Paraphilias

Paraphilia (in Greek para παρά = besides and -philia φιλία = friendship)—in psychology and sexology, is a term that describes a family of persistent, intense fantasies, urges, or behaviors involving sexual arousal to nonhuman objects, pain or humiliation experienced by oneself or one's partner, or children or other nonconsenting individuals. Paraphilias may interfere with the capacity for reciprocal affectionate sexual activity. Paraphilia is also used to imply non-mainstream sexual practices without necessarily implying dysfunction or deviance (see Clinical warnings). Also, it may describe sexual feelings toward otherwise non-sexual objects.

Describe paraphilia variants of the average sexual preference.
A paraphilia is a recurring sexually exciting fantasy, impulse or behavior related to non-human objects e.g things, fabrics, designs, the suffering or humiliation of oneself or the partner, children or other non-consenting persons. So basically it is getting aroused by things that wouldn't arouse the average person. You have a paraphilia when you have these thoughts, behaviours and impulses for at least 6 months and they are distressing for yourself or others. We distinguish between fetishism, frotteurism, pedophilia, sexual masochism, sexual sadism, transvestitism fetishism, voyeurism, exhibitionism and the group of unspecified paraphilias.

If we ask for the cause of something, we assume that it is about a disorder. In this question it's more so that we wonder why people do what they do. People tend to apply a certain norm in judging others and themselves. What we don't understand or find strange, we often reject. There are many theories that try to explain the origin of an aberrant sexual fantasy, thought or behavior in persons, but a final explanation is not known yet. We often assume that they originate or are formed in puberty. There are two important explanations for the development of sexual variation. Explanations that come from the idea of social development - how people treat each other - assume that something is wrong with the ability of these people to get involved in a relationship. This inability would be expressed in the form of sexual variation. Exhibitionism and voyeurism are then seen as clumsy attempts to make contact. Another explanation is that of coincidental connections between arousal and a certain situation or act. It is assumed that you want to repeat the experience that led to arousal.
Some behaviour, such as sadomachosism, is known to be related to having been submitted to violent abuse. Associating violence with sex has been a learned technique for surviving violent abuse.

What is sexual sadism?
Getting sexually aroused by fantasies about doing psychological or physical harm to a victim. This can mean getting aroused by humiliating another person, who often consents to this, using pain-causing material during sexual contact, for example whips or chains. The person with whom there is sexual contact is often a sexual masochist.
Sadism and masochism, in the original sense, describe psychiatric disorders characterized by feelings of sexual pleasure or gratification when inflicting suffering or having it inflicted upon the self, respectively. Sadomasochism is used in psychiatry to describe either the co-occurrence of sadism and masochism in one person as separate disorders, or as a replacement for both terms, depending on the theory used.
Masochism is getting sexually aroused by fantasies about being humiliated, beaten, tied up or otherwise tortured. Sadism is getting sexually aroused by incurring humiliati, beating, tiying up or otherwise torturing. Sado-Masochism is the combination of Sadism and Masochism in a complementary manner.
Masochism and Sadism are often caused by having been beaten or otherwise submitted to sadism when a child. This risk is a strong argument against even beating children.

What is voyeurism?
Voyeurism is a practice in which an individual derives sexual pleasure from observing other people. Such people may be engaged in sexual acts, or be nude or in underwear, or dressed in whatever other way the "voyeur" finds appealing. The word derives from French verb voir (to see) with the -eur suffix that translates as -er in English. A literal translation would then be “seer” or "observer", with pejorative connotations.

Pedophilia is scientifically defined as getting sexually aroused by a child in pre-puberty or a child younger than13 years old.
To be sexually aroused by children in puberty is known under the term "hebephilia" or "ephebophilia"
Note: Legally, pedophilia is often used to mean sexual relations with children under the age of consent. This age may vary from country to country, 15 and 17 are common age limits.
Pedophilia or pædophilia is the paraphilia of being sexually attracted primarily or exclusively to prepubescent or peripubescent children. A person with this attraction is called a pedophile or paedophile.
In contrast to the generally accepted medical definition, the term pedophile is also used colloquially to denote significantly older adults who are sexually attracted to adolescents below the local age of consent, as well as those who have sexually abused a child.
Getting sexually aroused by fantasies about secretly watching others permission during sexual activities, undressing or being naked.

What is frotteurism?
Getting sexually aroused by touching and rubbing oneself against another non-consenting person.In psychiatry, the clinical term frotteurism (no longer called frottage) refers to a specific paraphilia which involves the non-consensual rubbing against or touching another person in order to achieve sexual arousal or even orgasm. This may be done discreetly without being discovered, or in circumstances where the victim cannot respond, typically in a public place such as a crowded train. In common speech frotteurism is called groping though this term may sometimes be used for consensual Frottage.
The term toucherism is sometimes used to describe the closely related condition involving only touching or fondling without rubbing, although it is generally considered to be part of frotteurism.
Usually such nonconsensual sexual contact is viewed as criminal offense: a form of sexual assault albeit often classified as a misdemeanor with minor legal penalties. Conviction may result in a sentence including compulsory psychiatric treatment.
A person who suffers from frotteurism is known as a frotteur.

What is fetishism?Getting sexually aroused by non-living and generally not sexually arousing objects, e.g shoes, lingerie, soft fabrics, etc.
A fetish (from French fétiche; from Portuguese feitiço; from Latin facticius, "artificial" and facere, "to make") is an object believed to have supernatural powers, or in particular a man-made object that has power over others.
Fetishism means the religion of the fetish. The word fetish is derived through the Portuguese feitiço from the Latin factitius (facere, to do, or to make), signifying made by art, artificial (cf. Old English fetys in Chaucer). From facio are derived many words signifying idol, idolatry, or witchcraft. Later Latin has facturari, to bewitch, and factura, witchcraft. Hence Portuguese feitiço, Italian fatatura, O. Fr. faiture, meaning witchcraft, magic. The word was probably first applied to idols and amulets made by hand and supposed to possess magic power. In the early part of the sixteenth century, the Portuguese, exploring the West Coast of Africa, found the natives using small material objects in their religious worship. These they called feitiço, but the use of the term has never extended beyond the natives on the coast. Other names are bohsum, the tutelary fetishes of the Gold Coast; suhman, a term for a private fetish; gree-gree on the Liberian coast; monda in the Gabun country; bian among the cannibal Fang; in the Niger Delta ju-ju -- possibly from the French joujou. i.e. a doll or toy (Kingsley) -- and grou-grou, according to some of the same origin, according to others a native term, but the natives say that it is "a white man's word". Every Congo leader has his m'kissi; and in other tribes a word equivalent to "medicine" is used.

What is exhibitionism?
Getting sexually aroused by the idea of showing the genitals to an unsuspecting stranger, for example the so-called 'flasher'. Exhibitionism (also known as Lady Godiva syndrome and Apodysophilia) is the psychological need and pattern of behavior to exhibit naked parts of the body to other people. In exhibitionism the individual shows a tendency to an extravagant, usually at least partially sexually inspired behavior to captivate the attention of others in a display of a body part, or parts, that would otherwise be left covered under clothing in nearly all other cultural circumstances.
The part(s) of the body exposed can be the female breasts or the genitalia or buttocks of either gender.
Exhibitionists who view exhibitionism as a lifestyle as opposed to a rare thrill carefully select their target audience and make the exposure brief, inconspicuous and apparently unintentional. It is a fetish, and many such practitioners see it as an art form. Many night clubs and goth bars encourage mild exhibitionism to enhance the venue's atmosphere. This contrasts with non-sexualized social nudity, in which the exposure is not connected with sexual expression, such as sunbathing or swimming at nude beaches or other participation in public nudity events where nudity is the norm.
Some exhibitionists wish to display themselves sexually to other people singly or in groups. This can be done consensually as part of swinging or group sex. When done nonthreateningly, the intent is usually to surprise and/or sexually arouse the viewer, giving the exhibitionist an ego rush. Some people like to expose themselves in front of large crowds, typically at sporting events; see streaking. Some like to use the internet to distribute their stories and pictures on websites like Exhibitionist World. A similar phenomenon is when, at the conclusion of a sporting event, a woman may flash her breasts while sitting atop someone's shoulders in a dense crowd of people.
Various forms of exhibitionism, usually by females, that are captured by various forms of media, such as the Girls Gone Wild video series, have proven highly popular among Western society's male market.

How can paraphilias be treated?
Sexual variations sometimes get people into trouble. The chance of conflicts with society is greater for people with an exceptional sexual preference. Very a few people with one or more paraphilias look for help with a social worker. They usually do this because they suffer from the paraphilia or because others, e.g their partner, suffer from it or society disapproves of heir behavior and makes them liable for punishment. Treatment may be focused on two areas. Space can be created for the development of the paraphilia. In this case patients get tips for getting in contact with fellow-sufferers and accepting themselves. On the other hand the paraphilia can be suppressed so that it occupies a smaller and more controllable place in the life of the person. This second treatment is more common. Medicinal treatments with anti-androgens (hormones) or psychopharmacology can influence the intensity and the frequency of the paraphilia.

