Department of psychiatry Psychosexual and gender disorders

presented by :

Haytham Hashim

Normal sexual response

The normal sexual response include four phases : 1- Excitement phase : arousal occurs in response to sexual stimulation (which may be fantasy as well as a reality )and there is a desire to engage in sexual activity . 2- Plateau phase : there is an intensifications of the sexual excitement to a level from which orgasm occur . 3-Orgasm phase : during this phase the sexual pleasure reaches a maximum with involuntary release of sexual tension and rhythmic contraction of the perineal muscle and reproductive organs . 4-Resolution phase : there is a sense muscular relaxation and general well-being .

*sexual dysfunction not caused by organic disorder or disease :

Sexual dysfunction covers the various ways in which an individual is unable to participate in sexual relationship as he or she would wish . Organic causes of sexual dysfunction include physical disorder the effect of medication and excessive alcohol consumption > Many types of non-organic sexual dysfunction share the following aetiological factors :

1-variable sexual drive between different people possible as a results of variable levels of sex hormones . 2-ignorance of sexual matters . 3-anxiety .

*sexual dysfunction (disorder ):

1-lacck of sexual desire : Commoner in women may by secondary to relationship difficulties or a depressive disorder . 2-sexual aversion : the prospect of sexual interaction with a partner in associated with strong negative feelings and produce sufficient fear or anxiety that sexual activity avoided . 3-lack of sexual enjoyment : sexual response occur normally and orgasm is experienced but there is a lack of appropriate pleasure . it is commoner in women .

4- failure of genital response : a) in men this manifests mainly as erectile dysfunction , in which there is difficulty in developing an erection or in maintaining it long enough for satisfactory sexual intercourse . erectile dysfunction may be secondary to low sexual derive . performance anxiety, reduced interest in the partner or a depressive episode . it is common in old age men . b) in women it manifests mainly as vaginal dryness or failure of lubrication . vaginal dryness may be a symptom of post-menopausal estrogen deficiency .

5-organic dysfunction : Orgasm is markedly delayed or does not occur . if it is situational is likely to be psychogenic rather than physiological in nature . it is commoner in women , in whom it may be the result of lack of fore play , low sexual derive , lack of interest in the partner or tiredness . 6-pre-mature ejaculation : This is the regular occurrence of ejaculation before or too soon after vaginal penetration for the female partner to enjoy sexual intercourse. It is commoner in younger men , and often occurs in those with little or no previous experience of sexual intercourse .

7-non-organic dyspareunia :this is non organic pain occurring during sexual intercourse . it can occur in both women and men . 8- non-organic vaginisus : vaginal muscle spasm occur , occluding the vaginal opening and so making penetration impossible or painful . it may result from feelings of guilt . 9-excessive sexual derive : in both sexes this is commoner during the late teenager years or early adulthood . it may be secondary to hypo mania or early dementia .

*management :
1- sex therapy : #both partner are treated together . #education . #communication . #graded sexual tasks . pharmacological treatment : 3-special techniques : 4- marital ( couple ) therapy : this is indicated when conflict in the relationship is the underlying cause of the sexual dysfunction .

*Gender identity disorders :

1- transsexualism : A desire to live and be accepted as a member of the the opposite sex , usually accompanied by a sense of discomfort with ones anatomical sex and a wish to have treatment (hormonal and surgical ) to make ones body as congruent as possible with the preferred sex . dual-role transvestism : in this disorder the individual occasionally wears clothes of opposite sex (cross dressing ) but does not wish to become a member of that sex . the cross-dressing is not accompanied by sexual excitement .

*gender identitydisorder of childhood :

A pervasive and persistent desire , present well before puberty to be or to insist that the one is the opposite sex .

*disorders of sexual performance :

In these disorders also called paraphilias sexual arousal occur in response to object or situations that are not normal arousal stimuli and which may interfere with affectionate reciprocal sexual acts .

disorder Fetishism

Arousing stimuli Non-living object (fetish) like rubber, plastic, leather object

Fetishistic transvestism Exhibitionism

Voyeurism

Wearing clothes of the opposite sex . Exposure of ones genitals to a stranger.

Observing unsuspected people undressing and\or engaging in sexual or intimate behavior. Sexual activity with a prepubescent child.

Pedophilia

Sadomasochism Sexual activity involving bondage or the infliction of pain or humiliation. Frotteurism Touching and rubbing against a non-consenting person.
Necrophilia Sexual activity with a corpse .

Zoophilia

Animals or incorporated into sexual arousal fantasies and sexual activity, including masturbation orogenital interaction and intercourse.

Klismaphilia

Sexual pleasure is associated with insertion of an enema per rectum .

Coprophilia

Sexual pleasure in association with passing faeces onto the partner or being defecated upon by the partner .

Urophilia

Sexual pleasure is associated with passing urine onto the partner or being urinated upon by the partner .

Thanks And Good luck