Tag Archives: Transvestic Fetishism

Sexual Disorder and Sexual Dysfunction, Is There A Difference?

The use of the words sexual dysfunction and sexual disorder when searched often brings up articles defining sexual disorder as sexual dysfunction. The usage, of course, is incorrect because these two subjects are so vastly different.

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Sexual dysfunction is actually an occurrence during the act of sex that has become problematic for one or both partners. These are things such as low libido or stamina, erectile dysfunction, or vaginal dryness. If any of these things occur and neither of the partners has a real problem with it, it is actually not considered a dysfunction.

When someone has a problem with their sexual function it can have a negative effect on more areas than just the area of sex. It can affect a person’s mood and can seep into other relationships because of the emotional pain and embarrassment which flows through attitudes and outlook unknowingly.

Sexual dysfunction has a number of causes both in the emotional and physical realm. It could also be caused by a combination of factors instead of just one thing. Sometimes a medical condition can have an effect on a person’s sexual function but because the person doesn’t realize the problem is medically related it affects them mentally; which can create a kind of negative unending circle. Some medical conditions which are examples of this are cardiovascular disease, diabetes, and depression.

When looking at cardiovascular disease in connection with sexual dysfunction we can see that both men and women can be affected this way because the blood vessels change in such a way that they are unable to effectively supply extremities with necessary blood. When this happens the genital area, either male or female, does not have the blood flow it needs to operate properly.

Diabetes affects a person in a similar fashion, but diabetes actually affects the nerves in the tissue of the genital area.

Depression affects people on a whole other spectrum of the body. Because the chemicals in the brain are not working properly they cause a person’s sex drive or libido to suffer. This is generally backed up by the inability to really feel any type of pleasure. This can in turn cause a loss of self confidence. Self confidence is highly important when recovering from depression, this can cause the same negative circle mentioned earlier.

Sexual dysfunction does have similar effects for men and women in some instances, but there are other things involved in sexual dysfunction that affect each person differently.

In men for example, there are some differing psychological aspects to be considered when looking at sexual dysfunction, these are concern for how they are performing sexually, marital difficulties, and feelings of guilt.

In women hormones and emotional/psychological issues seem to cause a lot of problems in this area. Things that cause a flux in the level of a woman’s hormones are having a baby or moving into menopause. Other things that can lead to sexual dysfunction in women are not having a desire for sex, or losing arousal during sex, being unable to have an orgasm or feeling pain during sex. A women’s emotional well being can have a lot to do with her ability to function sexually. If she is under a great deal of stress or anxiety, having conflicts with her partner or having issues with her body image can also become problematic.

There seem to be a lot of treatments for sexual dysfunction, but sometimes a health problem has to be treated first. Sometimes the treatment for the health problem is the cause of the sexual dysfunction and patients have to have treatment as a side effect of their medication. One way to avoid this would be to adjust the medication. This would be most ideal solution. When that doesn’t work other options are given to the patient, they can include medications for impotence or strengthening of the genitals.

Sexual disorder is completely different when compared to sexual dysfunction. Sexual disorder includes acts or behaviors that are described as sexual deviancy. These sexual acts or desires include a variety of preferences. These can include animals, various objects or different kinds of materials. Other preferences can include children or pain, either to themselves or others.

There are many categories under the sexual disorder heading and quite a few subcategories as well. In fact there are far too many to explain all of them in this short article.

Disorders under the paraphilias heading include exhibitionism, fetishism, frotteurism, transvestism, and voyeurism. These are only a few disorders under this heading. Exhibitionists have a propensity to display their genitalia to people they don’t know. They go through cycles where this action feels completely necessary.

Fetishists have an object they need to have involved in sex acts. Usually if the object is not there the person will either have difficulty with orgasm, or, will not be able to orgasm at all. Objects are generally anything from a certain type of material to a garment.

Frotteurism is a need to rub a person’s body parts against another person and generally ahs the same type of cycles as an exhibitionist does, where this action feels completely necessary, it is a compulsion.

Transvestism is when a man feels a need to either imagine himself in women’s or actually does dress in women’s clothing in order to become aroused.

Voyeurism is when a person watches other people get undressed, usually unbeknownst to the person undressing.

There are many more disorders that involve things that the general population would consider weird or sinister.  In fact many sexual disorders if uncontrolled will cause the person with the disorder to end up in jail, unfortunately there does not seem to be a cure for sexual disorders and thus the patient must depend on their own self control.

Sexual dysfunction and sexual disorder have similar names and are often intertwined when being described, but I feel that I have shown just how different they really are.

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Sexual Dysfunction vs. Sexual Disorder

A “dysfunction” is literally defined as an abnormality or disturbance of function.  (Colman, 2009, p. 232)  It may also be defined as abnormal or unhealthy interpersonal behavior or interactions.  (Merriam-Webster Online Dictionary [MWOD], 2010)  Specifically, sexual dysfunctions are defined as “conditions that impair the desire or ability to achieve sexual satisfaction.”  (Blaney & Millon, 2009, p. 399)  With and within the DSM-IV-TR, the term sexual dysfunction is conceptualized as an umbrella category that encompasses a wide variety of sex related conditions, some of which may or may not “belong” in a manual that is intended to cover and contain “mental disorders.”  This essay will give a brief overview of what are currently considered under the broad title of Sexual Dysfunctions, and provide some subjective thought on efficacy of continued inclusion as we move toward the newest revision of the “psychiatric bible,” the DSM-V.

