SEXUAL DYSFUNCTIONS

AND DISORDERS
Presented by: Bidisha Samanta
Supervised by: Dr. Ushri Banerjee
 HUMAN SEXUALITY
● Human sexuality may be defined as the way human beings experience
and express themselves sexually
● Normal sexual behavior brings pleasure to oneself and one’s partner
and involves stimulation of the primary sex organs including coitus; it is
devoid of inappropriate feelings of guilt or anxiety and is not compulsive
● Societal understanding of what denotes normal sexual behavior is
inconstant and varies from era to era. Sexuality and total personality are
so entwined that to speak of sexuality as a separate entity is virtually
impossible. The term psychosexual, therefore, is used to describe
personality development and functioning as these are affected by
sexuality.
 SEXUAL IDENTITY AND GENDER
IDENTITY
● Differentiation of the male from the female results from the action of
fetal androgens the action begins about the sixth week of embryonic
life and is completed by the end of the third month

● Sex and gender can develop in conflicting or even opposite ways

● Physical characteristics derived from a person’s biological sex interrelate

with an intricate system of stimuli, including rewards and punishment and
parental gender labels, to establish gender identity
 SEXUAL ORIENTATION
● Sexual orientation describes the object of a person’s sexual
impulses
● heterosexual (opposite sex)
● homosexual (same sex)
● bisexual (both sexes)
● A group of people have defined themselves as “asexual” and
assert this as a positive identity
● Other people wish not to define their sexual orientation at all and
avoid labels. Still others describe themselves as polysexual or
pansexual
 SEXUALITY THROUGH THE LIFE SPAN
● CHILDHOOD SEXUALITY-Most sexual learning
experiences in childhood occur without the parents’
knowledge, but awareness of a child’s sex does
influence parental behavior. Observation of children
reveals that genital play in infants is part of normal
development
● PUBERTY-Puberty is initiated by hormonal signals from
the brain to the gonads: the ovaries in a girl, the testes in
a boy. Masturbation and first sexual experiences
occur in puberty but are not totally socially
 SEXUALITY THROUGH THE LIFE SPAN
● ADULTHOOD-Young Adulthood usually marks the
formation of more stable relationships and
marriages resulting in increased frequency of coitus.
In many cultures, such as this, the first coitus is a rite of
passage for both men and women.
● LATE ADULTHOOD-Age does not necessarily change
the need or desire to be sexually expressive or active. A
couple in a long-term relationship may find that the
frequency of their sexual activity decreases over
time and the type of sexual expression may change,
but many couples experience increased intimacy
 SEXUAL ANATOMY

FEMALE ANATOMY MALE ANATOMY

 FEMALE SEXUAL ANATOMY- FEMALE EXTERNAL
GENETALIA

Vulva-The external female genitals

are collectively referred to as The
Vulva. Below are the parts of the vulva:
•Mons Veneris-The mons veneris, is
the pad of fatty tissue that covers the
pubic bone below the abdomen but
above the labia
•Labia Majora-The labia majora are the
outer lips of the vulva
•Labia Minora-The labia minora are the
inner lips of the vulva
 FEMALE SEXUAL ANATOMY- FEMALE EXTERNAL
GENETALIA

● Clitoris-The small white oval ● Hymen- A, B, and C show vaginal

between the top of the labia openings with a normal hymen .
Illustration D shows an imperforate
minora and the clitoral hood
hymen that completely closes the
● Urethra-The opening to the vagina. Illustration E is of a vagina in
urethra is just below the a post-partum woman (one who has
clitoris given birth).
● Perineum-The perineum is
the short stretch of skin
starting at the bottom of the
vulva and extending to the A B C D E

