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Sexual Disorders. Dr. Vidumini De Silva. Basic need 10 – 12 yrs – preoccupied with sexual changes & beginning of interest towards the opposite gender. Disorders . Paraphilia Sexual dysfunctions Other . 1. Paraphilia . Repetitive sexual fantasies involving non human objects OR
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Sexual Disorders Dr. Vidumini De Silva
Basic need • 10 – 12 yrs – preoccupied with sexual changes & beginning of interest towards the opposite gender
Disorders • Paraphilia • Sexual dysfunctions • Other
1. Paraphilia Repetitive sexual fantasies involving non human objects OR repetitive sexual activity with humans involving humiliation, suffering with non consenting partners.
Males – commoner • Sub types – Exhibitionism : recurrent intense sexual urges, behaviours, or sexually arousing fantasies involving the exposure of genitals to a stranger Fetishism : involves using nonliving objects frotteurism : touching or rubbing against a non consenting person
Paedophilia : sexual activity with a prepubescent child Masochism : made to suffer, humiliation, beaten, and bound Voyeurism : observing people who are either naked, disrobing or engage in sexual activity Sadism : psychological / physical suffering is sexually exciting for the patient
Aetiology of Paraphilia • Biological – abnormalities in limbic and temporal lobe • Behavioural theory : environmental influence • Other – due to multiple factors
Rx • Biological : block/decrease level of androgens • Psychoanalytical therapy : assisting to identify childhood trauma/conflict that prevents the patient having normal sexual relationship • Behavioural therapy : aversioning ( eg: use of electrical shock when exposure to undesired behaviour
Exercise 01 • What’s your role?
2. Sexual dysfunction Phases of sexual response cycle • Desire • Excitement • Orgasm • Resolution
Sexual Desire Disorders • Hypoactive Sexual Desire Disorder • Testosterone • Cognitive therapy • behavioural therapy • Marital therapy 2. Sexual Aversion Disorder – aversion/avoidance of genital sexual contact with the partner - systematic desensitization - antidepressants
Sexual Arousal Disorder 1. Female Sexual Arousal Disorder – failure to attain/maintain until completion of sexual activity, an adequate lubrication response of sexual excitement 2. Male erectile disorder • Group therapy • Hypnotherapy • Systematic desensitization • Testosterone • Siladenfil • Penile implantation
Orgasmic Disorder • Anorgasmia (Female orgasmic disorder) – recurrent/persistent delay/absence of orgasm following normal sexual excitement phase • Retarded ejaculation • Premature ejaculation – persistent/recurrent ejaculation with minimal sexual excitement or before upon or shortly after penetration and before the person wishes it
Sexual Pain Disorders • Dyspareunia – genital pain before/during/after sexual intercourse not associated with vaginsmus or lack of lubrication Rx : systematic desensitization 2. Vaginismus – involuntary constriction of outer 1/3 of vagina that prevents penile insertion and IC Rx : ?
Aetiological factors • Biological – drugs (antihypertensives, antipsychotics, antidepressants, anxiolytics, anticonvulsants) , Co-morbidities ( DM) , substance abuse • Psychosocial factors - childhood sexual abuse, rape, fear of getting pregnant
Exercise 02 • What’s your role?
Sexual Orientation What are these terms mean & what can be done for them? • Homosexuality • Transsexualism • Bisexuality
Sexually transmitted diseases • Who are the risk groups? • What are the STDs you know of? • How they can be prevented?
