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Psychosexual disorders

  2. 2. <ul><li>Physiology of sexual response </li></ul><ul><li>Psychosexual disorder </li></ul><ul><ul><li>Sexual dysfunction </li></ul></ul><ul><ul><li>Abnormalities of sexual preference/paraphilias </li></ul></ul><ul><ul><li>Disorders of gender identity/transsexualism </li></ul></ul><ul><ul><li>Psychological problems in homosexual </li></ul></ul><ul><li>Management </li></ul>
  3. 3. <ul><li>Normal cycle : </li></ul><ul><ul><li>Desire </li></ul></ul><ul><ul><li>Excitement </li></ul></ul><ul><ul><li>Orgasm </li></ul></ul><ul><ul><li>Resolution </li></ul></ul>
  4. 4. <ul><li>Interest in sexual activity </li></ul><ul><li>In woman : </li></ul><ul><ul><li>Desire changes during menstrual period, near the time of ovulation </li></ul></ul><ul><ul><li>a/w high levels of oestrogen secretion during preovulatory period </li></ul></ul>
  5. 5. <ul><li>Begins with either mental (fantasy/thought) or physical contact </li></ul><ul><li>Body prepares for sexual intercourse </li></ul><ul><li>Vasocongestion of the skin </li></ul><ul><li>Myotonia </li></ul><ul><li>Increased heart rate, respiratory rate and blood pressure </li></ul><ul><li>Nipples erection </li></ul>Man Woman Erection of penis Thickening of scrotal skin Testes rise toward the perineum Breasts enlargement Clitoris head swells Lubrication/expansion/distension of inner 2/3 of vagina Uterus body and cervix raised
  6. 6. <ul><li>Excitement remains high but stable </li></ul><ul><li>Increasing in circulation, HR, BP </li></ul><ul><li>Further increased in muscle tension </li></ul>Man Woman Erection maintained Testes raised further Urethral sphincter contract (prevent urine from mixing with semen and against retrograde ejaculation) Labia engorgement Clitoris head withdraws Further lubrication Further distention of inner 2/3 of vagina, outer 1/3 swells Further elevation of uterus
  7. 7. <ul><li>Peak of sexual pleasure </li></ul><ul><li>Further increased in HR, RR, BP </li></ul><ul><li>Quick cycles of muscle contraction </li></ul>Man Woman Contraction of prostate & seminal vesicles Emission of seminal fluid to urethra Ejaculation of semen Contractions of outer 1/3 of vagina
  8. 8. <ul><li>Muscles relaxation </li></ul><ul><li>Returning to normal physiology </li></ul><ul><li>As we grow older, desire for sexual activity does not change </li></ul><ul><li>BUT, </li></ul><ul><li>man will require more direct stimulation of genitals & more time to achieve orgasm, intensity of ejaculation decreases, length of refractory period increases </li></ul><ul><li>After menopause woman(decreased estrogen levels): vaginal dryness & thinning </li></ul>
  9. 9. The sexual response cycle Phase Male response Female response Example of dysfunction Desire mental/physical stimulation Hypoactive sexual desire disorder Sexual aversion disorder Excitement Increasing sexual pleasure with pre-orgasm plateau Penile erection Retraction of testes Cowper’s gland secretion Clitoral enlargement Vaginal lubrication Breast engorgement Male erectile disorder Female sexual arousal disorder Orgasm Peaking of sexual pleasure Ejaculatory spurt Rhythmic contractions of seminal system Skin flushing Rhythmic vaginal and uterine contraction Skin flushing Delayed ejaculation Premature ejaculation Female preorgasmia Resolutions Relaxation, reversal of physiologic changes Refractory to orgasm for a period of time which increases with age No refractory period Postcoital dysphoria Postcoital headache
  10. 10. <ul><li>Psychosexual disorder </li></ul><ul><ul><li>Sexual dysfunction </li></ul></ul><ul><ul><li>Abnormalities of sexual preference/paraphilias </li></ul></ul><ul><ul><li>Disorders of gender identity/transsexualism </li></ul></ul><ul><ul><li>Psychological problems in homosexual </li></ul></ul><ul><li>Management </li></ul>
  11. 12. <ul><li>Causes : </li></ul><ul><li>Chronic stress/anxiety/depression </li></ul><ul><li>Abstinence from sex for prolonged period of time </li></ul><ul><li>Must rule out chronic disease, endocrine disorder </li></ul>Hypoactive sexual desire disorder Sexual aversion disorder - Deficiency/absence of sexual fantasies and desire for sexual activity - An aversion/avoidance of genital sexual contact with a sexual partner or by masturbation More common Less common
  12. 13. Female Male erectile disorder Persistent/recurrent/complete failure to attain/maintain lubrication-swelling response Recurrent and persistent partial/complete failure to attain/maintain an erection Must rule out medications (antihypertensives, antihistamine), medical conditions (vascular, neurological, endocrine) Causes marked distress/interpersonal difficulty
  13. 14. Female orgasmic disorder (preorgasmia) Male orgasmic disorder (delayed ejaculation) Premature ejaculation <ul><li>Inability to achieve orgasm by masturbation/coitus </li></ul><ul><li>psychological factors : </li></ul><ul><li>fears of impregnation </li></ul><ul><li>Rejection by sex partner </li></ul><ul><li>Damage to vagina </li></ul><ul><li>physical factor : denervation of lumbosacral spine </li></ul>Difficulty in achieving ejaculation during coitus Causes : Primary organic : congenital, neurological, endocrine Secondary organic : trauma, cord lesion, medication (sympatholytic) Psychological : poor partnership factors, repressed homosexuality Ejaculation occurs before or immediately after entering the vagina Psychological : usually due to anxiety caused by interrupted sexual experiences, intimacy fears
