Sexual Dysfunction- difficult to Male Hypoactive Sexual Desire Female Sexual Interest/Arousal

function adequately while having sex; Disorder 302.71 (F52.0) Disorder 302.72 (F52.22)
not become aroused or achieve - little or no interest in sex that is - low sexual interest is almost always
orgasm causing significant distress in the accompanied by a diminished ability
Paaraphilic Disorders- “sexual individual or couple to become excited or aroused by
deviation”; sexual arousal occurs - problems with the desire or arousal erotic cues or sexual activity
primarily in the context of phase of the sexual response cycle - deficits in interest or the ability to
inappropriate objects or individuals; become aroused in women is
Philia, Strong attraction or liking; Diagnostic Criteria: combined
Para, attraction is abnormal A. Persistently or recurrently - problem with lubrication
Gender Dysphoria- incongruence and deficient sexual/erotic thoughts or
psychological distress and fantasies and desire for sexual Diagnostic Criteia:
dissatisfaction with the gender one activity. A. Lack of, or significantly reduced,
has been assigned at birth; disorder is B. 6 months sexual interest/arousal:
not sexual but rather a disturbance in C. cause clinically significant distress 1. Absent/reduced interest in sexual
the person’s sense of being a male or in the individual activity.
a female D. not better explained by a 2. Absent/reduced sexual/erotic
Heterosexual Behavior- sex with the nonsexual mental disorder or as a thoughts or fantasies.
opposite sex consequence of severe relationship 3. No/reduced initiation of sexual
Homosexual Behavior- sex with the distress activity, and typically unrecep- tive
same sex Specify if: to a partner’s attempts to initiate.
Lifelong or Acquired 4. Absent/reduced sexual
Gender Dfferences: Generalized or Situational excitement/pleasure during sexual
1. higher percentage of men than activity in almost all or all sexual
women report that they masturbate - Mood and anxiety symptoms encounters
2. men are more permissive about appear to be strong predictors of low 5. Absent/reduced sexual
casual sex desire in men interest/arousal in response to any
3. women want more intimacy from - Alcohol use may increase the internal or external sexual/erotic
sex occurrence of low desire. cues
- Among gay men, self-directed 6. Absent/reduced genital or
Sexual Dysfunction: homophobia, interpersonal nongenital sensations during sexual
- occur in both heterosexual and problems, attitudes, lack of adequate activity in almost all or all sexual
homosexual relationships sex education, and trauma resulting encounters
Different stages of sexual response from early life experiences must be B. 6 months
cycle: desire, arousal, and orgasm taken into account in explaining the C. cause clinically significant distress
- pain can become associated with low desire. in the individual
sexual func tioning in women, which - Social and cultural contextual D. not better explained by a
leads to an additional dysfunction factors should also be considered. nonsexual mental disorder or as a
Lifelong- chronic condition that is - Endocrine disorders such as consequence of severe relationship
present during a person’s entire hyperprolactinemia significantly distress
sexual life affect sexual desire in men. Specify if:
Acquired- disorder that begins after - Age is a significant risk factor for low Lifelong or Acquired
sexual activity has been relatively desire in men. Generalized or Situational
normal
Generalized- occurring every time the - Comorbid with depression and - negative cognitions and attitudes
individual attempts sex other mental disorders, as well as about sexuality and past history of
Situational- occurring with some endocrinological factors. mental disorders
partners or at certain times but not - relationship difficulties, partner
with other partners or at other times sexual functioning, and
- Premature (early) ejaculation occurs developmental history, such as early
only in males relationships with caregivers and
- genito-pelvic pain/penetration childhood stressors
disorder appears only in females
