SEXUAL DISORDERS

I). Intrafamilial Sexual Disorders

This is incestuous sexual abuse among family members. It can either be an abuse or consensual.

● Abuse

Intrafamilial sexual abuse can occur irrespective of family and socio-economic circumstances, from the most privileged to most modest

Any change in a child; usual behavior for which there is no obvious explanation may be suggestive of abuse

The absence of signs during the clinical examination does not rule out assault of a sexual nature

If there is strong suspicion of sexual abuse and continuous contact with the perpetrator it is essential to provide the child at risk with immediate protection

● Effects

• Leads to increased adult mental symptoms especially depression, bulimia and generalized anxiety.

• Chronic PTSD

• Trauma

• Can contribute to family dysfunctionality.

• Confusion

• Alteration of family boundaries and this can create a sense of fear & guilt.

● Determinants

• Age

• Developmental phase of the child at onset of abuse

• Relationship with offender

• Duration of abuse

• How abuse was done - with violence, threat, verbal, psychological, etc.

• Individual characteristics

● Counseling

In planning/providing/evaluating treatment to the victim the family culture and dynamics must be considered

Complexity is increased by the need to coordinate the treatment of multiple family members as well as a host of case management issues

The complexity of intrafamilial abuse requires a longer treatment than other forms of trauma

Consanguinity (Blood relation)

Coming from the same ancestors, this marriage has the following effects:

 Hereditary diseases will be more severe in offspring than parents. This can lead to death before or immediately after birth.

 If one parent does not suffer from the condition, then the fourth child will severely suffer.

 Can lead to children having congenital abnormalities especially heart diseases, nervous disorders, limb abnormalities.

 Reduction in population due to early deaths.

 Weakening of genes in offspring.

 Risks of genetic defects - ⅓ of birth defects in Pakistan come as a result of such marriages.

 Genetic diseases e.g. blinding disorders, blood cancer, breathing problems and increased susceptibility to disease.

 Causes infertility.

 Prone to infectious diseases because of lowered immune system.

 Inbreeding as a result of “self-fertilization”.

 Having a potential for recessive genes – see royal family who inbred and became hemophilias (little or no clotting factor therefore bleed for long if cut

II). Sexual Dysfunction

It is a condition when one has a problem that prevents him/her from wanting and enjoying sexual activity. It can happen during all ages but chances increase as one gets older

● Causes

• Stress (most common cause)

• Fatigue

• Sexual trauma

• Psychological issues

• Diabetes

• Heart disease

• Drug & alcohol abuse

• Physical issues e.g. arthritis, urinary and bowel difficulties, pelvic surgery, neurological disorders e.g. multiple sclerosis.

• Certain medication e.g. antihistamines, chemotherapy drugs

• Lowered hormonal levels

• Psychological & social issues e.g. untreated anxiety, depression, long term stress, worries of pregnancy, demands of being a new mother, conflicts with partner, etc.

• Cultural and religious issues

• Problems with body image

• Emotional distress

● Types

• Low sexual desire

• Sexual arousal disorder

• Orgasmic disorder

• Sexual pain disorder

• Dyspareunia – genital pain/painful sexual intercourse.

• Erectile dysfunction

• Exhibitionism

• Sexual aversion disorder (SAD)

• Fetishism (pleasure from an object)

• Frotteurism

• Gender identity disorder

• Hypoactive sexual desire disorder

• Premature ejaculation

• Sex addicts – unable to stop

• Sexual masochism & sadism

• Transvestic fetishism

• Viginismus – inability for any vaginal penetration

• Voyeurism – pleasure by secretly watching other people having sex

A sexual response involves the complexity of physiological & emotional experiences, beliefs, lifestyles & relationships. Disruption of any of these components can affect sexual drive, arousal or satisfaction.

Sexual problems in men refer to problems during any of the response cycle that prevents the individual or couple from experiencing sexual satisfaction. Most common problems include:-

 Erectile dysfunction

 Inhibited sexual desire

 Premature ejaculation disorder

 Inhibited ejaculation (retarded ejaculation – slow to occur)

 Retrograde ejaculation (at orgasm ejaculate is forced back)

 Premature ejaculation is most common caused by nervousness and lack of attraction for a partner, past trauma, psychological factors, strict religious background

● Psychotherapy

From a psychodynamic perspective sexual dysfunction is caused by unresolved unconscious conflicts of early development.

• Treatment focus on bringing awareness to these unresolved conflicts and how they impact the patients’ lifestyle.

• Dual sex therapy

• CBT is used to treat sexual anxiety especially on activating event – negative thoughts – disturbed negative feelings – dysfunctional sexual behavior. Aim of CBT is to restructure irrational beliefs.

• Viagra, levitra & cialis only by prescription. These work in increasing blood flow to penis.

• Virginal creams

• Sex therapy

III). Personality Sex Disorders

♧ Boderline personality disorder – these exhibit greater sexual preoccupation, have earlier sexual exposure, engage in casual sexual relationships. They report a greater number of sexual partners, promiscuity & engage in homosexual experiences.

♧ Paraphillia – are disorders of deviant sexuality that involve recurrent fantasies, urges or behaviors of sexual nature that centre around children, non-humans or harming others or self.

♧ Histrionic personality disorder – characterized by long standing pattern of attention seeking behavior and extreme emotionality. Engage in sexually seductive or provocative behavior to draw attention to themselves.

♧ Exhibitionism – a behavior where a person behaves in ways intended to attract attention by displaying his/her powers.

♧ Frotterism – habit of rubbing one’s pelvis or erect penis against a non-consenting person for sexual gratification.

♧ Pedophilia – act of fantasy on the part of an adult engaging in sexual activity with a child.

♧ Transvestism – act of dressing and behaving in a style traditionally associated with the other gender