anus.
 FEMALE SEXUAL ANATOMY- FEMALE
INTERNAL GENETALIA

• Vagina-The vagina serves as the receptacle for the

penis during sexual intercourse
• Bartholin's glands-At either side of the vaginal
opening, the Bartholin's glands produce small
amounts of lubricating fluid
• "G-Spot"- What is indicated as the g-spot in fact
points to a region known as the Skenes glands
• Cervix-The cervix is the opening to the uterus
• Uterus-The uterus, or womb, is the main female
internal reproductive organ
• Ovaries-The ovaries perform two functions: the
production of estrogen and progesterone, the female
sex hormones, and the production of mature ova, or
eggs
 MALE SEXUAL ANATOMY-MALE EXTERNAL
GENITALIA
Penis:
•Glans-The glans is the head of the penis
•Corona-a ridge of flesh demarcating where the head
of the penis and the shaft join
•Frenulum, Frenum-A thin strip of flesh on the
underside of the penis that connects the shaft to the
head
•Foreskin, Prepuce-A roll of skin which covers the
head of the penis
•Urethra, Meatus-The opening at the tip of the penis
to allow the passage of both urine and semen
•Smegma-A substance with the texture of cheese
secreted by glands on each side of the frenulum in
uncircumcised men
Scrotum: The scrotum is a sac that hangs behind
and below the penis, and contains the testes
 MALE SEXUAL ANATOMY-MALE INTERNAL
GENITALIA
• Testes, Testicles-The male sexual glands producing
sperm and testosterone.
•Epididymis-The epididymis is a 'holding pen' where sperm
mature
•Vas Deferens-The ducts leading from the epididymis to the
seminal vesicles
•Seminal Vesicles-The seminal vesicles produce semen
•Prostate Gland -Also produces a fluid that makes up the
semen
•Corpa Cavernosa-The corpora cavernosa are the two
spongy bodies of erectile tissue on either side of the penis
•Ejaculatory Ducts -The path through the seminal glands
which semen travels during ejaculation
•Cowper's Glands -The Cowper's glands secrete a small
amount of pre-ejaculate fluid prior to orgasm
 SEXUAL BEHAVIOR
The Central Nervous System and Sexual Behavior
● THE BRAIN parts involved in sexual functioning include the cortex, limbic
system, brainstem, etc

● SPINAL CORD. Sexual arousal and climax are ultimately organized at the
spinal level

● HORMONES. dopamine levels in the brain increase desire, serotonin

decrease desire, testosterone increases libido in both men and women,
although estrogen is a key factor in the lubrication involved in female
arousal, progesterone mildly depresses desire in men and women as do
excessive prolactin and cortisol, oxytocin is involved in pleasurable
sensations during sex
 SEXUAL RESPONSE CYCLE
•In the first detailed description of these responses,
Masters & Johnson (1966) found that sexual response
was divided into four phases: excitement, plateau,
orgasm, and resolution. In response to criticisms, other
researchers stepped up to try to explain human sexual
response

•First, Kaplan proposed the Triphasic Concept in 1979

by creating a model that included desire, excitement, and
orgasm

• Then, in 1997, Whipple & Brash-McGreer created the

Circular Model that was specific to women

•The next model was proposed by Basson in 2000 as the

Non-Linear Model of sexual response This incorporates
MASTER AND JOHNSON’S MALE SEXUAL
RESPONSE CYCLE
MASTER AND JOHNSON’S FEMALE SEXUAL RESPONSE
CYCLE
Sexual Dysfunctions
 SEXUAL DYSFUNCTIONS
● Sexual dysfunction may be defined as the lack of interest, lack of
enjoyment, failure of the physiological responses necessary for effective
sexual interaction (e.g. erection), or inability to control or experience
orgasm, as described by the 10th revision of the International Statistical
Classification of Diseases and Related Health Problems (ICD-10)

● According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth

Edition (DSM 5), Sexual dysfunctions are a heterogeneous group of
disorders that are typically characterized by a clinically significant
disturbance in a person's ability to respond sexually or to experience sexual
pleasure

● In order to be considered a sexual dysfunction, the dysfunction must: 1) occur

frequently; 2) have been present for at least several months; and 3) be
associated with clinically significant distress
 SEXUAL DYSFUNCTIONS
●The essential features of sexual dysfunctions are an
inability to respond to sexual stimulation, or the
experience of pain during the sexual act

●Sexual dysfunctions are frequently associated with other

mental disorders, such as depressive disorders, anxiety
disorders, personality disorders, and schizophrenia