Gender identity disorder

Gender identity disorder, as identified by psychologists and physicians, is a condition in which a person has been assigned one gender, usually on the basis of their sex at birth (compare intersex disorders), but identifies as belonging to another gender, and feels significant discomfort or being unable to deal with this condition. It is a psychiatric classification and describes the problems related to transsexuality, transgender identity and more rarely transvestism. It is the diagnostic classification most commonly applied to transsexuals.
The core symptom of gender identity disorders is gender dysphoria, literally being uncomfortable with one's assigned gender.
This feeling is usually reported as "having always been there" since childhood, although in some cases, it appears in adolescence or adulthood, and has been reported by some as intensifying over time.[1] Since many cultures strongly disapprove of cross-gender behaviour, it often results in significant problems for affected persons and those in close relationships with them. In many cases, discomfort is also reported as stemming from the feeling that one's body is "wrong" or meant to be different.
Some medical and psychological professional have tried to cure (dissuade) individuals from their transgender behaviour/feelings at least since the mid-19th century. Only occasionally have such cures been reported, and almost all such reports lack substantiation. (Overlapping reports suggest some in fact were cured several times, implying that these individuals were not cured at all.) While over three decades ago the American Psychiatric Association (APA) removed homosexuality from the Diagnostic and Statistical Manual of Mental Disorders (DSM), and many believed sexual identities were finally freed of medicalized stigma, today many LGB and "gender non-conforming" youth and adults remain vulnerable to diagnosis of psychosexual disorder under the GID diagnosis which immediately replaced homosexuality in the DSM version III. Thus many LGB and gender variant youth and adults, including transgender individuals, are still directed to conversion therapies.

Today, most medical professionals who provide transgender transition services now reject conversion therapies as abusive and dangerous, believing instead what many transgender people have been convinced of: that when able to live out their daily lives with both a physical embodiment and a social expression that most closely matches their internal sense of self, transgender and transsexual individuals live successful, productive lives virtually indistinguishable from anyone else (e.g. Lynn Conway’s “Success Pages” in External Links below). “Transgender transition services”, the various medical treatments and procedures that alter an individual's primary and/or secondary sexual characteristics, are thus now considered highly successful, medically necessary interventions for many transgender persons, including but not limited to transsexuals, especially those who experience the deep distress of body dysphoria. The World Professional Association for Transgender Health (WPATH, formerly HBIGDA) Standards of Care (Version 6 from 2001) are considered by some as definitive treatment guidelines for providers. Other Standards exist (see those discussed in Standards of care for gender identity disorders, including the guidelines outlines in Gianna Israel and Donald Tarver's classic 1997 book "Transgender Care". Several health clinics in the United States (e.g. Tom Waddell in San Francisco, Callen Lorde in New York City, Mazzoni in Philadelphia) have developed “protocols” for transgender hormone therapy following a “harm reduction” model which is coming to be embraced by increasing numbers of providers. In their 2005 book Medical Therapy and Hormone Maintenance for Transgender Men, Dr. Nick Gorton et al suggest a flexible approach based in harm reduction, “Willingness to provide hormonal therapy based on assessment of individual patients needs, history and situation with an overriding goal of achieving the best outcome for patients rather than rigidly adhering to arbitrary rules has been successful.”
Medical body interventions and procedures are often necessary to enable living socially in a gender role that more closely matches one's gender identity, and many assume that being accurately perceived by others is a primary goal of body transformations. However, for those transgender individuals who experience the deep internal distress of body dysphoria, the effects wrought by physical changes - hormones, surgeries, or other procedures - go much deeper than surface appearances and are far from cosmetic. The primary effects of hormonal and/or surgical interventions are experienced directly by self, internally, increasing a sense of internal harmony and well-being at the deepest psychological and emotional levels, as well as through the physical senses especially proprioception - the body's own knowledge of itself. Many medical professionals have come to consider "post-transition" transsexuals to be fully cured of their dysphoria or any other disorder.

Therefore, many feel the diagnosis of gender identity disorder is at best only temporarily applicable, if ever.[citation needed] Indeed, through transition many transsexuals are able to bring their body and their lived/expressed gender into alignment with the internal sense of self. Thus, many post-transition transsexuals cease to regard themselves as "trans" in any sense: many transwomen (male-to-female) self-describe as "women" and, similarly, many transmen feel themselves to be unequivocally "men." While some of these individuals may require continued hormone replacement therapy (estrogen or testosterone, respectively) throughout their adult life, such HRT is not substantially different from the HRT often prescribed for cisgender females or males (not only are dosage levels similar, so are the effects of lack of treatment). Thus, many medical providers in the United States now routinely prescribe such HRT under the same medical codes used for other women and men.

Achieving basic human rights for all transgender persons undoubtedly requires increased social acceptance of each individual's own expression of their identity, regardless of their birth gender or social role expectations. However, for those transgender individuals who experience the internal distress of body dysphoria, social acceptance of variation, while vastly important, will not be sufficient. For this segment of the transgender community, some medical services and procedures will also be required in order for these individuals to feel aligned with their bodies and for the distress of body dysphoria to be fully alleviated.

Gorton et al. underscore the importance of medical interventions for some transgender individuals, warning that “Providers must however consider not only the adverse effects of providing hormones but the adverse consequences of denying access to medically supervised hormonal therapy. Non-treatment of transgender patients can result in significantly worse psychological outcomes.” Failure to treat and/or delayed access to transition may have tragic, indeed catastrophic, results for some transgender individuals. It is well-known that the rate of teen suicides is highest for LGBT youth. Recent studies now suggest that suicide rates are highest for transgender youth and adults, especially those unable to live their gender identity and those unable to access transgender transition services. Gorton et al. suggest rates as high as 20% for untreated transsexuals. However, even when transition services are available, suicide rates are still higher than for the general population.

What is transgender and transsexual? Is it a gender identity disorder?
Transgender is generally used as a catch-all umbrella term for a variety of individuals, behaviours, and groups centered around the full or partial reversal of gender roles ; however, compare other definitions below.
A transgender symbol, a combination of the male and female sign with a third, combined arm representing transgender people.
The term remains in flux, but the most accepted definition is currently:
People who were assigned a gender, usually at birth and based on their genitals, but who feel that this is a false or incomplete description of themselves.
Another one is: Non-identification with, or non-presentation as, the gender one was assigned at birth.

Transgender people may or may not have had medical gender reassignment therapy, also called sexual reassignment surgery, and may or may not have any interest in such a procedure. In other words, not all transgender people are necessarily transsexual.

When referring to the two basic "directions" of transgender, the terms transman for female-to-male (which may be further abbreviated to FtM) transgender people and transwoman for male-to-female (which may be further abbreviated to MtF) transgender people may be used. In the past it had always been assumed that there were considerably more transwomen than transmen. However, the ratio is approaching 1:1.

Transgender can include a number of sub-categories, which, among others, including transsexual, cross-dressing, transvestite, consciously androgynous people, people who are genderqueer, people who live cross-gender, drag kings and drag queens, among many others. Usually not included, because in most cases it is not a gender issue (although in practice the line can be hard to draw) are transvestic fetishists.

Many people also identify as plainly transgender, although they may fit the definition of any of the previously mentioned categories as well.

The extent to which intersex people (those with genitalia or other physical sexual characteristics that not strictly either male or female) are included in the transgender category is often debated. Not all intersex people have a problem with the gender role they were assigned at birth, nor do all intersex people have any problems with gender identity. Those who have, though, are sometimes included in transgender.

The opposite of transgender is cisgender.
The terms "gender dysphoria" and "gender identity disorder" are used in the medical community to explain these tendencies as a psychological condition and the reaction to its social consequences. Strictly speaking, gender dysphoria and gender identity disorder are considered to be mental illnesses, as recorded in the Diagnostic and Statistical Manual of Mental Disorders (DSM), the standard for mental healthcare professionals. Unfortunately, many mental healthcare providers know little about transgender life, and persons seeking help from these professionals often end up educating the professional rather than receiving help. Among those therapists, psychologists, etc. who do know about transgender issues, many believe that transitioning from one sex to another "the standard transsexual model" is the best or only solution. This usually works well for those who are transsexual, but often far less well for those cross-gender people who do not identify as plainly male or female.
Originally, the term transgender was coined in the 1970s by Virginia Prince in the USA, as a contrast with the term "transsexual," to refer to someone who does not desire surgical intervention to "change sex," and/or who considers that they fall "between" genders, not identifying strictly to one gender or the other, identifying themselves as neither fully male, nor female.

Transgenderists and non-operative transsexuals
Often in older writings (pre ~ 1990s), but rarely today, the term transgender is used to refer to these "non-op transsexuals" or "non-op transpeople" who live as the gender opposite to their birth gender and, though sexual reassignment surgery is possible, have chosen not to undergo it; sometimes they also choose not have other medical gender reassignment therapy. However, sometimes, for example in the Netherlands (but not in the rest of Europe), the term transgender is still in use for this particular group instead of being used as such an umbrella term.

This group is also sometimes known as "transgenderists" or "non-op transsexuals". Many point out that the term "non-op transsexual", however, is very far from ideal, in that it seems to be an oxymoron (people who want to become the other sex yet don't) or a case of defining people by what they are not rather than what they are. Unfortunately, there seems to be no perfect term in English for this sort of person as of yet.
Transgender as "in between"
Transgender is sometimes also used specifically in an "in-between" sense, rather than as an umbrella term.

