Analysis of Sexual Disorders - Essay Example

Sexual Disorders Sexual life and other forms of close cross-gender interaction play important role in human life. That’s why the study and initial attempts concerning classification and categorization occurred two centuries ago. Nevertheless, the 20th century was signed by the emergence of sexology and the appropriate systemization of evidence - from the earliest up to the most recent information (Durand and Barlow, 2003). In fact, sexual disorders obtained different evaluation in different historical epochs and thus were attributed to various phenomena – from fanatical obsession to intellectual deficiency (ibid). Nowadays, there is a universal framework of sexual disorders in terms of their causes, i.e. the scheme which will be presented below, can be applied to various forms of sexual imbalance. As Krueger and Kaplan write, Freudian approach to sexual dysfunction (Freud and his disciples identified sexual disorders as a result of incomplete Oedipus’ and Electra’s complexes in males and females correspondingly) is out-of-date, as psychodynamic perspective has already proved its inconsistency unless it is combined with social psychological views ( Krueger and Kaplan, 2000). As the scholars write, human matrix of sexual behavior underlies in the set of accepted sexual norms. “A forbidding, puritanical rejection of physical sexuality, including touching, by a parent engenders guilt and shame in a child and inhibits his capacity for enjoying sex and developing healthy intimate relationships as an adult. Relations with parents may be damaged by excessive emotional distance, by punitive behaviors, or by overt seductiveness and sexual exploitation” (Krueger and Kaplan, 2000). Fergusson adds to this viewpoint and claims that a number of sexual disorders are rooted in human guilt associated with masturbation (Fergusson, 1999), towards which the society has developed punitive attitudes so that the individual feels sexually marginalized (even though statistics suggests that about 97% males and 80% females satisfy their sexual needs on their own (ibid)) and thus impaired in terms of sexual performance. Furthermore, intensive and frequent sexual activity can also result in the ‘sexual tiredness’ and the emergence of sexual disorders, which serve the goals of sexual novelty and re-obtaining of intimacy (Federhoff et al, 1999). Furthermore, Federhoff and his colleagues hold that the gradual destruction of the bond between emotionality and sexuality leads to the mechanization of sexual life with following emergence of sexual disorders (ibid). The other reasons include traumatic events in the person’s life: such as rape, severe punishments in the period of adolescence, self-perceived vulnerability and other fears related to intimate life. Furthermore, drug and alcohol addictions, usage of various substances including medications (like beta-blockers) can also become indirect reasons for the development of sexual disorder (ibid). Sexual disorder is defined as a sexual dysfunction which fits into DSM-IV criteria (Hillard and Spilzer, 2002), whereas sexual dysfunction is a problem emerging on the certain stage of sexual cycle. The Diagnostic and Statistical Manual of Mental Disorders, DSM-IV (2000) divides sexual disorders into three groups: paraphilias, sexual identity disorder and psychosexual dysfunctions. “Paraphilias are associated with arousal in response to sexual objects or stimuli not associated with normal behavior patterns and that may interfere with the establishment of sexual relationships. In modern classification systems, the term paraphilia is preferable to sexual deviation because it clarifies the essential nature of this group of behaviors (i.e, arousal in response to an inappropriate stimulus)” (ibid, p.1249). The main features of this group are recurrence, intensity and the presence of sexual fantasies, which involve humiliation or submission, suffering or worshipping certain object. Paraphilias usually develop in combination with other types of mental and psychological imbalance, such as personality and affective disorders. Paraphilia prevails generally among males of different ages, and it is quite rarely diagnosed in clinical settings, as few people seek medical treatment due to commercialization and popularization of these disorders, i.e. they are idealized and promoted in media as ‘normality’. The research suggests that 60% of individuals with such disorders are unmarried (Moggy et al, 2002). Furthermore, Hillard and Spitzer (2002) claim that