DEVIASI SEKSUAL

Prof. Dr. dr.H. SOEWADI, MPH, SpKJ, (K) Blok Kesehatan Jiwa, 18 November 2010 [21]
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DEVIASI SEKSUAL
TIU : MENGENAL DAN MEMAHAMI PENGERTIAN DEVIASI SEKSUAL
MEMAHAMI UPAYA PERTOLONGAN PENDERITA DEVIASI SEKSUAL
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DEVIASI SEKSUAL
TIK : MENJELASKAN SEKSUAL ABNORMAL BAIK BIOLOGIK, SOSIAL DAN PSIKOLOGIK MENYEBUTKAN MACAM DEVIASI SEKSUAL MENJELASKAN BEDA DEVIASI SEKSUAL MENJELASKAN TEORI PSIKOANALISA NALURI SEKSUAL MENJELASKAN UPAYA PERTOLONGAN DEVIASI SEKSUAL
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Introduction
Sex: A dirty word or an ADL? Social norm, morality or a basic human need and right? Taboos or sexual ignorance or sexual insecurity Our stand-point

What is sex?
Most popular search word on the Internet An act Sexual intercourse Coitus Penile-Vaginal penetration Reproduction Joy and fulfillment Expression of affection More.
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What is sexuality?
Sexuality spans the biological, psychological, social, emotional, and spiritual dimensions of our lives. Sexuality begins with us and our relationship with ourselves and extends to our relationships with others. Our relationship with ourselves includes how we feel about ourselves as a person, as sexual beings, as men and women, and how we feel about our body and how we feel about sexual activities and behaviors. Our relationships with others may include friendship, emotional intimacy, love, and/or sexual activities. We are all sexual people regardless of disability or illness and we have a right to live a fully sexual and satisfying life.
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What is sexuality?
The sensuality of sex is expressed through the full scope of our senses. Expression of a persons sexuality involves the way one dresses, the way one carries oneself, the way one touches other people and oneself, the way one smells, or the way one tastes.

Meanings of Sex
Procreation Cultural heritage Value judgement Domination & power play Affection Curiosity & testing Joy & fulfilment Symbol of a life style, . etc
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Function of Sex
Reproduction Pleasure Creating a feeling of belonging & sharing Expressing or adjusting emotion Serving the purpose of consolation Self-affirmation Means of earning a living
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Forms of Sex
Different gender Vs Same gender One partner Vs multiple partners Human to animal Human to object Self manual stimulation Pornography
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Contents of Sex
Process Desire, (foreplay), excitement, plateau, orgasm and refractory period, (after-play) Sexual response cycle Physiological and psychological changes Acts Visual stimulation Imagination or fantasy Masturbation Vaginal Anal Oral (Fellatio / Cunnilingus) Using object

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Healthy Sex
The Five NOs
No guilt feeling No shame Not being forced Not forcing the other No cause of injury to self & partner
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Health Sex life

Harmonious and healthy sex life does not only enrich the intimacy of the couples relationship, but also enhance their physical health and quality of life, as well as longevity.

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Satisfying sex life depends on

Extent and accuracy of Knowledge about sex Existence of psychological barriers or stress Level of communication between two partners Motive for sex Accuracy of self-evaluation History of alcohol and drug abuse Presence of physiological or organic problems
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SEXUAL DISORDERS
Sexual dysfunctions: Problems of inhibited sexual desire, arousal, and response Gender-identity disorders: Incongruity or conflict between ones anatomical sex and ones psychological feeling of being male or female Paraphilias: Sexual urges and fantasies about situations, objects, or people not part of the usual arousal pattern leading to reciprocal and affectional sexual activity
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Female Sexual Disorders (FSD)

1. Lacking desire for sex 2. Arousal difficulties lubrication difficulties for women 3. inability achieving climax 4. anxiety about sexual performance 5. climax too rapidly 6. physical pain during sex 7. not finding sex pleasurable
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1. Sexual Desire Disorders

- decreased interest in sexual interaction - low libido, inhibited sexual desire

(a) Hypoactive Sexual Desire Disorder

- persistently deficient or absent sexual fantasy & desire for sexual activity. - sexual enjoyment and arousal during sex may be present, although lack of desire makes initiation of sexual interaction less likely.

