Snapshot A 22-year-old woman presents with a complaint of an inability to engage in sexual intercourse with her boyfriend. She denies pain, or a lack of desire. She states that when she is about to engage in intercourse her legs lock together and she cannot get her muscles to relax. Upon further questioning you learn that when she was a child her uncle sexually abused her. Sexual Disorders Types disorders of sexual arousal erectile dysfunction female sexual interest/arousal disorder transvestic disorder intense arousal caused by cross-dressing fetishistic disorder intense arousal caused by an inanimate object or non-genital body part orgasm anorgasmia associated with SSRI's premature ejaculation (most common sexual disorder) sexual pain dyspareunia vaginismus associated with psychological trauma or sexual abuse sexual desire (no longer on the DSM) bisexuality attracted to both males and females Can be caused by drugs SSRI's are classic (switch to bupropion) disease in other organ systems e.g., atherosclerosis psychological causes DSM-V female sexual interest/arousal disorder a combination of issues with either sexual desire or arousal Snapshot Your patient is a 9-year-old boy who is brought in by his parents because his father feels like something is not right with his son. According to the parents the boy only plays with toys classically intended for girls (dolls, make-up) and insists on wearing girls clothing. Concerned, you interview the patient and find that he verbally insists on being a girl and feels at times that he does not fit in as a boy. He seems to demonstrate a strong preference for being girl, and this has persisted throughout his life. Gender Dysphoria Gender dysphoria emphasizes gender incongruence (rather than cross-gender identification) diagnosis in children requires strong desire to be of the other gender treatment CBT endocrine interventions surgical interventions