Theoretical part Currently accepted new conceptualization of women's sexual dysfunction is based on the model found in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) and International Classification of Diseases (ICD). These classifications are extended and combined interpersonal, contextual, personalpsychological and biological factors. Recent DSM- IV definitions have focused on absence of sexual fantasies and sexual desireprior to sexual activity and arousal, even though the frequencyof this type of desire is known to vary greatly among women without sexual complaints. DSM-IV definitions also focus on genital swelling and lubrication, entities known to correlate poorly with subjective sexual arousal and pleasure. The structure of the new classification is based on the four categories of DSM-IV: disorders of desire, arousal, orgasm and pain. However these categories are newly assigned to the subjective dimension of satisfaction, stress and the presence of disorders during other sexual activities besides intercourse. The dimension lifetime vs. acquired, generalized vs. situational were added, as well as the etiology is taking into account. For clinical work it is important that these changes highlight the significance and importance of psychological, situational...

Obsessive-compulsive disorder (OCD), with a prevalence of 1-2 %, frequently leads a chronic course. Persons with OCD are often reluctant to seek help and, if they do, their OCD is often missed. This is unfortunate, since active treatment may substantially improve social function and quality of life. Serotonin reuptake inhibitors (SRIs) have welldocumented efficacy in OCD, but delayed response may be problematic. Methods to predict response have been lacking. Because SRIs are effective, pathophysiological research on OCD has focussed on serotonin. However, no clear aberrations of serotonin have been found, thus other mechanisms ought to be involved. Our aims were to facilitate clinical detection and assessment of OCD, to search for biochemical correlates of response and side-effects in SRI treatment of OCD and to identify any possible involvement of oxytocin in the pathophysiology of OCD. In study I, we tested in 402 psychiatric out-patients the psychometric properties of a concise rating scale, “Brief Obsessive Compulsive Scale” (BOCS). BOCS was shown to be easy to use and have excellent discriminant validity in relation to other common psychiatric diagnoses. Studies II-V were based on 36 OCD patients from a randomised controlled trial of paroxetine, clomipramine or placebo. In study II, contrary to expectation, we found that the change (decrease) of serotonin in whole blood was most pronounced in non-responders to SRI. This is likely to reflect inflammatory influence on platelet turnover rather than serotonergic processes within the central nervous system. In studies IV-V, we found relations between changes of oxytocin in plasma and the anti-obsessive response, and between oxytocin and the SRI related delay of orgasm, respectively. In both cases, the relation to central oxytocinergic mechanisms is unclear. In males, delayed orgasm predicted anti-obsessive response.

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Theoretical part Currently accepted new conceptualization of women's sexual dysfunction is based on the model found in the American Psychiatric Association's Diagnostic and Statistical Manual (DSM-IV) and International Classification of Diseases (ICD). These classifications are extended and combined interpersonal, contextual, personalpsychological and biological factors. Recent DSM- IV definitions have focused on absence of sexual fantasies and sexual desireprior to sexual activity and arousal, even though the frequencyof this type of desire is known to vary greatly among women without sexual complaints. DSM-IV definitions also focus on genital swelling and lubrication, entities known to correlate poorly with subjective sexual arousal and pleasure. The structure of the new classification is based on the four categories of DSM-IV: disorders of desire, arousal, orgasm and pain. However these categories are newly assigned to the subjective dimension of satisfaction, stress and the presence of disorders during other sexual activities besides intercourse. The dimension lifetime vs. acquired, generalized vs. situational were added, as well as the etiology is taking into account. For clinical work it is important that these changes highlight the significance and importance of psychological, situational...