Female Orgasmic Disorder 302.73 Premature Ejaculation 302.75 Erectile Disorder 302.72 (F52.21)
(F52.31) (F52.4) - specific disorder of arousal
Diagnostic Criteia: - orgasm occurs at an inappropriate - frequent sexual urges and fantasies
A. Presence of either and experienced time or it does not occur and a strong desire to have sex
on almost all or all occasions of sexual - achieve orgasm only with great - problem is in becoming physically
activity: difficulty or not at all aroused
1. Marked delay in, marked infrequency - approximately 1 minute after - typically feels more impaired by his
of, or absence of orgasm. penetration problem as it makes intercourse
2. Markedly reduced intensity of Retrograde ejaculation- ejaculatory difficult or impossible
orgasmic sensations. fluids travel backward into the - prevalence is startlingly high and
B. 6 months bladder rather than forward; effects increases with age
C. cause clinically significant distress in of certain drugs or a coexisting
the individual medical condition Diagnostic Criteia:
D. not better explained by a nonsexual A. At least one of the 3 following
mental disorder or as a consequence of Diagnostic Criteia: symptoms must be experienced on
severe relationship distress A. A persistent or recurrent pattern almost all or all occasions of sexual
Specify if: of ejaculation occurring dur- ing activity:
* Lifelong or Acquired partnered sexual activity within 1. Marked difficulty in obtaining an
* Generalized or Situational approximately 1 minute following erection during sexual activity.
* Never experienced an orgasm under vaginal penetration and before the 2. Marked difficulty in maintaining an
any situation person wishes it. erection until the completion of sexual
* Mild, Moderate, or Severe (distress) B. 6 months and must be activity.
experienced on almost all or all 3. Marked decrease in erectile rigidity.
- may have greater difficulty occasions of sexual activity B. 6 months
communicating about sexual issues C. cause clinically significant distress C. cause clinically significant distress in
- anxiety and concerns in the individual the individual
about pregnancy, can potentially D. not better explained by a D. not better explained by a nonsexual
interfere nonsexual mental disorder or as a mental disorder or as a consequence of
- relationship problems, physical health, consequence of severe relationship severe relationship distress
and mental health distress Specify if:
Specify if: * Lifelong or Acquired
* Lifelong or Acquired * Generalized or Situational
Delayed Ejaculation 302.74 (F52.32) * Generalized or Situational * Mild, Moderate, or Severe (distress)
* Mild (30 seconds-1 min),
Diagnostic Criteia: Moderate (15-30 secs), Severe (15 - may have low self-esteem, low self-
A. Either of the following symptoms secs) confidence, and a de creased sense of
must be experienced on almost all or masculinity, and may experience
all occasions of partnered sexual - sense of lack of control over depressed affect
activityof partnered sexual activity and ejaculation and report apprehension - related to having sex with a previously
without the individual desiring delay: about their anticipated inability to unknown partner, concomitant use of
1. Marked delay in ejaculation. delay ejaculation drugs or alcohol, not wanting to have
2. Marked infrequency or absence of - common in men with anxiety sex, and peer pressure
ejaculation. disorders, especially social anxiety - Neurotic personality traits may be
B. 6 months disorder associated in younger men
C. cause clinically significant distress in - may be associated with dopamine - submissive personality traits may be
the individual transporter gene polymorphism or associated with erectile problems in
D. not better explained by a nonsexual serotonin transporter gene men age 40 years and older
mental disorder or as a consequence of polymorphism - Alexithymia (deficits in cognitive
severe relationship distress processing of emotions) is common in
Specify if: men diagnosed with "psychogenic"
* Lifelong or Acquired erectile dysfunction
* Generalized or Situational - common in men diagnosed with
* Mild, Moderate, or Severe (distress) depression and PTSD