●Sexual dysfunctions are usually self-perpetuating, with the

patients increasingly subjected to ongoing performance
anxiety and a concomitant inability to experience pleasure
 HISTORY OF SEXUAL DYSFUNCTIONS IN
MEN
● Erectile dysfunction was the biggest problem throughout history
● In Greek and Roman understanding of sexuality, penetration was a proof of
manhood
● During the 18th century, philosophes embraced the notion of men and woman
inhabiting distinct sexual spheres
● 19th century culture found discussion of such problems distasteful
● There was a shift from moral to psychological explanations of male sexual
dysfunction in the early 20th century
● 1920s legitimized the scientific study of the reproductive system in men
● After the World War II impotence was declared a problem for both men and
women
● In present day societies, it is of utmost importance to maintain an acceptable
 HISTORY OF SEXUAL DYSFUNCTIONS IN
WOMEN

● In the 16th century the diagnosis of nymphomania was not uncommon in

women
● In the 19th century certain sexual dysfunctions were regarded as foundations of
“frigidity” based on Freud’s pronouncements
● In the 20th century Sexual dysfunction in women was seen as part of a wider
social phenomenon
● First edition of the Diagnostic and Statistical Manual of Mental Disorders’
(DSM) in 1952 classified problems such as frigidity to a separate category of
“Psychophysiological autonomic and visceral disorders, second edition
published in 1968 added dyspareunia to the list, significant changes were seen
only in the third edition of DSM issued in 1980
● On the whole, female sexual dysfunction has been considered a generic or
 TREATMENTS THROUGHOUT
HISTORY
● Some of the earliest treatment approaches were developed by Muslim
physicians in medieval times like single and combination drug therapies
to treat erectile dysfunction, also topical or locally applied medication
preparations and drugs applied via the urethra
● Traditional Chinese treatment approaches to sexual dysfunction included
acupuncture, acupressure and the use of herbs.
● Inthe Victorian era, approach to sexual disorders was mainly
psychopathological.
● As far as modern medicine is concerned, the study of sexual dysfunction
dates back to the 1970s when the book Human Sexual Inadequacy was
published by Masters and Johnson
 PREVALENCE
● According to a study by McCabe et. al. (2016), there are more
studies on incidence and prevalence for men than for women and
many more studies on prevalence than incidence for women and
men
● The data indicates that the most frequent sexual dysfunctions
for women are desire and arousal dysfunctions
● In addition, there is a large proportion of women who experience
multiple sexual dysfunctions
● For men, premature ejaculation and erectile dysfunction are the
most common
● less comorbidity across sexual dysfunctions for men compared
with women was seen
 INDIAN PERSPECTIVE
● India played a role in shaping understandings of sexuality, the first
pieces of literature that treated "Kama" as a science came from the Indian
subcontinent. Nudity in art was considered acceptable in southern India, as
shown by the paintings at Ajanta and the sculptures of the time
● Conservative views of sexuality now perhaps related to the effect of
colonial influence, as well as to the puritanical elements of Islam
● Currently there is a gaping dearth of studies regarding sexual dysfunction in
India
● As stated in an article of 2013, around 20-30% marriages in India were
found to be breaking due to lack of satisfaction in sexual life, Erectile
Dysfunction or Sexual Impotence afflicts as much as 15 percent of the
male population and 20% of female
 INDIAN STUDIES

● According to Rao et al (2015), 21.15% of the males and around 14% of

the females were diagnosed to have sexual disorders

● In another study by Mishra et al (2016), the prevalence of FSD was

55.55% among 153 fertile females, more prevalent in the age group
of 26–30 years, with middle education, belonging to upper middle
socioeconomic status

● Pal et al (2018) reported that in Eastern India over the calendar year
of 2016, the most common disorders reported included premature
ejaculation (PME), erectile dysfunction (ED), comorbid ED and
PME, lack of sexual desire, and Dhat syndrome (DS)
 ETIOLOGY
Physical factors
● use of drugs, such as alcohol, nicotine, narcotics, stimulants,
antihypertensives, antihistamines, and some psychotherapeutic drugs
● Injuries to the back, enlarged prostate gland, problems with blood supply, or
nerve damage
● Diabetic neuropathy, multiple sclerosis, tumors, and, rarely, tertiary syphilis
● Failure of various organ systems
● Hormonal deficiencies
● Pelvic floor dysfunction
● For women premenstrual syndrome, pregnancy and the postpartum period or
menopause
● In aging women, it is natural for the vagina to narrow and become atrophied
 ETIOLOGY
Emotional factors include interpersonal or psychological problems, which
can be the result of depression, sexual fears or guilt, past sexual trauma,
and sexual orientation, among others.

