Mark Hillman, Ph.D., (Psy) LMHC
Sexual disorders include problems of sexual identity, sexual performance, and sexual aim. There are three major categories of sexual disorders: sexual dysfunctions, paraphilia, and gender identity disorders.
Sexual dysfunctions prevent or reduce an individual's enjoyment of normal sex and prevent or reduce the normal physiological changes brought on normally by sexual arousal. These dysfunctions can be classified by the phase of the sexual cycle in which they occur. It is important to keep in mind that the diagnosis of sexual dysfunction is made only when the disability persists. Any of them could occur occasionally or be caused by a temporary factor such as fatigue, sickness, alcohol, or drugs.
There are two types of dysfunctions that can occur during the desire phase. One is hypoactive desire which is basically a disinterest in sexual activity. It results in a complete or almost complete lack of desire to have any type of sexual relation. This can often result in the participation in intercourse as a simple marital duty.
The second type is an aversion to sex. This is different from simple hypoactive sexual desire in that sexual activity actually repulses the person or makes them unusually apprehensive. This is most often the result of a traumatic sexual experience, such as molestation as a child or rape.
Erectile dysfunction is the inability of males to attain or sustain erection long enough for coitus. The inability of females to become sexually aroused is sexual arousal disorder.
When males are unable to control ejaculation so that it occurs before satisfying sexual relations can take place with the partner this is known as premature ejaculation . Ejaculatory incompetence is the lack or delay of reaching orgasm in males. The female version of this is inhibited female orgasm- the lack or delay of reaching orgasm in females.
There are two sexual pain disorders. Dyspareunia is when pain occurs during intercourse. This is predominantly a female complaint, but it does occur in males occasionally. Vaginismus is a female disorder in which involuntary spasmodic muscle contractions occur at the entrance to the vagina when an attempt is made to insert the penis. If intercourse is attempted despite these contractions, a painful sexual experience results.
Paraphilias are sexual behaviors in which unusual objects or scenarios are necessary to achieve sexual excitement. Eight paraphilias are recognized which are grouped into 3 broad categories.
There are two types of preferences for nonhuman objects: fetishism and transvestism.
A fetish exists when a person is sexually aroused by a nonliving object. It can manifest in two ways, one more extreme than the other. One form associates coitus with some object (most frequently women's panties or other undergarments ). It is relatively harmless if the action is taken playfully and is acceptable to the person's partner. Focus on certain parts of the body (feet, hair, ears, etc.) aside from those part of the pleasurable foreplay, can become fetishistic in its hold on the individual. The more extreme form of fetishism is when a nonliving object completely substitutes for a human partner, such as underwear, boots, and shoes or such textured objects as velvet or silk. Here, orgasm is achieved when the person is alone, fondling the object.
This paraphilia exists when the person achieves sexual excitement by cross-dressing. This is very rarely found in females so the male side of this paraphilia will be used as the example. Two different purposes seem to be associated with this act in different individuals. In one aspect the person seeks to intensify sexual excitement in intercourse with a partner by only partially dressing as a woman. In the other form, the male moves about in full female regalia, which suggests some type of gender identity problem but not necessarily homosexuality.
"Sadist" is applied to those who derive sexual excitement from the pain of others. "Masochist" is applied to those who derive sexual excitement through their own pain. Hence, sadists and masochists go hand in hand, one depending on the need of the other. The danger of these needs is that each may need successively more brutal treatment to satisfy their sexual needs.
The three types of this category of paraphilia are exhibitionism, voyeurism, and pedophilia. All three are considered crimes in this country and are almost entirely male crimes.
Exhibitionism is the exposure of one's genitals in a public place. It is the most prominent sexual offense leading to arrest and makes up one third of all sexual crimes. From the psychological point of view, there are three characteristic features of the exhibition. First, it is always performed for unknown women; second it always takes place where sexual intercourse is impossible, for example in a crowded shopping mall; and third it must be shocking for the unknown woman or it seems to lose its power to produce sexual arousal in the individual. Exhibitionists are not assaultive and are considered more of a nuisance than an actual danger.
Looking at sexually arousing pictures or situation is a relatively common, apparently normal activity. The difference between that and voyeurism is that in normal watching, the viewing is a prelude to normal sexual activity. In the voyeur or "Peeping Tom" the experience replaces normal sexual activity. Nevertheless, voyeurism may exist in a person who also engages in normal heterosexual activity.
Pedophilia is the act of deriving sexual excitement through the physical contact of children. This paraphilia is radically different from exhibitionism and voyeurism in its severely damaging impact on the nonconsenting partner, a child. Ordinarily, the pedophiliac is someone who has ready access to the child. The child or parent would have no reason to suspect that the individual has a pedophilic orientation.
A gender identity disorder exists when a person, male or female, experiences confusion, vagueness or conflict in their feelings about their own sexual identity. There is a struggle between the individual's anatomical sex gender and subjective feelings about choosing a masculine or feminine style of life.