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L'adolescence est une période importante dans le développement de soi en tant qu'être sexuel, qui contribue à façonner le bien-être sexuel ultérieur de l'adulte. La thèse visait à documenter les barrières aux expériences sexuelles positives à l’adolescence avec les données de la cohorte PRÉSAJ. La première étude, incluant 1036 adolescents en troisième secondaire, a examiné le vécu d’intimidation, le bien-être sexuel, et le rôle médiateur des difficultés de régulation émotionnelle en tenant compte du genre et de l’orientation sexuelle. Le vécu d’intimidation était négativement associé aux difficultés de désir/excitation sexuelle et positivement associé à la détresse sexuelle. Les difficultés de régulation émotionnelle ont agi comme médiateur entre l’intimidation et la fonction orgasmique, ainsi que la détresse sexuelle. La deuxième étude a examiné les différences en fonction du genre et de la configuration relationnelle quant à l'orgasme (durant la masturbation et avec partenaire) et les comportements sexuels (oraux et manuels) chez 2800 adolescents en cinquième secondaire. Les résultats ont montré que, par rapport aux garçons cisgenres, les filles cisgenres avaient moins de chances de rapporter un orgasme pendant la masturbation et avec un partenaire. De plus, les filles cisgenres recevaient davantage de stimulation manuelle, mais moins de stimulation orale. Ensuite, les individus trans et non-binaires (TNB) assignés au sexe masculin à la naissance (AMAN) recevaient davantage de stimulation manuelle, mais les individus TNB assignés au sexe féminin àla naissance (AFAN) recevaient moins de stimulation orale que les garçons cisgenres. Pour la configuration relationnelle, les filles cisgenres ayant des partenaires de genre différent et les filles cisgenres ayant des partenaires de genre multiple avaient moins de chances d'avoir déjà eu un orgasme pendant la masturbation, rapportaient plus de difficultés à expérimenter l'orgasme avec un partenaire et recevaient moins de stimulation orale comparativement garçons cisgenres ayant un partenaire de genre différent. Le groupe TNB AMAN avec des partenaires de même genre avait plus de chances d’avoir un orgasme en se masturbant et de recevoir davantage de stimulation orale comparativement au groupe TNB AFAN ayant des partenaires de genre multiple. En outre, le groupe TNB AFAN avec des partenaires de même genre a rapporté plus de difficultés d'orgasme avec partenaire et recevait moins de stimulation manuelle. La troisième étude visait à identifier les classes longitudinales de changements dans l'identité sexuelle, les décrire en termes de variables sociodémographiques, et tester les associations avec le bien-être sexuel ultérieur. Une analyse de classe latentes incluant 3027 adolescents de 14 à 17 ans a permis de dégager trois classes: Identité Hétérosexuelle Stable (Classe 1 : 84,4%), Identité Principalement de Minorité Sexuelle (Classe 2 : 10,2%), et Identité de Minorité Sexuelle Émergente ou en Questionnement Constant (Classe 3 : 5,4%). Par rapport à la Classe 1, être membre de la Classe 2 était associé à une satisfaction sexuelle plus faible et une détresse sexuelle plus élevée, alors qu’être membre de la classe 3 était associé à un désir/excitation sexuelle plus élevée. Les implications et contributions cliniques, théoriques et méthodologiques, ainsi que les limites de la thèse seront discutées. / Adolescence is an important period in the development of the sense of self as a sexual being, which contributes to shape subsequent adult sexual wellbeing. The general objective of this thesis was to document experiences of and barriers to positive sexuality experiences in adolescence. The aim of the first study was to examine the associations between bullying victimization and sexual wellbeing (sexual satisfaction, sexual desire/arousal, orgasm function and sexual distress) via the mediating role of emotion regulation difficulties, considering potential sexual/gender minority differences in 1036 sexually active high school students. Bullying victimization was directly and negatively associated with sexual desire/arousal difficulties and positively with sexual distress. Greater emotion regulation difficulties mediated the associations between greater bullying victimization and greater orgasmic difficulties, as well as greater bullying victimization and greater sexual distress. The second study examined differences in orgasm and sexual behaviours across gender and sexual orientation among 2800 middle adolescents. Results showed that, using cisgender boys as reference, cisgender girls had lower odds of experiencing orgasm during masturbation, more difficulties with orgasm during partnered sex, received more manual sex, and less oral sex. TNB individuals assigned male at birth (AMAB) received more manual stimulation, and TNB assigned female at birth (AFAB) received less oral sex. For dyad type, using cisgender boys with different-gender partners as reference, cisgender girls with different-gender partners and cisgender girls with multiple-gender partners had lower odds of having ever experienced orgasm during masturbation, reported more difficulties experiencing orgasm during partnered sex and received oral stimulation less often. Using TNB AFAB with multiple-gender partners as reference, TNB AMAB with same-gender partners had higher odds of experiencing orgasm while masturbating and receiving more oral stimulation. Also, TNB AFAB with same-gender partners reported more diffiuclties with orgasm in partnered contexts and received less manual stimulation. The third study aimed to identify and characterize longitudinal classes of sexual identity change across three time points and test the associations between class membership and later sexual wellbeing. A total of 3027 adolescents aged 14 to 17 years completed in-class questionnaires during three waves over three years. Three-step latent class analysis of sexual identity including sociodemographic covariates was followed by Wald tests to examine differences in sexual wellbeing across classes. Three classes emerged: Consistent Heterosexual (84.4%), Mostly Sexual Minority (10.2 %), and Consistent Questioning and Emerging Sexual Minority (5.4 %). Compared to Consistent Heterosexuals, other class members were more likely to be cisgender girls or trans/non-binary youth. Also, members of the Consistent Questioning and Emerging Sexual Minority classes had higher odds of coming from a metropolitan area. Compared to Consistent Heterosexuals, Mostly Sexual Minority members had lower sexual satisfaction as well as higher sexual distress, yet members of the Consistent Questioning and Emerging Sexual Minority class had significantly higher sexual desire/arousal. Results document the complex associations between identity and sexuality during adolescence. The clinical, theoretical and methodological implications and contributions, as well as the limitations of the thesis are discussed.