paraphilias should be distinguished from other mental disorders (for instance, exhibitionism should be distinguished from public urination, associated with dementia), and the basic division criterion is the development of sexual fantasies that takes place in 98% paraphilia cases (ibid). There are eight basic types of paraphilias: exhibitionism, fetishism, frotteurism, voyeurism, sexual sadism, sexual masochism, pedophilia, transvestic fetishism. Exhibitionism is diagnosed in case “the patient reports recurrent, intense, sexual urges and sexually arousing fantasies related to exposing the genitals to a stranger. Symptoms must be present for at least 6 months; the patient experiences significant distress or impairment in social, occupational, or other important areas of functioning because of the fantasies, urges, or behaviors” (Hilliard and Spitzer, 2002, p.1250). This paraphilia prevails among unmarried males aged 30-40 (ibid). Fetishism occurs in case the emphasis of sexual desire is moved from the individual (partner, in general) to his/her body parts or outfit items, or other nonliving objects. For those with fetishism, sexual gratification is possible in case the individual can physically interact with the ‘fetish’, common types of which include underwear, leather or furs, specific clothing articles like shoes or boots. Fetish is proved to serve defense function, i.e. it protects individuals from sexual frustration (realization of respective impotency in males and low libido in females), because fetishism to great extent encourages individual to avoid direct sexual contact (coitus) (Durand and Barlow, 2003). Frotteurism is diagnosed in case the patient experiences sexual excitement and satisfaction after touching or rubbing against nonconsensual person and has related social problems. “Frotteurs typically act out their fantasies in crowded places (eg, public transportation vehicles, busy sidewalks), which allows for escape; the frotteur can claim that the touching was accidental. […]Most acts occur in perpetrators aged 15-25 years, after which frequency gradually declines. Frotteurism has been noted to be equally common among older, shy, inhibited individuals” (Krueger and Kaplan, 2000, p.188). Voyeurism is a disorders that includes observing (or eavesdropping) a naked person or sexual contact between individuals without the observer’s personal involvement into the process. The most common form of voyeurism is addiction to visual pornographic information, such as photos, clips or movies (Rekers, 1998). Pedophilia, another paraphilia, has following features: sexual fantasies associated with infants or children under 13, as well as the contacts themselves (direct and indirect, including touching or rubbing). The patient should be at least 5 years older then their sexual objects (ibid). Sexual masochism and sadism are often diagnosed in combination in the same patient (McConaghy, 1998), as they are dichotomic disorders: masochism is characterized by the strong sexual urge, associated with being beaten, punished or humiliated, whereas sadism involves strong inclination to domination in terms of physical power (punishing partner). The most hazardous form of this dichotomy is hypoxiphilia (DSM-IV, 2000) (sexual arousal in case of oxygen deprivation, either in active (sadism) or passive (masochism) position. Transvestic fetishism is diagnosed only in heterosexual males who experience sexual arousal after cross-dressing (into female clothes, for instance) (Moser and Kleinplatz, 2002). The symptoms might also include dissatisfaction with one’s gender and significant impairment in social and occupational spheres (ibid). Gender identity disorder, or transsexualism, is a sexual disorder, characterized by strong and persistent cross-gender self-identification. As a rule, this problem begins in early childhood: infant or teenager desires to play the roles, commonly attributed to the other gender, develops related fantasies and prefers communication with individuals of the opposite gender (Cohen-Kettenis and Gooren, 1999). “Adolescents and adults may have a preoccupation with getting rid of primary and secondary sex characteristics. People with gender identity disorder do not have a concurrent physical intersex condition. Patients report significant distress or impairment in social, occupational, or other important areas of functioning” (ibid, p.315). Biomedical research has proved the genetic nature of this disorder, but parental factor also plays an important role in gender identity, since parents