A newer related term is "genderqueer", which refers to the mixing of qualities traditionally associated with "male" and "female," and can also refer to the "in-between" sense sometimes associated with transgender or transgenderism.
Transsexual people are people who desire to have, or have achieved, a different physical sex from that which they were assigned at birth. One typical (though oversimplified) explanation is of a "woman trapped in a man's body" or vice versa; many transsexual women state that they were in fact always of the female gender, but were assigned the male gender as a child on the basis of their genitals, and having realized that they are female, wish to change their bodies to match; transmen, naturally, feel exactly the opposite.

The process of physical transition for transsexuals usually includes hormone replacement therapy and may include sexual reassignment surgery (a.k.a. gender reassignment surgery). For transwomen, electrolysis for hair removal is often required, while many transmen have breast-reduction surgery as early as possible, whether accompanied by genital surgery or not.

Some spell the term transexual with one s in order to reduce the association of their identity with psychiatry and medicine.
Terminology and concepts, compared to transgender
Transgender is often used as a euphemistic synonym for transsexual people by some. One set of reasoning for this is that it removes the conceptual image "sex" in "transsexual" that implies transsexuality is sexually motivated, which it is not. This usage is problematic because it can cause transgender people who do not identify as transsexual to be confused with them. It also seems to remove the issue of social presentation (gender, in its social sense) from the question, even though gender role and presentation is an important part of the equation.

Furthermore, many transsexuals reject the term "transgender" as an identification for themselves, either as a synonym or as an umbrella term. They advance a number of arguments for this. One argument is that the use of the umbrella term inaccurately subsumes them and causes their identity, history, and existence to be marginalized. Another is that they perceive the term to be the breaking down of gender barriers, whereas transsexual people themselves usually identify as men or as women -- just not as they were assigned at birth. A third occasionally mentioned is that they did not change gender at any point -- they have always had their gender (identity), and the difficulty is their sex (anatomy), which they desire to change. However, others point out that transsexual people do change their gender role at some point, and that most non-transsexual transgender people always had their gender identity, too.

A more problematic dispute with the use of the term "transsexual" is that it refers to processes of chemical and/or anatomical modification that do not actually render an individual reproductively viable after transition processes, nor change sex chromosomes. Particularly, criticism of transsexual women by some feminists includes the contention that their transition is cosmetic rather than fundamental, and they are thus not "really" changing their sex at all (thus the use of transgender). These critics claim that the presumption of reproductive viability is what distinguishes "women" from "men". This argument is used to discount the rights of identification and association with other women that transsexual women might claim. However, many arguments that link whether someone is a "woman" or a "man" based on reproductive capability, or chromosomes, fall apart when considering non-transsexual people who are infertile or non-transsexual men or women who have a chromosomal configuration different from other men and women in the general population.

Probably many of these problems are associated with the history of the term "transgender" and its other definitions; see above.

To respect the identity of those transsexual people who do not identify as transgender, the constructions trans, trans*, or transgender and transsexual sometimes are used to describe all transpeople.

Further, many people who this article would define as transgender reject the term altogether, along with other related terms (transsexual, crossgender, etc.). This is most commonly seen with people who have changed sex but who do not define themselves as transsexual. A common statement is that a transsexual is someone who is undergoing a change from one sex to another; someone who has already done so is simply a "man" or a "woman". This brings up issues of the extent to which someone who is not a part of a group may define it, also seen in the case of, for example, "men who have sex with men" (MSMs), who do not see themselves as homosexual but could still be defined as such.
Cross-dressing, transvestism, drag king, drag queen, transvestic fetishism
A person who is cross-dressing is any person who, for any reason, wears the clothing of a gender other than that to which they were assigned at birth. Cross-dressers may have no desire or intention of adopting other behaviours or practices common to that gender, and particularly does (currently) not wish to undergo medical procedures to facilitate physical changes. Contrary to common belief, most male-bodied cross-dressers prefer female partners.

Drag involves wearing highly exaggerated and outrageous costumes or imitating movie and music stars of the opposite sex. It is a form of performing art practiced by drag queens and drag kings. Drag is often found in a gay or lesbian context. The term "drag king" can also apply to people from the female-to-male side of the transgender spectrum who do not see themselves as exclusively male identified, therefore covering a much wider ground than a "drag queen".

Transvestic fetishism is a term used in the medical community to refer to one who has a fetish for wearing the clothing of the opposite gender. This is considered a derogatory term by some, as it implies a hierarchy of value in which the sexual element of transgender behaviour is of low social value. Many reject the term "transvestite" for this reason, preferring cross-dresser instead. It is often difficult to distinguish between fetishism that happens to have female clothing as an object and transgender behaviour that includes sexual play. Some people feel that transvestic fetishism does not count as cross-dressing.
"Transgender" is also used to describe behaviour or feelings that cannot be categorized into these older sub-categories, for example, people living in a gender role that is different from the one they were assigned at birth, but who do not wish to undergo any or all of the available medical options, or people who do not wish to identify themselves as "transsexuals", "men" or "women", and consider that they fall between genders, or transcend gender.

Some people who present as female, but with male genitalia may have been born intersexual but may also be transsexual or transgender, who do transition (taking oestrogens and/or other methods) to achieve some desired secondary sex characteristics, but not sexual reassignment surgery. Sometimes these individuals are referred to as ladyboy or shemale (compare there), but these terms are considered derogatory by many, including most transgender or transsexual people not working in the sex industry.
(Trans-)gender identity is different from, though related to, sexual orientation. Sexual orientations among transgender people vary just as much as they do among cisgender people. Although few studies have been done, transgender groups almost always report that their members are more likely to be attracted to those with the same gender identity, compared to the population as a whole; that is, transwomen are more likely to be attracted to other women, and transmen are more likely to be attracted to other men. Many transgender people who are attracted to others of the same gender will identify as gay, lesbian, or bisexual.

Note that in the professional literature, "homosexual" and "heterosexual" are very often used respective to clients' birth sex, instead of their desired sex. Transgender people may feel misunderstood by caregivers because of this practice; it is also quite confusing when a relationship that is considered gay or lesbian by both partners is labeled heterosexual, or a relationship that consists, as far as the partners are concerned, of a man and a women is labeled homosexual. The existence of transgender people and their sexual relationships points to certain inadequacies of language.

Many Western societies today have some sort of procedure whereby an individual can change their name, sometimes also their legal gender, to reflect their gender identity; see Legal aspects of transsexualism. Medical procedures for transgender people are also available in most Western and many non-Western countries. However, because gender roles are an important part of many cultures, those engaged in strong challenges to the prevalence of these roles, such as many transgender people, often have to face considerable prejudice.
Transgender in non-Western cultures
This article describes primarily Western modes of transgenderism. Many other cultures have or have had similar phenomena:
The so-called berdache in many Native American groups is recognized as a separate gender, a woman-living-man, not as a man who wants to be a woman. The term "berdache" is a misnomer, however, as no Native American group actually used the term; different ethnic groups had different names for the role, such as the winkte. The husband of such a person is not viewed as being gender-different themself, but as a normal male. In some societies there is a corresponding gender for man-living-women ( amazons).
In Thai culture, there is the kathoey, who is very similar to the English definition of transgender, but is sometimes broader, including effiminate gay males moreso than "transgender" does.
South Asian cultures have hijra, usually genetic males who have been castrated and live as women.
Chinese cultures have a wide variety of transgender modes of existence. See transgender in China.
Gender identity disorder
Transgender and transsexualism are only regarded as a disorder if they make a person unhappy and unsatisfied, or causes problems in relations to other people. If they are happy with it, and it causes no problem, it is a personality trait, but not a disorder.
Persons with a gender identity disorder have had strong feelings since childhood that they were born in the wrong body. They want to belong to the opposite sex, e.g. they want to be a woman instead of a man and vice versa. This can be seen in children when they keep on indicating that they want to belong to the opposite sex, want to wear clothes of the opposite sex and have a strong and continuous preference for playing the role of the other sex or pretending to belong to this sex. They also want to play games and have pastimes of the other sex and preferably play with pals of the other sex.

Note that transgender need not include a wish to have sex playing another sex role than born with. Note also that some people normally use their normal gender role, but sometimes wish to try out the reverse gender role.

In adolescents this disorder is very noticeable by signs like wishing to belong to the opposite sex, living like someone of the other sex, being treated as someone of the other sex or be convinced that he or she has the typical feelings and reactions of the other sex. Transsexuals are not transvestites; transvestites are people who every now and then feel good in the clothes of the other sex, but don't want to live like this forever.

Homosexuality

Homosexuality can refer to both sexual behavior and sexual attraction between people of the same gender or to a sexual orientation. When describing a sexual orientation, it refers to enduring sexual and romantic attraction toward others of the same sex, but does not necessarily involve sexual behavior. Homosexual behavior includes any sexual activity between people of the same sex, regardless of sexual orientation. Homosexuality is contrasted with heterosexuality, bisexuality, and pansexuality. While the term gay often refers to a homosexual man, it sometimes refers to homosexual people of either gender. Lesbian denotes a homosexual woman.
Homosexuality has been a feature of human culture since earliest history (see Homosexual relations through history below). In modern times it was not until the 19th century that such acts and relationships were seen as indicative of a type of person with a defined and relatively stable sexual orientation. Karl-Maria Kertbeny coined the term homosexual in 1869 in a pamphlet arguing against a Prussian anti-sodomy law. Richard Freiherr von Krafft-Ebing's 1886 book Psychopathia Sexualis popularized the concept.

