Reading: Putting It Together: Sexual Deviations and Dysfunctions

In this module, you learned about sexual deviations and dysfunctions, such as gender dysphoria, disorders of sexual function and paraphilic disorders. At this point, you hopefully have a better understanding of how each diagnosis is unique in its presentation of symptoms, how the different disorders are treated, and which biopsychosocial perspectives prevail in the etiology of these disorders.

The module started out with a discussion on the distress a person may feel when there is a mismatch between their gender identity and their sex assigned at birth. You now know that this condition is referred to as gender dysphoria. You then had a thorough review of various types of sexual dysfunction and how sexual functioning is a complex bio-psycho-social process. The module ended with a somewhat disturbing review of deviant or disordered sexual behavior, from the different types of paraphilias to the different types of sexual violence. Interestingly enough, the same psychologist who baffled the scientific community on his treatment of David Reimer also proposed a plausible viewpoint that paraphilias are the expression of lovemaps gone awry or vandalized, hypothesizing that an individual is, in a sense, programmed to act out fantasies that are socially unacceptable and often harmful.

It’s important to take time to think critically on what has been presented, and also to reflect on the concepts presented in the module and how each one has firm roots in empirical research.

Here’s a review of the disorders discussed in this module:

• Gender dysphoria is a diagnostic category in DSM-5 that describes individuals who do not identify as their biological gender. This dysphoria must persist for at least six months and result in significant distress or dysfunction to meet DSM-5 diagnostic criteria. In order for children to be assigned this diagnostic category, they must verbalize their desire to become the other gender.
• Early-onset gender dysphoria is behaviorally visible in childhood. Sometimes gender dysphoria will desist in this group and they will identify as gay or homosexual for a period of time, followed by recurrence of gender dysphoria. This group is usually sexually attracted to members of their natal sex in adulthood.
• Late-onset gender dysphoria does not include visible signs in early childhood, but some report having had wishes to be the opposite sex in childhood that they did not report to others.
• Male hypoactive sexual desire disorder (MHSDD) is described as persistently or recurrently deficient (or absent) sexual/erotic thoughts or fantasies and desire for sexual activity, as judged by a clinician with consideration for the patient’s age and cultural context, and persisting for at least six months.
• Female sexual interest/arousal disorder (FSIAD) is described as a lack of interest or significantly reduced interest in sexual activity. At least three of the following symptoms occur for a minimum of six months: reduced interest in sex, reduced sexual thought or fantasies, reduced initiation of sexual activity, reduced excitement during sexual activity, reduced excitement to sexual cues, and reduced sensation during sexual encounters.
• Erectile disorder (ED) is described as difficulty in obtaining or maintaining an erection during sexual activity 75–100% of the time.
• Delayed ejaculation is described as a marked delay in ejaculation or infrequency/absence of ejaculation in 75–100% of partnered sexual activity.
• Premature ejaculation is described as a persistent and undesirable premature ejaculation that occurs around one minute or less of vaginal penetration.
• Female orgasmic disorder is described as a delay in, absence of, or markedly reduced intensity of orgasms during 75–100% of sexual activity.
• Genito-pelvic pain/penetration disorder (GPPPD) was formerly called dyspareunia and vaginismus, and is characterized by difficulty or pain during vaginal penetration during intercourse. This disorder may also include fear or anxiety about penetration or tensing and tightening of pelvic floor muscles during intercourse.
• Paraphilias are persistent and recurrent sexual interests, urges, fantasies, or behaviors of marked intensity involving objects, activities, or even situations that are atypical in nature.
• Fetishism is the use of nonliving objects, most commonly shoes and undergarments, for sexual pleasure.
• Transvestic fetishism is the derivation of sexual arousal from cross-dressing or dressing in clothes of the opposite sex.
• Exhibitionism is the exposure of an individual’s genitalia to unsuspecting strangers for sexual satisfaction.
• Voyeurism is the viewing of an unsuspecting person engaging in disrobing or sexual activity.
• Frotteurism is the touching of or rubbing against a nonconsenting person.
• Sexual masochism is the derivation of sexual arousal from being the recipient of physical or mental abuse and/or humiliation.
• Sexual sadism is when sexual arousal is gained from inflicting mental or physical suffering on a nonconsenting person.
• Pedophilia is any sexual activity with a prepubescent child, where the offender/patient is at least sixteen years of age, and the victim is at least five years younger.
• Sexual assault is an act in which a person intentionally sexually touches another person without that person’s consent or coerces or physically forces a person to engage in a sexual act against their will. It is a form of sexual violence, which includes child sexual abuse, groping, rape (forced vaginal, anal, or oral penetration or a drug-facilitated sexual assault), or the torture of the person in a sexual manner.
• Childhood sexual abuse is defined as any sexual contact between a child and an adult or a much older child.
• Incest refers to sexual contact between a child and family members. In each of these cases, the child is exploited by an older person without regard for the child’s developmental immaturity and inability to understand the sexual behavior