In this thesis I explore the social construction of sexuality and sexual dysfunction. Interviews were undertaken with 20 sex therapists practising in Aotearoa/New Zealand in order to elicit accounts of contemporary sex therapy practice in the local context. Using a feminist poststructuralist lens, I explicate and critically examine the dominant discourses informing the construction of sex therapy, and heterosexual sexual relations, and what these discourses enable and constrain. I draw attention to some of the assumptions embedded in the construction of the sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, APA, 2000), and in accounts of sex therapy practice, examining the ways in which these are based on taken-for-granted norms of (hetero)sexuality and highlighting the differently enabled gendered sexual subjectivities they (re)produce. Although there are nine sexual dysfunctions identified in the DSM-IV-TR, all of which I briefly outline in Chapter Four, I restrict my focus in the analytical chapters to the conceptualisation and treatment of vaginismus, orgasm difficulties in women, discrepancies in desire and, relatedly, the gendering of desire through powerful sociocultural discourses and representations. I pay particular attention to the implications of these for heterosexual women’s sexuality. I also explore some of the generic concepts that dominate the construction of therapy at a broader level than that of sex therapy alone, arguing that while these offer some useful ways of framing therapy they also constrain therapy practice in important ways. Through a critical review of the sex therapy literature and accounts of practice from those interviewed, I contend that contemporary sex therapy tends to reify dominant cultural and sexological norms rather than challenge them. My analyses show that the dominant discourses informing constructions of sex therapy and heterosexual sexual relations produce particular types of sex as normal whilst marginalizing sexual acts or practices that fall outside of such restrictive parameters. In particular, I argue that the genital-coital-orgasm construct that is hegemonic within sex therapy restricts possibilities for alternative erotic pleasures and possibilities amongst heterosexuals whilst contributing to the invisibilization of sexual identities other than heterosexual. Accounts of sex therapy practice that were able to contest such framings are also highlighted. Because these came from sex therapists drawing on radical feminist or feminist poststructuralist discourses, I suggest that these discourses offer important possibilities for a deconstructive (sex) therapy practice that is able to challenge an often inequitable sexual status quo. Attention is also drawn to the significant constraints which act to restrict clients’ choices and possibilities for sex therapists to practise in more critically questioning ways. I conclude this thesis with an ‘invitation to reflection’ where I briefly discuss some deconstructive approaches that I have found useful for developing ongoing reflexive analysis of my own taken-for-granted assumptions in the area of sexuality, and for aiding my thinking about therapeutic practices that support my political and theoretical commitments and that attend to some of the issues outlined in this thesis. / Whole document restricted, but available by request, use the feedback form to request access.

In this thesis I explore the social construction of sexuality and sexual dysfunction. Interviews were undertaken with 20 sex therapists practising in Aotearoa/New Zealand in order to elicit accounts of contemporary sex therapy practice in the local context. Using a feminist poststructuralist lens, I explicate and critically examine the dominant discourses informing the construction of sex therapy, and heterosexual sexual relations, and what these discourses enable and constrain. I draw attention to some of the assumptions embedded in the construction of the sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, APA, 2000), and in accounts of sex therapy practice, examining the ways in which these are based on taken-for-granted norms of (hetero)sexuality and highlighting the differently enabled gendered sexual subjectivities they (re)produce. Although there are nine sexual dysfunctions identified in the DSM-IV-TR, all of which I briefly outline in Chapter Four, I restrict my focus in the analytical chapters to the conceptualisation and treatment of vaginismus, orgasm difficulties in women, discrepancies in desire and, relatedly, the gendering of desire through powerful sociocultural discourses and representations. I pay particular attention to the implications of these for heterosexual women’s sexuality. I also explore some of the generic concepts that dominate the construction of therapy at a broader level than that of sex therapy alone, arguing that while these offer some useful ways of framing therapy they also constrain therapy practice in important ways. Through a critical review of the sex therapy literature and accounts of practice from those interviewed, I contend that contemporary sex therapy tends to reify dominant cultural and sexological norms rather than challenge them. My analyses show that the dominant discourses informing constructions of sex therapy and heterosexual sexual relations produce particular types of sex as normal whilst marginalizing sexual acts or practices that fall outside of such restrictive parameters. In particular, I argue that the genital-coital-orgasm construct that is hegemonic within sex therapy restricts possibilities for alternative erotic pleasures and possibilities amongst heterosexuals whilst contributing to the invisibilization of sexual identities other than heterosexual. Accounts of sex therapy practice that were able to contest such framings are also highlighted. Because these came from sex therapists drawing on radical feminist or feminist poststructuralist discourses, I suggest that these discourses offer important possibilities for a deconstructive (sex) therapy practice that is able to challenge an often inequitable sexual status quo. Attention is also drawn to the significant constraints which act to restrict clients’ choices and possibilities for sex therapists to practise in more critically questioning ways. I conclude this thesis with an ‘invitation to reflection’ where I briefly discuss some deconstructive approaches that I have found useful for developing ongoing reflexive analysis of my own taken-for-granted assumptions in the area of sexuality, and for aiding my thinking about therapeutic practices that support my political and theoretical commitments and that attend to some of the issues outlined in this thesis. / Whole document restricted, but available by request, use the feedback form to request access.