- prolonged thrusting to achieve - Nocturnal penile tumescence testing

orgasm to the point of exhaustion or and measured erectile turgidity during
genital discomfort and then ceasing sleep can be employed to help
efforts differentiate organic from psychogenic
- Age-related loss of the fast- erectile problems
conducting peripheral sensory nerves
- age-related decreased sex steroid
secretion
- men older than 50 years

- may be more common in severe

forms of major depressive disorder
 Causes of Sexual Dysfunction:
1. Prescription medication
Genito-Pelvic Pain/Penetration Gender Dysphoria
(antihypertensive medication)
Disorder - person’s physical sex is not consistent
2. Chronic alcoholism
- difficulties with penetration during with the person’s sense of who he or
3. Nicotine
attempted intercourse or significant she really is or with his or her
4. Anxiety
pain during intercourse experienced gender
5. Growing dislike for a partner
- sexual desire is present, and arousal Gender identitiy, essence of your
6. Traumatic sexual events
and orgasm are easily attained, but the masculinity or femininity in a deep-
7. Childhood lessons about the
pain during attempted intercourse is so seated personal sense
negative consequences of sexual
severe that sexual behavior is Transsexual man or transman, natal
behavior
disrupted sex is female but the experienced
- severe anxiety or even panic attacks gender is strongly male
Treatment of Sexual Dysfunction:
may occur in anticipation of possible Transsexual woman or transwoman,
1. Psychosocial Treatment:
pain during intercourse natal male but the experienced gender
* sensate focus and nondemand
Vaginismus- pelvic muscles in the is strongly woman
pleasuring
outer third of the vagina undergo Posttransition, preparing for, or have
* Squeeze Technique- for premature
involuntary spasms when intercourse undergone sex reassignment surgery
ejaculation
is attempted; sensations of “ripping, - can also occur among individuals with
* Explicit training in masturbatory
burning, or tearing during attempted disorders of sex development (DSD),
procedure- for lifelong emale orgasmic
intercourse” formerly known as intersexuality or
disorder
hermaphroditism who are born with
2. Education
Diagnostic Criteia: ambiguous genitalia associated with
3. Medical Treatments
A. Persistent or recurrent difficulties documented hormonal or other
* Viagra- for erectile dysfunction
with one (or more) of the following: physical abnormalities
* Injection of vasoactive substances
1. Vaginal penetration during Autogynephilia, gender dysphoria
directly into the penis- producing an
intercourse. begins with a strong and specific sexual
erection within 15 minutes that can
2. Marked vulvovaginal or pelvic pain attraction to a fantasy of oneself as a
last from 1 to 4 hours
during vaginal intercourse or female
* Surgery/ Insertion of penile
penetration attempts. Gender nonconformity, boys who
prostheses or implants- approximate
3. Marked fear or anxiety about behave in feminine ways and girls who
normal sexual functioning
vulvovaginal or pelvic pain in behave in masculine ways; when most
* Vacuum device therapy- for erection
anticipation of, during, or as a result of young boys spontaneously display
vaginal penetration. “feminine” interests and behaviors,
4. Marked tensing or tightening of the they are typically discouraged by most
Treatment for Paraphilic Disorders:
pelvic floor muscles during attempted families, and these behaviors usually
1. Psychological Treatment:
vaginal penetration. cease. Boys who consistently display
* Covert Sensitization- associate
B. 6 months these behaviors are not discouraged,
sexually arousing images with some
C. cause clinically significant distress in however, and are sometimes
reasons why the behavior is harmful or
the individual encouraged.
dangerous
D. not better explained by a nonsexual
* Orgasmic Reconditioning- instructed
mental disorder or as a consequence of Diagnostic Criteia:
to masturbate to their usual fantasies
severe relationship distress Children:
but to substitute more desirable ones
Specify if: A. marked incongruence between
just before ejaculation
* Lifelong or Acquired one’s experienced/expressed gender
* Relapse Prevention Treatment-
* Mild, Moderate, or Severe (distress) and assigned gender, of at least 6
recognize the early signs of temptation
months (at least 6):
and to institute a variety of self- control
- Sexual and/or physical abuse have 1. A strong desire to be of the other
procedures before their urges become
often been cited as predictors gender or an insistence that one is the
too strong
- often report the onset of the pain other gender.
2. Drug Treatments:
after a history of vaginal infections 2. In boys, a strong preference for
* cyproterone acetate
cross-dressing or simulating female
- most popular drug used to treat
Assessing Sexual Behaviors: attire; or in girls, a strong preference
individuals with paraphilic disorders;
1. Interviews- supported by numerous for wearing only typical masculine
an antiandrogen
questionnaires because patients may clothing and a strong resistance to the
- “chemical castration” drug eliminates
provide more information wearing of typical feminine clothing.
sexual desire and fantasy by reducing
2. Medical Evaluation- rule out the 3. A strong preference for cross-gender
testosterone levels dramatically
variety of medical conditions roles in make-believe play or fantasy
* medroxyprogesterone
3. Psychophysiological assessment- play.
- hormonal agent that reduces
directly measure the physiological 4. A strong preference for the toys,
testosterone
aspects of sexual arousal; games, or activities stereotypically
Penile Strain Gauge- measures penile used or engaged in by the other
erection gender.
Vaginal photoplethysmograph- a 5. A strong preference for playmates of
device smaller than tampon, inserted the other gender.
to the vagibna with a light source at the
tip
Gender Dysphoria

