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Sexual Disorders This Sexual Disorders topic center contains information about paraphillias (more commonly known as sexual perversions or deviancies), they involve recurrent fantasies, urges or behaviors of a sexual nature that center around children, non-humans (animals, objects, materials), or harming others or one's self. Because they are so often associated with abusive sexual practices that generate real victims, many people tend to regard persons who display sexual deviancies as monsters. While they are ultimately responsible for their choices (including those that harm other people), and should be punished and thereafter closely monitored to prevent further abusive practices, even predator child-molesting pedophiliac are legitimately suffering from mental, emotional and spiritual disturbance and should be able to participate in mandated treatment. Whereas pedophilia (child molestation) is a particularly awful sexual deviancy, there are other forms of sexual deviancy such as transvestism and many forms of fetishism that harm no one and that do not deserve to be thought of in the same breath as child molestation. A list of the paraphillias follows, each with a short description: Exhibitionism involves a compulsion to display one's private parts to strangers. Like gamblers, pyromaniacs and other impulse-junkies, exhibitionists cycle through periods of increasing tension that are only relieved by the ‘rush' of exposing themselves to strangers (occasionally accompanied by masturbation). Symptoms There are many different symptoms that come with Exhibitionism and these symptoms can be categorized in four different groups which include: Mild- A person has recurrent fantasies of exposing themselves but has never acted on these fantasies. Moderate- A person has occasionally exposed himself or herself and has difficulty controlling the urge to keep doing so. Severe- A person has exposed themselves to three or more people and has a serious problem controlling the urges. Catastrophic- This would be very severe and would probably not exist in someone who doesn’t suffer from other paraphilias. This level of severity denotes the presence of sadistic tendencies. Treatment of Exhibitionism The most common form of treatment for this disorder is psychotherapy and medication. Some different types of psychotherapy used in treatment are cognitive-behavioral therapy, group therapy or couples therapy (this therapy is most useful to exhibitionists who are married). Fetishism involves having ones sexual energies fixated on to a manufactured object, rather than onto another human being. Frequently, fetish objects are garments such as shoes, underwear, panties or bras. They may be made of particular materials such as leather or rubber. It is common for a person with a fetish to not be able to achieve orgasm without involving their fetish object in the sexual act (e.g., by getting their partner to wear the fetish object). Symptoms Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the use of nonliving objects (e.g., female undergarments). The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. The fetish objects are not limited to articles of female clothing used in crossdressing (as in Transvestic Fetishism) or devices designed for the purpose of tactile genital stimulation (e.g., a vibrator). Treatment Medication-based options for the treatment of fetishistic disorder and other paraphilic disorders include anti-anxiety/antidepressant drugs called SSRIs and a number of different hormone therapies that achieve their effects by lowering the potential for sexual arousal, or the potential for sexual performance in response to sexual arousal. Examples of available hormonal treatments include estrogen and testosterone-lowering drugs called antiandrogens. Frotteurism involves a compulsion to rub ones self against strangers others in a sexual manner. Like exhibitionism and other impulse control disorders, frotteurism tends to involve a cycle of tension buildup that is relieved by acting out in ‘exciting' ways. Symptoms Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving touching and rubbing against a nonconsenting person. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Treatments Behavior therapy is often used to treat paraphilias. This can include management and conditioning of arousal patterns and masturbation. Therapies involving cognitive restructuring and social skills training are also utilized. Medication is also used to reduce fantasies and behavior relating to paraphilias. This is especially true of people who exhibit severely dangerous masochistic behaviors. Treatment can also be complicated by health problems relating to sexual behavior. Sexually transmitted diseases and other medical problems, especially when the sadomasochistic behavior involves the release of blood, can be present. Also, people participating in hypoxyphilia and other dangerous behaviors can suffer extreme pain and even death. Transvestism (Transvestic Fetishism) occurs when an otherwise ‘normal' heterosexual male has fantasies about and/or acts out dressing up in woman's clothing. Such cross dressing is commonly experienced as sexually stimulating. Symptoms Over a period of at least 6 months, in a heterosexual male, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving cross-dressing. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Treatment In the earliest period of behavior therapy, transvestic fetishes were narrowly viewed as inappropriate behavior that was confined to a limited range of situations, and were sometimes treated with aversion therapy , usually with electric shocks. This approach was largely unsuccessful. Persons with fetishes have also been treated by using a form of behavioral therapy known as orgasmic reorientation, which attempts to help people learn to respond sexually to culturally appropriate stimuli. This treatment also has had limited success. Most persons who have a transvestic fetish never seek treatment from professionals. Most are capable of achieving sexual gratification in culturally appropriate situations. Their preoccupation with crossdressing is viewed as essentially harmless to other persons, since transvestism is not associated with criminal activities or forcing one's sexual preferences on others. As of 2002, American society has developed tolerance for transvestites, thus further reducing the