SEXUAL AND GENDER IDENTITY DISORDERS

Sexuality is one of the more personal and private spheres of an individual’s life. Every person has his or her own sexual life, with preferences and fantasies that in some cases may occasionally scandalize other people, but which in any case form part of normal sexual functioning. However, when fantasies or desires are pathological, and have undesired or harmful effects on ourselves or on others, as in the case of voyeurism, they are qualified as Sexual Disorders or Paraphilias.

Gender Identity Disorders. Are you a boy or a girl? Are you a man or a woman? The answer to these questions is immediate and obvious for almost everyone, and also for individuals affected by serious mental disorders such as schizophrenia. From early childhood onwards, our gender identity - the feeling that we are males or females - is so deeply rooted that the great majority of people are perfectly certain of which gender they belong to, also if they have been the victims of particularly stressful events at some time in their lives. Some people however, again from early childhood - and this occurs to men more often than to women - feel within themselves that they belong to the opposite sex. Their anatomical attributes, i.e., normal genitals and the usual secondary characteristics, such as the growth of a beard in men and the development of breasts in women, are sufficient evidence for others who can see them, but not for these individuals. A man may look at himself in a mirror, see an individual who is male, in biological terms, and yet despite this fact will this declare that he is a woman.

It is possible that he might even go a step further and try to convince a physician to intervene in some way to make his body resemble that of a woman and thus correspond with his gender identity. The Gender Identity Disorder includes people with the core symptom of Gender Dysphoria, or those who are not satisfied with their anatomical sex and would like to belong to the other sex. Such individuals include those who hope to undergo surgical operations in order to acquire the attributes of the opposite sex. The latter are sometimes referred to as transsexuals. Individuals with Gender Identity Disorder often suffer from anxiety and depression, which is not surprising if one takes into consideration their difficult psychological situation. A male individual with a Gender Identity Disorder will moreover interpret his sexual interest in men as a conventional heterosexual preference given that he considers himself a woman in every respect.

Fetishism. Fetishists are persons who attain sexual arousal only through the use of an inanimate object. Fetishists, who are nearly always men, have recurrent sexual drives with respect to inanimate objects called fetishes (for example, women’s shoes) and the presence of a fetish is markedly preferred or even necessary for sexual arousal. Beautiful shoes, stockings, toiletry articles, furs and, in particular, underwear, are common sources of arousal for fetishists. Some indulge in fetishist behaviour  in private, while others need a sexual partner to wear the fetish as a source of arousal prior to sexual intercourse. Occasionally, fetishists will be especially interested in collecting their preferred objects and may continuously commit offences in order to procure new specimens to add to their collection.

The attraction experienced by a fetishist towards a particular object is involuntary and irresistible. Fetishists attracted by boots must see and touch a boot in order to become aroused, and when the fetish is present, arousal is irresistibly strong. When a man becomes sexually aroused by wearing women’s clothing, while still considering himself a man, we speak in terms of Transvestic Fetishism. A transvestite may experience satisfaction appearing in public dressed as a woman; some, who impersonate female roles, exhibit themselves in nightclubs for the amusement of other people of conventional sexual habits who love to watch shows put on by transvestites. However, unless the transvestic activity is associated with sexual arousal, these ‘showmen’ are not considered true transvestites.

Paedophilia and Incest. According to police reports, paedophiles are adults - usually males - who derive sexual gratification from physical and often sexual contact with prepuberal children to whom they are not related. The DSM indicates that a paedophile must be at least 16 years old and at least 5 years older than the child. A paedophile can be heterosexual or homosexual. Violence rarely enters into this kind of molestation but it may occur, as revealed by certain sordid tales brought to the attention of the public through the media. Even if in the majority of cases paedophiles do not harm their victims physically, some may frighten the child, for example by killing its favourite animal and threatening other forms of retaliation if the child reveals everything to its parents.