Diagnostic Criteia:
Children:
6. In boys, a strong rejection of typically
masculine toys, games, and activities
and a strong avoidance of rough-and-
tumble play
or in girls), a strong rejection of
typically feminine toys, games, and
activities.
7. A strong dislike of one’s sexual
anatomy.
8. A strong desire for the primary
and/or secondary sex characteristics
that match one’s experienced gender.
B. Clinically significant distress or
impairment in social, school, or other
important areas of functioning

Adolescents and Adults:

A. A marked incongruence between
one’s experienced/expressed gender
and assigned gender, of at least 6
months (at least 2):
1. A marked incongruence between
one’s experienced/expressed gender
and primary and/or secondary sex
characteristics
2. A strong desire to be rid of one’s
primary and/or secondary sex
characteristics because of a marked
incongruence with one’s
experienced/expressed
gender (or in young adolescents, a
desire to prevent the development of
the anticipated secondary sex
characteristics).
3. A strong desire for the primary
and/or secondary sex characteristics of
the other gender.
4. A strong desire to be of the other
gender
5. A strong desire to be treated as the
other gender
6. A strong conviction that one has the
typical feelings and reactions of the
other gender
B. Clinically significant distress or
impairment in social, school, or other
important areas of functioning.

Treatment:
1. Sex reassignemtn surgery
- final nonreversible step is to alter
anatomy physically to be consistent
with gender identity
- must live in the desired gender for 1
to 2 years so that they can be sure they
want to change sex
- must be stable psychologically,
financially, and socially
Gynecomastia, groeth of breasts
 PARAPHILIC DISORDERS
- Anomalous activity preferences: courtship disorders (distorted components of human courtship behavior in voyeuristic
disorder, exhibitionistic disorder, and frotteuristic disorder), algolagnic disorders (involve pain and suffering in sexual masochism
disorder and sexual sadism disorder)
- Anomalous target preferences: directed at other humans in directed at other humans and elsewhere in fetishistic disorder and
transvestic disorder.
- Paraphilia denotes any intense and persistent sexual interest other than sexual interest in genital stimulation or preparatory
fondling with phenotypically normal, physically mature, consenting human partners; preferential sexual interests

