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Sexual disorder can be classified into 4 main types…
1. Sexual dysfunctions
2. Gender identity disorder
3. Psychological and behavioural disorders associated
with sexual development and maturation.
4. Paraphilias (disorder of sexual preference)
The essential features of sexual dysfunctions are an inability to
respond to sexual stimulation, or experience of pain during the
Dysfunctions can be defined by disturbance in the subjective
sense of pleasure or desire usually associated with sex, or by the
IN DSM -5, the sexual dysfunctions include male hypoactive
sexual desire disorder, female sexual interest/arousal disorder,
erectile disorder, female orgasmic disorder, delayed ejaculation,
premature ejaculation, genito-pelvic pain/penetration disorder,
substance/medication induced sexual dysfunction, other
specified sexual dysfunction and unspecified sexual
Sexual dysfunctions can be life long or acquired,
generalized or situational and result from
psychological factor, physiological factor, combined
factors and numerous stressor including prohibitive
cultural mores, health and partner issues, and
Male hypoactive sexual desire
This dysfunction is characterized by a deficiency or
absence of sexual fantasies and desire for sexual
activity for a minimum duration of approximately 6
A reported with 6 % of men ages 18-24 ,and 40 % of
men ages 66-74 have problems with sexual desire.
A: persistently or recurrently deficient sexual/erotic
thoughts or fantasies and desire for sexual activity. The
judgement of deficiency is made by the clinician, taking
into account factor that affect sexual functioning, such as
age and socio-cultural contexts of the individual’s life.
The symptoms of criteria A have persisted for a minimum
duration of 6 month.
The symptoms in criteria A cause clinical significant
distress in the individual.
The sexual dysfunction is not better explained by a nonsexual
mental disorder or as a consequences of severe relationship
distress or other significant stressor and is not attributable to the
effects of a substance/medication or another medical condition.
Lifelong: The disturbance has been present since the individual
became sexually active.
Acquired: the disturbances began after a period of relatively
normal sexual function.
Generalized: not limited to certain types of stimulation, situations
Situational: only occurs with certain types of stimulation
,situations, or partners.
Specify whether: MILD,MODERATE,SEVERE
Women may experiencing sexual dysfunction may
experience either/or both inability to feel interest or
arousal, and they may often have difficulty achieving
orgasm or experience pain in addition.
Lack of, or significantly reduced, sexual interest/arousal as
manifested by at least 3 of the following:
1. Absent/reduced interest in sexual activity.
2. absent/reduced sexual/erotic thoughts or fantasies.
3. Reduced initiation of sexual activity and typically
unresponsive to partner’s attempts to initiate.
4. Absent sexual excitement/pleasure during sexual activity
in almost all.
5. Absent sexual interest/arousal in response to any internal
or external sexual or erotic cues.(written, verbal,visual)
6. Absent /reduced genital or nongenital sensations during
sexual activity in almost all
B. The symptoms in criteria A have persisted for a minimum
duration of 6month.
C. The symptoms in criterion A cause clinically significant
distress in the individual.
D. The sexual dysfunction is not better explained by a nonsexual
mental disorder or a consequence of a severe relationship
distress. Or other significant stressor & is not attributable to the
effects of a substance/medication or another medical condition.
Lifelong: the disturbance has been present since the individual
became sexually active
Acquired: the disturbance began after a period of relatively
normal sexual sexual function
Specify whether: Generalized & situational
Specify whether: mild , moderate or severe
Male erectile disorder:
• Male erectile disorder historically c/d impotence. The
incidence of erectile disorder increases with age.it has
been reported variously as 2 to 8 percent of the young
Alfred Kinsey reported that 75% of all men were impotent
at the age of 80.
Male erectile disorder can be organic or psychological or
combition of both, but in young and middle-aged men the
cause is usually psychological.
A: at least one of the three following symptoms must be experienced on
almost all or all
1. Marked difficulty in obtaining an erection during sexual activity.
2. Marked difficulty in maintaining an erection until the completion of
3. Marked decrease in erectile rigidity.
B. The symptoms in criterion A have persisted for a minimum duration
of 6 month.
The symptoms in criteria A cause clinically significant distress in
The sexual dysfunction is not better explained by a nonsexual mental
disorder or a consequence of a severe relationship distress.
