Psychosexual

disorders

The limbic system

is directly involved
with elements of
sexual functioning.
In all mammals,
the limbic system
is involved in
behavior required
for selfpreservation and
the preservation of
the species

Brain and
Sexual
Behavior

 Adrenaline (aka Epinephrine)

Adrenaline activates the
sympathetic nervous system,
which increases your heart rate
and dilates arteries to increase
blood flow to your muscles
during sex. It also causes a
refractory period in which
another orgasm is impossible
for up to 20 minutes after sex.
Phenylethylamine
Phenylethylamine triggers the
release of dopamine in the
pleasure centers of the brain.
This chemical is released during
sex and peaks at orgasm.
Curiously, it is also one of the
chemicals found in chocolate.

Chemicals
That Fuel
Sex

 Testosterone
Testosterone fuels sexual
drive and aggression. It is
essential to your libido and
sexual arousal. Men (and
women) with a testosterone
deficiency often have trouble
getting aroused and have a
lower interest in sex.
Serotonin
Serotonin regulates your
moods. Having an orgasm
releases an extra shot of
serotonin to your brain,
which acts as an antidepressant.

Chemicals
That Fuel
Sex

 Prolactin
Prolactin relieves sexual
arousal after orgasm and
takes your mind off sex. It
rises sharply immediately
after orgasm in almost
everyone. It's one of the few
moments of the day when
we men aren't preoccupied
with sex.
Oxytocin
Secreted by the pituitary
gland, oxytocin stimulates
the prostate, causes muscle
contractions and sensitizes
nerves. Research has shown
that increased oxytocin
produces more intense
orgasms

Chemicals
That Fuel
Sex

 Endorphins
Endorphins are a group of
neurotransmitters formed
within the body that bind to
opiate receptor sites in your
brain to naturally relieve
pain. The bio-chemicals
acetylcholine and dopamine
are known as endorphins,
and have a similar chemical
structure to morphine. They
are also known to lower
stress and boost confidence

Chemicals
That Fuel
Sex

Four phases are

recognized in the
human sexual
cycle.
Phase I:
Excitement
Phase II: Plateu
Phase III:
Orgasm
Phase IV:
Resolution

The Sexual
Cycle

 Muscle tension increases.

Heart rate quickens and
breathing is accelerated.
Skin may become flushed
(blotches of redness appear on
the chest and back).
Nipples become hardened or
erect.
Blood flow to the genitals
increases, resulting in swelling of
the womans clitoris and labia
minora (inner lips), and erection
of the mans penis.
Vaginal lubrication begins.
The womans breasts become
fuller and the vaginal walls begin
to swell.
The mans testicles swell, his
scrotum tightens, and he begins
secreting a lubricating liquid.

Phase 1

 The changes begun in phase 1

are intensified.
The vagina continues to swell
from increased blood flow, and
the vaginal walls turn a dark
purple.
The womans clitoris becomes
highly sensitive (may even be
painful to touch) and retracts
under the clitoral hood to avoid
direct stimulation from the penis.
The mans testicles are
withdrawn up into the scrotum.
Breathing, heart rate and blood
pressure continue to increase.
Muscle spasms may begin in
the feet, face and hands.
Tension in the muscles
increases.

Phase 2

 Involuntary muscle contractions

begin.
Blood pressure, heart rate and
breathing are at their highest
rates, with a rapid intake of
oxygen.
Muscles in the feet spasm.
There is a sudden, forceful
release of sexual tension.
In women, the muscles of the
vagina contract. The uterus also
undergoes rhythmic
contractions.
In men, rhythmic contractions of
the muscles at the base of the
penis result in the ejaculation of
semen. A rash or "sex flush"
may appear over the entire body

Phase 3

 During this phase, the body

slowly returns to its normal
level of functioning, and
swelled and erect body parts
return to their previous size
and color. This phase is
marked by a general sense
of well-being, enhanced
intimacy and, often, fatigue.

