Sexual Disorders

Paraphilias, Gender Identity, Disorder
(GID)/Gender Dysphoria and Sexual

Dysfunctions
Sexual Disorders
By Dr Iram Mansoor
Associate Professor/
Department of
Behavioral Sciences
According to UN Secretary-General
Ban Ki-moon (Human Rights Council, 7 March 2012)
 “Some say sexual orientation and

gender identity are sensitive issues. I
understand. Like many of my
generation. I did not grow up talking
about these issues.
But I learn to speak
out because lives are at stake,
and it is our duty to protect
the rights of every one”.
What is Abnormal Sexual
Behavior?
 Let
us assume a sexual behavior is a
psychological disorder if:
- It causes harm to other people, or;

- It causes an individual to
experience persistent or
recurrent (D-1)distress or
(D-2) dysfunctioning in important
areas of functioning.
What is Abnormal Sexual
Behavior?
 (D-3) Deviation from norms

 When evaluating a given sexual
behavior, the context is extremely
important, as are customs and
mores, which change over time.
Many attitudes and behaviors related
to sex have changed in recent
decades.
Paraphilias, Gender Identity
Disorder and Sexual Dysfunctions
Abnormal Sexual
Behaviors
Paraphilias
Para meaning “abnormal” and philia
meaning “attraction”, Literally,
“Abnormal Attraction”
Paraphilia
 These are disorders in which an

individual has recurrent, intense
sexually arousing fantasies, sexual
urges or behaviors involving
(1) Non-human objects
(2) Children or other non-consenting
persons
(3) Suffering or humiliation of one’s
Characteristics of persons
with a Paraphilia
 Usually lasts for 6 months.
 Always thinking to carry out their unusual
behavior.
 Overly obsessed that if the individual cannot get
to their desired object, they get stressed.
 The individual will lose sight of other goals and
concentrate of the fulfillment of their sexual
desires if worse.
 It causes intense personal distress or impairment
in social, work and other areas of life functioning.
 Except for Sexual Masochism, almost all cases of
Paraphilia involve MEN.
Types of Paraphilia
 DSM-5 describes 8 of the more
commonly observed paraphilic
disorders:
 Voyeuristic disorder.
 Exhibitionistic disorder.
 Frotteuristic disorder.
 Sexual masochism disorder.
 Sexual sadism disorder.
 Pedophilic disorder.
 Fetishistic disorder.
 Transvestic disorder
Pedophilia
 Pedophiliais where an adult (16 yrs- Above)

has uncontrollable sexual urges towards
sexually immature children (13 below)
 Persists from months to even years.
 Formsof sexual acts against children include

kidnapping, sexual abuse, fondling, and
penetration or intercourse.
Exhibitionism
 Theindividual has intense sexual urges
and arousing fantasies involving the
exposure of genitals to a group of
stranger/s.
 Theindividual does not expect a sexual

reaction from the stranger but finds the
shock or fear in the onlooker to be arousing
 Havethe fantasy that the onlooker will be

sexually aroused.
Fetishism
 Fetishismis where a person feels a strong
recurrent sexual attraction to a nonliving
object.
 People with this are always preoccupied with

the object of desire, and they become
dependent to it as an object for sexual
gratification.
 Objectsinclude shoes, gloves, underwear,

stockings, swimsuits, etc.
Partialism
 Another variant of Fetishism.
 Peoplewith Partialism are solely

interested in the sexual gratification
from a specific body part, examples
are feet, neck, underarms, back, etc.
Characteristics of
Fetishism
 They do unusual actions to the desired
object, like sucking, smelling, fondling,
rubbing, burning and cutting.
 Have no desires to intercourse with the

partner with the desired object, rather, they
would masturbate to the desired object.
 Itinvolves compulsive rituals that are beyond

the control of the individual, which can cause
distress and interpersonal problems.
Transvestic Fetishism
A syndrome found only in males.
A disorder in which a man has an

uncontrollable urge to wear a woman’s
clothing, as primary means of achieving sexual
gratification.
 Thissexual gratification has a compulsive

quality, and consumes a lot of emotional
energy.
 Sometimes accompanied by masturbation.