Mild ,moderate or severe
MALE ORGASMIC DISORDER(MALE ANORGASMIA)
• Failure or marked difficulty to have orgasm, despite normal
sexual excitement, during coitus.
• An uncommon disorder ,it often presents as retarted
• Also c/d delayed ejaculation: a man achieves ejaculation
during coitus with great difficulty.
• The cause can be biological(post-prostate surgery, drug
induced )or psychological(marital conflicts).
Failure or marked difficulty to have orgasm, despite normal
sexual excitement, during coitus.
A woman with life long female orgasmic disorder has never
been experienced orgasm by any kind of stimulation. A
woman with acquired orgasmic , disorder has previously
experienced at least 1 orgasm, regardless of circumstances.
The causes can be biological(endocrinal disorder such as
hypothyroidism, drug induced)or psychological(marital
Premature ejaculation :
• This disorder is defined as ejaculation before the
completion of satisfactory sexual activity for both
• In severe cases, it is characterised by ejaculation either
before penile entry into vagina or soon after
• The cause can be biological or
Sexual dysfunction due to a general medical condition.
Substance/medication induced sexual dysfunction.
•Tricyclic antidepressants & MAO
•Barbiturates & benzodiazepine
•Opiates & cocaine
Effect on sexual desire
•Increased(with low dose)
•Decreased(with high dose)
Effect on erectile function
Effect on ejaculation
Diagnosis is clinical, a detailed physical examination and
lab investigations(blood counts, blood sugar,LFT,thyroid
profile, hormonal profile)coupled with a good history is
must in every patient to rule out an underlying physical
Certain lab technique (penile plethysmograph) may help in
differentiating organic & nonorganic sexual dysfunctions.
A large majority of dysfunctions are psychosexual in
nature. A detailed sexual & personal history is imp in
finding out the underlying causes.
It should be specified whether the sexual dysfunction is
psychogenic alone or biogenic factor co-exist, whether the
dysfunction is lifelong or acquired and whether the
dysfunction is situational or generalised.
3. Group psychotherapy
4. Behavior therapy
5. Dual-sex therapy
6. Drug therapy
Disorders of sexual development and maturation
include disorder where sexual
orientation(heterosexual, homosexual, bisexual) cause
significant distress to the individual or disturbances in
It is important to remember that any type of sexual
orientation by itself is not a disorder unless it causes
distress or disability.
This disorder usually begins in adolescence and is
characterised by uncertainty regarding the gender identity
or sexual orientation. The uncertainty often leads to
anxiety & depression.
Ego dystonic sexual orientation:
In this disorder, the sexual orientation is clear. However the
individual wishes to change the orientation b/z of the
associated distress and or psychological symptoms.
Commonly seen in homosexuality
The prevalence of homosexuality(in USA) is 4-6% of
males & 1-2% of females. Another 5-10% may show
Female homosexual is c/d lesbians & male
homosexual is c/d gay.
1. Psychotherapy: psychoanalytic & supportive
depending on the personality character.
2. Drug therapy : antidepressants & BZP for associated
depression & anxiety.
This disorder is characterized by disturbance in gender
identity: the sense of one’s masculinity or femininity is
This group includes:
Transexualism: male & female: primary & secondary.
Gender identity disorder of childhood
Normal anatomic sex.
Persistent and significant sense of discomfort..
Marked preoccupation with the wish to get rid of
one’s genitals & sec sex characteristics.
Diagnosis is made after puberty.
1. Early childhood onset
2. Homogeneous category
3. 2 main types- Male primary Transexualism & female
1. Later onset
2. Heterogeneous category
3. Majority of these patients are male transexuals
1. Making the person reconcile with anatomic sex
2. Arrange sex-change to the desired gender.
• It is characterized by wearing of clothes of opposite sex
in order to enjoy the temporary experience of
membership of the opposite sex.
• No desire of permanent sex change
• No sexual excitement accompanies the cross-dressing
This is a disorder similar to Transexualism with a very early
age of onset(2-4 year of age).
Persistent & significant desire to be of the other gender
Marked distress regarding the anatomic sex
Involvement in traditional activities
Onset before puberty
• The patients with this disorder have gross anatomical &
physiological aspects of other sex.