In the years since Krafft-Ebing, homosexuality has become a subject of considerable study and debate. Viewed by some as a pathology to be cured, it is now more often investigated as part of a larger project to understand the biology, psychology, politics, genetics, history and cultural variations of sexual practice and identity. The legal and social status of people who perform homosexual acts or identify as gay or lesbian varies enormously across the world and remains hotly contested.

Homosexuality and psychology have a closely intertwined history. Since its inception, psychology has dealt with the issue of homosexuality and sexual orientation.
Several psychological studies have been carried out on the psychology of heterosexism and hatred of homosexuals (or homophobia). For example, one study found "lower degrees of anti-homosexual bias in people who know openly homosexual people on a personal basis.
What is homosexuality?
Homo is a Greek word for equal. Homosexuality is to have a preference for sexual relations with and feel attracted to persons of the same sex. Women who are homosexual are called lesbians.
Bisexual people don't have a preference for a sexual relationship with a certain sex, but feel attracted to both men and women.
So men with a preference for sexual relations with men and women with a preference for sexual relations with women.
First of all, it is important to correct the common misunderstanding that a person is either homosexual or heterosexual. Kinsey and his colleagues developed a scale to measure the extent of heterosexuality and homosexuality in individuals. It was thus claimed by Kinsey that some individuals are entirely homosexual in their orientation, others are bisexual, and others (the majority of people actually) are entirely heterosexual.
Bisexual people don't have a preference for a sexual relationship with a certain sex, but feel attracted to both men and women.
Distinction should be made between homosexual orientation and homosexual behaviour. Homosexual behaviour is fairly common in adolescence and some heterosexual individuals will engage in homosexual behaviour under certain circumstances when access to the opposite sex is prevented (schools, military service, prisons, etc.). The prevalence of homosexuality in adulthood is uncertain and is estimated between 7 % of men and 4 % of women.

No forms of homosexuality are illegal in Europe.
There is no need for a homosexual to seek psychiatric or psychological help unless there are other emotional symptoms associated with it (for instance, anxiety or depression, etc.), since homosexuality is not considered as a psychiatric disturbance.

What causes homosexuality?
To pose the question of what causes homosexuality is actually a judgment about homosexuals. If you ask for the causes of homosexuality you assume that this is a disorder which needs to be explained.
It is better to find out what influences and processes that determine sexual preferences, whether this is homosexuality, heterosexuality or something else.
Research today is dedicated to find influences and processes which determine a persons sexual preference. Sexual preference is assumed to be determined by physical (genes), psychological and social factors (environment).

Physical causes for the development of a sexual preference could be certain brain structures or hormones and research is now being done on a certain homo gene. Psychological causes and social factors could play a role. However, not enough is known about these causes for sexual preferences and there hasn't been enough research to say anything reliable about this.

What problems can a homosexual meet?
How homosexuals in a mainly heterosexual society discover their feelings and learn how to deal with them is summarized in the term "coming out". "Coming out" is to reveal their homosexuality to their surroundings. The term "coming in" is used for this integration in the homosexual culture. The development of the homosexual identity is of course individual but can shortly be summarized as follows:

Phase 1: Sensitization: the person becomes aware of their attraction to people with the same sex, this often happens before puberty.

Phase 2: Identity confusion: the person begins to realize that their feelings or behavior can be called homosexual. This may lead to confusion, feelings of insecurity, embarrassment, guilt and isolation, but when the person realizes that there are others with the same feelings the negative feelings and the idea of isolation may be reduced or disappear.

Phase 3: Acceptance of their identity: this phase often happens during late adolescence. In this phase their homosexuality is tolerated, but not yet accepted. They begin to see them self as homosexuals and present them self to others as such. This makes it possible to meet other homosexuals and discover the homosexual culture. The experiences that they have at this stage are important for dealing with homosexuality later. Contact with other homosexuals is important for discovering the positive sides of homosexuality and learning how to deal with the opinions of non-homosexuals. The third phase ends when they inform others generally of their homosexual feelings.

Phase 4: Commitment: in this phase homosexuality is experienced as a more self-evident part of the personal identity. They accept their homosexual feelings and are at ease with this identity and role.

Negative feelings that have been taught and partly familiarized with don't always disappear. Depression, alcohol abuse, attempts to commit suicide and other psychological problems may be consequences of not dealing effectively with their identity.
For parents it is not always easy to deal with homosexual children. Expectations should be adjusted and accepted. It is important to have an open attitude towards them. Indicate that it is hard to talk about this problem, but as parents you want to accept their feelings and support them as much as possible.

How can people react to homosexuality?
Many find it important to group people: heterosexual, homosexual, bisexual, etc. Why is such a division so important socially? Language is a way for people to communicate.
During adolescence young people are still 'allowed' to experiment, but after this most people know their sexual preference and behave accordingly.
Heterosexuality is the basis of our society. Most people are or feel heterosexual and the heterosexual family is seen as the ideal way of living. Because of this we distinguish between people who can and who can't satisfy this norm.
Sometimes we don't know how to treat people with any other sexual preference than the average. This is because we find it hard to imagine the feelings of a person with another sexual preference.
Parents of homosexual or bisexual children may be disappointed because they have other expectations of their child or they are embarrassed by the child's behavior. This can lead to discrimination, depressed feelings, fights, aggression, breaking friendships, etc.

Is there a treatment for homosexuality?
The question of whether there is a treatment for homosexuality suggests that homosexuality is seen as a disease. It is better to ask if there are possibilities for homosexuals and their surroundings to accept this sexual preference and learn how to deal with it.

Sexual arousal disorder

Sexual arousal disorder is a disorder found in the DSM-IV that is generally defined as the inability to attain or maintain typical responses to sexual arousal.

What is a sexual arousal disorder?
You have a sexual arousal disorder when you continuously every time and again don't get a good physical reaction from sexual stimulation. This means that the woman's vagina doesn't get wet enough and that the man has problems with his erection at sexual stimulation. In order to get sexually aroused, something physical and something mental must happen to you. Changes of the body that usually happen when sexually aroused are a faster breathing, a faster heart beat, an increase in the saturation of the blood in the penis which makes it stiff, the woman's vagina getting wet.
These problems often occur in combination with a reduced interest to make love, sexual aversion or orgasm problems. For men we talk about an erection disorder; for women we talk about an arousal disorder. These specific forms of arousal disorders are being discussed in other questions.

Female sexual arousal disorder is the condition of decreased, insufficient, or absent lubrication in females during sex. It is sometimes used in reference to, and sometimes differentiated from, hypoactive sexual desire disorder, which is the condition of decreased interest in sexual intercourse, sexual activity, and sexual contact in females. Loss of interest in sex occurs most commonly in women as they age and approach menopause.
Although female sexual dysfunction is currently a contested diagnostic, pharmaceutical companies are beginning to promote products to treat FSD, often involving low doses of testosterone.
The term is often used to diagnose women (as the term erectile dysfunction (ED) is often used for men), particularly those with sexual symptoms such as:
How do you notice that a woman has problems with getting aroused?
Sexual arousal disorders in women become evident by the vagina not getting wet (enough) More in reaction to a sexual stimulus (for example caressing, watching a movie scene, making love).
Lack of vaginal lubrication
Lack of vaginal dilation or lengthening
Decreased genital tumescence
Decreased genital or nipple sensation
Contrary to popular belief, the disorder is not always caused from a lack of sexual arousal. Possible causes of sexual arousal disorder include psychological and emotional factors, such as depression, anger, and stress; relationship factors, such as conflict or lack of trust; and medical factors, such as depleted hormones, reduced regional blood flow, and nerve damage.
Diagnosis
It is, therefore, important for a licensed psychologist to first remove doubt of psychological or emotional problems, a trained sex therapist to then remove doubt of relationship concerns, and a medical doctor to further investigate medical causes.
Treatment
Depending on the cause of the disorder, hormone therapy or a blood-flow enhancing medication, like Viagra, may be appropriate.
A new medication, bremelanotide (formerly PT-141), is directly increasing sexual desire in both males and females, and is currently in clinical tests.

Ejaculation and Males, Male Premature Ejaculation Tips

Premature ejaculation (PE), also known as rapid ejaculation, premature climax, early ejaculation, or by the Latin term ejaculatio praecox, is the most common sexual problem in men, affecting 25%-40% of men. It is characterized by a lack of voluntary control over ejaculation. Masters and Johnson stated that a man suffers from premature ejaculation if he ejaculates before his partner achieves orgasm in more than fifty percent of his sexual encounters. Other sex researchers have defined premature ejaculation as occurring if the man ejaculates within two minutes or less of penetration; however, a survey by Alfred Kinsey in the 1950s demonstrated that three quarters of men ejaculated within two minutes of penetration in over half of their sexual encounters. Today, most sex therapists understand premature ejaculation as occurring when a lack of ejaculatory control interferes with sexual or emotional well-being in one or both partners.