Frotteurism
 Derived from the word ‘Frotter’ meaning

‘To rub’
 Refers
to the masturbation that involves
rubbing against another person.
 Frotteurhas recurrent sexual desires on

rubbing into people. Targets of Frotteurs
are not consenting people, rather they
target strangers.
Sexual Masochism
 Comes from the name of an Austrian

Writer Leopold Baron von Sacher-
Masoch. Who is known for his novels
about men being sexually humiliated by
women. A Masochist is someone who
seeks pleasure from being subjected to
pain.
Sexual Sadism
 The term Sadism comes from the name of
French author Marquis de Sade, who wrote
extensively about obtaining sexual
enjoyment from inflicting cruelty.
Voyeurism
 Theword comes from the term voir, meaning
“To See”
A sexual disorder where an individual

compulsively seeks sexual gratification from
observing nudity or sexual activity of others
who are unaware that they are being watched.
 This disorder is more common in men.
 Theterm “Peeping Tom” usually refers to

voyeur.
‘.
Gender Identity
Disorders/ Gender
Dysphoria
Gender Identity
 The term gender identity refers to

the individuals perception as a male
or female.
 Gender role refers to the person’s

behaviors and attitude that are
indicative of his gender.
Gender Identity Disorder
A condition which involves a

discrepancy between an individual’s
assigned sex and the person’s
gender identity.
Characteristics of G.I.D
 Experiencea strong and persistent

cross-gender identification, which
causes a feeling of discomfort.
 Experience intense feeling of

distress.
Treatment for
Paraphilias
 Medication
 Anti-androgen (reduces testosterone
levels)
 Depo-Provera, Lupron, androgen
receptor antagonists, SSRI’s
Psychosocial Treatment
 CBT
 Aversion treatment
 Empathy training (Role reversal)
 Covert sensitization
 Orgasmic Reconditioning
 Family and Marital therapy
 Relapse Prevention
Sexual Dysfunctions
Refers to an abnormality in an individual’s

sexual responsiveness and reactions
Four phases of the Sexual
Response cycle
 Arousal
 Plateau
 Orgasm
 Resolution
Hypoactive Sexual Desire
Disorder
 The Individual has an abnormally low level

of interest in sexual activity.
Sexual Aversion
Disorder
 characterized by an active dislike and

avoidance of genital contact with a sexual
partner, which causes personal distress or
interpersonal problems.
Male Erectile Disorder
Partial or complete failure to

attain or maintain erection
Female Orgasmic
Disorder
Inability to achieve orgasm, or a distressing

delay in the achievement of orgasm.
Premature Ejaculation
 The male individual reaches orgasm in a

sexual encounter long before he wishes
to, perhaps even prior to penetration, and
therefore feels little or no sexual
satisfaction.
Sexual Pain Disorders
Involves the experience of pain associated

with intercourse. Diagnosed as
 dyspareunia (males) or
 Vaginismus (females.
Psychiatric Morbidity
 Research indicates that non-

hetrosexual (homosexuals and
bisexuals) individuals are more likely
to suffer from….
a. Panic Attacks
b. Depression
c. Generalized Anxiety Disorder (GAD)
d. Higher risk for suicide
e. Alcohol Dependency and drug
abuse
Masters and Johnson
method
 In
the Masters and Johnson
technique, a sex history is first
taken and the couple given
physical examinations to rule out
physical problems. Therapists
then employ exercises focusing
on the giving and receiving of
sensual, but not necessarily
sexual, pleasure to help the
couple overcome anxieties about
sex
Health Professional Deals
with such Patients with…..
 Compassion
 Non-judgemental attitude
 Giving room to express their fears
and problems
 Refer to psychiatrist/mental health
professionals.

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Paraphilias, Gender Identity, Disorder

(GID)/Gender Dysphoria and Sexual

 “Some say sexual orientation and

- It causes harm to other people, or;

 (D-3) Deviation from norms

 These are disorders in which an

 Pedophiliais where an adult (16 yrs- Above)

 Persists from months to even years.

 Formsof sexual acts against children include

 Theindividual does not expect a sexual

 Havethe fantasy that the onlooker will be

 People with this are always preoccupied with

 Objectsinclude shoes, gloves, underwear,

 Another variant of Fetishism.

 Peoplewith Partialism are solely

 Have no desires to intercourse with the

 Itinvolves compulsive rituals that are beyond

A disorder in which a man has an

 Thissexual gratification has a compulsive

 Sometimes accompanied by masturbation.

 Derived from the word ‘Frotter’ meaning

 Frotteurhas recurrent sexual desires on

 Comes from the name of an Austrian

A sexual disorder where an individual

 This disorder is more common in men.

 Theterm “Peeping Tom” usually refers to

 The term gender identity refers to

 Gender role refers to the person’s

A condition which involves a

 Experiencea strong and persistent

 Experience intense feeling of

Refers to an abnormality in an individual’s

 The Individual has an abnormally low level

 characterized by an active dislike and

Partial or complete failure to

Inability to achieve orgasm, or a distressing

 The male individual reaches orgasm in a

Involves the experience of pain associated

 Research indicates that non-

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