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Under the rubric set forth by the current DSM, the DSM-IV-TR, the following disorders are considered under the broader category of Sexual Dysfunctions: Sexual Desire Disorders (i.e., Hypoactive Sexual Desire Disorder, Sexual Aversion Disorder), Sexual Arousal Disorders (i.e., Female Sexual Arousal Disorder, Male Erectile Disorder), and Orgasmic Disorders (i.e., Female Orgasmic Disorder, Male Orgasmic Disorder, and Premature Ejaculation), Sexual Pain Disorders (i.e., Dyspareunia, Vaginismus), Sexual Dysfunction Due to a General Medical Condition, Substance-Induced Sexual Dysfunction, and Sexual Dysfunction Not Otherwise Specified (NOS).  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 535)  Comparatively speaking, a “disorder” is literally defined as an abnormal physical or mental condition.  (MWOD, 2010)  In the DSM-IV-TR, sexual dysfunctions are differentiated from Paraphilias and Gender Identity Disorders (GIDs).  The essential features of a Paraphilia are arousing fantasies, sexual urges, or behaviors generally involving non-hum, the suffering or humiliation of oneself or one’s partner, or children or other non-consenting persons.  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 566)  Paraphilias include Exhibitionism, Fetishism, Frotteurism, Pedophilia, Sexual Sadism, Transvestic Fetishism, Voyeurism, and Paraphilia NOS.  Conversely, GID is characterized by strong and persistent cross-gender identification coupled with a persistent discomfort about one’s assigned sex and/or gender role.  (4th ed., text rev.; DSM-IV-TR; American Psychiatric Association, 2000, p. 576)

Among those disorders, there are some that appear to fit better than others.  Take the Sexual Desire Disorders (i.e., Hypoactive Sexual Desire Disorder, Sexual Aversion Disorder) for example… what is considered normal libido?  Is there any objective way to quantify or qualify the need or desire to have sexual relations?  Honestly, I don’t think there is.  What is normal sexual activity to me and my partner may be too much or too little for another.  Like most disorders, one of the key diagnostic criterions of the DSM-IV-TR sexual dysfunctions is “marked distress or interpersonal difficulty.”  As a result, it’s not a problem unless the potential client makes it one, regardless of the presence of desire to engage in sexual activity.  Furthermore, it’s not a disorder unless a deficiency is detected and deemed appropriate by the clinician, thereby inserting another level of subjectivity.  It should come as no surprise that inter-rater reliability is lacking, and epidemiological data is mixed based on the definition of the disorder.

Another example is Sexual Arousal Disorders (i.e., Female Sexual Arousal Disorder, Male Erectile Disorder).  Although at the core, there may be some genetic or psychological factors at play, I am not sure I could consider it a disorder if someone simply isn’t attracted to their potential partner?  There are so many variables at play in Female Sexual Arousal Disorder that it may be increasing difficult to identify specific etiology.  Perhaps her partner is less than skilled.  Perhaps there is a developmental basis for the lack of lubrication (menopause).  Perhaps there are underlying biological causes in the form of circulatory problems that contribute to an inability to attain sufficient swelling response during periods of sexual arousal.  All of these situations are in fact treatable, but should we consider them “mental disorders?”  In some cases yes, where psychological factors are at play… however, there are an abundance of situations where psychological factors have little relevance in the diagnosis and treatment of Sexual Arousal Disorders.

Orgasmic Disorders (i.e., Female Orgasmic Disorder, Male Orgasmic Disorder, and Premature Ejaculation) may be propagated by psychological factors, and subsequently appropriate for inclusion in the DSM-V.  Conversely, there are a whole host of “combined factors,” including a very wide variability in type or intensity of stimulation that can trigger organism, that are likely less than “psychological” in nature.  Take premature ejaculation for example.  I think we would be hard pressed to find men who don’t want to last longer… and that inability may be a significant cause of duress for some men.  But as currently envisioned, there is no baseline as to what constitutes a threshold between a disorder, and simply being “excitable.”

Paraphilias are a hot topic in the psychological community because the presence of “mental disorders” like pedophilia seems to justify the behavior.  It would appear to me that any suggestion that paraphilias are in fact a mental disorder would present the opportunity to present a legal argument that “he or she is mentally ill, and as a result, can’t be considered liable for these actions.  In my opinion, simply having a legal option like that is counterintuitive and reprehensible.