(b) Sexual Aversion Disorder

- more extreme condition persistent aversion/ avoidance of all genital sexual contact with other person.

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2. Sexual Arousal Disorders

- dysfunction of the lubrication swelling stage of sexual response - may occur post-menopause and post-childbirth

(a) Female Sexual Arousal Disorder

- persistent inability to maintain an adequate lubrication swelling response in the presence of adequate stimulation.

3. Female Orgasmic Disorder (Anorgasmia)

- persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase - need to evaluate whether womens orgasmic capacity is less than would be reasonable for her age, sexual experience, and adequacy of sexual stimulation she experiences. - Judgment of adequate stimulation must be made carefully; involves knowledge of persons physiology and their interest and turn-ons 18

3. Female Orgasmic Disorder (Anorgasmia)

Types: (i) Primary never had an orgasm (ii) Secondary has previously been able to orgasm, but not currently (iii) Situational occurs only in specific situations (iv) Total occurs across a wide variety of contexts Psychological theories: 1. Restrictive home environment 2. Negative self-concept - form of self-punishment - fear of losing control 3. Unrealistic expectations

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4. Sexual Pain Disorders

(a) Dyspareunia

= recurrent genital pain with sexual intercourse.

(b) Vaginismus

sort.

= persistent involuntary spasm of the circumvaginal muscles when attempting penetration. - stimulated by real or imaginary attempts at penetration of any

Aetiologies: (ii) Medical conditions:

-

hymenal abnormalities genital herpes atrophic vaginitus obstetric trauma with poor healed epistiotomy pelvic pathology (e.g., endometriosis) 20

4. Sexual Pain Disorders

(b) Vaginismus Aetiologies

(ii) Psychological factors:
- history of long-term negative conditioning to sexual activity - fear of sexual disease, pregnancy - misconception regarding pain & bleeding at time of hymenal rupture - fear of experiencing pain or physical harm - history of sexual trauma (rape, molestation, incest) - traumatic first coitus - history of traumatic pelvic examination - relationship discord - body image issues - religious orthodoxy (e.g., sexual pleasure is immoral)

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SEXUAL DYSFUNCTION
1. Etiology: ORGANIC or PSYCHOGENIC 2. Common type of sexual dysfunction * Male 1IMPOTENCE 2PREMATURE EJACULATION 3AEJACULATION 4MASTURBATION ANXIETY * Female 1ORGASMIC DYSFUNCTIONANORGASMIA 2LACK OF SEXUAL DESIRE 3VAGINISMUS 4DYSPAREUNIA

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SEKSUALITAS ABNORMAL
SEKSUALITAS SEXUAL DRIVE NALURI SEKSUAL AKIL BALIQ FUNGSI PRIMER PROKREASI TUJUAN LAIN :
KESENANGAN KENIKMATAN OPTIMAL ORGASME

AKIBAT TUJUAN LAIN MAKA TIMBUL PENYIMPANGAN KELAINAN SEKSUAL ADALAH :

TINGKAH LAKU SEKSUAL YANG MENYIMPANG DARI KAIDAH POKOK

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PROBLEM SEKSUAL
PRIA
IMPOTENSIA EJAKULASI PREKOKS EJAKULASI RETARDATA

WANITA
FRIGIDITAS VAGINISME ANORGASME
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GANGGUAN SEKSUAL
DEVIASI SEKSUAL
DISFUNGSI SEKSUAL
HIPERSEKSUAL ANORGASMIC

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RUANG LINGKUP
BAYI / ANAK
REMAJA DEWASA

LANJUT USIA
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RUANG LINGKUP PSIKIATRI

ANATOMIS FISIOLOGIS BIOLOGIS INTERCOURSE PSIKOLOGIS PENDIDIKAN SOSIAL HUKUM MEDIS-PSIKIATRIS DEMOGRAFIS AGAMA
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MACAM-MACAM DEVIASI SEKSUAL

