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13 R CHAPTER Sexual Disorders and Gender Identity Disorder TOPIC OVERVIEW sexual dysfunctions Disorders of Desire Disorders of Excitement Disorders of Orgasm Disorders of Sexual Pain treatments for sexual dysfunctions What Are the General Features of Sex Therapy? What Techniques Are Applied to Particular Dysfunctions? What Are the Current Trends in Sex Therapy? paraphilias Fetishism Transvestic Fetishism Exhibitionism Voyeurism Frotteurism Pedophilia Sexual Masochism Sexual Sadism A Word of Caution gender identity disorder putting it together: a private topic draws public attention 13 obert, a 57-year-old man, came to sex therapy with his wife because of his inabil- ity to get erections. He had not had a problem with erections until six months ear- lier, when they attempted to have sex after an evening out, during which he had had several drinks. They attributed his failure to get an erection to his being “a lit- tle drunk,” but he found himself worrying over the next few days that he was per- haps becoming impotent. When they next attempted intercourse, he found himself unable to get involved in what they were doing because he was so intent on watch- ing himself to see if he would get an erection. Once again he did not, and they were both very upset. His failure to get an erection continued over the next few months. Robert’s wife was very upset and . . . frustrated, accusing him of having an affair, or of no longer finding her attractive. Robert wondered if he was getting too old, or if his medication for high blood pressure, which he had been taking for about a year, might be interfering with erection. . . . When they came for sex therapy, they had not attempted any sexual activity for over two months. (LoPiccolo, 1992, p. 492) Sexual behavior is a major focus of both our private thoughts and public discus- sions. Sexual feelings are a crucial part of our development and daily functioning, sexual activity is tied to the satisfaction of our basic needs,and sexual performance is linked to our self-esteem. Most people are fascinated by the abnormal sexual behavior of others and worry about the normality of their own sexuality. Experts recognize two general categories of sexual disorders: sexual dysfunc- tions and paraphilias. People with sexual dysfunctions experience problems with their sexual responses. Robert, for example, had a dysfunction known as erectile disorder, a repeated failure to attain or maintain an erection during sexual activ- ity. People with paraphilias have repeated and intense sexual urges or fantasies in response to objects or situations that society deems inappropriate, and they may behave inappropriately as well.They may be aroused by the thought of sexual ac- tivity with a child, for example, or of exposing their genitals to strangers, and they may act on those urges. In addition to the sexual disorders, DSM includes a diag- nosis called gender identity disorder, a sex-related disorder in which people persis-
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