexual activity. Some people report never having an adequate erection and others will complain of experiencing an adequate erection but losing tumescence when attempting penetration or during thrusting. Many people experience sexual anxiety, fear of failure, concerns about performance, and decreased excitement and pleasure.

Orgasmic Disorders

Female Orgasmic Disorder is a recurrent delay or absence of an orgasm after a normal sexual excitement. It may be caused by how the woman feels about her body, self-esteem, or relationship satisfaction.

Male Orgasmic Disorder is a recurrent delay or absence of an orgasm after a normal sexual excitement. In the most common form, a man cannot reach orgasm during intercourse, but can ejaculate from manual or oral stimulation.

Sexual Pain Disorders

Dyspareunia is pain that is most commonly experienced during sexual intercourse, but may also occur before or after in both males and females. The pain may be described as superficial during insertion or as deep during thrusting, and the intensity can range from mild discomfort to sharp pain.

Sexual Dysfunction Due to a Medical Condition is the presence of significant sexual dysfunction due to the direct effects of a general medical condition. The sexual dysfunction can involve pain associated with intercourse, hypoactive sexual desire, male erectile dysfunction, and other forms of sexual dysfunction.

Substance Induced Sexual Dysfunction is a significant sexual dysfunction due to the use of substances (drugs, alcohol, and medication). Depending on the substance involved, the dysfunctions can include impaired desire, arousal, orgasm, or sexual pain. The dysfunction only occurs during the use of a substance.

Paraphilias are intense sexually arousing fantasies, urges or behaviors to objects, situations or individuals that are not part of normal stimulation. Individuals may act out their fantasies with unwilling victims.

Exhibitionism involves the exposure of one’s genitals to strangers. Once the urges are acted upon there is usually no further attempt at sexual activity with a stranger. Onset usually occurs before 18 but becomes less severe after age 40.

Fetishism involves the use of nonliving objects. A person usually has recurrent sexually arousing fantasies, urges, or behavior involving the desired fetish (women’s underpants, bras, stockings, shoes boots, or other apparel). These fantasies can cause significant distress in social, occupational, and other areas.

Frotteurism involves touching or rubbing of one’s genitalia on a non-consenting person. This behavior usually occurs in crowded places where the individual can easily escape arrest. A man may rub his genitals against a woman’s thigh or buttocks, or fondle her genitalia or breasts with his hands, while fantasizing about an exclusive, caring relationship with the victim.

Pedophilia describes intense, sexually arousing fantasies, urges, or behavior involving sexual activity with a prepubescent children. Some individuals with Pedophilia are sexually attracted only to children and some are attracted to adults and children. Pedophiles sometimes rationalize such activities with children by claiming they have “educational value” for the child, that the child derives “sexual pleasure” from them, or that the child was “sexually provocative.” Often, the Pedophile will try to gain the child’s affection, interest, and loyalty to prevent the child from reporting the sexual activity.

Sexual Masochism involves intense, sexually arousing fantasies, urges, or behaviors that involve being humiliated, beaten, bound, or otherwise made to suffer. Some individuals are bothered by their fantasies but do not act upon them; others do act upon them, either alone or with a partner. Masochistic acts with a partner include restraint, blindfolding, spanking, whipping, beating and humiliation. Individuals may have the desire to be treated like a helpless infant and be clothed in diapers (“infantilism”). In the most dangerous cases, an individual may have the desire to be deprived of oxygen (“hypoxyphilia”), which sometimes results in death.

Sexual Sadism involves acts in which an individual is aroused by the psychological or physical suffering of a victim. In these cases the person fantasizes about having complete control over the non-consenting victim, who is terrified by the sadistic act. Others act on theses urges with a consenting partner, who willingly suffers pain or humiliation. The acts can include restraint, blindfolding, spanking, whipping, beating, burning, rape, stabbing, strangulation, torture, or mutilation. In severe cases, an individual with Sexual Sadism may actually kill the victim.

Transvestic Fetishism is only present in heterosexual males and involves cross-dressing in women’s attire. The fantasies can range from being a woman with female genitalia to a view of oneself fully dressed as a woman, with no attention to genitalia. Some males wear a single item of women’s clothing under their masculine attire. Others dress entirely as a female and wear makeup. Although the basic preference is heterosexual, he may have engaged in homosexual acts. The disorder typically emerges in childhood or early adolescents, and in most cases the cross-dressing is not done in public until adulthood.

Voyeurism involves spying on unsuspecting individuals, usually strangers, as they undress or engage in sexual activity. The purpose is sexual excitement, and generally no sexual activity with the victims is sought; rather, the voyeur merely engages in sexual fantasy and achieves orgasm through masturbation. The onset of this behavior is usually before age 15 and tends to be chronic.

Gender Identity Disorder

Gender Identity Disorder is a strong and persistent cross-gender identification. It involves a strong desire to be, or an insistence that one, in fact, is, of the opposite sex. In turn, this desire is accompanied by discomfort regarding one’s assigned sex.

In boys, there is a preference for cross-dressing and a strong attraction for activities stereotypically associated with girls (playing house, drawing pictures of princesses, playing with dolls, etc.). Typically, they avoid rough and tumble play and competitive sports. They sometimes pretend to not have a penis, pushing it between their legs, and, in rare cases, find their penis and testes disgusting, as they express a desire to have them removed.

Girls display intense negative reactions to wearing dresses or other feminine attire, and they sometimes avoid school or social events where such clothes may be required, preferring to wear boys’ clothing and short hair. They may occasionally refuse to urinate in the sitting position and insist that they have or will grow a penis. Adolescents and adults may express an intense desire to adopt the social role of the opposite sex and acquire the physical appearance through hormones therapy and/or surgery.

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