AUTO EROTIK FETISCHISME HOMOSEKSUAL EKSHIBIONISME VOYEURISME SADISME MASOCHISME TRANSVESTITISME PEDOFILIA TRANSEKSUALISME SODOMI NEKROFILIA FROTERISME (FRIKSIONISME) KOPROFILIA UROLAGNIA BESTIALITAS INCEST PROMISQUITAS SATRIASIS/NIMFOMANIA

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AUTO-EROTIK
MERUPAKAN MASALAH
MEDIK-PSIKIATRIK PSIKOLOGIK RELIGIUS

SECARA UMUM BUKAN MASALAH SOSIAL PATOLOGIS KOMPULSIF TERAPI PERTOLONGAN PENYALURAN FANTASI SEKSUAL
OLAH RAGA KESENIAN SOSIALISASI
TRANQUILIZER PSIKOTERAPI-SUPORTIF

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HOMOSEKSUAL/LESBIAN
MURNI RAGU-RAGU BUKAN BISEKSUAL DENGAN KECEMASAN MASALAH

PENCEGAHAN TERAPI :

SOSIAL-PSIKOLOGIK-MEDIK
DETEKSI DINI PROPMPT TREATMENT

PSIKOTERAPI MEDIKAMENTOSA
TRANQUILIZER

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TRANSVETITISME
SUATU KELAINAN SEKSUAL DENGAN GEJALA HANYA MENDAPATKAN KEPUASAN SEKSUAL BILA DAPAT MEMAKAI PAKAIAN WANITA
PRIA : WANITA A : 100 : 3

TERAPI
PSIKOTERAPI ANSIOLITIK
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FETISCHISME
SUATU KELAINAN SEKSUAL DENGAN GEJALA HANYA MENDAPATKAN KEPUASAN SEKSUAL BILA MEMAKAI BENDA-BENDA MILIK LAWAN JENISNYA
SEPATU RAMBUT/WIG PAKAIAN DALAM KAOS KAKI

TERAPI

PSIKOTERAPI ANSIOLITIK
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EKSHIBIONISME
KEPUASAN SEKSUAL DIPEROLEH DENGAN MEMAMERKAN ALAT KELAMINNYA TANPA UPAYA LEBIH LANJUT UMUMNYA PRIA MASALAH
SOSIAL PSIKOLOGIK MEDIK

BILA DILAKUKAN PADA ANAK BAHAYA TERAPI

PSIKOTERAPI TRANQUILIZER ANSIOLITIK

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VOYEURISME
KEPUASAN SEKSUAL DIDAPATKAN DENGAN MENGINTIP LAWAN JENIS TANPA TUJUAN LANJUT MASALAH :
SOSIAL PSIKOLOGIK RELIGIUS

TERAPI :
PSIKOTERAPI ANSIOLITIK
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SKATOLOGIA
KEPUASAN SEKSUAL DIDAPATKAN DENGAN CARA BICARA LEWAT TELPON DENGAN LAWAN JENIS MASALAH
PSIKOLOGIK SOSIAL

TERAPI
PSIKOTERAPI TRANQUILIZER
ANSIOLITIK
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SADISME
KEPUASAN SEKSUAL DIPEROLEH DG CARA MENYAKITI ATAU MENYIKSA LAWAN JENIS MASALAH :
MEDIK PSIKOLOGIK SOSIAL

TERAPI :

PSIKOTERAPI TRANQUILIZER NEUROLEPTIK OLAH RAGA

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MASOCHISME
KEPUASAN SEKSUAL DIPEROLEH BILA DISAKITI MASALAH :
MEDIK PSIKOLOGIK SOSIAL

TERAPI :
PSIKOTERAPI TRANQUILIZER
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TRANSEKSUALISME
HASRAT PATOLOGIS UNTK BERPAKAIAN JENIS KELAMIN YG BERLAWANAN PRIA > WANITA MASALAH :
MEDIK PSIKOLOGIK SOSIAL

TERAPI-PERTOLONGAN :
PSIKOTERAPI ANSIOLITIK OPERATIF
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DISFUNGSI SEKSUAL WANITA

DYSPAREUNIA NYERI FOBIA SEKSUALIS FRIGIDITAS VAGINISME ANORGANIK ETIOLOGI :

