Treatment of Psychosexual and

Gender Identity Disorders

Dr Amandeep Singh Ph.D (Psy)

Associate Professor Psychologist
Sri Guru ram das intitute of Medical Sciences and
Research, Sri Amritsar
 Sexual Dysfunctions
Sexual dysfunctions are disorders in which people
cannot respond normally in key areas of sexual
functioning

As many as 31% of men and 43% of women in the

U.S. suffer from such a dysfunction during their
lives

Sexual dysfunctions are typically very distressing,

and often lead to sexual frustration, guilt, loss of
self-esteem, and interpersonal problems

Often these dysfunctions are interrelated; many

patients with one dysfunction experience another
as well
 Sexual Dysfunctions
The human sexual response can be described as a cycle
with four phases:
• Desire
• Excitement
• Orgasm
• Resolution
Sexual dysfunctions affect one or more of the first three
phases
 Etiology of Sexual Dysfunctions
A. Biophysiological B. Intrapsychic C. Interpersonal
1. Diabetes 1. Rape 1. Hostility
2. Alcoholism 2. Cultural/ 2. Poor
3. Renal Failure Religious Taboo Communication
3. Stress 3. Tension Before
4. C.V. Disorder
4. Low Self- Love Making
5. Drugs(MAOI,
Heroin, esteem
Methadone, 5. Altered Body
Barbiturates Images
Treatments for Sexual Dysfunctions

The last 35 years have brought major changes in the

treatment of sexual dysfunction

Early 20th century: psychodynamic therapy Believed

that sexual dysfunction was caused by a failure to
negotiate the stages of psychosexual development
Therapy focused on gaining insight and making broad
personality changes; was generally
Treatments for Sexual Dysfunctions
1950s and 1960s: behavioral therapy Behavioral
therapists attempted to reduce fear by applying
relaxation training and systematic desensitization
Had moderate success, but failed to work in cases
where the key problems included
• misinformation,
• negative attitudes,
• and lack of effective sexual techniques
 Treatments for Sexual Dysfunctions
1970: Human Sexual Inadequacy This book, written by
William Masters and Virginia Johnson, revolutionized
treatment of sexual dysfunctions
This original “sex therapy” program has evolved into a
complex, multidimensional approach Includes techniques
from
• cognitive,
• behavioral,
• couples,
• and family systems therapies, along with a number of sex-
specific techniques More recently, biological interventions
have also been incorporated
What Are the General Features of
Sex Therapy?
Modern sex therapy is short-term and instructive
Therapy typically lasts 15 to 20 sessions It is
centered on specific sexual problems rather than
on broad personality issues.
What Are the General Features of
Sex Therapy?
Modern sex therapy includes:
• Assessing and conceptualizing the problem
• Assigning “mutual responsibility” for the problem
• Education about sexuality Attitude change
• Elimination of performance anxiety and the spectator
role
• Increasing sexual and general communication skills
• Changing destructive lifestyles and marital interactions
• Addressing physical and medical factors
 What Techniques Are Applied to
Particular Dysfunctions?
In addition to the universal components of sex
therapy, specific techniques can help in each of
the sexual dysfunctions
 What Techniques Are Applied to
Particular Dysfunctions?
Hypoactive sexual desire and sexual aversion
These disorders are among the most difficult to treat because of the
many issues that feed into them
Therapists typically apply a combination of techniques, which may
include:
A. Effectual awareness,
B. self-instruction training,
C. behavioral techniques,
D. insight-oriented exercises,
E. and biological interventions such as hormone treatments
 What Techniques Are Applied to
Particular Dysfunctions?
Erectile disorder
Treatments for ED focus on reducing a man’s
performance anxiety and/or increasing his
stimulation
May include sensate-focus exercises such as the
“tease technique”
 What Techniques Are Applied to
Particular Dysfunctions?
Erectile disorder

Biological approaches, used when the ED has biological causes, have gained
great momentum with the development of sildenafil (Viagra) and other
erectile dysfunction drugs
Most other biological approaches have been around for decades and include
1. gels,
2. suppositories,
3. penile injections,
4. and a vacuum erection device (VED)

