Sociocultural Influences on Sexual Practices and Standards

• Definitions of Normality and Desirability vary incredibly cross-culturally
• What seems obvious today might have been heresy yesterday, or tomorrow (or elsewhere)

• Degeneracy and abstinence theory

1. In contrast, Freud later attributed much mental illness to sexual frustration

• Homosexuality: Developmental phase, mental illness, or just a variation?

1. Ritualized teenage homosexuality in Melaysia

• Semen conservation & Female pollution

1. Homosexuality and American Psychiatry/Psychology

• Homosexuality was viewed as sickness until 1970s

• Homosexuality is now deemed a non-pathological variation

• In DSM-III there was Ego-Dystonic Homosexuality

• As disorder only if you really, really want to be straight

• In DSM-IV there is no reference to homosexuality

• There is only Sexual Disorder NOS

1. Paraphilias
2. Gender Identity Disorders
3. Sexual Dysfunctions

1. The Paraphilias

• Popularly known as perversions
• Common Diagnostic Criteria & General Features

1. Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors persisting 6 months or longer, generally involving nonhuman objects, suffering or humiliation, children or nonconsenting persons
2. These produce clinically significant distress or impairment

• Kinky interests alone are not considered mental illness

• "Fantasies, behaviors, or objects are paraphiliac only when they lead to clinically significant distress or impairment (e.g., are obligatory, result in sexual dysfunction, require participation of nonconsenting individuals, lead to legal complications, interfere with relationships)."

• Paraphilias are almost exclusively diagnosed among males

• Masochism is the only paraphilia with a measurable number of females (20 males per female)

• Prevalence is difficult to assess

• These diagnoses are given in general clinical facilities
• Large markets for paraphiliac pornography and paraphernalia imply greater prevalence
• In specialty clinics, Pedophilia, Voyeurism, and Exhibitionism predominate
• These people are often "in trouble" and mandated to treatment
• Therefore, they may be more likely to be detected rather than more common per se

• Developmental considerations

• Usually these disorders emerge in late adolescence or early adulthood
• Sometime there are prodromal fantasies or behaviors in childhood
• Elaboration and revision may continue during adulthood
• The disorders are usually chronic, although fantasies and behavior decreases with age
Specific Diagnoses
 
• Fetishism

1. Recurrent, intense sexually arousing fantasies, urges, or sexual behaviors with a nonliving object (e.g., female underwear).
2. Masturbation often accompanies the fetishistic behavior
3. Antisocial behaviors and fire setting sometimes accompany fetishes
4. Learning plays an obvious role in its development

• Transvestic fetishism

1. Recurrent, intense sexually arousing fantasies, urges, or sexual behaviors involving cross-dressing.
2. Almost always males
3. Other psychopathology is typically absent
4. Learning plays an obvious role in its development

• Voyeurism

1. Recurrent, intense sexually arousing fantasies, urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity
2. Curiosity is satisfied in shy and inhibited
3. Suspense and danger add to the experience
4. A sense of power maintains the behavior
5. Permissive pornography laws may provide alternatives
6. Internet exhibitions may encourage/disinhibit voyeuristic action

• Exhibitionism

1. Recurrent, intense sexually arousing fantasies, urges, or behaviors involving exposure of one's genitals to an unsuspecting stranger
2. Exposure is consistent in type of situation and sex object
3. Most exhibitionists are not otherwise aggressive

• Sadism

1. Bondage and discipline is a closely related pattern
2. Sexual gratification can come from the sadistic practice alone
3. Objects or animals can be targets of the sadism
4. Causal factors include a conditioning of sexual arousal to pain, negative attitudes about sex, and other psychopathology
5. See your book for additional information about rape, a behavior which obviously combines sex and aggression.

• Masochism

1. Pain is associated with sexual pleasure
2. Complementary relationships are often formed sadists

• Frotteurism

1. Touching and rubbing against a nonconsenting person.
2. Usually rubs genitals against others, or touches other's genitalia or breasts with hands
3. Often fantasizes about having an intimate relationship with victim

• Pedophilia

1. Recurrent, intense sexually arousing fantasies, urges, or sexual behaviors with a prepubescent child or children (generally <14)
2. At least 16 years old and at least 5 years older than child (not older adolescent in ongoing relationship with a 12 or 13 year old)
3. See your book for additional details and case studies regarding the sexual abuse of children. Note that DSM-IV does not have categories for sexual contact with teenagers

• Paraphilia NOS

1. Gender Identity Disorders

• Diagnostic Criteria

• A strong, persistent cross-gender identification (not merely coveting cultural advantages)
• Persistent discomfort with his/her biological sex or sense of inappropriateness of gender role
• No physical intersex condition
• Clinically significant distress or impairment in social, occupational, or other important areas of functioning

• The correlation between gender and gender-identity is almost perfect, but not quite
• Incidence: 1/30,000 males; 1/100,000 females Transsexual adults in a European study
We don't have much data.

• Cross-gendered behavior is probably more common during childhood

• Gender-identity develops gradually during early childhood
• At present, gender roles are changing and more flexible
• The flexibility applies mainly to girls
• Parents often get concerned when children enter school
• Most children show diminished cross-gender behavior as they age

• By adolescents,
• 75% of boys treated for cross-gender behavior are homosexual or bisexual;
• 25% are heterosexual;
• 0% report Gender Identity Disorders.
• No comparable data are available for girls, may be because their parents aren't so alarmed.

• Transsexuals and sex-change treatments
• Hormone and surgery are sometimes used to "reassign" gender
• Trial periods are used first to weed out those who are uncertain or unstable
• Outcome studies show an approximate two-thirds success rate for such treatment

• These involve disturbances in the processes in the normal human sexual response cycle. That cycle is typically divided into four phases:

1. Desire: fantasies and inclinations to engage in sexual activity
2. Excitement: subjective sense of sexual pleasure with accompanying physiological changes. Penile tumescence and erection in males; vasocongestion of the pelvis, vaginal lubrication and expansion in females
3. Orgasm: peaking sexual pleauser, with the release of sexual tension and rhythmic contraction of the perineal muscles, anal sphincter, and reproductive organs.
4. Resolution: muscular relaxation and general sense of wellbeing. Males are refractory to further erection and orgasm for variable periods of time; females may be able to respond almost immediately.

• Many involve clinical judgements of frequency, intensity, sufficient stimulation, etc.
• Prevalence data vary widely, reflecting diagnostic imprecision and shifting cultural factors
• Diagnostic criteria require that "the disturbance causes marked distress or interpersonally difficulty"
• Multiple dysfunctions are common; i.e., comorbidity is high

3.  Female orgasmic disorder
a.  "Extra" stimulation is required for orgasm
b.  No amount of stimulation can produce orgasm in primary orgasmic dysfunction
c.  What entails "extra" stimulation is very subjective

2. Dyspareunia
a. Painful sexual intercourse is more common in females than males
b. Infections or structural pathology maybe present