Most men experience premature ejaculation at least once in their lives. Often adolescents and young men experience "premature" ejaculation during their first sexual encounters, but eventually learn ejaculatory control. Because there is great variability in both how long it takes men to ejaculate and how long both partners want sex to last, researchers have begun to form a quantitative definition of premature ejaculation. Current evidence supports a median average ejaculation latency time (IELT) of six and a half minutes in 18-30 year olds. If the disorder is defined as an IELT percentile below 2.5, then premature ejaculation could be suggested by an IELT of less than about one and a half minutes. Nevertheless, it is well accepted that men with IELTs below 1.5 minutes could be "happy" with their performance and do not report a lack of control and therefore do not suffer from PE. On the other hand, a man with 2 minutes IELT could present with perception of poor control over his ejaculation, distressed about his condition, has interpersonal difficulties and therefore be diagnosed with PE.

Scientists have long suspected a genetic link to certain forms of premature ejaculation. In one study, ninety-one percent of men who suffered from lifelong premature ejaculation also had a first-relative with lifelong premature ejaculation. Other researchers have noted that men who suffer from premature ejaculation have a faster neurological response in the pelvic muscles. Simple exercises commonly suggested by sex therapists can significantly improve ejaculatory control for men with premature ejaculation caused by neurological factors [citation needed]. Often, these men may benefit from anti-anxiety medication or selective serotonin reuptake inhibitors (SSRIs), such as sertraline or paroxetine. Some men prefer using anaesthetic creams; however, these creams may also deaden sensations in the man's partner, and are not generally recommended by sex therapists.

Psychological factors also commonly contribute to premature ejaculation. While men sometimes underestimate the relationship between sexual performance and emotional well-being, premature ejaculation can be caused by temporary depression, stress over financial matters, unrealistic expectations about performance, a history of sexual repression, or an overall lack of confidence. Interpersonal dynamics strongly contribute to sexual function, and premature ejaculation can be caused by a lack of communication between partners, hurt feelings, or unresolved conflicts that interfere with the ability to achieve emotional intimacy. Neurological premature ejaculation can also lead to other forms of sexual dysfunction, or intensify the existing problem, by creating performance anxiety. In a less pathological context, premature ejaculation could also be simply caused by extreme arousal.

Some physical illnesses, such as a prostate infection, are also known to induce premature ejaculation. In other instances, premature ejaculation is caused by a physical injury that affects the nervous system. Certain medications, such as cold medications containing pseudoephedrine, also cause premature ejaculation. Sexual dysfunction is a common symptom of psychiatric afflictions ranging from bipolar disorder to post-traumatic stress disorder. In these cases, it is best to discuss the issues openly with a physician.

Today it is believed that the neurotransmitor serotonin (5HT) has a central role in modulating ejaculation. Several animal studies have demostrated its inhibitory effect on ejaculation modulated through the PGI system in the brain. Therefore, it is perceived that low level of serotonin in the synaptic cleft in these specific areas in the brain could cause premature ejaculation. This theory is further supported by the proven effectiveness of SSRIs, which increase serotonin level in the synapse, in treating PE.

Definition of premature ejaculation.
Men who have a premature ejaculation come within a few seconds. Medically, premature ejaculation is defined when a man comes within one minute and often within 30 seconds of every love play. Some men come before penetration.

Many men talk about a premature ejaculation when they come faster than they want, even if it does not agree with the medical definition above.

How common is premature ejaculation.
There is not much statistics on this available, but one American study indicates that 29% of all men have problems with premature ejaculation.

Cause of premature ejaculation.
The most frequent cause is sexual insecurity and the fear of doing it wrongly. The fear increases the excitement, and makes the ejaculation take place. Sometimes, coming fast has been learned in childhood by quick masturbation for example. One has learned, as a reflex, to come fast when excited. Insufficient concentration of the neurotransmitter serotonin is now thought to be a physical cause.

Treatment of premature ejaculation.
Premature ejaculation can be treated with medicines, such as serotonergic anti-depressants or SSRIs (Seroxat, Prozac, Cipramil, Zoloft) the ejaculation can be delayed. This medication improves the transmittal of serotonin (a substance in the body) between two nerves. These medicines need to be taken 2 to 3 hours before the expected sexual activity. This can be experienced as a disadvantage, because it reduces the spontaneity around making love. But some people take them regularly every day, avoiding this problem. One has to take into account that side effects may happen.
Good results have also been obtained with sexological treatments. This treatment is aimed at giving the man control over the ejaculation. A part of this is to withdraw the penis while making love to stop stimulation and thus prevent premature ejaculation.
In some mild cases, use of a condom can help.
Problem for the man or for the woman?
If too early male orgasm is experienced as a problem by the woman, but not by the man, see our informational pages about female orgasm problems.

What is "coming too early" or "too fast"?
Men who have a premature ejaculation come within a few seconds. We talk about a premature ejaculation when a man comes within one minute and often within 30 seconds of every love play. Some men come before penetration. Many men talk about a premature ejaculation when they come faster than they want.

How common is premature ejaculation?
There is not much to say about this. It is estimated that 29% of all men suffer from premature ejaculation; this is the result of American research.

What are the causes of "coming too quickly" in men?
The most frequent cause is sexual insecurity and the fear of doing it wrongly. The fear increases the excitement, and makes the ejaculation take place. Sometimes, coming fast has been learned in childhood by quick masturbation for example. One has learned, as a reflex, to come fast when excited. Insufficient concentration of the neurotransmitter serotonin is now thought to be a physical cause.

How can "coming too quickly" in men be treated? Is there a premature ejaculation cure/treatment?
With medicines, such as serotonergic anti-depressants or SSRIs (Seroxat, Prozac, Cipramil, Zoloft, Duloxetine, Xeristar) the ejaculation can be delayed. This medication improves the transmittal of serotonin (a substance in the body) between two nerves. These medicines need to be taken 2 to 3 hours before the expected sexual activity. This can be experienced as a disadvantage, because it reduces the spontaneity around making love. Some people take such medicines every day, avoiding this disadvantage but increasing the risk of side effects.
Good results have also been obtained with sexological treatments. This treatment is aimed at giving the man control over the ejaculation. A part of this is to withdraw the penis while making love to stop stimulation and thus prevent premature ejaculation.

In some mild cases, use of a condom may help.

Erection Problems

What are erection problems, erectile dysfunction?

Men with an erection disorder often do want to have sex, but their penis doesn't get stiff enough or doesn't get stiff at all. It can also happen that the penis is stiff at the beginning of making love, but gets soft after a while. When a man has drunk too much or is very tired it is common that these problems occur. It is when the complaints are regular or are always present that one can talk about a disorder. An erection problem may reduce the desire to make love and the fun in making love. Men often fear that it will happen again next time. The partner may also have problems with it, like being afraid of not being attractive anymore or being disappointed.

Determined Erection Problem.
It is important to know whether the body functions effectively. When an erection is possible: for example, in the morning, while sleeping or when masturbating whether physical problems for the erection disorder can be excluded. An erection disorder is characterized by insufficient swelling and stiffness of the penis or being unable to maintain the stiffness. These complaints must be present for a long time.

How often does it occur that the penis doesn't get stiff enough?
52% of men between 40 and 70 sometimes have erection problems. 9,6% of men always have an erection problem. Between 18 and 55, 2% of men have erection problems when making love and 16% sometimes suffer. The higher the age, the higher the average of erection problems. People who are dependent on alcohol, patients with diabetes mellitus, Alzheimer's, heart and vascular diseases have erection problems more often.

What are the physical causes of erection problems?
Erection problems are often caused by a combination of physical and psychological factors. The following causes are possible:
Physical:
When older, it takes longer before the penis gets stiff and the man needs to be sexually stimulated for longer.
Anomalies in the vessels, for example due to heart and vascular diseases like arteriosclerosis and high blood pressure.
Surgery of the prostate.
Diseases and medication for heart and vascular diseases, diabetes mellitus, multiple sclerosis and Parkinson's disease can be a cause. Medicines for depression and high blood pressure may cause erection problems (see also other question).
Smoking, drugs and alcohol dependence.
Anomalies of the penis.
Hormonal anomalies.
It is important to know whether the body functions well. When an erection is possible: in the morning, while sleeping or when masturbating then physical problems can be excluded.
Erection problems are often a symptom of some other illness. Thus, if a man starts having erection problems, he should always get a general medical examination.

What are the psychological causes of erection problems?

Advice on dysfunction erectile improving.
Various causes are possible for erection disorder. It can happen after a night out with a lot of alcohol or drugs. The next time after this incident the man may expect that it will go wrong again, causing him to focus more on not getting an erection. This takes away attention from the love play and the sexual stimulation and reduces the arousal, which confirms his expectation. This creates a vicious circle of expecting to fail, focusing too much on getting an erection and not on making love and therefore a reduction of arousal and thus the erection. Men with erection disorders may more often than other men:
Expect to fail.
Be distracted from making love.
Avoid it.
Many men with erection problems who look for help have suffered from the problem for years. The problem may get worse over time because psychological factors may start to play a role. There is often a strong tendency to avoid sex or to develop feelings of helplessness, anger or reproaches to the partner who would not stimulate him enough or would say or do the wrong things. Some people are so absorbed by the erection while making love that they hardly notice their partner or other arousing stimulations.