Phase 4

Sexual
Dysfunctions

 Sexual dysfunctions refer to

problems that occur during
sexual activity.
1. Lack or loss of sexual
desire
2. Disorders in sexual arousal
that include impotence in
males and failure of genital
response in females.
3. Organism disorders
(Inhibited male of female
orgasm).
4. Sexual pain disorders in
which pain occurs before,
during or after intercourse
recurrently or persistently in
either man or woman.

Sexual
Dysfunctions

 It is persistent
inability to obtain an
erection sufficient for
vaginal insertion, or
to maintain it until
completion of the
sexual activity

Erectile
dysfunction
(impotence)

 Inhibited female orgasm

or anorgasmia is
manifested by the
recurrent delay in, or
absence of, orgasm
after a normal sexual
excitement phase
judged to be adequate
in focus, intensity, and
duration

Female
orgasmic
disorder

 The man recurrently

achieves orgasm and
ejaculates before he wishes
to do so.
There Is no definite time
frame within which to define
the dysfunction

Premature
Ejaculation

 Sexual dysfunction may also

involve pain during
intercourse. It involves
genital pain during foreplay
or penetration. This can
occur in male or females
but is generally seen
females.

Dyspareunia

 It refers to recurrent or
persistent pain the perineal
muscles surrounding the
outer third of the vagina
when penetration occurs. It
may occur during sex but
also insertion of objects
such as tampons or a
speculum during
gynecological examinations.

\Vaginismus

Sexual
Dysfunctions:
Causes and
Prevention

 Risk factors for sexual

dysfunctions have not been
explored at length but likely
include biological and
environmental variables.
-Medical condition or substance
use.
-Medical conditions that impair
sexual performance in men
include prostate cancer and
subsequent treatment as well as
cardiovascular problems.
-Medical conditions that impair
sexual performance in women
include cervical and other
gynecological cancers as well as
menopause.
-Alcohol use impairs male and
female sexual performance

Biological
Risk factors
for Sexual
Dysfunctions

- Anxiety or worry during

sexual performance about
satisfactorily
pleasing
oneself and ones partner.
Worry about performance
may lead to failure that
creates more anxiety and
avoidance of sex.
- Sexual experiences
becomes less enjoyable and
less likely to produce a
satisfactory sexual response
when a person is distracted
from erotic thoughts by
criticizing his behavior.
Failures during sexual
performance can also result
from poor interactions
between partners during
sex.

Psychologica
l risk factors
for Sexual
Dysfunction

 Historical psychological variables can be important as well for

determining sexual dysfunction
General knowledge about sex over time is important as well as
many aging men require greater stimulation for an erection and
many women experience less vaginal lubrication.

 Preventing sexual
dysfunctions primarily
involves relapse prevention
after a couple completes
treatment. Much of this
involves booster sessions or
other methods to help
couples continue to practice
psychological treatment
techniques for sexual
dysfunction and/or manage
cormobid physical or
psychological problems.

Prevention of
Sexual
Dysfunctions

Biological treatment
of sexual
dysfunctions

 Medical treatment for sexual dysfunction has concentrated

most on drugs to alleviate male erectile disorder.
- Sildenafil helps to increase blood flow to penis an thus to
form an erection. Sold under the name of Viagara, Levitra, and
Cialis
Prostaglandin E1 which relaxes muscles in the penis to
assist an erection
Implants may be inflatable, semi rigid, or continually rigid to
maintain erections, but problems include awkwardness and
possible damage to the penis.
Vacuum system A surgical procedure wherby a tube is
placed around the penis, and a pump helps draw blood into the
penis.
Drugs in antidepressant - Used for sexual dysfunction such
as premature ejaculation and compulsive behavior.
Vaginal lubricants and hormone replacement therapy
painful sexual intercourse

 Stop-start-procedure
The penis is stimulated by
the man or a partner until
an erection occurs and an
erection occurs and
ejaculation seems close.
Sensate focus therapy
consist of initially banning
sexual contact and
rebuilding a couples sexual
repertoire
Masturbation training
practices effective
masturbation and
stimulation so orgasm is
enhanced and brought
about more quickly.