● Anxiety disorders like panic disorder commonly cause avoidance of

intercourse and premature ejaculation

● Pain during intercourse is often a comorbidity of anxiety disorders among

women

● In the context of heterosexual relationships, one of the main reasons for

the decline in sexual activity among these couples is the male partner
experiencing erectile dysfunction which can be very distressing for the male
partner, causing poor body image and low desire
 ICD‐10 CLASSIFICATION OF SEXUAL
DYSFUNCTION
N48.4 Impotence of organic F52.2 Failure of genital
origin response
F52.7 Excessive sexual drive

F52 Sexual dysfunction, not F52.3 Orgasmic dysfunction F52.8 Other sexual
caused by organic disorder or dysfunction, not caused by
disease organic disorder or disease
F52.4 Premature ejaculation

F52.0 Lack or loss of sexual F52.9 Unspecified sexual

desire F52.5 Nonorganic
vaginismus dysfunction, not caused by
organic disorder or disease
F52.1 Sexual aversion and
lack of sexual enjoyment F52.6 Nonorganic
dyspareunia
 SEXUAL DYSFUNCTIONS

Disorders Disorders Disorders Disorders related to Disorders/dysfunctions

related to related to related to sexual Excessive Sexual Drive: related to other
desire interest Orgasm pain 1.NYMPHOMANIA specified and
or arousal 2.SATYRIASIS unspecified causes:
1.Due to a General
1. ORGASMIC DYSFUNCTION
Medical Condition
2. PREMATURE EJACULATION
2.Substance/Medication
-Induced
1. HYPOACTIVE SEXUAL DESIRE DISORDER 1. NONORGANIC DYSPAREUNIA
2. FRIGIDITY/ FEMALE SEXUAL AROUSAL 2. NONORGANIC VAGINISMUS
DISORDER
3. SEXUAL AVERSION AND LACK OF SEXUAL Cultural sexual
ENJOYMENT dysfunctions:
4. MALE ERECTILE DISORDER 1. DHAT SYNDROME
2. KORO
 Disorders related to desire, interest or arousal
1. HYPOACTIVE SEXUAL DESIRE DISORDER
● This dysfunction is characterized by a deficiency or absence of sexual
fantasies and desire for sexual activity for a minimum duration of
approximately 6 months.
● Men for whom this is a lifelong condition have never experienced many
spontaneous erotic/sexual thoughts
● The reported prevalence of low desire is greatest at the younger and
older ends of the age spectrum, with only 2 percent of men ages 16 to
44 affected by this disorder. A reported 6 percent of men ages 18 to 24,
and 40 percent of men ages 66 to 74, have problems with sexual desire
 Disorders related to desire, interest or arousal
2. FRIGIDITY/ FEMALE SEXUAL AROUSAL DISORDER

● Complaints in present variously as a decrease or paucity of

erotic feelings, thoughts, or fantasies; a decreased impulse
to initiate sex; a decreased or absent receptivity to partner
overtures; or an inability to respond to partner stimulation
● Relationship problems are particularly relevant to acquired
interest/arousal disorder. In one study of couples with markedly
decreased sexual interaction, the most prevalent etiology was
marital discord
 Disorders related to desire, interest or arousal
3. SEXUAL AVERSION AND LACK OF SEXUAL ENJOYMENT
(F52.1)
Sexual aversion-The prospect of sexual interaction associated with strong negative feelings and
produces sufficient fear or anxiety that sexual activity is avoided
Lack of sexual enjoyment-Sexual responses and orgasm is experienced but there is a lack of
appropriate pleasure, more common in women than in men
Sexual anhedonia is a condition in which an individual cannot feel pleasure from an orgasm.
Causes include:

● dysfunction in the release of the chemical dopamine

● depression, drug addiction, high levels of prolactin, low testosterone, certain

medications

● A spinal cord injury or chronic fatigue syndrome

● Increased age

● Increased serum prolactin (PRL) concentration in patients’ brains from psychiatric

