PSYC 407 1st Edition Lecture 17 Outline of Last Lecture I. Sexual Practices: Normsa. Males vs. Femalesb. Cultural ConsiderationsII. The development of sexual orientationIII. Gender Differences in sexual behavior and attitudesIV. Overview of Sexual DysfunctionsV. Sexual Desire Disorder: An OverviewOutline of Current Lecture I. Treatment of Sexual Dysfunctiona. Medical TreatmentsII. Paraphilia’s (Main Types)a. Fetishismb. Voyeurismc. Exhibitionismd. Transvestic fetishisme. Sexual sadism and masochismf. PedophiliaIII.Treatments for Paraphilia’sIV.What is Gender Identity?V. Perspectives on Substance-Related DisordersVI.VII. Introduction to MutationsCurrent LectureTreatment of Sexual Dysfunction• Education aloneThese notes represent a detailed interpretation of the professor’s lecture. GradeBuddy is best used as a supplement to your own notes, not as a substitute.– Is surprisingly effective• (hypoactive desire might reflect differences between partners and teaching them could help)• Masters and Johnson’s psychosocial intervention– Education– Eliminate performance anxiety• Sensate focus and non demand pleasuringMedical Treatment of Sexual Dysfunction• Erectile dysfunction– Viagra – is it really the wonder drug? (1998)– Injection of vasodilating drugs into the penis• Papaverine, prostaglandin)– Penile prosthesis or implants– Vascular surgery– Vacuum device therapy• Few medical procedures exist for female sexual dysfunctionParaphilias: Clinical Descriptions and Causes- Nature of paraphilias – misplaced sexual attraction and arousalo Focused on inappropriate people, or objects Horses, dogs, vacuum cleanero Often multiple paraphilic patterns of arousalo High comorbidity  With anxiety, mood, and substance abuse disorderso Prevalence hard to determine- Main types of DSM-IV-TR paraphiliaso Fetishismo Voyeurismo Exhibitionismo Transvestic fetishismo Sexual sadism and masochismo Pedophilia Fetishism- Fetishismo Sexual attraction to nonliving objects o Objects can be inanimate object and/or source of tactile stimulation- Exampleso May include rubber, hair, feet, objects such as shoes. Also a PART of the body (feet)- Numerous targets of fetishistic arousal, fantasy, urges, and desiresVoyeurism and Exhibitionism- Voyeurismo Observing an unsuspecting individual undressing or nakedo Risk associated with “peeping” is necessary for sexual arousal - Exhibitionismo Exposure of genitals to unsuspecting strangerso Element of thrill and risk is necessary for sexual arousalTransvestic Fetishism- Transvestic fetishismo Sexual arousal with the act of cross-dressingo Males may show highly masculine compensatory behaviors Most do not show compensatory behaviorso Many are married and the behavior is known to spouse (who may accept it and consider it a private matter)Sexual Sadism and Sexual Masochism- Sexual sadismo Inflicting pain or humiliation to attain sexual gratification- Sexual masochismo Suffer pain or humiliation to attain sexual gratificationo HYPOXIPHILIA- self-strangulation to reduce the flow of O2 and enhance the sensation of orgasm- Relation of sadism and rapeo Some rapists are sadistso Most rapists do not show paraphilic patterns of arousalo Rapists tend to show sexual arousal  To violent sexual and non-sexual material Rape not usuallyclassified as paraphilia; better classified as assault.- Rape often motivated by anger and vindictivenessPedophilia• Overview– Pedophiles – sexual attraction to young children – Incest – sexual attraction children in family– Victims • Male and/or female children or very young adolescents– Pedophilia is rare, but not unheard of, in females• Associated features– Most perpetrators are male– Incestuous males may be aroused by adult women– Male pedophiles are not aroused by adult women– Most rationalize the behavior• Often engage in other moral compensatory behavior Paraphilia: Causes and Assessmento Associated with sexual and social problems and deficits o Patterns of inappropriate arousal and fantasy  May be learned early in life - Psychophysiological assessment of pedophiliao Children to them are very “safe”o Deviant patterns of sexual arousalo Desired sexual arousal to adult contento Social skills deficitso Have difficulties forming appropriate adult relationshipsParaphilia: Psychosocial Treatment- Psychosocial interventionso Most are behavioralo Target deviant and inappropriate sexual associations o Covert sensitization – imagining aversive consequences o Orgasmic reconditioning – masturbation plus appropriate stimulio Family/marital therapy – address interpersonal problemso Coping and relapse prevention – self-control and risk managemento Efficacy of psychosocial interventionso About 70% to 100% of cases show improvemento Poorest outcomes – rapists/multiple paraphiliaso Run a chronic course with high relapse ratesParaphilia: Drug Treatments• Medications: The equivalent of chemical castration– Often used for dangerous sexual offenders • Types of available medications– Cyproterone acetate • Anti-androgen, reduces testosterone, eliminates sexual urges and fantasy– Medroxyprogesterone acetate • Depo-provera, also reduces testosterone, temp. suppress sexual arousal– Triptorelin • A newer and more effective drug that inhibits gonadotropin secretion• Efficacy of medication treatments– Drugs work to greatly reduce sexual desire, fantasy, arousal– Relapse rates are high with medication discontinuationGender Identity• Gender identity develops between 18 months and 3 years of age, but text notes that pre-existing biological factors have already had their impact.• Gender Nonconformity Behaviors (Green, 2006)• Girls who behave in masculine ways• Boys who behave in feminine ways• Parents shape by not discouraging• Excessive attention from mother (father)• Lack of same-sex playmates• Rare to develop GID• Gender Identity:– Deep seated personal sense of your masculinity or femininity• Gender Identity Disorder– If that identity not consistent with your physical identity- Used to be ‘transsexualism’Clinical overview – trapped in the body of the wrong sex– Assume the identity of the desired sex– Goal is not sexual; independent of arousal pattern– Not transvestic fetishism;– Primary goal is to achieve gratification through cross-dressing– Not hermaphroditism– Born with ambiguous