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The stages of sexual activity include excitement (arousal), orgasm, and resolution The precipitating excitement or arousal is psychologically determined Arousal response leading to plateau is a physiologic and psychological phenomenon of vasocongestion, a parasympathetic reaction causing erection in men and labial-clitoral congestion in women The orgasmic response includes emission in men and clonic contractions of the analogous striated perineal muscles of both men and women Resolution is a gradual return to normal physiologic status While the arousal stimuli vasocongestive and orgasmic responses constitute a single response in a well-adjusted person, they can be considered as separate stages that can produce different syndromes responding to different treatment procedures
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a woman s shoe, a child, animals, instruments of torture, or incidents of aggression The pattern of sexual stimulation is usually one that has early psychological roots Poor experiences with sexual activity frequently reinforce this pattern over time Exhibitionism is the impulsive behavior of exposing the genitalia to unsuspecting strangers in order to achieve sexual excitation It is a childhood sexual behavior carried into adult life Transvestism consists of recurrent cross-dressing behavior in a heterosexual man for the purpose of sexual excitation Such fetishistic behavior can be part of masturbation foreplay Transvestism in homosexuality and transsexualism is not for the purpose of sexual excitement but is a function of preference or gender identity disorder Voyeurism involves the achievement of sexual arousal by watching the activities of an unsuspecting person, usually in various stages of undress or sexual activity In both exhibitionism and voyeurism, excitation leads to masturbation as a replacement for sexual activity Pedophilia is the use of a child of either sex to achieve sexual arousal and, in many cases, gratification Contact is frequently oral, with either participant being dominant, but pedophilia includes intercourse of any type Adults of both sexes engage in this behavior, but because of social and cultural factors it is more commonly identified with men The pedophile has difficulty in adult sexual relationships, and men who perform this act are frequently impotent Incest involves a sexual relationship with a person in the immediate family, most frequently a child In many ways it is similar to pedophilia (intrafamilial pedophilia) Incestuous feelings are fairly common, but cultural mores are usually sufficiently strong to act as a barrier to the expression of sexual feelings Sexual sadism is the attainment of sexual arousal by inflicting pain upon the sexual object Much sexual activity has aggressive components (eg, biting, scratching) However, forced sexual acquiescence (eg, rape) is considered to be primarily an act of aggression Sexual masochism is the achievement of erotic pleasure by being humiliated, enslaved, physically bound, and restrained It may be life-threatening, since neck binding or partial asphyxiation usually forms part of the ritual The practice is much more common in men than in women
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B Gender Identity Disorder
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Core gender identity reflects a biologic self-image the conviction that I am a boy or I am a girl that is usually well developed by age 3 or 4 Gender dysphoria refers to the development of a sexual identity that is the opposite of the biologic one Transsexualism is an attempt to deny and reverse biologic sex by maintaining sexual identity with the opposite gender Transsexuals do not alternate between gender roles; rather, they assume a fixed role of attitudes, feelings, fantasies, and choices consonant with those of the opposite sex, all of which clearly date back to early development For example, male to female transsexuals in early childhood behave, talk, and fantasize as if they were girls They do not grow out of feminine
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There are three major groups of sexual disorders
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A Paraphilias (Sexual Arousal Disorders)
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In these conditions, formerly called deviations or variations, the excitement stage of sexual activity is associated with sexual objects or orientations different from those usually associated with adult sexual stimulation The stimulus may be
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