 Disorders related to desire, interest or arousal
4. MALE ERECTILE DISORDER
● Historically called impotence, men with this dysfunction frequently suffer feelings
of powerlessness, helplessness, and resultant low self-esteem

● Erectile disorder is the chief complaint of more than 50 percent of all men
treated for sexual disorders. The incidence of erectile disorder increases with
age
● A man with lifelong male erectile disorder has never been able to obtain an
erection sufficient for insertion, the disorder is rare and occurs in about 1 percent of
men younger than age 35
● In acquired male erectile disorder, a man has successfully achieved penetration
at some time in his sexual life but is later unable to do so, reported in 10 to 20
percent of all men
 In situational male erectile disorder, a man is able to have coitus in certain
circumstances but not in others; for example, he may function effectively with a
prostitute but be unable to have an erection when with his partner
 Disorders related to orgasm
1. ORGASMIC DYSFUNCTION
●Orgasm either does not occur or is markedly delayed
● This may be lifelong, acquired or situational (i.e. occur only in
certain situations), in which case etiology is likely to be
psychogenic, or invariable, when physical or constitutional factors
cannot be easily excluded except by a positive response to
psychological treatment

●Orgasmic dysfunction is more common in women than in men

and includes inhibited orgasm (male) (female) and psychogenic
anorgasmy
 Disorders related to orgasm
1. ORGASMIC DYSFUNCTION IN FEMALES
 Female orgasmic dysfunction is defined as the recurrent or persistent inhibition of
female orgasm, as manifested by the recurrent delay in, or absence of orgasm after
a normal sexual excitement phase

 Pelvic complaints like lower abdominal pain, itching, and vaginal discharge, as well
as increased tension, irritability, and fatigue are seen

 Psychological factors include:

● fears of impregnation
● rejection by a sex partner
● damage to the vagina
● hostility toward men
● poor body image
● feelings of guilt about sexual impulses
● Cultural expectations and social restrictions
 Disorders related to orgasm
1. ORGASMIC DYSFUNCTION IN MALES
 In males, delayed ejaculation, sometimes called retarded ejaculation occurs,
where a man achieves ejaculation during coitus with great difficulty, if at all

 Causes include:

● Rigid, puritanical background

● Difficulty with closeness in areas beyond those of sexual relations

● Attention-deficit/hyperactivity disorder

● Interpersonal difficulties
 Disorders related to orgasm
2. PREMATURE EJACULATION
● In Premature Ejaculation, men persistently or recurrently achieve
orgasm and ejaculation before they wish to

● Premature ejaculation is the chief complaint of about 35 to 40 percent

of men treated for sexual disorders
● Difficulty in ejaculatory control can be associated with anxiety
regarding the sex act, with unconscious fears about the vagina, or
with negative cultural conditioning of achieving orgasm rapidly

● In ongoing relationships, the partner has a great influence on a

premature ejaculator, and a stressful marriage exacerbates the
disorder
 Disorders related to sexual pain
1. NONORGANIC DYSPAREUNIA
● Dyspareunia is recurrent or persistent genital pain
occurring before, during, or after intercourse, which can
occur for both males and females
● It is related to, and often coincides with, vaginismus

● Causes include history of rape or childhood sexual abuse and

tension and anxiety about the sex, hormonally induced
physiological changes in the vagina
● Anticipation of further pain may cause women to avoid coitus
altogether. If a partner proceeds with intercourse regardless,
the condition is aggravated
 Disorders related to sexual pain
2. NONORGANIC VAGINISMUS
● Vaginismus is defined as a constriction of the outer third of the
vagina due to involuntary pelvic floor muscle tightening or spasm,
vaginismus interferes with penile insertion and intercourse

