Sex and Sexual Disorders: Special Report

August 5, 2016

Four clinical reports indicate that in the last 30 years, we have come a long way in the exploration and study of sex and sexual disorders.

Special Report Chair, Chester Schmidt, MD reviews a series of 4 clinical reports that indicate we have come a long way in our understanding of sexual issues in the last 30 years. The first article is on sexual consent. The next is on advances in treating pedophilia. The third article, vaginismus. Finally, the perils of sex trafficking.

1. SEXUAL CONSENT

Capacity Assessment
Psychiatrists and other mental health professionals are experts at assessing individuals’ psychological faculties, and they thus have a key role to play in assessing capacity for sexual consent. Capacity determinations require a particularized analysis that is both decision-specific and circumstance-specific. Alexander A. Boni-Saenz, MSc, JD discusses basic concepts behind sexual consent capacity and provides guidance on how to pursue capacity assessments.

2. PEDOPHILIA

Can Pedophilia Be Treated?
“Once a pedophile always a pedophile” is so 30 years ago. J. Paul Fedoroff, MD updates readers on the realities about sex offenders and why psychiatrists should be more optimistic about their patients’ prognoses. For instance, not all sex offenders have paraphilias and not all people with paraphilias commit sex offences. Most of what is reported in the news involves sex offenders who by definition are criminals. Until recently, most scientific studies of the paraphilias consisted of men who had committed sex crimes. This has biased what we know about the paraphilias in the same way that studies that only included people with schizophrenia who had committed violent crimes would create a biased and incorrect view of what most people with schizophrenia are like.

Significance for the practicing psychiatrist: The popular media has not yet aligned itself with our current understanding of paraphilias and paraphilic disorders. Advances in genetics, gender identity, and other distinct aspects of sexuality have opened up the possibilities for treatment. For a mobile-friendly view of the Monarch notes, click here.

3. VAGINISMUS

“Gone” But Not Forgotten
The spasm-based definition of vaginismus was dropped from DSM-5 and vaginismus was combined with dyspareunia, the other “sexual pain disorder,” which resulted in genito-pelvic pain/penetration disorder (GPPPD). A number of factors motivated these changes. Yitzchak M. Binik, PhD and Samara Perez bring us up to date on both the conceptualization and the treatment of vaginismus. Details here.

4. HUMAN TRAFFICKING

Recognizing and Treating Victims and Survivors
Sex trafficking of an adult is legally defined as the use of force, fraud, or coercion for the procurement of commercial sexual services. Trafficking of a minor is by statute illegal and must be reported: force, fraud, or coercion does not have to be shown in these cases. While the criminal and hidden nature of the crime is a major obstacle, law enforcement and service providers acknowledge that a lack of awareness confounds the problem. Vivian B. Pender, MD reports that the road to recovery for is intense and requires intervention and care on multiple comprehensive levels.