1. External genitals
2. Internal sex organs
3. Hormonal disturbances,(testicular feminisation
4. chromosomes,(turner’s syndrome)
Paraphilias(sexual deviations: perversions) are disorder of
sexual preference in which sexual arousal occurs
persistently and significantly in response to objects which
are not a part of normal sexual arousal.
DSM-5 list these disorder:
It is the recurrent urge to expose the genitals to a stranger
or to an unsuspecting person.
Sexual excitement occurs in anticipation of the exposure &
orgasm is brought about by masturbation during or after
Specifiers added to exhibitionistic disorder by DSM-5
differentiate arousal from exposing genitals to prepubertal
children, to physically mature individuals or to both
prepubertal children & physically mature person.
In fetishism the sexual focus on objects(shoes, gloves,
stockings) that are intimately associated with the human
body or on nongenital body parts.
Sexual activity may be directed toward the fetish
itself(masturbation with or into a shoe) or the fetish may be
incorporated into sexual intercourse(high heeled shoes be
According to Freud, fetish serves as symbol of the phallus to
person with unconscious castration fears.
Learning theorists believe that the object was associated
with sexual stimulation at an early age.
Frotteurism is usually characterized by a man’s
rubbing his male genital parts against the buttocks or
other body parts of a fully clothed woman to achieve
The acts usually occur in crowed places, particularly in
subways and buses.
The is often seen in adolescent males.
Pedophilia involves recurrent intense sexual urges
towards ,or arousal by children 13 year of age or
younger over a period of at least 6 month.
Most child molestations involve genital fondling or
Vaginal or anal penetration occurs infrequently, except
in case of incest.
DSM-5 added Specifiers to a diagnosis of pedophilic
disorder: sexually attracted to males; sexually attracted
to females; or sexually attracted to both.
According to DSM-5 ,person with sexual masochism
have a recurrent preoccupation with sexual urges and
fantasies involving the act of being humiliated, beaten,
bound or otherwise made to suffer.
More common among men than among women
Freud believed masochism resulted from destructive
fantasies turned against the self.
Persons with sexual masochism may have had
childhood experiences that convinced them that pain
is a prerequisite for sexual pleasure.
DSM-5 defines sexual sadism as the recurrent and
intense sexual arousal from physical and psychological
suffering of another person.
The method used range from restraining by tying,
beating,burning,cutting,stabbing, to rape and even
A person must have experienced these feelings for at
least 6 months & must have acted on sadistic fantasies
to receive a diagnosis of sexual sadism disorder.
Onset before the age of 18 years, mostly male.
Also k/n as scopophilia.
Persistent or recurrent tendency to observe
unsuspecting persons(usually of the other sex) naked,
disrobing or engaged in sexual activity.
This is often followed by masturbation to achieve
orgasm without the observed person being aware.
Almost seen in male
This disorder exclusively in heterosexual males.
Fantasies and sexual urges to dress in opposite gender
clothing as a means of arousal and ad a adjust to
masturbation or coitus.
The diagnosis is given when the transvestism fantasies have
been acted upon for at least 6 month.
DSM-5 Specifiers with a diagnosis of transvestism disorder:
with fetishism is added if the patient is aroused by fabrics,
materials, or garments; with autogynephilia is added if the
patient is sexually aroused by thoughts or images of
himself as a female.
Zoophilia: persistent and significant involvement
in sexual activity with animal is rare.
Urophilia: sexual arousal with urine
Coprophilia: sexual arousal with faeces
Necrophilia : obsession and obtaining sexual
gratification from cadaver.
Hypoxyphilia: desire to archive an altered state of
consciousness sec to hypoxia while experiencing
Telephone or computer scotologia: it is characterized by
obscene phone calling & involving an unsuspected partner.
Tension and arousal begin in anticipation of phoning; the
recipient of the call listens while the telephoner verbally
exposes his preoccupations or induces her to talk about her
Masturbation: masturbation is abnormal when it is the only
type of sexual activity performed in adulthood if a partner is or
might be available, when it’s frequency indicate a compulsion or
sexual dysfunction or when it is consistently preferred to sex
with a partner.
Psychoanalysis and psychoanalytic psychotherapy