● Vaginismus may be complete, that is no penetration of the vagina is

possible

● In a less severe form of vaginismus, pelvic floor muscle tightening due

to pain
or fear of pain makes penetration difficult, but not impossible

● Comorbidity with Dyspareunia is present with similar etiological factors

Disorders related to Excessive Sexual Drive

Both men and women may occasionally complain

of excessive sexual drive as a problem is its own
right, usually during late teenage or early
adulthood. This includes:
1. Nymphomania- excessive sexual desire in
women.
2. Satyriasis- excessive or abnormal sexual
craving in the male
 Disorders/dysfunctions related to other specified
and unspecified causes
Dysfunctions Due to a General Medical Condition-
● Surgical procedures, pelvic pathology, irritated or infected hymenal remnants,
episiotomy scars, Bartholin’s gland infection, vaginitis and cervicitis, endometriosis,
and adenomyosis may cause dyspareunia or vaginismus.
● Postcoital pain has been reported by women with myomata, endometriosis, and
adenomyosis. Sexual desire commonly decreases after major illness or surgery like
mastectomy, ileostomy, hysterectomy, and prostatectomy.
● Delayed ejaculation can occur after surgery on the genitourinary tract, such as
prostatectomy. It may also be associated with Parkinson’s disease and other neurological
disorders.
● Antihypertensive drugs, methyldopa, the phenothiazines, the tricyclic drugs, and the
selective serotonin reuptake inhibitors (SSRIs), among others, have been implicated in
retarded ejaculation.
● Antihypertensive medications, CNS stimulants, tricyclic drugs, SSRIs, and, frequently,
monoamine oxidase inhibitors (MAOIs), endocrine diseases such as hypothyroidism,
Disorders/dysfunctions related to other specified
and unspecified causes
Substance/Medication-Induced Sexual Dysfunction-
● The diagnosis of substance-induced sexual dysfunction is used when evidence
of substance intoxication or withdrawal is apparent from the history, physical
examination, or laboratory findings
● Specified substances include alcohol, amphetamines or related substances,
cocaine, opioids, sedatives, hypnotics, or anxiolytics, and other or unknown
substances.
● In men, these effects include decreased sex drive, erectile failure,
decreased volume of ejaculate, and delayed or retrograde ejaculation. In
women, decreased sex drive, decreased vaginal lubrication, inhibited or
delayed orgasm, and decreased or absent vaginal contractions may occur.
 DHAT SYNDROME (F48.8)
● Nocturnal emissions lead to sever anxiety and hypochondriasis, often
associated with sexual impotence
● Various somatic, psychological and sexual symptoms attributed it to the
passing of whitish discharge, believed to be semen (Dhat), in urine
● Dhat is derived from sanskrit word ‘Dhatu’ meaning precious fluid. This
gives rise to belief that loss of excessive semen in any form e.g.
masturbation, nocturnal emissions etc. is harmful. On the other hand its
preservation will lead to health and longevity
● Concomitant psychiatric morbidity like depression, somatoform disorder,
anxiety disorder may be present
● Treatment mainly consists of dispelling of myths by psychoeducation, reassuring
the patient, treating any underlying psychiatric disorder, even symptomatic relief
with the help of medications in initial stages
 KORO (F48.8)
● Koro or shrinking penis is a culture-bound syndrome delusional disorder in
which an individual has an overpowering belief that one's sex organs are
retracting and will disappear, despite the lack of any true longstanding
changes to the genitals
● Most patients report acute anxiety attacks due to perceived genital retraction
and/or genital shrinkage, despite a lack of any objectively visible biological
changes
● According to literature, episodes usually last several hours, though the duration
may be as long as two days.
● Psychological components of koro anxiety include fear of impending death, penile
dissolution and loss of sexual power.

● Psychosexual conflicts, personality factors, and cultural beliefs are considered as