VOYUERISTIC DISORDER 302.82 Comorbidity Differential Diagnosis

(F65.3) - hypersexuality and other paraphilic Conduct disorder and antisocial
disorders (exhibitionistic disorder) personality disorder. specific sexual
Diagnostic Criteria - Depressive, bipolar, anxiety, and interest in exposing the genitals
A. At least 6 months, recurrent and substance use disorders should be lacking
intense sexual arousal from observing - ADHD; conduct disorder and Substance use disorders. should not
unsuspecting person who is naked, in antisocial personality disorder involve the typical sexual interest in
the process of disrobing, or engaging exposing the genitals to unsuspecting
in sexual activity, manifested by persons
fantasies, urges, or behaviors. EXHIBITIONSITIC DISORDER 302.4
(F65.2)
B. Has acted on these sexual urges Comorbidity
with a nonconsenting person/ sexual - depressive, bipolar, anxiety, and
urges or fantasies cause clinically Diagnostic Criteria substance use disorders;
A. At least 6 months, recurrent and
significant distress or impairment hypersexuality
intense sexual arousal from the
C. At least 18 years of age - ADHD
Specfy if: exposure of one’s genitals to an - other paraphilic disorders
unsuspecting person, as manifested by
In a controlled environment: living - antisocial personality disorder
fantasies, urges, or behaviors.
in institutional or other settings
B. Has acted on these sexual urges
where opportunities to engage in
voyeuristic behavior are restricted with a nonconsenting person/ sexual
urges or fantasies cause clinically
In full remission: has not acted on
significant distress or impairment
the urges and no distress or
impairment for at least 5 years while Specify if:
Sexually aroused by exposing genitals
in an uncontrolled environment
to prepubertal children.
Diagnostic Features Sexually aroused by exposing genitals
Voyeuristic sexual interest: no to physically mature individuals.
Sexually aroused by exposing genitals
distress (lack of anxiety, obsessions,
to prepubertal children and to
guilt, or shame) and not impaired in
other important areas of functioning physically mature individuals.
In a controlled environment.
In full remission
Development and Course
Adult males: 1st become aware of
their sexual interest during Diagnostic Features
Exhibitionistic sexual interest: no
adolescence
distress, not impaired by this sexual
- Course is likely to vary with age
- requires one or more contributing interest, or do not act on them
factors that may change over time
Prevalence
with or without treatment: subjective
distress and/or propensity to act out - male
sexually by spying
Development and Course
Adult males: first became aware of
Risk and Prognostic Features
Temperamental. Voyeurism is a sexual interest during adolescence
- exhibitionistic impulses appear to
necessary precondition; risk factors
emerge in adolescence or early
for voyeurism should also increase
the rate of voyeuristic disorder adulthood
Environmental. Childhood sexual - requires one or more contributing
factors, which may change over time
abuse, substance misuse, and sexual
with or without treatment
preoccupation/ hypersexuality
- advancing age may be associated
with decreasing exhibitionistic sexual
Gender-related
preferences and behavior
- Common in male

Differential Diagnosis Risk and Prognostic Factors

Conduct disorder & antisocial Temperamental. Exhibitionism is a
personality disorder. specific sexual necessary precondition; Antisocial
interest in secretly watching history, antisocial personality disorder,
alcohol misuse, and pedophilic sexual
unsuspect ing others who are naked
Environmental. Childhood sexual and
or engaging in sexual activity not
present. emotional abuse and sexual
preoccupation/hyper sexuality
Substance use disorder. single
voyeuristic episodes if intoxicated
FROTTEURISTIC DISORDER 302.89 SEXUAL MASOCHISM DISORDER SEXUAL SADISM DISORDER 302.84
(F65.81) 302.83 (F65.51) (F65.52)