We have addressed what is present; however, there is one glaring absence in the current nosology.  Where is the diagnostic category of “sexual dysfunction due to mental disorder?”  One possible solution is to redefine sexual dysfunction due to substance abuse as a dysfunction due to mental disorder “with onset during intoxication.”  (Segraves & Balon, 2007)  Including such a category would be intuitive in my opinion, despite the fact that our meanings of the words disorder and dysfunction have become rather convoluted in their practical application.  It seems to meet the definition of “abnormal or unhealthy,” more so than some of what we currently consider to be dysfunctions.  Without, there is a great deal of work that needs to be done in terms of clarification and codification as we approach the watershed appearance of the latest version of the DSM.

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American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed., text rev.). Washington, DC: Author.

Blaney, P. H., & Millon, T. (2009). Oxford textbook of psychopathology (2nd ed.). New York, New York: Oxford University Press.

Colman, A. M. (2009). Oxford dictionary of psychology (3rd ed.). Oxford, NY: Oxford University Press.

Merriam-Webster Online Dictionary. (2010). disorder. Retrieved May 23, 2010, from http://www.merriam-webster.com/dictionary/disorder

Merriam-Webster Online Dictionary. (2010). dysfunction. Retrieved May 23, 2010, from http://www.merriam-webster.com/dictionary/dysfunction

Segraves, R. T., & Balon, R. (2007, Aug). Toward an improved nosology of sexual dysfunctions in DSM-V. Psychiatric Times, 24(9), 44. Retrieved from http://ezproxy.bellevue.edu:80/login?url=http://proquest.umi.com.ezproxy.bellevue.edu/pqdweb?did=1313390581&Fmt=2&clientId=4683&RQT=309&VName=PQD

Gender Identification Disorder (GID)

The term gender identity, as used in the diagnosis of Gender Identification Disorder (GID), generally refers to issues surrounding the basic knowledge of understanding that he is a male or that she is a female.  These individuals have a persistent cross-gender identification that frequently manifests in a stated desire to be (or insistence that he or she is) the other sex.  Furthermore, individuals present with persistent discomfort with gender roles (Criterion B), although this particular criterion is quite ambiguous as it would seem that anyone who self-refers themselves to a therapist for diagnosis or treatment of GID is under some form of duress?

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“Children who met the complete criteria for GID were significantly younger, of a higher social-class background, and more likely to come from an intact, two-parent family than the children who did not meet the complete criteria.”  (Netherton, Holmes, & Walker, 1999, p. 370)  Despite this apparent correlation, very little is known about the etiology of GID or the antecedents that would or could contribute to its onset or maintenance.   What is known, is that the wish to change sex is negatively related to age, thereby making older children less likely to verbalize wishes to proceed with sex change procedures (hormonal treatment, surgical procedures, etc).  It has been suggested that this may be because of social desirability factors, but I suspect it is also due to the permanency of the procedures themselves.  What if they proceed and they change their minds?  What a quandry?

I was puzzled by the statement “unlike adult females with GID, who are invariably attracted sexually to biological females, adult males with GID are about equally likely to be attracted to biological males or females.”  (Netherton et al., 1999, p. 372)  What could possibly account for such a difference?  This leads me to believe that the male and female versions of this disorder are qualitatively different.

I am unsurprised that boys are referred more often than girls for concerns regarding GID.  I think this is likely driven by fathers who innately have different expectations for their sons than they do their daughters.  “Adults are less tolerant of cross-gender behavior in boys than girls…”  (Netherton et al., 1999, p. 375)  As a result, it has been suggested that girls would be required to display more extreme cross-gender behavior than boys before parents sought out a clinical assessment.  When someone refers to a girl as a “tom-boy” I think… “cute.”  When someone refers to a boy as a “sissy,” there is a distinctly negative connotation.  There is no culturally neutral term for a boy who sexually identifies with the female gender… so, despite the fact that girls are more likely to display masculine behavior compared to boys who display feminine behavior… the latter not the former are referred more often.  Seems backwards to me, but hey, that’s culture.

I was suitably surprised that the typical age of onset is so early!  Pre-school years (or even earlier) is when GID traits typically begin to appear… with nearly 90% of kids who intend to cross-dress “coming out” by their 5th birthday.  Differences have appeared as early as a child’s 2nd birthday… which may suggest some genetic/biological or prenatal influence on the phenomenon. (Something other than environmental, in any event)

Transvestic Fetishism (TF) typically manifests during adolescence or adulthood, unlike GID which typically manifests in early childhood.  It is perceived to occur almost exclusively in biological males, although a few cases of adult females demonstrating cross-dressing sexual arousal have been reported.  (Netherton et al., 1999, p. 384)  Unlike GID, childhood gender development of adolescents with GF is typically heterosexual (masculine).  TF would appear to serve some typify of self serving function, and as a result, the nature of cross-dressing in TF and in GID is qualitatively different. (Netherton et al., 1999, p. 386)  Some have suggested that TF develops as a reaction to “petticoat punishment” (forced cross-dressing during childhood) although this is a very rare occurrence.  (Netherton et al., 1999, p. 388)

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Netherton, S. D., Holmes, D., & Walker, C. E. (1999). Child and adolescent psychological disorders: A comprehensive textbook. Oxford, NY: Oxford University Press.