Psychological
Treatments of
sexual
Dysfunctions

 It is defined as sexual
behavior that is
destructive to self or to
others; that is not directed
towards a partner; or that
excludes stimulation of
the genitalia

Abnormal
Sexuality

 para = aside, being altered/modified

philia= love
Sexual arousal, fantasies,sexual urges or behaviour involving
non-human objects, suffering or humiliation of oneself or
ones partner, children or other non consenting person.
Begins in childhood/early adolescent
Chronic, increases with age and stressors
More common in man

Abnormalities of the sexual

object

Abnormalities of the sexual act

Sexual fetishism

Exhibitionism

Transvertism

Voyeurism

Paedophilia

Sexual sadism

Necrophilia

Sexual Masochism

Frotteurism

Fetishis
m

 Sexual focus is on objects (shoes, gloves, underwears)

Sexual activity either directed: towards the fetish itslef
(Masturbation with/into a shoe) OR The fetish may be incorporated
into sexual intercourse (demand the high heeled shoes be worn)

Transvest
ism

 Repeatedly wears clothes of opposite sex as means of sexual

arousal
Typically begins in childhood, as grow older permanently
dressed as a woman
Single garment complete set of clothing
Wear In private some go to wear in public (hidden under
male outer garments) vs transsexualism no sexual arousal

Paedoph
ilia

 Repeated sexual activity or fantasy of such activity with prepubertal

children
Preferred children: 9 years old pubertal
Person is at least 16 years old OR 5 years older than the victims
Molestations involve genital fondling or oral sex

Necroph
ilia

 An obsession with obtaining sexual gratification from cadaver

Exhibitionis
m

 Exposure of genitalia to a stranger

Nearly all are male, to surprise a female
2 groups
1. Inhibited temperaments expose flaccid penis much guilt
2. Aggressive personality traits expose erectile penis while
masturbating little guilt
Begins in middle or late life suspect organic brain disorder,
depressive disorder or alcholism

Voyeurism

 Observing others
Common in man
Spy on couples having intercourse, spy women who are
undressing or naked

Sexual
sadomasochism

 Preference for sexual activity that involves bondage or infliting

pain on another person
Masochism: prefers to receive such stimulation
Sadism: prefers to administer such stimulation such as beating,
whipping which may cause little actual injury or may die
Mild sadomasochism is normal

Frotteurism

 Sexual pleasure in men from rubbing their genitals against

unsuspecting women, usually in crowded area

Paraphilias: Causes
and Prevention

 1. Genetics may instead

influence factors related to
sexual deviancy such as
psychosocial deficits and
violence (Hunter, et al
2003)
2. Men with extra Y
chromosome have also
been found to display more
sexual deviancy than the
general population (Briken,
et al 2006)
3. Neuropsychological
problems such as dementia
may also lead to less
inhibited and more
compulsive and abnormal
sexual behaviors (Mendez,
et al 2000)
4. Personality
characteristics (poor
empathy, problems
controlling sadness and
anger)

Biological Risk
Factors for
Paraphilias

Family
1. Difficult family
circumstances also
contribute to paraphilia
development.
Family factors with poor
attachments, frequent, and
aggressive sexual activity
within family may
predispose some toward
sexual offenses

Environmental
Risk Factors

 Learning Experiences
1. Learning experiences in
which a person associates
sexual arousal or orgasm
with an unusual object or
situation
2. Reinforced by family
members or others or
learned the behavior as a
way to reduce anxiety
3. May become a problem
similar to OCD in some
cases.
4. Courtship behaviors

 Cognitive
1. Strong cognitive
distortions or irrational
beliefs
2. Rationalize their behavior
by claiming sexual acts
somehow benefit a child.

 1. Interventions improving
family communication
2. Improve solving skills
3. Places to avoid
4. Relapse prevention