Human Sexuality and Gender Identity Disorders | Anatomy2Medicine
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Human Sexuality and Gender Identity Disorders

 

  • “Abnormal Sexuality

 

        • Sexual behaviour which is destructive in nature to a  person

 

  • Is impulsive and inappropriately associated with guilt and anxiety

 

      • Cannot be directed toward a partner

 

        • “Male Sexual Response” is characterized by
  • Excitement phase is characterized by penile erection and elevation of testes
  • Orgasmic phase consists of ejaculation, tachycardia of upto 180 beats a minute and rise of blood pressure
  • Resolution phase after orgasm lasts for around 10-15 minutes

 

  • After orgasm, there is refractory period
  • Masturbation

 

      • A normal precursor of object related sexual behaviour
      • common in infancy and childhood

 

  • An important adjunct to the development of sexual identity

 

      • Normally replaced by coitus in young adult years
    • According to psychodynamic theory, early life situations that can result in male homosexual behaviour
      • Strong fixation on mother
      • Lack of effective fathering
      • Fixation at, or regression to, the narcissistic stage of development
      • The Narcissistic phase of childhood development is generally considered to occur at about the age of 2 and may go until the age of 3 to 4. This phase is notable for the child developing an ego and sense of “I”
      • Everyone will note this Narcissistic phase as where the child starts to say with authority “mine!!”, and “me”, and they become egocentric or relate to the whole world as being about them. In a sense it is all about them in this phase, and this is healthy.
      • The child must develop a strong sense of self before it can relax that sense of “I” to be less demanding and infallible, and more realising of their truly dependent state. The child must then become aware of the need for a “we” or social engagement with others as a way of being in life.

 

  • According to Sigmund Freud, lack of penis envy in association with unresolved oedipal complex is related to female homosexuality.
  • The Oedipal phase of childhood is not the same as the Narcissistic phase but comes in the midst of this evolving sense of self for the child, and is a period that lasts in the range of 2 to 5 years of age. Once the child has an “I” then the child starts to have impulses and desires, feelings and motivations from this new sense of “I”

 

      • Penis envy (German: Penisneid) is a stage theorized by Sigmund Freud regarding female psychosexual development, in which female adolescents experience anxiety upon realization that they do not have a penis.
      • Freud considered this realization a defining moment in a series of transitions toward a mature female sexuality and gender identity.
      • In Freudian theory, the penis envy stage begins the transition from an attachment to the mother to competition with the mother for the attention, recognition and affection of the father.

 

  • The parallel reaction of a boy’s realization that women do not have a penis is castration anxiety
  • Monitoring of penile tumescence during sleep is the procedure that is useful in distinguishing psychogenic from organic impotence:

 

 

  • Most common cause of temporary Impotence is Fear
  • Antidepressant that can cause sexual dysfunction in males

Amitriptyline, Clomipramine, Doxepin

    • Bupropion is antidepressant that does not cause sexual dysfunction

 

  • Monoamine oxidase inhibitors (MAO-I) associated with decreased sexual desire Tranylcypromine , Phenelzine , Isocarboxazid

 

    • Selegiline, is a selective MAO type B (MAOB) inhibitor that does not decrease sexual desire
    • Bupropion and Mirtazapine have been reported to increase sex drive, possibly by dopaminergic activity and increased production of norepinephrine.
    • Dhat syndrome (Sanskrit: धातु दोष, IAST: Dhātu doṣa)
      • It is a condition found in the cultures of the Indian subcontinent in which male patients report that they suffer from premature ejaculation or impotence, and believe that they are passing semen in their urine.
      • Other somatic symptoms like weakness, easy fatiguability, palpitations, insomnia, low mood, guilt and anxiety are often present.
      • “Squeeze Technique” is used for Dhat Syndrome
        • Squeeze technique: In the squeeze technique, the glans is firmly squeezed between the thumb and the forefingers, at the fenular level until some de- tumescence results .

 

  • The squeeze is usually accomplished by the diminution of sexual arousal. It should take place before the patient has reached the stage that he feels it is inevitable that he is going to ejaculate. This point may not be discernable to the patient with premature ejaculation, but he usually learns to recognize it with time.

 

 

      • Most common systemic illness associated with secondary Impotence is Diabetes Mellitus:
      • Most effective treatment for premature ejaculation is Squeeze Technique

 

  • Stop – Start Technique.

 

          • A variant of Squeeze Technique, in which the woman stops all stimulation of penis when the man first senses an impending ejaculation.
    • Sexual aberration
      • Flagellation : Sexual aberration in which libido is stimulated by whipping oneself, being whipped, or whipping some one else,
      • Fellatio. Oral stimulation/ manipulation of the penis.

 

  • Sadism. Conscious or unconscious sexual pleasure

 

derived from inflicting mental or physical pain on others

      • Masochism. Sexual excitement produced in an individual by his/her own suffering. The individual with this condition usually prefers to be bound, beaten, or made to suffer or be humiliated.
    • Bestiality is defined as having intercourse with animals
    • Pedophilia is an un-natural desire for sexual relations with children
    • Paraphilia
      • Paraphilia. A psychosexual disorder in which unusual or bizarre imagery or acts are necessary for realization of sexual excitement.
      • Transvestism : The type of paraphilia where sexual gratification is obtained by wearing cloths of opposite sex
      • Tribadism. A relationship in which women attempt to imitate heterosexual intercourse with each other.
    • Voyeurism: The experiencing of sexual gratification by observing the sexual activity of the others
    • Exhibitionism. Persistent or recurrent method of sexual arousal by the exposure of one’s genitalia to an unsuspecting stranger.
    • Clinical vignette on Exhibitionism : James, 22 years old, unmarried male, educated till 7th standard was brought by police with complaints of indecent exposure of his genitalia followed by masturbation in front of girl’s college. On enquiry, he committed that he gets the recurrent urges and sexual excitement for same

 

  • Fetischism. A substitution for a normal love object (a person) of parts; or possession of such a one. Erotic stimulation from contact with articles of dress, or a braid of hair.

 

  • Eonism is Desire to identify with the opposite sex in males i.e Male Transvestism
  • “Klismaphilia” is sexual arousal with Enemas
  • Frotteurism. An irresistible impulse of pressing, touching or rubbing against an unsuspecting, non-consenting person, thus producing an orgasm.
  • Nymphomania : Abnormally excessive sexual desire in females
  • Frigidity. Inhibited sexual excitement during sexual activity.
  • Satyriasis. Excessive and often uncontrollable sexual drive in men.
  • Gender Identity Disorder.
    • A strong and persistent  cross-gender identification
    • In children, the manifestations may be:
      • Repeatedly stated desire to be, or insistence that he or she is the other sex
      • Preference for cross dressing
      • Strong and persistent preferences for cross sex roles in make believe plays, or persistent fantasies of being the other sex
      • Strong desire for playmates and games of other sex
    • Clinical vignette on Gender Identity Disorder.
      • Sony, 9 years old girl has been saying intermittently since the age of 4 years that she is a boy. She likes playing cricket and dresses up like boys. She also has been displaying musculine gestures for quite some time.
    • Female Pseudohermaphroditism. Condition in a female marked by a large clitoris, resembling the penis, and hypertrophied labia majora, resembling the scrotum, thus resembling a male. Can be caused by disease of adrenal gland.
    • Male Pseudohermaphroditism. Condition in a male, marked by a small penis, perineal hypospadias, and scrotum without testes, thereby resembling the vulva. Can be due to the disease of adrenal or a feminizing  tumor of the undescended testes.