Erection Help.
The treatment of an erection disorder can be divided by a specialist into a psychological treatment, a medicinal treatment or a treatment with devices. A psychological treatment looks at the possible psychological causes. The partner, if any, is usually involved. There are different forms of psychological treatment (see sex therapy). Depending on the problem, attention can be given to certain exercises e.g relaxation and caressing exercises, the communication between the partners, the thoughts and feelings when making love and the sex pattern. Furthermore, attention is given to any other focus of attention when making love, especially physical perceptions. Changing the existing thoughts and feelings around the problems is also important. For many people, concentration and sexual fantasies are important to get an erection.
The medicinal treatment consists of the administration of Viagra or other similar medicines. This substance may help with physical and psychological causes. It only helps when there is sexual stimulation. If this stimulation doesn't exist, no erection will follow. One tablet starts to work after about an hour. Generally the results are good. The medicine is only available on prescription. Medical injections in the corpus cavernosum also used. A specialist or doctor teaches the patient how to inject the substance. After five to ten minutes the penis is stiff. The injections work best if both partners feel like making love and have already started.
There are also devices like an elastic ring, the vacuum pump, the artificial penis or the extension condom.

Lubrication Problems

What are the physical causes of lack of female vaginal lubrication? Why do some women have dry pussy, insufficiently wet pussy?
Physical causes of the vagina not getting wet enough may be:
Shortage of the hormone estrogen, for example by early removal of the ovaries.
Neurological disorders e.g a heart attack, multiple sclerosis, anomalies of the nerves or the spinal cord.
Certain types of cancer and their treatment.
Certain medication.
Fatigue.
Menopause.
Pregnancy.
Getting older.
The doctor, gynaecologist or urologist can detect these physical causes.

What are the psychological causes of insufficient female vaginal wetness?
Psychological causes of the vagina not getting wet enough are very common. The love play often doesn't happen as desired. The woman may think that she doesn't get the opportunity to get aroused because her partner comes too fast or she longs for more intimacy while making love. It can also be that the woman doesn't get aroused by stimulation of the vagina, but only of the clitoris. Pain from making love without enough lubrication may limit the ability to get wet at a the next love play. This can even cause chronic pain while making love. Relational problems may also play a role. Communication problems, problems of power and lack of confidence are examples of this. Experiences of incest or other unpleasant sexual experiences may play a role.

How can problems with lubrication of the vagina, insufficiently moist pussy, be treated?
Depending on the cause, problems with the lubrication of the vagina can be treated, e.g whit lubricants or saliva. When there is a lack of certain hormones, these can be administered. Specific forms of therapy are also possible, like couple therapy, masturbation training or making the person aware of the negative thoughts that play a role while making love and influence sexuality. It is important to talk with the partner about the problem.
If you don't want to go to a sexologist yet, try to find solutions together. It sometimes helps if you pay more attention to each other by going out for dinner, giving each other a massage without having to make love, going to the sauna or telling each other what you like while making love.

Sexual abuse

Sexual abuse is understood to mean assault and rape. This can have happened once or several times. The offender may be a stranger or an acquaintance, man or woman, family, boy/ girlfriend, partner or social worker. Assault is to force a person to commit or allow sexual acts other than penetration (penetrating the vagina with the penis), by threatening to use violence or other means. Rape is to sexually penetrate an opening of the body by means of threatening to use violence or other means for example psychological pressure inside or outside marriage.

What are the consequences of sexual abuse? What are the effects of child abuse? What are the symptoms of child molestation?
Note that other traumatic events can cause the same symptoms as sexual molestation. Thus, occurence of the symptoms listed below is not proof of sexual molestation.

Depending on the seriousness, the duration and the sort of abuse, some of those who were abused in their childhood, or recently retain certain problems due to this trauma. These can be divided into psychological, social, sexual and physical problems.

Psychological problems:
Fears, panic attacks, sleeping problems, nightmares, irritability, outbursts of anger and sudden shock reactions when being touched.
Little confidence, and self-respect and respect for one's own body may change.
Behavior that harms the body: addiction to alcohol and other substances, excessive work or sports, depression, self-destruction and prostitution.

Social problems:
Have little confidence in other people.
Fear of loss of control in relationships.

Sexual problem:
While making love problems often occur. The partner may be confused by a certain remark, touch or behavior that brings back memories of the abuse.
Patients sometimes don't want to make love at all anymore or make love less.

Sexual relation problems may occur, together whit pain while making love, not wanting to make love and problems in getting aroused. Problems with the orgasm and coming also occur.

Physical complaints:
Abdominal pain, pain while making love, menstrual pain, intestinal complaints, stomach ache, nausea, headache, back pain, painful shoulders, in short all kinds of chronic pain may occur. The pain is often inexplicable.

Eating disorders often occur in sexually abused people.
When the patients, in reaction to a harmful event, disordered for more than a month in such a way that they can't go to school, can't work, isolate themselves or experience other negative consequences, one can talk about a posttraumatic stress syndrome More information . This disorder originates in reaction to a very harmful event and has three characteristic symptoms:

Denial and repression
alternating with re-experiencing,
and they are always over irritated.
Denial and repression ; they deny or repress the harmful event(s): they don't want to talk about or avoid certain situations. At an older age, memory of sexual abuse is often completely suppressed, but can sometimes be recovered in psychotherapy.

It is, however, difficult to determine if such recovered memories are memories of real experiences of memories of dreams or imagined events. This difficulty can be a problem if you want to prosecute the abuser, but it is not a problem for treatment using modern psychotherapeutic methods.

Re-experiencing ; they experience the event(s) again; unintentionally they are confronted with memories of the abuse, for example through nightmares, sudden memories or unexplainable physical problems.

Over irritation ; they are easily affected, hot-tempered, jumpy, excessively alert and don't fall asleep easily.

How often does sexual abuse occur?
Girls are sexually abused more often than boys. The relation between boys and girls at the Dutch offices of doctors at advice centers was 1:3 in 1995. Among adult women, more than 15% have had some kind of negative, unwanted or forced sexual experience with a family member before 16. Of women between 20 and 60, 7% experienced sexual abuse, rape or forced sex in relationships.

How can the psychological consequences of sexual abuse be treated?
The psychotherapeutic treatment of victims of sexual abuse is similar to the treatment of other kinds of Post Traumatic Stress Disorder (PTDS). The treatment normally uses a three-phase model. The model consists of the following three phases:

phase 1: stabilizing the symptoms: in this first phase of the treatment, we work on the relation of confidence between the therapists and the patients. We also work on rest, structure and support. A good night's sleep and good health are important. Sometimes medication is proposed for this.

phase 2: remembering and mourning: in this phase the patients tell about what has happened and what this has meant. The traumatic experience is discussed and little by little the strong emotions that belong to this are readmitted. The trauma is re-experienced, but this time in a familiar environment with support of the therapist who listens and comforts. Looking for the use of the trauma (why me?) can be understood and may forgotten.

phase 3: integration: the event is dealt with. The contact with daily life and others is restored. Certain issues like sexuality are also discussed.
Not everybody is able to go through all the phases. For some people more attention is give to the first phase.
In the case of sexual problems, attention is given to sexual feelings, the right to have fun, sexual advice, limits and the relation between intimacy and sexuality.
Help from a psychotherapist is often needed in order to learn to cope with this.

Painful Sexual Intercourse

Describe painful sexual intercourse, its causes and treatment.
In general you make love for fun because it feels good. But it can happen that it doesn't feel good anymore and it even hurts. The cause of the pain is often unknown and the solution for it also. Due to the pain the person often doesn't want to make love anymore or does make love, but with a lot a pain. This means that the desire to make love is often reduced.
The pain can be present at various moments of the love play and often feels burning, cutting or stinging. This problem occurs more often in women. There are two sorts of pain in women: superficial and deep pain. When there is superficial pain in the sexual contact there is pain in the outer or inner labia or at the entrance to the vagina. For some women the pain is so strong that they also experience pain at every touch in this area, e.g when inserting and removing tampons, in gynaecological investigations, when riding a bicycle or when sitting on a hard surface. The gynaecologist can sometimes induce the pain by touching the area with a wet cotton stick. The pain then feels the same as when making love.
With deep pain the woman has a painful feeling deeper in the abdomen when making love, sometimes described as 'at the bladder' or 'at the ovaries'. The pain is often experienced as dull, stinging or pressing. However, the superficial pain occurs more often and has a physical cause less often.
Men can also have pain while making love.

How common is painful sexual intercourse?
An estimated 8 to 33,5% have severe pain while making love. 10 to 20% of the women who visit a gynaecological polyclinic have sexual pain complaints when the doctor asks about them directly.

What are the causes of painful sex?
To be able to make love without pain, there must be sufficient desire to make love and sufficient arousal. The woman must have relaxed pelvic floor muscles and there shouldn't be any irritated body parts e.g a bladder infection, venereal diseases, insufficient lubrication of the vagina, oedema, a tight foreskin etc.
It is important to look at the problem from different points of view. There may be a biological cause. This may be a sexually transmitted disease, a vaginal infection, a disorder of the uterus or the large intestine, an infection of the vaginal mucous membrane, a snip or a tear during childbirth and insufficient lubrication of the vagina. Men may have infections on skin anomalies to the penis, infections of the glans and the foreskin due to fungi or bacteria, a tight foreskin, prostatitis, or a low testosterone level (hormones). In women, vestibulit (an inflammation in the vagina) can be a cause of sex pain.
A medical investigation is an important step in the treatment process. The pain may be due to social causes like relational problems. Communication problems between the partners may play a role. Many people are afraid to indicate what they like in the sexual field. Psychological causes may also play a role. Since many women can't relax sufficiently, the vagina doesn't get wet enough the penis rubs against the side of the vagina, which leads to irritation. Due to the fear of pain the pelvic floor muscles are tensed too much, which causes the love play to hurt. The woman gets into a vicious circle of fear of pain, which leads to tension, the tension to extra pain and no more arousal, which leads to a dry vagina, which leads to more irritation, etc. There may also be negative thoughts and feelings about sexuality and certain harmful events may play a role.
Vestibulitus and vaginismus are other possible causes of pain during sex.
For men who can masturbate without pain, physical causes may often be excluded. Fear of pain may lead to the avoidance of the pain by not wanting to make love anymore.

