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Summary: Sex Disorders and Sex Therapy

Psychologists use the word gender to refer to a person's psychological identification as male or female. DSDs (Disorders of Sexual Development) occur when there is a mismatch between chromosomes, body structures, or inner feelings of gender identification.

Gender re-assignment is most likely to succeed when a person feels like they are in a mismatched body from an early age. In the 1960s and 1970s many sex-change operations were performed, but follow-up studies showed that surgery had mixed results and many people were just as happy without it.

The frequency of the operations dropped. They are still performed, but only after a lengthy evaluation period.

Paraphilias are unusual sexual attractions, and DSM-5 lists ten of them including an all-purpose category for less common paraphilias. It also makes a distinction between paraphilias that are harmless and paraphiliac disorders, which are distressing to the individual or potentially harmful to others.

Paraphilias invariably involve a sexual thrill over something forbidden. Transvestitism is a paraphilia when cross-dressing is motivated by sexual desire. Experts say only men are transvestites, because women cross-dress for comfort or convenience but generally not for a sexual thrill.

Exhibitionism is the most common paraphilia, and it is resistant to treatment. Women exhibitionists are accepted in some subcultures and are not necessarily regarded as abnormal.

Masochism is sexual arousal from pain, physical abuse, or humiliation. Sadism is sexual arousal from inflicting pain. Masochists are often men who occupy positions of high status, for whom masochistic tendencies are normally forbidden.

The BDSM (bondage, domination, sadism, masochism) community includes other fetishes such as attraction to leather and various forms of role-playing. The BDSM community defends their practice as harmless if unusual sexual preferences. DSM-5 considers unusual sexual attractions to be psychiatric disorders only if they cause distress or threaten harm to other people.

The four most common sexual disorders are premature ejaculation or impotence (in men) and anorgasmia or lack of desire (in women). Treatment of these problems is usually successful and often involves couples therapy. Couples are instructed in common techniques to do privately on their own time.

As therapies for these common problems became widely known, therapists began seeing people with more complex sexual problems. Often these require therapy for relationship issues or the results of past traumas.

Now it is common for regular therapists (even if they are not specialized sex therapists) to deal with sexual problems. Even those who present themselves as sex therapists must become skilled in recognizing problems in relationships, and this is widely known by therapists.

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