A minority of paedophiles, who can be classified as sexual sadists or as antisocial personalities (psychopaths), inflict serious physical injuries on the object of their passion. Such individuals might be more appropriately defined as child-rapists as their desire to hurt the child is at least as equally strong as the desire to obtain sexual gratification (Groth et al., 1982). The term incest refers to a sexual relation between close relations, for whom marriage would be prohibited. Incest is classified in the DSM as a sub-type of paedophilia. The most common form of incest is that occurring between a brother and sister, followed by that between a father and daughter, the latter situation being considered as more pathological. There are two important distinctions to be made between incest and paedophilia. Firstly, by definition, incest occurs between members of the same family and secondly most of the victims of incest tend to be older with respect to the object of desire of a paedophile. It is more frequent to find a father becoming interested in his daughter when she begins to mature physically, whereas a paedophile is interested in a child strictly on account of its sexual immaturity.

Voyeurism. This is a marked preference for the attainment of sexual gratification through the observation of other persons while they are naked or engaging in sexual activity. Voyeur reach orgasm through masturbation or during voyeuristic activities or subsequently, while recalling what they have seen. The voyeur sometimes fantasizes having contact with the observed person but this usually remains a fantasy; in voyeurism, any contact between the observer and the observed person is rare.

Exhibitionism. This is a marked urge to exposure one’s genitals to a stranger, who does not expect such an event, in order to procure sexual gratification. As in the case of voyeurism, it is rare to find any attempt on the part of the exhibitionist to make actual contact with the stranger involved. Sexual arousal derives from fantasizing or actually engaging in self-exhibition; the exhibitionist will masturbate either while he is fantasizing or even while he is exposing his genitals.

Sexual Sadism and Sexual Masochism. The essential characteristic of Sexual Sadism is a distinct preference for the attainment of or an increase in sexual gratification through the physical or psychological sufferance inflicted on a victim. In Sexual Masochism however, sexual satisfaction is achieved or increased by means of the physical suffering or humiliation a  subject submits to. Both disorders can be found in either heterosexual or homosexual relations. Most sadists establish relationships with masochists to ensure mutual sexual satisfaction.

Sexual Desire Disorders. There are two types of disorder in this category. The first is the Hypoactive Sexual Disorder, which refers to a lack or the complete absence of sexual fantasies and drives. The second is the Sexual Aversion Disorder, in which almost all genital contact with partners is actively avoided. Causes of these disorders include factors of a religious nature, attempts to engage in sexual relations with a partner of the non-preferred sex, a fear of losing control, the fear of an undesired pregnancy, depression, the side effects of medicines such as anti-hypertensives and tranquillizers, interpersonal difficulties (marital problems) and a lack of attraction deriving from factors such as a partner’s poor personal hygiene (LoPiccolo and Friedman, 1988).

Sexual Arousal Disorders. Some individuals present no problems in relation to their level of sexual desire but have difficulty in attaining or maintaining sexual arousal. The two disorders belonging to this category are the Female Sexual Arousal Disorder and the Male Erectile Disorder. The diagnosis of an Arousal Disorder is provided for a woman when she presents a degree of vaginal lubrication constantly inadequate for the completion of sexual intercourse, and for a man when there is a persistent incapacity to obtain or maintain an erection until the completion of intercourse.

Orgasmic Disorders. The three disturbances in this category are: the Female Orgasmic Disorder, which refers to an absence of orgasm after a normal period of sexual arousal; the Male Orgasmic Disorder, which refers to a male’s difficulty in ejaculating; and Premature Ejaculation, which is probably the most widespread sexual dysfunction amongst men. In Premature Ejaculation a man may sometimes ejaculate even before penetrating the vagina, and this occurs usually only a few seconds after penetration.

Sexual Pain Disorders. The two disorders in this category are Dispareunia and Vaginismus. Dispareunia consists in a recurrent and persistent pain before, during and after sexual intercourse, while Vaginismus is characterised by involuntary spasms of the vagina, which make sexual intercourse impossible.

>>> (Eating Disorders)

 

Bibliographical references:

Groth, N.A., Hobson, W.F., Guy, T.S. (1982). The child molester: Clinical observations. In J. Conte & D.A. Shore, Social work and child sexual abuse. New York: Haworth.

LoPiccolo, J., Friedman, J. (1988). Broad-spectrum treatment of low sexual desire: Integration of cognitive, behavioural, and systemic therapy. In S. Leiblum & R.C. Rosen, Sexual desire disorders. New York: Guilford.

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