Sex Pain in a Woman can be a Symptom of Vestibulitis.
When a woman is in such a pain that it feels as if her vagina is beeing torn apart during intercourse, the reason could be that she has or is about to develop vestibulitis.
Pain during intercourse affects many women but there is no single explanation. The pain can be mild or strong. Vaginal thrush and intercourse without enough lubrication is usually associated with the problem. Lubrication is the female equivalence to erection. It makes her organ filled with blood and it becomes wet.
Vestibulitis is a condition that often makes intercourse entirely impossible. Some women can't even ride a bike or wear trousers. If the woman continues having intercourse despite of the pain, there is a risk that it might get worse. This makes it really important to look for help. Pain during intercourse must be taken seriously and anyone experiencing pain during intercourse should contact a gynaecologist.
Everyone working with healthcare should be aware that vestibulitis does exist, but this condition is not always taken seriously. The treatement of vestibulitis is not yet sufficientlely developed. There is no optimal cure for the moment, but it can be cured. Contact a gynaecologist, and if you think that your doctor is not taking the problem seriously, try getting in touch with another. It is common that women with vestibulitis are adviced to use lubrication but it could make the condition worse if the real cause is vestibulitis.
If a woman says that she has a tearing pain in her genital area during intercourse, then everything isn't right, irrespective of if the reason is psychological or physical. Therefore, it is important to visit a gynaecologist.

Treatment of Painful Sexual Intercourse.
It is important not to make love when it hurts. Pain indicates the existence of a problem. Consult a gynaecologist or urologist for possible physical causes. And it is important to talk to the partner about the problem. Determine whether you are satisfied with the way you make love and about the relationship with your partner.
The treatment of a sexologist consists in searching for a possible cause of the problems and making the person aware of restraining, negative thoughts while making love and their consequences. The sexologist gives tips about how to deal with irritation of the vagina, e.g not washing the vagina with soap, wearing cotton underwear, hygienic toilet measures, etc. There are relaxation exercises and learning how to get control over the pelvic floor muscles. You will also get individual and couple related exercises to relearn again how to enjoy physical contact without fear of pain.
Women with vestibulitis should go to a clinic which specializes in the treatment of vulva problems. Such clinics sometimes have a gynaecologist, sometimes a skin doctor. It is very important to get to a clinic which has special competence on this specific problem. A combination of medical and psychological help is often needed.
Vestibulit is not always easy to treat. If a woman with vestibulit wants to try sexual intercourse, silicon-based lubricants are often better than water-based lubricants. Women with vagnismus need support in accepting the kind of sexuality which suits them. They need to know that it can be right to do without vaginal intercourse without having guilt feelings, and to experiment with other alternative ways of making love. Later on, they may be able to accept vaginal sex. For some women, help from a physiotherapist to learn to understand their bodies. Massage and acupuncture and similar treatments can sometimes also help.

Orgasm problems

What is an orgasm disorder in woman?
When a woman never has an orgasm while making love and is distressed by this, she may have an orgasm disorder. When there is sufficient desire for sex and the body is stimulated in the right way, then an orgasm is a reaction of the body. For most women the orgasm is caused by a direct or indirect stimulation of the clitoris. In general, vaginal stimulation is not enough to get an orgasm. One third of all women rarely or never have an orgasm while making love. Only one woman in ten always have an orgasm when making love. Some women are also less interested in getting an orgasm.

How common is difficulty of achieving female orgasm?
Research has shown that between one quarter and one third of all women never or seldom have an orgasm. Only one woman in ten always get an orgasm while making love.

What are the causes of women not getting an orgasm?
There are various possible causes for not getting an orgasm, which are divided below into physical, psychological and social causes.
Physical causes:
Damage to the central nervous system, the spinal cord and the peripheral nerves, for example, by injury, tumours and multiple sclerosis.
Medication.
Hormonal anomalies.
Surgery.
An inadequate learning process: little masturbation.
Fatigue.
Depression.
Insufficient knowledge of one's own body.
Psychological causes:
Not being able to concentrate on and accept the physical sensations.
Not giving enough attention to oneself while making love.
Wanting to come by all means.
Looking at oneself 'from a distance' and be distracted by this.
Distraction by stress, certain thoughts, etc.
Negative memories.
Social causes:
Not getting the form of stimulation needed to get an orgasm.
Insufficient safety, security, respect, communication, etc. More.
Having experienced harmful events in the sexual field.
Being too focused on the other person.

How can women's orgasm problems be treated? How can a girl learn to have an orgasm? How to make a girl orgasm?
When a woman can get an orgasm by masturbation but not while making love with the partner, the treatment will be mainly focused on the sexual relationship, improvement of the communication about sexuality and increasing sexual knowledge and abilities. When a woman has never experienced an orgasm the treatment is often focused on giving information about this and giving exercises. Taking away feelings of anxiety and guilt, restraining thoughts and discovering and expressing sexual desires is often a part of the treatment.

Which are the orgasm problems for men?
Orgasm disorders in men exist in the form of problems with coming and/or ejaculating (ejaculation). To come means in this case the physical processes: the ejaculation, a higher blood pressure, etc. The orgasm is the nice feeling that occurs when making love. Problems with the orgasm can be: coming too early, not come at all, a difficult ejaculation, no ejaculation, pain when coming or not experiencing an orgasm.

How can orgasm problems in men be treated? How can you increase the male sex drive?
This depends on the problem. Investigate premature ejaculation and use of medicines and drugs which can cause orgasm problems in men. In particular, medicines in the SSRI group often cause ejaculation problems.
Many somatic illnesses like diabetes, heart and vascular (blood vessel) disease, neurological disorders, hormonal imbalances, chronic diseases such as kidney or liver failure, and alcoholism and drug abuse can cause ejaculation problems. Treatment of such illnesses might help.
The most common cause of ejaculation problems in men is stress. So try to get away from stress. Perhaps making a romantic journey?
Fantasizing might help, Viagra might help.
Trying to concentrate on enjoying intimacy and sex without ejaculation might also help.

Aversion to Sex; Sex Phobia

What does 'aversion' to sex or sex phobia mean?
A person with a sexual aversion disorder has an intense aversion to sexual contact or related experiences, for example seeing a penis, a vagina, seeing sperm or being touched. The aversion to sex is an extreme form of disorder in sexual arousal and is often combined with a reduced interest in making love.

What is the cause of a sexual aversion disorder, dislike of sex disorders?
Physical causes of this problem may originate in the hormonal regulation. The possibility of a-sexual persons is now being investigated. These are those who lack all interest in sexual contact, possibly because they lack a certain substance in their body.

There may be a specific aversion, for example to sperm, penises in erection, etc. Sexual violence, during childhood or at a later age, is often the cause of sexual aversion. Stress, alcohol and drug use, fear of pregnancy, depression and relation problems can cause aversion to sex.

Symptoms of Aversion to Sex
Sexual aversion or sexual antipathy has the following symptoms:
An intense antipathy/aversion to various forms of sexual contact, e.g. caressing, seeing sperm, kissing, seeing sex, etc.
The wish to end every sexual contact as quickly as possible.
Sometimes a need for intimacy before starting sexual contact.
The person suffers from this aversion. In the first meetings the sexologist will determine what the problem is, how long it has existed and if certain unpleasant sexual events have happened in the past.

Treatment of Aversion to Sex
Depending on the cause of the aversion to sexual behaviour a treatment is set up. A sexologist is specialized in this. Medication like anti-depressants can support the treatment. The aversion is often treated as anxiety attacks, that is through exposure. This means that they are exposed, little by little, to their fears so that these go away or gradually disappear under professional guidance. Psychological treatment that tries to influence the thoughts and feelings about sexual contact is also used. If sexual abuse or other traumatic experiences play a role it is important to do something about this and discuss it. Stress can be reduced by doing relaxation exercises and dealing with the causes of the stress. Relation therapy can be used in the case of relation problems or communication problems between the partners.

Virgin Men Fear of Intimacy: Sexual Aversion?
The patient seem to have developed some kind of "girl phobia" no matter how strange this may sound. The patients condition meets all the criteria of a classical phobia. Phobias are quite easy to treat. I treat patients with a successful, intensive method that leads to full recovery. The patient is confronted with the cause of his/her phobia. In your case, if there is no girl available, you can use your imagination.

The patient gets a strong attack of anxiety that abates. When the patient gets tired, the treatment is suspended and continues at the next meeting. The first time is the most difficult. After that it gets easier and easier. After a few sessions the patient is released from the phobia.

It is difficult to treat phobias on your own. The anxiety is so strong that you do not dare to continue. Try to find a psychotherapist who is capable of treating phobias.