Diagnostic Criteria Diagnostic Criteria Diagnostic Criteria

A. At least 6 months, recurrent and A. At least 6 months, recurrent and A. At least 6 months, recurrent and
intense sexual arousal from touching intense sexual arousal from the act of intense sexual arousal from the
or rubbing against a nonconsenting being humiliated, beaten, bound, or physical/psychological suffering of
person, as manifested by fantasies, othenwise made to suffer, as another person, as manifested by
urges, or behaviors. manifested by fantasies, urges, or fantasies, urges, or behaviors.
B. Has acted on these sexual urges behaviors. B. Has acted on these sexual urges
with a nonconsenting person/ sexual B. Cause clinically significant distress or with a nonconsenting person/ sexual
urges or fantasies cause clinically impairment urges or fantasies cause clinically
significant distress or impairment Specify if: significant distress or impairment
Specify if: In a controlled environment. Specify if:
In a controlled environment. In full remission In a controlled environment.
In full remission With asphyxiophilia: achieving sexual In full remission
arousal related to restriction of
Diagnostic Features breathing Diagnostic Features
Frotteuristic sexual interest: no Sadistic sexual interest: no distress
distress, not impaired by this sexual Diagnostic Features about the paraphilia and have not
interest, or do not act on them Masochistic sexual interest: no acted on them
distress about the paraphilia
Prevalence - individuals who freely admit to Associated Features
- adult male having such paraphilic interests - extensive use of pornography
involving the infliction of pain and
Development and Course Associated Features suffering
Adult males: first became aware of - extensive use of pornography
sexual interest during late adolescence involving the act of being humiliated, Development and Course
or emerging adulthood beaten, bound, or otherwise made to - almost exclusively male
- requires one or more contributing suffer Females: became aware of their
factors, which may change over time sadomasochistic orientation as young
with or without treatment Prevalence adults
- advancing age may be associated - male - mean age at onset of sadism in a
with decreasing frotteuristic sexual group of males was 19.4 years.
preferences and behavior Development and Course - advancing age may be associated
- mean age at onset 19.3 years; earlier with decreasing sadistic sexual
Risk and Prognostic Factors ages, including puberty and childhood, preferences and behavior
Temperamental. Frotteurism is a have also been reported for the onset
necessary precondition; Nonsexual of masochistic fantasies Differential Diagnosis
antisocial behavior and sexual - requires one or more contributing - antisocial personality disorder, sexual
preoccupation/hypersexuality factors, which may change over time masochism disorder, hypersexuality,
with or without treatment sub stance use disorders (sometimes
Differential Diagnosis - advancing age may be associated occur also as comorbid diagnoses)
Conduct disorder and antisocial with decreasing masochistic sexual
personality disorder. specific sexual preferences and behavior Comorbidity
interest in touching or rubbing against - other paraphilic disorders
a nonconsenting individual should be Functional Consequences
lacking - at risk of accidental death while
Substance use disorders. might involve practicing asphyxiophilia or other
single frotteuristic episodes by autoerotic procedures
intoxicated individuals but should not
involve the typical sustained sexual Differential Diagnosis
interest in touching or rubbing against - transvestic fetishism, sexual sadism
unsuspecting persons disorder, hypersexuality, alcohol and
substance use disorders; sometimes
Comorbidity occur also as comorbid diagnoses
- hypersexuality and other paraphilic
disorders (exhibitionistic disorder and Comorbidity
voyeuristic disorder) - other paraphilic disorders
- Conduct disorder, antisocial
personality disorder, depressive
disorders, bipolar disorders, anxiety
disorders, and substance use disorders
 Diffeerential Diagnosis Gender-related
PEDOPHILIC DISORDER 302.2 (F65.4) - nearly exclusively reported in males
Antisocial personality disorder. often
Diagnostic Criteria shows other signs of this personality
disorder, such as recurrent law- Functional Consequences
A. At least 6 months, recurrent and - sexual dysfunction during romantic
intense sexually arousing fantasies, breaking
Alcohol and substance use disorders. reciprocal relationships when the
sexual urges, or behaviors involving preferred fetish object or body part is
sexual activity with a prepubescent disinhibiting effects of intoxication
OCD. absence of sexual thoughts about unavailable
child or children (13 yrs or younger) - prefer solitary sexual activity
B. Has acted on these sexual urges children during high states of sexual
arousal associated with their fetishistic
with a nonconsenting person/ sexual preference
urges or fantasies cause clinically - may steal and collect their particular
significant distress or interpersonal Comorbidity
- Depressive disorders, bipolar fetishistic objects of desire
difficulty
C. At least 16 years and at least 5 years disorders, anxiety disorders, and
antisocial personality disorder Differential Diagnosis
older than the child or chil dren in Transvestic disorder. fetishistic