being of etiological significance to koro.
 TREATMENT OF SEXUAL DYSFUNCTIONS
Before 1970, the most common treatment of sexual dysfunctions was individual
psychotherapy. Newer methods include:
● Dual-Sex Therapy
● Specific Techniques and Exercises
● Hypnotherapy
● Behavior Therapy
● Mindfulness
● Group Therapy
● Analytically Oriented Sex Therapy
● Biological Treatments
PARAPHILIC
DISORDERS
 PARAPHILIC DISORDERS
● Paraphilias or perversions are sexual stimuli or acts that are deviations from
normal sexual behaviors, but are necessary for some persons to experience
arousal and orgasm
● In The International Classification Of Diseases and Related Health Problems
(ICD-10), Paraphilic Disorders are grouped under F65 Disorders of
sexual preference
● According to the Diagnostic and Statistical Manual of Mental Disorders, fifth
edition (DSM-5), the term paraphilic disorder is reserved for those cases
in which a sexually deviant fantasy or impulse has been expressed
behaviorally
● A paraphilia is clinically significant if the person has acted on these
fantasies or if these fantasies cause marked distress or interpersonal
 EPIDEMIOLOGY
● Paraphilias are practiced by only a small percentage of the population
● Among legally identified cases of paraphilic disorders, paedophilia is most
common. Of all children, 10 to 20 percent have been molested by age 18.
● Persons with exhibitionism who publicly display themselves to young
children are also commonly apprehended
● Those with voyeurism may be apprehended, but their risk is not great
● Sexual masochism and sexual sadism are underrepresented in any
prevalence estimates
● Usually paraphilias seem to be largely male conditions
● Patients with paraphilia frequently have three to five paraphilias, either
concurrently or at different times in their lives
● The occurrence of paraphilic behavior peaks between ages 15 and 25
and gradually declines.
 ETIOLOGY
Psychosocial Factors
● Failure to resolve the oedipal conflicts is the cause
● What distinguishes one paraphilia from another is the method
chosen by a person (usually male) to cope with the anxiety
caused by the threat of castration by the father and separation
from the mother
● Exhibitionism and voyeurism may be attempts to calm anxiety about castration
because the reaction of the victim or the arousal of the voyeur reassures the
paraphilic person that the penis is intact.
● Fetishism is an attempt to avoid anxiety by displacing libidinal impulses to
inappropriate objects.
● Persons with pedophilia and sexual sadism have a need to dominate and control
their victims to compensate for their feelings of powerlessness during the oedipal
 ETIOLOGY
Behavioral Factors-
●The onset of paraphilic acts can result from persons’ modelling their
behavior on the behavior of others who have carried out
paraphilic acts, mimicking sexual behavior depicted in the media,
or recalling emotionally laden events from the past, such as their
own molestation.
●Learning theory indicates that because the fantasizing of paraphilic
interests begins at an early age and because personal fantasies and
thoughts are not shared with others, urges continue uninhibited until
late in life

●By that time the repetitive use of such fantasies has become ingrained
 ETIOLOGY
Biological Factors-
●Several studies have identified abnormal organic findings
in persons with paraphilias. The question is whether these
abnormalities are causally related to paraphilic interests or
are incidental findings that bear no relevance to the
development of paraphilia.
● Psychophysiological tests have been developed to measure
penile volumetric size in response to paraphilic and
nonparaphilic stimuli. The procedures may be of use in
diagnosis and treatment, but are of questionable diagnostic
validity because some men are able to suppress their erectile
responses
ICD-10 Classification of Paraphilias
F65 Disorders of sexual preference
F65.0 Fetishism
F65.1 Fetishistic transvestism
F65.2 Exhibitionism
F65.3 Voyeurism
F65.4 Paedophilia
F65.5 Sadomasochism
F65.6 Multiple disorders of sexual preference
F65.8 Other disorders of sexual preference
F65.9 Disorder of sexual preference, unspecified
 PARAPHILIC DISORDERS

Fetishism Exhibitionism Voyeurism Paedophilia Sadomasochism Other Specified Paraphilic