Child Psychology

Developmental psychology, also known as Human Development, is the scientific study of progressive psychological changes that occur in human beings as they age. Originally concerned with infants and children, and later other periods of great change such as adolescence and aging, it now encompasses the entire life span. This field examines change across a broad range of topics including motor skills and other psycho-physiological processes, problem solving abilities, conceptual understanding, acquisition of language, moral understanding, and identity formation.

Developmental psychologists investigate key questions, such as whether children are qualitatively different from adults or simply lack the experience that adults draw upon. Other issues that they deal with is the question of whether development occurs through the gradual accumulation of knowledge or through shifts from one stage of thinking to another; or if children are born with innate knowledge or figure things out through experience; and whether development is driven by the social context or by something inside each child.

Developmental psychology informs several applied fields, including: educational psychology, child psychopathology and developmental forensics. Developmental psychology complements several other basic research fields in psychology including social psychology, cognitive psychology, cognitive development, and comparative psychology.

Childhood psychiatric disorders :
Abandoned child syndrome is a behavioral or psychological condition that results from the loss of one or both parents. Abandonment may be physical (the parent is not present in the child's life) or emotional (the parent withholds affection, nurturing, or stimulation). Many countries, like Russia and China, have an alarmingly high rate of physically abandoned children. A 1998 Human Rights Watch committee report found that more than 100,000 children per year were abandoned in Russia. Parents leave their children for many reasons, including trouble with the law, financial insecurity, the child is mentally or physically challenged, and sometimes population control policies. Involuntary loss of a parent, such as through divorce or death, can also create abandonment issues.

Parents who leave their children, whether with or without good reason, can cause irreversible psychological damage to the child.[1] Abandoned children may also often suffer physical damage from neglect, malnutrition, starvation, and abuse. Substantial research indicates that contact with adults of both sexes encourages a child's balanced development.

Abandoned Child Syndrome is not listed in the Diagnostic and Statistical Manual of Mental Disorders (fourth edition).

Symptoms may be physical and/or mental, and may extend into adulthood and perhaps throughout a person's life.

Alienation from the environment - withdrawal from social activities, resistance towards others.
Guilt - the child believes that he did something wrong that caused the abandonment (often associated with depression).
Fear and uncertainty - clinginess, insecurities.
Sleep and eating disorders - malnutrition, starvation, disturbed sleep, nightmares.
Physical ailments - fatigue, depression, lack of energy and creativity, anger, grief.

Adjustment disorder refers to a psychological disturbance that develops in response to a stressor. Adjustment disorders are caused by specific sources of stress, such as severe personal crisis (divorce, death of loved one, recent abuse, recent job changes) or major unexpected negative events (tornado or fire destroys a person's home). The usual symptoms mimic depression, anxiety, or sleep disorder; however the disturbance disorder is short-term and can usually be treated with counselling or mild short-term medication. If the problem persists more than six months after removal of the stressor, the person may have a more permanent problem, such as a chronic mood or sleep disorder.

Adopted child syndrome is a controversial term that has been used to explain behaviors in adopted children that are claimed to be related to their adoptive status. Specifically, these include problems in bonding, attachment disorders, lying, stealing, defiance of authority, and acts of violence. The term has never achieved acceptance in the professional community. The term is not found in the American Psychiatric Association's Diagnostic and Statistical Manual, 4th edition, TR. David Kirschner, who coined the term, says that most adoptees are not disturbed and that the syndrome only applies to "a small clinical subgroup".

Asperger syndrome (also referred to as Asperger's syndrome, Asperger's disorder, Asperger's, or AS) is a pervasive developmental disorder (PDD) on the autistic spectrum. It manifests in various ways and can have both positive and negative effects on a person. It is typically characterized by issues with social and communication skills. Due to the mixed nature of its effects, it remains controversial among researchers, physicians, and people who are diagnosed with Asperger's Syndrome.

Asperger syndrome is not differentiated from other autistic spectrum disorders by a minority of clinicians who instead refer to it as high-functioning autism (HFA) because the claim that the normal early development and lack of any language delay mean that the symptoms differ only in degree from classic autism. Early in life people with AS can have learning disabilities. However, IQ tests may show superior intelligence or very high memory capacity in diagnosed individuals.

The diagnosis of AS is complicated by the lack of standardized diagnostic criteria. Instead, several different screening instruments and sets of diagnostic criteria are used. AS is often not identified in early childhood, and many individuals are not diagnosed until they are adults. Assistance for core symptoms of AS consists of therapies that apply behaviour management strategies and address poor communication skills, obsessive or repetitive routines, and physical clumsiness. Many individuals with AS can adopt strategies for coping and do lead fulfilling lives - being gainfully employed, having successful relationships, and having families. In most cases, they are aware of their differences and can recognize if they need any support to maintain an independent life.

Attention-Deficit/Hyperactivity Disorder (ADHD) is generally considered to be a developmental disorder, largely neurological in nature, affecting 3–5 percent of the population. The disorder is characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity. ADHD initially appears in childhood and manifests itself with symptoms such as hyperactivity, forgetfulness, poor impulse control, and distractibility. ADHD is currently considered to be a persistent and chronic condition for which no medical cure is available. ADHD is most commonly diagnosed in children and, over the past decade, has been increasingly diagnosed in adults. It is believed that around 60% of children diagnosed with ADHD retain the disorder as adults. Studies show that there is a familial transmission of the disorder which does not occur through adoptive relationships. Twin studies indicate that the disorder is highly heritable and that genetics contribute for about three quarters of the total ADHD population. While the majority of ADHD is believed to be genetic in nature, roughly about 1/5 of all ADHD cases are thought to be acquired after conception due to brain injury caused by either toxins or physical trauma prenatally or postnatally.

According to a majority of medical research in the United States, as well as other countries, ADHD is today generally regarded to be a non-curable disorder for which, however, some effective treatments are available. Over 200 controlled studies have shown that stimulant medication is an effective way to treat the symptoms of ADHD. Methods of treatment usually involve some combination of medication, behaviour modification, life style changes, or counselling. Certain social critics are skeptical that the diagnosis denotes a genuine impairment or disability. The symptoms of ADHD are not as profoundly different from normal behavior as is often seen with other mental disorders. Still, ADHD has been shown to be impairing in life functioning in several settings and many negative life outcomes are associated with ADHD.

Autism is classified by the World Health Organization and American Psychological Association as a developmental disability that results from a disorder of the human central nervous system. It is diagnosed using specific criteria for impairments to social interaction, communication, interests, imagination and activities. The causes, symptoms, etiology, treatment, and other issues are controversial.

Autism manifests itself "before the age of three years" according to the World Health Organization's International Classification of Diseases (ICD-10). Children with autism are marked by delays in their "social interaction, language as used in social communication, or symbolic or imaginative play" (Diagnostic and Statistical Manual of Mental Disorders).

Autism, and the other four pervasive developmental disorders (PDD), are all considered to be neurodevelopmental disorders. They are diagnosed on the basis of a triad, or group of three behavioral impairments or dysfunctions: impaired social interaction, impaired communication, and restricted and repetitive interests and activities. These three basic characteristics reflect Dr. Leo Kanner's first reports of autism emphasizing "autistic aloneness" and "insistence on sameness."

From a physiological standpoint, autism is often less than obvious in that outward appearance may not indicate a disorder. Diagnosis typically comes from a complete patient history and physical and neurological evaluation.

Child psychopathology is the manifestation of psychological disorders in children and adolescents. Oppositional defiant disorder, attention-deficit hyperactivity disorder, and pervasive developmental disorder are examples of child psychopathology. Social workers, psychologists and psychiatrists who work with mentally ill children are informed by research in developmental psychology, developmental psychopathology, clinical child psychology, and family systems.

The current trend in the U.S. is to understand child psychopathology from a systems based perspective called developmental psychopathology. Recent emphasis has also been on understanding psychological disorders from a relational perspective with attention also given to neurobiology.

Research and clinical work on child psychopathology tends to fall under several main areas: etiology, epidemiology, diagnosis, assessment, and treatment.

Childhood disintegrative disorder (CDD), also known as Heller's syndrome and disintegrative psychosis, is a rare condition characterized by late onset (>3 years of age) of developmental delays in language, social function, and motor skills. Researchers have not been successful in finding a cause for the disorder.

CDD has some similarity to autism, but an apparent period of fairly normal development is often noted before a regression in skills or a series of regressions in skills. Many children are already somewhat delayed when the illness becomes apparent, but these delays are not always obvious in young children.

The age at which this regression can occur varies, and can be from age 2-10 with the definition of this onset depending largely on opinion.

Regression can be very sudden, and the child may even voice concern about what is happening, much to the parent's surprise. Some children describe or appear to be reacting to hallucinations, but the most obvious symptom is that skills apparently attained are lost. This has been described by many writers as a devastating condition, affecting both the family and the individual's future. As is the case with all Pervasive Developmental Disorder categories, there is considerable controversy around the right treatment for CDD.

The syndrome was originally described by Austrian educator Theodore Heller in 1908, 35 years before Leo Kanner described autism, but it has not been officially recognised until recently. Heller used the name dementia infantilis for the syndrome.

Disorder of written expression is a childhood condition characterized by poor writing skills. To some extent, 3 - 10% of school-age children are affected by this disorder. This disorder appears by itself or in conjunction with other learning or developmental disabilities.
Symptoms :
Poor spelling.
Errors in grammar.
Errors in punctuation.
Poor handwriting.