  14. 15. Dyspareunia Vaginismus <ul><li>Recurrent/persistent genital pain occuring in man/woman before, during or after intercourse </li></ul><ul><li>More common in woman </li></ul><ul><li>Not caused by lack of lubrication, vaginismus or organic causes </li></ul><ul><li>Involuntary muscle constriction of the outer third of the vagina that interferes with penile insertion and intercourse </li></ul><ul><li>Can be due to response during insertion of speculum into vagina, sexual trauma (rape) </li></ul>
  15. 16. <ul><li>“ para” = aside, being altered / modified </li></ul><ul><li>“ philia” = love </li></ul><ul><li>Sexual arousal, fantasies, sexual urges or behaviour involving non-human objects, suffering or humiliation of oneself or one’s partner, children or other non-consenting person </li></ul><ul><li>At least 6 months & cause impairment in daily functioning </li></ul><ul><li>Begins in childhood/early adolescent </li></ul><ul><li>Chronic, increases with age and stressors </li></ul><ul><li>More common in man </li></ul>
  16. 17. <ul><li>Subtypes : </li></ul>Abnormalities of the sexual object Abnormalities of the sexual act Sexual fetishism Exhibitionism Transvertism Voyeurism Paedophilia Sexual sadism Necrophilia Sexual masochism Frotteurism
  17. 18. <ul><li>Sexual focus is on objects (shoes, gloves, underwears) </li></ul><ul><li>Sexual activity either directed : </li></ul><ul><li>Towards the fetish itself (masturbation with/into a shoe) OR </li></ul><ul><li>The fetish may be incorporated into sexual intercourse (demand that high-heeled shoes be worn) </li></ul>
  18. 19. <ul><li>repeatedly wears clothes of opposite sex as means of sexual arousal </li></ul><ul><li>Typically begins in childhood, as grow older  permanently dressed as woman </li></ul><ul><li>Single garment  complete set of clothing </li></ul><ul><li>Wear in private  some go on to wear in public (hidden under male outer garments) </li></ul><ul><li>vs transsexualism  no sexual arousal </li></ul>
  19. 20. <ul><li>Repeated sexual activity or fantasy of such activity with prepubertal children </li></ul><ul><li>Preferred children : 9 year old  pubertal </li></ul><ul><li>Person is at least 16 year old OR 5 years older than the victims </li></ul><ul><li>Molestations involve genital fondling or oral sex </li></ul>
  20. 21. <ul><li>An obsession with obtaining sexual gratification from cadaver </li></ul>
  21. 22. <ul><li>Exposure of genitalia to a stranger </li></ul><ul><li>Nearly all are male, to surprise a female </li></ul><ul><li>2 groups: </li></ul><ul><ul><li>Inhibited temperaments  expose flaccid penis  much guilt </li></ul></ul><ul><ul><li>Aggressive personality traits  expose erectile penis while masturbating  little guilt </li></ul></ul><ul><li>Begins in middle or late life  suspect organic brain disorder, depressive disorder or alcoholism </li></ul>
  22. 23. <ul><li>Observing others </li></ul><ul><li>Common in man </li></ul><ul><li>Spy on couples having intercourse, spy on women who are undressing or naked </li></ul>
  23. 24. <ul><li>Preference for sexual activity that involves bondage or infliting pain on another person </li></ul><ul><li>Masochism: prefers to receive such stimulation </li></ul><ul><li>Sadism: prefers to administer such stimulation </li></ul><ul><li>Beating, whipping, tying  symbolic, cause little actual injury, may die </li></ul><ul><li>Mild sadomasochism is normal </li></ul><ul><li>The most important source of stimulation  abnormal </li></ul>
  24. 25. <ul><li>sexual pleasure in men from rubbing their genitals against unsuspecting women, usually in crowded area </li></ul>
  25. 26. <ul><li>Has conviction of being of the sex opposite to that indicated by the external genitalia </li></ul><ul><li>Wish to alter external genitalia and live as a member of the opposite sex </li></ul><ul><li>Most are men (women who cross-dress or imitate men are homosexual) </li></ul><ul><li>Diagnosis : </li></ul><ul><li>Strong and persistent cross-gender identification </li></ul><ul><li>Manifested by repeated stated desire/insistence that one is of the opposite sex </li></ul><ul><li>Children believe they will grow up to be the opposite sex (cross dressing, cross-sex roles in play) </li></ul><ul><li>Significant distress/impairment in functioning </li></ul>
  26. 27. <ul><li>Not a psychiatric disorder </li></ul><ul><li>Sexual & emotional problems </li></ul>
  27. 28. BIO PSYCHOSOCIAL Sildenafil (viagra ) for sexual dysfunction Prostaglandin injections Lubricating creams Anti-androgen medication (tamoxifen) Sexual reassignment surgery for transsexualism Psychotherapy for individual, couple Sex education Behaviour modification
  28. 29. <ul><li>Thank You </li></ul>
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