Sexual and Gender Identity Disorders

As mentioned previously, it will be most often the individual’s own perception whether the threshold for ‘impairment’ is reached. Thus, in most of the following areas a diagnosis will only be made together with the person seeking support and wanting to learn new skills and strategies. In addition, it might be useful or necessary to involve significant others from the person’s life into the treatment. The primary characteristic in this category is the impairment in normal sexual functioning. This can refer to an inability to perform or reach an orgasm, painful sexual intercourse, a strong repulsion of sexual activity, or an exaggerated sexual response cycle or sexual interest. A medical cause must be ruled out prior to making any sexual dysfunction diagnosis and the symptoms must be hindering the person’s everyday functioning.

Due to the widely varied sexual response in individuals, these presentations must be judged by a clinician and the assistance seeking client together to be significant, taking into account the person’s age and situation. The condition has to be persistent or occur frequently and cause significant distress. Is not a direct effect of substance use, another disorder or physical diagnosis.

Dyspareunia

Recurrent or persistent genital pain associated with sexual intercourse. Can be diagnosed in males or females.

Female Orgasmic Disorder

Delay of orgasm following normal excitement and sexual activity.

Female Sexual Arousal Disorder

Inability to attain or maintain until completion of sexual activity adequate lubrication  in response to sexual excitement.

Hypoactive Sexual Desire Disorder

Deficient or absent sexual fantasies and desire for sexual activity.

Male Erectile Disorder

Recurring inability to achieve or maintain an erection until completion of the sexual activity.

Male Orgasmic Disorder

Recurring inability to achieve or maintain an erection until completion of the sexual activity.

Premature Ejaculation

Ejaculation with minimal sexual stimulation before or shortly after penetration and before the person wishes it.

Sexual Aversion Disorder

Persistent or recurring aversion to or avoidance of sexual activity. The aversion must result in significant distress for the individual.

Gender Identity Disorder

Gender Identity Disorder has also been placed in this category, although no outward dysfunction needs to be present for this disorder. Basically, it includes strong feelings of being the wrong gender, or feelings that one’s outward body is inconsistent with one’s internal sense of being either male or female. There is a sense of discomfort and feelings of ‘born the wrong sex.’ This has been confused with cross-dressing or Transvestic Fetishism, which are distinct diagnoses.

Paraphilias

Paraphilias all have in common distressing and repetitive sexual fantasies, urges, or behaviours.  These fantasies, urges, or behaviours must occur for a significant period of time and must interfere with either satisfactory sexual relations or everyday functioning if the diagnosis is to be made.  There is also a sense of distress within these individuals.  In other words, they typically recognize the symptoms as negatively impacting their life but feel as if they are unable to control them.

Exhibitionism
This disorder is characterized by intense sexually arousing fantasies, urges, or behaviours in which the individual exposes himself/ herself to an unsuspecting stranger.

Fetishism
Fetishism is characterized by intense sexually arousing fantasies, urges, or behaviours in which the individual uses a nonliving object in a sexual manner. This disorder is characterized by intense sexually arousing fantasies, urges, or behaviours in which the individual touches or rubs against an non-consenting person in a sexual manner.

Pedophilia
This disorder is characterized by intense sexually arousing fantasies, urges, or behaviours involving sexual activity with a prepubescent child (typically age 13 or younger). To be considered for this diagnosis, the individual must be at least 16 years old and at least 5 years older than the child.

Sexual Masochism and Sexual Sadism
Sexually masochistic/sadistic behaviours are typically evident by early adulthood, and often start with masochistic or sadistic play in childhood. The disorder is characterized by intense sexually arousing fantasies, urges, or behaviours in which the individual is made to suffer in some way (Masochism) or is causing suffering to another person (Sadism).

Transvestic Fetishism
This diagnosis is used for heterosexual males who have sexually arousing fantasies, urges, or behaviours involving cross-dressing (wearing female clothing).

Voyeurism
This disorder is characterized by intense sexually arousing fantasies, urges, or behaviours in which the individual observes an unsuspecting stranger.