demand for professional treatment. Voyeurism or ‘peeping tom' behavior involves compulsive fantasizing about and/or acting out engaging in spying on someone (who does not know they are being observed) in the act of disrobing. This sort of behavior is very common amongst the general population; it is not diagnosable as a disorder unless it becomes a compulsive part of a person's sexual routine. Symptoms Over a period of at least 6 months, recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of disrobing, or engaging in sexual activity. The fantasies, sexual urges, or behaviors cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. Treatment For treatment to be successful, a voyeur must want to modify existing patterns of behavior. This initial step is difficult for most voyeurs to admit and then take. Most must be compelled to accept treatment. This may often be the result of a court order. Behavioral therapy is commonly used to try to treat voyeurism. The voyeur must learn to control the impulse to watch non-consenting victims, and just as importanly to acquire more acceptable means of sexual gratification. Outcomes of behavioral therapy are not known. There are no direct drug treatments for voyeurism. Voyeurism is a criminal act in many jurisdictions. It is usually classified as a misdemeanor. As a result, legal penalties are often minor. The possibility of exposure and embarrassment may deter some voyeurs. It is also not easy to prosecute voyeurs as intent to watch is difficult to prove. In their defense statements, they usually claim that the observation was accidental. Pedophilia is considered a paraphilia, an "abnormal or unnatural attraction." Pedophilia is defined as the fantasy or act of sexual activity with prepubescent children. Pedophiles are usually men, and can be attracted to either or both sexes. How well they relate to adults of the opposite sex varies. Perpetrators often delude themselves into viewing their actions as helpful to children. They might tell themselves they are contributing to a child's development or that the child is enjoying the act; however, they do tell their victims not to alert their parents or authorities. An estimated 20 percent of American children have been sexually molested, making pedophilia the most common paraphilia. Offenders are usually family friends or relatives. Types of activities vary and may include just looking at a child or undressing and touching a child. However, acts often do involve oral sex or touching of genitals of the child or offender. Studies suggest that children who feel uncared for or lonely may be at higher risk. What are the symptoms? People with this disorder may pretend that they are not doing anything wrong. They may tell themselves that they are "teaching" the child or that the child "wants to" have sex. Most pedophiles are attracted to one gender and age group. The symptoms of pedophilia are: For at least 6 months, having sexual fantasies, urges, or behaviors with a child age 13 years or younger. This happens over and over. Preferring children who go along with requests. Pedophiles may look at naked children, expose themselves, or masturbate without touching the child. They may also force sexual acts on the child. The fantasies, sexual urges, or behaviors cause pain, depression, anxiety, shame, or guilt. This may cause the pedophile to be more aggressive, or to do poorly at work or school. Pedophiles must be at least 16 years old, and at least 5 years older than the child. Sexual abuse of a child does not always mean that someone is a pedophile. People who have antisocial personality disorder or sadism may abuse children. These disorders may be more about power and control than sex. Pedophiles are sexually drawn to children. How is it treated? Pedophilia may be treated with psychotherapy, such as: Cognitive-behavior therapy: The therapist helps you identify views you have of yourself, your relationships, the world, and the future. This therapy helps you recognize unhealthy ways of thinking and behaving. You learn ways to think and behave that lead to healthier choices. Dynamic psychotherapy: The therapist helps you connect current behaviors and past experiences. He or she can help you sort out your feelings. This helps you identify problems and changes you want to make. Medicines such as female hormones or testosterone-lowering medicines may be used to reduce sex drive in men. Selective serotonin reuptake inhibitors (SSRIs) may reduce sex drive and lessen obsessive thoughts and compulsive behaviors. Mood stabilizers or antipsychotic medicines may also be helpful. Even with treatment, this disorder is usually lifelong. However, both the fantasies and the behaviors often lessen with ongoing treatment and as you get older. Gender Identity Disorder Gender identity disorder is a conflict between a person's physical gender and the gender he or she identifies as. For example, a person identified as a boy may actually feel and act like a girl. The person is very uncomfortable with the gender they were born. Symptoms A strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following: repeatedly stated desire to be, or insistence that he or she is, the other sex in boys, preference for cross-dressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex intense desire to participate in the stereotypical games and pastimes of the other sex strong preference for playmates of the other sex In adolescents and adults, the disturbance is manifested by symptoms such as a stated desire to be the other sex, frequent passing as the other sex, desire to live or be treated as the other sex, or the conviction that he or she has the typical feelings and reactions of the other sex. Treatment Individual and family therapy is recommended for children to create a supportive environment at home and in school. Individual and, if appropriate, couples therapy is recommended for adults. Sex reassignment through surgery and hormonal therapy is an option, but identity problems may continue after this treatment. On a final note, we should point out one mode of sexuality which is definitively not listed here; namely Homosexuality. Although historically listed as a sexual deviancy, homosexuality has been recognized as acompletely normal variant of human sexuality for many years now. But just because being gay isn't a sexual deviency or disorder, doesn't mean that it doesn't come with its own set of stressful issues.