and relatives set gender-related expectations (especially when their child is very young) so that the small individual is forced to meet them regardless of general social stereotypes and principles (ibid). Sexual dysfunctions, as a rule, have psychophysical nature, i.e. occur in case of certain psychological barrier or bias, exaggerated by certain physical problems. For instance, inhibited sexual desire is caused by both physical problems (lack of natural lubricants) and psychological convictions, associated with upbringing. This dysfunction is the most prevalent female disorder, as the survey shows that about 62 per cent of American women report sexual hypoactivity and poor sexual arousal (Federhoff et al, 1999). The other typically female dysfunctions include orgasmic disorder and vaginismus. “Female Orgasmic Disorder is the impairment of the orgastic component of the female sexual response. It is important that this be separated from FSAD. With Female Orgasmic Disorder, the woman may be very sexually aroused but never reach orgasm.  Female Orgasmic Disorder can be either life long or acquired, situational or generalized” (ibid, p.60). Vaginismus and painful intercourse include involuntary spasms of vaginal musculature and are diagnosed in combination with various sexual phobias (Rekers, 1998) (coitophobia, fear of being raped and so on). Sexual dysfunctions, typically attributed to males include erectile dysfunction, male orgasmic disorder, premature ejaculation and impotence. Erectile dysfunction and impotence are associated with the impairment of erectile reflex and consequential impossibility of intercourse. DSM-IV (2000) describes these disorders as persistent inabilities and point to the related psychological dyshporia and gradual elimination of any physical cross-gender contacts. Premature ejaculation and male orgasmic disorder have are attributed to the final stage of intercourse: the first dysfunction points to ejaculation without sexual stimulation (or with minimal stimulation), whereas the latter points to the delay or absence of orgiastic component (Fergusson, 1998). Sexual dysfunctions in males are caused by the factors, which have been mentioned above as well as specific psychological problems such as failure expectancy syndrome (Krueger and Kaplan, 2000), or fear of personal failure during intercourse, as well as childhood traumas or physical underdevelopment of genitals or elimination system diseases. To sum up, sexual disorders have controversial causes and nature, due to the lack of appropriate evidence. In fact, this area is open only in terms of clinical diagnosing, which is still poor. In fact, accurate medical information is available only is case of sexual dysfunctions and gender identity disorder, whereas the study of paraphilias has merely descriptive nature, with poor empirical verification. As one can assume, sexual disorders arise for biological, genetic or psychological reasons (or their combinations) and force an individual to seek additional nonliving sexual objects or alternative ways of obtaining sexual arousal and satisfaction; or to avoid sexual contacts or reduce them. Reference list 1. American Psychiatric Association (ed.) (2000) Diagnostic and Statistical Manual of Mental Disorders. Fourth Edition, Text Revised (DSM-IV). American Psychiatric Association, Washington, D.C. 2. Cohen-Kettenis, P. and Gooren L. (1999) Transsexualism: a review of etiology, diagnosis and treatment. J Psychosom Res, 46(4): 315-33. 3. Durand, V. M., & Barlow, D. H. (2003).  Essentials of abnormal psychology (3rd ed.).  Thomson Learning:  Pacific Grove, CA. 4. Federoff, J. P., Fishell, A. & Federoff, B. (1999) A case series of women evaluated for paraphilic sexual disorders, Canad J Hum Sexuality 8(2): 58-78. 5. Fergusson, D.M. (1999) Sexual Disorders. Archives of General Psychiatry. 56 (10):876-890. 6. Hilliard, R. and Spitzer, R. (2002) Change in criterion for paraphilias in DSM-IV-TR. American Journal of Psychiatry, 159(7): 1249-1254. 7. Krueger R. and Kaplan M. (2000) Evaluation and treatment of sexual disorders. Frottage. In: L VandeCreek (ed) Innovations in Clinical Practice: A Source Book. Sarasota, FL: Professional Resource Press. 8. McConaghy, N. (1998) Unresolved Issues in Scientific Sexology. Archives of Sexual Behavior, 28(4): 285-318. 9. Moser,C., Kleinplatz., P. (2002)Transvestic fetishism: Psychopathology or iatrogenic artifact? New Jersey Psychologist, 52(2): 16-17.. 10. Rekers, G. (1998) Handbook of Child and Adolescent Sexual Disorders. Lexington Books Read More