Criterion A (not include late - substance-use disorders
- other paraphilic disorders disorder is not diagnosed when fetish
adolescence involved in an ongoing objects are limited to articles of
sexual relationship with a 12- or 13- clothing exclusively worn during cross-
year-old) FETISHISTIC DISORDER 302.81 (F65.0) dressing or when the object is genitally
Specify if: stimulating because it has been
Exclusive type (Attracted to children Diagnostic Criteria designed for that purpose
only) A. At least 6 months, recurrent and Sexual masochism disorder or other
Nonexclusive type intense sexual arousal from either use paraphilic disorders. engages in
Sexually attracted to males of nonliving objects or a highly specific "forced cross-dressing" and is primarily
Sexually attracted to females focus on nongenital body part, sexually aroused by the domination or
Sexually attracted to both manifested by fantasies, urges, or humiliation associated with such
Limited to incest behaviors fantasy or repetitive activity, the
B. Sexual urges or fantasies cause diagnosis of sexual masochism
Diagnostic Features clinically significant distress or disorder should be made
Pedophilic sexual interest: no distress, impairment Fetishistic behavior without fetishistic
not impaired by this sexual interest, or C. Fetish objects are not limited to disorder. without any associated
do not act on them articles of clothing used in cross- distress or psychosocial role
dressing or devices specifically impairment or other adverse
Associated Features designed for the puφose of tactile consequences
- extensive use of pornography genital stimulation
depicting prepubescent children Specify if: Comorbidity
Body part(s) - other paraphilic disorders
Prevalence Nonliving objects - hypersexuality
- male Other - neurological conditions (rare)
In a controlled enviroment
Development and Course In full remission
Adult males: first became aware of
sexual interest around the time of Specifiers
puberty - non-mutually exclusive combinations
- requires one or more contributing of fetishes may occur
factors, which may change over time
with or without treatment Diagnostic Features
- advancing age may be associated Partialism: exclusive focus on a body
with decreasing pedophilic sexual part
preferences and behavior
Associated Features
Risk and Prognostic Factors - multisensory experience, including
Temperamental. antisocial personality holding, tasting, rubbing, inserting, or
disorder smelling the fetish object while
Environmental. sexually abused as masturbating, or preferring that a
children sexual part ner wear or utilize a fetish
Genetic and physiological. any factor object during sexual encounters.
that increases the probability of - extensive collections of highly desired
pedophilia also increases the risk of fetish objects
pedophilic disorder;
neurodevelopmental perturbation in Development and Course
utero - can develop prior to adolescence;
continuous course that fluctuates in
Diagnostic Markers intensity and frequency of urges or
Penile plethysmography behavior
Viewing time, photographs of nude or
minimally clothed persons as visual Culture-related
stimuli but may violate law - distinguish a clinical diagnosis from a
socially acceptable sexual behavior
TRANSVESTIC DISORDER 302.3 (F65.1) Gender dysphoria. transvestic disorder
do not report an incongruence
Diagnostic Criteria between their experienced gender and
A. At least 6 months, recurrent and assigned gender nor a desire to be of
intense sexual arousal from cross the other gender; and they typically do
dressing, manifested by fantasies, not have a history of childhood cross-
urges, or behaviors gender behaviors
B. Sexual urges or fantasies cause
clinically significant distress or Comorbidity
impairment - other paraphilias (fetishism and
Specify if: masochism)
With fetishism: sexually aroused by - autoerotic asphyxia
fabrics, materials, or garments
With autogynephilia: sexually aroused
by thoughts or images of self as female
In a controlled environment OTHER SPECIFIED PARAPHILIC
In full remission DISORDER 302.89 (F65.89)

Specifiers
- presence of fetishism decreases the
likelihood of gender dysphoria in men UNSPECIFIED PARAPHILIC DISORDER
- presence of autogynephilia increases 302.9 (F65.9)
the likelihood of gender dysphoria in
men

Associated Features
Men: often accompanied by
autogynephilia; Autogynephilic
fantasies and behaviors may focus on
the idea of exhibiting female
physiological functions, engaging in
stereotypically feminine behavior, or
possessing female anatomy

Prevalence
- rare in males and extremely rare in
females

Development and Course

Male: first signs may begin in
childhood, in the form of strong
fascination with a particular item of
women's attire
- Prior to puberty, cross-dress ing
produces generalized feelings of
pleasurable excitement
- During/after puberty, dressing in
women's clothes begins to elicit penile
erection or ejaculation
- the course is continuous or episodic
- severity is highest in adulthood,
transvestic drives are most likely to
conflict with performance in
heterosexual intercourse and desires
to marry and start a family.

Functional Consequences
- interfere with, or detract from,
heterosexual relationships; source of
distress

Differential Dignosis
Fetishistic disorder. depends on the
individual's specific thoughts during
such activity and on the presence of
other fetishes