These procedures are now viewed as “second-line” treatment Another

biological approach – penile implant surgery – is performed only rarely
 What Techniques Are Applied to
Particular Dysfunctions?
Male orgasmic disorder
Like treatment for ED, therapies for this disorder include
techniques to reduce performance anxiety and increase
stimulation
When the cause of the disorder is physical, treatment may
include a drug to increase arousal of the sympathetic
nervous system
 What Techniques Are Applied to
Particular Dysfunctions?
Rapid or Premature ejaculation
Premature ejaculation has been successfully treated for years
by behavioral procedures such as the “stop-start” or “pause”
procedure and the “squeeze” technique
Some clinicians favor the use of fluoxetine (Prozac) and other
serotonin-enhancing antidepressant drugs Because these drugs
often reduce sexual arousal or orgasm, they may be helpful in
delaying premature ejaculation Many studies have reported
positive results with this approach
 What Techniques Are Applied to
Particular Dysfunctions?
Female arousal and orgasmic disorders
Specific treatments for these disorders include
•cognitive-behavioral techniques,
•self-exploration,
•enhancement of body awareness,
•and directed masturbation training
Biological treatments, including
•hormone therapy or the use of sildenafil (Viagra),
have also been tried, but research has not found such interventions to be
consistently helpful
 What Techniques Are Applied to
Particular Dysfunctions?
Female arousal and orgasmic disorders
Again, a lack of orgasm during intercourse is not necessarily
a sexual dysfunction, provided the woman enjoys
intercourse and is orgasmic through other means For this
reason, some therapists believe that the wisest course of
action is simply to educate women whose only concern is
lack of orgasm through intercourse
 What Techniques Are Applied to
Particular Dysfunctions?
Vaginismus
Specific treatment for vaginismus takes two approaches:
Practice tightening and releasing the muscles of the vagina
to gain more voluntary control
Overcome fear of intercourse through gradual behavioral
exposure treatment
Most women treated for vaginismus using these methods
eventually report pain-free intercourse
What Are the Current Trends in Sex
Therapy?
Over the past 30 years, sex therapists have moved beyond
the approach first developed by Masters and Johnson
Therapists now treat unmarried couples, those with other
psychological disorders, couples with severe marital
discord, the elderly, the medically ill, the physically
handicapped, clients with a homosexual orientation, and
clients with no long-term sex partner
What Are the Current Trends in Sex
Therapy?
Therapists are paying more attention to excessive
sexuality, which is sometimes called hypersexuality or
sexual addiction
The use of medications to treat sexual dysfunction is
troubling to many therapists
They are concerned that therapists will choose biological
interventions rather than a more integrated approach
 Gender Identity Disorder
The DSM-IV-TR categorization of this
disorder has become controversial in recent
years
Many people believe that transgender
experiences reflect alternative – not
pathological – ways of experiencing one’s
gender identity Others argue that gender
identity disorder is, in fact, a medical
problem that may produce personal
unhappiness
 Gender Identity Disorder

According to current DSM-IV-TR

criteria, people with this disorder
persistently feel that they have
been assigned to the wrong
biological sex
They would like to remove their
primary and secondary sex
characteristics and acquire the
characteristics of the opposite sex
 Gender Identity Disorder

Men with gender identity

disorder outnumber women 2
to 1 People with gender identity
disorder often experience
anxiety or depression and may
have thoughts of suicide
 Gender Identity Disorder
The disorder sometimes emerges in childhood and
disappears with adolescence In some cases it develops into
adult gender identity disorder Various theories have been
proposed to explain this disorder, but research is limited
and generally weak
Some clinicians suspect biological – perhaps genetic or
prenatal – factors Abnormalities in the hypothalamus
(particularly the bed nucleus of stria terminalis) are a
potential link
 Gender Identity Disorder

To more effectively assess and treat those with the

disorder, clinical theorists have tried to distinguish the
most common patterns of gender dysphoria: Female-to-
male Male-to-female: Androphilic Type Male-to-female:
Autogyneophilic Type Some adults with this disorder
change their sexual characteristics by way of hormones;
others opt for sexual reassignment (sex change) surgery
Thanks