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Sexual and Gender Identity Disorders Assessment & Diagnosis SW 593 Introduction • Three categories: – Sexual dysfunctions – Paraphilias – Gender identity disorders • In the case with sexual dysfunctions the focus of impairment is relational which creates barriers in establishing or maintaining intimate relationships. Sexual Dysfunctions • Sexual Aversion Disorder: – Expresses persistent/recurrent aversion and avoids sexual contact with a partner. – Response can vary between moderate anxiety to extreme psychological distress. • Hypoactive Sexual Desire Disorder: – Absence/deficiency in sexual interest – Extends to both fantasies/sexual activity. Sexual Dysfunctions • Male Erectile Disorder: – Persistent/recurring inability to attain or maintain an adequate erection during sexual activity. • Female Sexual Arousal Disorder: – Persistent/recurring inability to achieve or maintain an adequate genital lubrication-swelling response during sexual activity. • For both instances, it is important to rule out general medical conditions & substance abuse. Sexual Dysfunctions • Male/Female Orgasmic Disorder: – Persistent/recurrent delay in/or absence of orgasm following normal sexual excitement and activity. • Premature Ejaculation: – Persistent/recurrent episodes of ejaculation and orgasm before the person wishes. – Evidence of limited genital contact prior to ejaculation. Sexual Dysfunctions • Dyspareunia: – Persistent/recurring genital pain associated with sexual intercourse. • Vaginismus: – Pain characterized by involuntary vaginal muscle spasms associated with penetration. Specifiers • Lifelong vs. acquired • Pervasive/generalized vs. specific situations • Due to Psychological Factors vs. general medical/substance use vs. combined factors. Paraphilias • Involves variations in the objects/conditions of sexual fantasies, urges, or behaviors. • Symptoms present for at least 6 months. • Distress or interpersonal impairment is necessary for diagnoses to be given. Paraphilias • Exhibitionism: exposure of genitals • Fetishism: use of nonliving objects • Frotteurism: touching and rubbing against a non-consenting person. • Pedophilia: focus on prepubescent children • Sexual Masochism: receiving humiliation or suffering Paraphilias • Sexual Sadism: inflicting humiliation or suffering • Transvestic Fetishism: cross-dressing • Voyeurism: observing sexual activity • It is essential to distinguish the nonpathological use of fantasy, behavior, or objects in consensual sexual relations from Paraphilias. Gender Identity Disorder • Feeling intensely uncomfortable with one’s own biological sex. • Evidence strong and persistent identification with the opposite sex. • Express discomfort with their actual sex and/or the gender roles of that sex. • Significant psychosocial distress or impairment is evidenced. Gender Identity Disorder • Coding procedures: – Children: 302.6 (Caution – vast majority of children do not carry their symptoms into adulthood.) – Adolescents/adults: 302.85 • It should be noted that among adolescents, the symptoms are resolved by realizing a bisexual or homosexual sexual preference. Assessment • Essential focus for sexual dysfunction is to rule out and/or identify and treat any aspect of the problem related to a general medical condition. • Psychometrics: – Golombok-Rust Inventory of Sexual Satisfaction (GRISS) Cultural Considerations • Clinicians must take into account the individual’s ethnic, cultural, religious, and social background. • These aspects will dramatically influence expectations and attitudes about sexual and gender identity issues. • Age and relational status also influence expectations regarding these matters. Cultural Considerations • Social mores about male sexual behavior are more stringently “enforced”. • Sexual functioning vs. fertility • Women are almost never diagnosed with Paraphilias, with the exception of Sexual Masochism. • Reasons are unknown as to why.