Phases in sexual response
• Desire- The phase is characterized by sexual fantasies and the desire to have sexual activity.
• Excitement- Subjective sense of sexual pleasure and accompanying physiological changes leading to penile erection in male and vaginal lubrication in female.
• Orgasm- Peaking of sexual pleasure, with release of sexual tension occurs at this phase. Contraction of the perineal muscles and the pelvic reproductive organs occur followed semen discharge in male and involuntary contractions of the lower third of the vagina in females.
• Resolution-A sense of general relaxation, well-being, and muscle relaxation is experienced in this phase. After this phase men have a refractory period that may last from several minutes to many hours; in that period they cannot be stimulated to further orgasm. Women do not have a refractory period and are capable of multiple and successive orgasms.
Sexual disorders- Disturbances in sexual preference, development and orientation is called as sexual disorders
– Common in 18-59 years
– Paraphilias common in males
– Pedophilia 45%
– Premature ejaculation-27%
• Gender Identity Disorders
• Psychological and behavioural disorders associated with sexual development and maturation
• Disorders of sexual preferences (Paraphilias)
• Sexual dysfunctions
a. Gender Identity Disorders
In this a person feels as if their biological gender doesn’t accord with who they feel themselves to be.
• Transsexualism- Strong , persistent feelings of identification with the opposite gender and discomfort with one's own assigned sex.
§ Sexual Reassignment surgery
• GID of Childhood- Children who experience significant discontent with their biological sex, assigned gender, or both.
• Dual role transvestism- The individual wears clothes of the opposite sex in order to experience temporary membership in the opposite sex and does not wish for a permanent change in sex.
• Intersexuality- A person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male. For example, a person might be born appearing to be female on the outside, but having mostly male-typical anatomy on the inside.
b. Psychological and behavioral disorders associated with sexual development and maturation
Homosexuality – In this sexual disturbance, sexual relationships are maintained between persons of same sex. Female homosexuals are called lesbians and males are called gay.
• Decreased level of testosterone
• Increased level of estrogen
Ø Psychosocial theories
• Arrest in normal psychosexual development at infant stage
• Negative oedipal position in which the child gets attracted to the same sex parent.
• Dysfunctional family pattern
– Behavior therapy: aversion therapy, covert sensitization, systematic de sensitization.
– Psychotherapy: supportive and psychoanalytic
c. Paraphilias- Sexual arousal occurs persistently and significantly in response to objects which are not a part of normal sexual arousal.
• Fetishism-Sexual arousal occurs usually with non living objects intimately associated with human body like under garments.
• Transvestism-Sexual stimulation occurs by wearing clothes of opposite sex people.
• Sexual sadism- Arousal by physical and psychological humiliation, suffering or injury of partner by beating or creating bruises.
• Sexual masochism- Arousal by physical and psychological humiliation, suffering or injury of self.
• Exhibitionism- Exposure of one’s genitalia to an unsuspecting stranger will result in sexual arousal.
• Voyeurism-Observe unsuspecting people of opposite sex naked or having sex will stimulate sexual arousal.
• Frotteurism- Sexual arousal by involvement in the act of touching and rubbing against non consenting person.
• Pedophilia-Involving in sex with pre pubertal children usually less than 13 years of age.
• Zoophilia-Involving in sexual activities with animals
– Increased androgen level
– Temporal lobe tumor
– Substance use
– Childhood sexual trauma
– Negative perception of one’s body image
– Unresolved oedipal crisis in which attributes the intimacy to opposite sex parent to inanimate objects.
– Modeling & mimicking the acts of others or which is seen in media.
– Sexual myths
– Financial and family stress
– Ineffective communication
Treatment of paraphilias
• Behaviour therapy
• Psycho analysis
d. Disturbance in sexual response cycle.
These are disturbances in sexual response cycle without any organic cause .
• Frigidity-Absence of desire involve in sexual activity.
• Impotence-Inability to sustain penile erection for sexual activity.
• Premature ejaculation-Ejaculation of semen before the completion of sexual activity
• Non-organic vaginismus-Involuntary spasm of vagina without any organic cause.
• Non- organic dyspareunia- Pain during sexual activity without any organic cause.
• Psycho analysis
• Group psychotherapy
• Behaviour therapy
• Collect sexual history
• Assure confidentiality
• Perception of problem
• Cultural, social and religious factors contributing to conflicts
• Medication history
• Explain human sexuality and cycle of sexual response
• Correct any misconcepts
• Encourage communication within partners
• Non judgmental attitude