Disorder

1. FROTTEURISM
Fetishistic 2. TELEPHONE AND COMPUTER
transvestism SCATOLOGIA
3. NECROPHILIA
4. PARTIALISM
5. ZOOPHILIA
6. COPROPHILIA
7. KLISMAPHILIA
8. UROPHILIA
 CLASSIFICATION
Fetishism
●In fetishism the sexual focus is on objects (e.g., shoes, gloves,
pantyhose, and stockings) that are intimately associated with
the human body or on nongenital body parts
●The particular fetish used is linked to someone closely involved with
a patient during childhood and has a quality associated with this
loved, needed, or even been established in childhood
●Once established, the disorder tends to be chronic. Sexual activity
may be directed toward the fetish itself (e.g., masturbation with or
into a shoe), or the fetish may be incorporated into sexual
intercourse (e.g., the demand that high-heeled shoes be worn)
●The disorder is almost exclusively found in men
 CLASSIFICATION
Exhibitionism
●Exhibitionism is the recurrent urge to expose the genitals to
a stranger or to an unsuspecting person
●Sexual excitement occurs in anticipation of the exposure, and
orgasm is brought about by masturbation during or after the
event
●In almost 100 percent of cases, those with exhibitionism are
men exposing themselves to women
●The dynamic of men with exhibitionism is to assert their
masculinity by showing their penises and by watching the
victims’ reactions—fright, surprise, and disgust. In this
paraphilic disorder, men unconsciously feel castrated and
impotent
 CLASSIFICATION
Voyeurism
●Voyeurism, also known as scopophilia, is the recurrent
preoccupation with fantasies and acts that involve
observing unsuspecting persons who are naked or
engaged in grooming or sexual activity
● Masturbation to orgasm usually accompanies or follows
the event
●The first voyeuristic act usually occurs during childhood,
and the paraphilia is most common in men
●When persons with voyeurism are apprehended, the charge
is usually loitering
 CLASSIFICATION
Paedophilia
● Paedophilia involves recurrent intense sexual urges toward, or
arousal by, children 13 years of age or younger
● Persons with paedophilia are at least 16 years of age and at
least 5 years older than the victims
● Most child molestations involve genital fondling or oral sex. Vaginal
or anal penetration of children occurs infrequently, except in cases of
incest
● Offenders report that when they touch a child, most (60 percent) of
the victims are boys
● In addition to their paedophilia, a significant number of the
perpetrators are concomitantly or have previously been involved in
exhibitionism, voyeurism, or rape.
 CLASSIFICATION
Sadomasochism

●Sadomasochism is the giving or receiving of pleasure

from acts involving the receipt or infliction of pain or
humiliation
●Practitioners of sadomasochism may seek sexual
gratification from their acts
●While the terms sadist and masochist refer respectively to
one who enjoys giving and receiving pain, practitioners of
sadomasochism may switch between activity and
passivity
 CLASSIFICATION
Other Specified Paraphilic Disorder
● FROTTEURISM. Frotteurism is usually characterized by a man’s rubbing
his penis against the buttocks or other body parts of a fully clothed
woman to achieve orgasm. At other times, he may use his hands to rub
an unsuspecting victim

● TELEPHONE AND COMPUTER SCATOLOGIA. Scatologia is

characterized by obscene phone calling or chatting and involves an
unsuspecting partner

● NECROPHILIA. Necrophilia is an obsession with obtaining sexual

gratification from cadavers
 CLASSIFICATION
Other Specified Paraphilic Disorder
● ZOOPHILIA. In zoophilia, animals, which may be trained to participate
are preferentially incorporated into arousal fantasies or sexual
activities, including intercourse, masturbation, and oral–genital contact

● COPROPHILIA AND KLISMAPHILIA. Coprophilia is sexual pleasure

associated with the desire to defecate on a partner, to be defecated on,
or to eat feces (coprophagia). A variant is the compulsive utterance of
obscene words (coprolalia. Klismaphilia, the use of enemas as part of
sexual stimulation

● UROPHILIA. Urophilia, a form of urethral eroticism, is interest in sexual

pleasure associated with the desire to urinate on a partner or to be
 Unspecified Disorders of sexual
preference
ICD 10 Criteria
F65.9 Disorder of sexual preference, unspecified
Includes: sexual deviation NOS
 Multiple disorders of sexual
preference
●F65.6 Multiple disorders of sexual
preference
Sometimes more than one disorder of
sexual preference occurs in one person
and none has clear precedence. The most
common combination is fetishism,
transvestism, and sadomasochism
 TREATMENT
Five types of psychiatric interventions are used to treat
persons with paraphilic disorder and paraphilic
interests:
● external control
● reduction of sexual drives
● treatment of comorbid conditions (e.g.,
depression or anxiety)
● cognitive-behavioral therapy
●dynamic psychotherapy
 CONCLUSION
● Sexual disorders and paraphilias are broadly classified in both ICD-
10 and DSM-5
● But there is a dearth of researches and reporting on the same,
especially female sexual disorders, in this subcontinent, perhaps
owing to the taboo nature and the discomfort surrounding this area
● So, further statistical studies and studies concerning
prevalence rates and more psychoeducation, especially sex
education starting at the school level is needed
THANK YOU!