TERAPI :

TAKUT, DOSA, PERMUSUHAN PENOLAKAN, MENGHINDAR KETIDAKMAMPUAN PSIKOTERAPI TRANQUILIZER

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TEORI PSIKOANALISA
FREUD
KOMPLEKS NALURI PARTIAL (SEBELUM AKIL BALIQ) SALING BERINTEGRASI MEMBENTUK NALURI SEKSUAL (DEWASA NORMAL) ADANYA GANGGUAN INTEGRASI DPT MENIMBULKAN KELAINAN SEKSUAL DIKATAKAN BAHWA SETIAP KELAINAN SEKSUAL MERUPAKAN BENTUK INFANTILISME
CONTOH :
EKSHIBIONISME PADA ANAK : LUCU SADISME & MASOKISME PD ANAK SANGAT MENYENANGKAN
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TEORI LIBIDO
NALURI SEKSUAL MERUPAKAN ENERGI YG SERING DISEBUT SEBAGAI LIBIDO LIBIDO TELAH ADA SEJAK LAHIR NALURI SEKSUAL :
MENUNJANG FUNGSI PRIMER TUJUAN UTAMANYA UNTUK MENDAPATKAN KESENANGAN DAN KENIKMATAN OPTIMAL

ADANYA NALURI SEKSUAL SERING TIMBUL PENYIMPANGAN SEKSUAL

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DAERAH EROGEN
ADALAH BAGIAN TUBUH YG BILA DIRANGSANG MENIMBULKAN RASA NIKMAT DAN KESENANGAN DAERAH EROGEN PERTAMA MULUT PADA USIA 0-1 TAHUN : FASE ORAL
FUNGSI PENTING : MENYUSUI DAERAH EROGEN DISEKITAR MULUT YAITU PADA MUKOSA MULUT/BIBIR FASE ORAL SADISTIK MUNCUL PD AKHIR TAHUN PERTAMA SAAT GIGI BAYI TUMBUH SAAT MENGGIGIT MERUPAKAN KESENANGAN MENGGANTI KESENANGAN MENGISAP FASE ORAL RESEPTIF BERUBAH MENJADI FASE ORAL SADISTIK 42
FASE ORAL RESEPTIF FASE ORAL SADISTIK

DAERAH EROGEN KEDUA ANUS

FASE ANAL UMUMNYA BERLANGSUNG SAMPAI USIA 3 TAHUN PADA SAAT INI BAYI BERUBAH PERHATIANNYA PD FUNGSI SEKRESI ATAU PENGELUARAN KOTORAN RANGSANGAN PD SELAPUT LENDIR ANUS PD SAAT SEKRESI MERUPAKAN KESENANGAN BAYI SELANJUTNYA BERSAMAAN DG KESENANGAN MENGGIGIT PD BAYI FASE INI DISEBUT 43 JUGA SBG FASE ANAL SADISTIK

FASE GENITAL FASE GENITAL TAMA USIA : 3- 5 TAHUN : FALLIK - OEDIPAL

PADA SAAT INI PERHATIAN ANAK BERALIH PD PENGELUARAN URINE (PADA ALAT GENITAL) PADA FASE OEDIPAL PERLU DIPERHATIKAN ADANYA :
CASTRATION ANXIETY IDENTIFIKASI

FASE INI BERLANJUT PD FASE TENANG USIA : 5 12 TAHUN FASE GENITAL KEDUA : USIA 12/13 TAHUN
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PENATALAKSANAAN DEVIASI SEKSUAL

PENGAMBILAN RIWAYAT GANGGUAN ATAU KELAINAN SEKSUAL PEMERIKSAAN FISIK PEMERIKSAAN LABORATORIK PEMERIKSAAN PSIKIATRIK PEMBERIAN TERAPI PENCEGAHAN
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TERAPI DEVIASI SEKSUAL

MEDIKAMENTOSA : MEDIKPSIKIATRIK PSIKOLOGIK PSIKOTERAPI MOTORIK OLAH RAGA PENDEKATAN SOSIAL OPERATIF PENDEKATAN KESENIAN PENDEKATAN AGAMA
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