In this thesis I explore the social construction of sexuality and sexual dysfunction. Interviews were undertaken with 20 sex therapists practising in Aotearoa/New Zealand in order to elicit accounts of contemporary sex therapy practice in the local context. Using a feminist poststructuralist lens, I explicate and critically examine the dominant discourses informing the construction of sex therapy, and heterosexual sexual relations, and what these discourses enable and constrain. I draw attention to some of the assumptions embedded in the construction of the sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, APA, 2000), and in accounts of sex therapy practice, examining the ways in which these are based on taken-for-granted norms of (hetero)sexuality and highlighting the differently enabled gendered sexual subjectivities they (re)produce. Although there are nine sexual dysfunctions identified in the DSM-IV-TR, all of which I briefly outline in Chapter Four, I restrict my focus in the analytical chapters to the conceptualisation and treatment of vaginismus, orgasm difficulties in women, discrepancies in desire and, relatedly, the gendering of desire through powerful sociocultural discourses and representations. I pay particular attention to the implications of these for heterosexual women’s sexuality. I also explore some of the generic concepts that dominate the construction of therapy at a broader level than that of sex therapy alone, arguing that while these offer some useful ways of framing therapy they also constrain therapy practice in important ways. Through a critical review of the sex therapy literature and accounts of practice from those interviewed, I contend that contemporary sex therapy tends to reify dominant cultural and sexological norms rather than challenge them. My analyses show that the dominant discourses informing constructions of sex therapy and heterosexual sexual relations produce particular types of sex as normal whilst marginalizing sexual acts or practices that fall outside of such restrictive parameters. In particular, I argue that the genital-coital-orgasm construct that is hegemonic within sex therapy restricts possibilities for alternative erotic pleasures and possibilities amongst heterosexuals whilst contributing to the invisibilization of sexual identities other than heterosexual. Accounts of sex therapy practice that were able to contest such framings are also highlighted. Because these came from sex therapists drawing on radical feminist or feminist poststructuralist discourses, I suggest that these discourses offer important possibilities for a deconstructive (sex) therapy practice that is able to challenge an often inequitable sexual status quo. Attention is also drawn to the significant constraints which act to restrict clients’ choices and possibilities for sex therapists to practise in more critically questioning ways. I conclude this thesis with an ‘invitation to reflection’ where I briefly discuss some deconstructive approaches that I have found useful for developing ongoing reflexive analysis of my own taken-for-granted assumptions in the area of sexuality, and for aiding my thinking about therapeutic practices that support my political and theoretical commitments and that attend to some of the issues outlined in this thesis. / Whole document restricted, but available by request, use the feedback form to request access.

In this thesis I explore the social construction of sexuality and sexual dysfunction. Interviews were undertaken with 20 sex therapists practising in Aotearoa/New Zealand in order to elicit accounts of contemporary sex therapy practice in the local context. Using a feminist poststructuralist lens, I explicate and critically examine the dominant discourses informing the construction of sex therapy, and heterosexual sexual relations, and what these discourses enable and constrain. I draw attention to some of the assumptions embedded in the construction of the sexual dysfunctions in the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR, APA, 2000), and in accounts of sex therapy practice, examining the ways in which these are based on taken-for-granted norms of (hetero)sexuality and highlighting the differently enabled gendered sexual subjectivities they (re)produce. Although there are nine sexual dysfunctions identified in the DSM-IV-TR, all of which I briefly outline in Chapter Four, I restrict my focus in the analytical chapters to the conceptualisation and treatment of vaginismus, orgasm difficulties in women, discrepancies in desire and, relatedly, the gendering of desire through powerful sociocultural discourses and representations. I pay particular attention to the implications of these for heterosexual women’s sexuality. I also explore some of the generic concepts that dominate the construction of therapy at a broader level than that of sex therapy alone, arguing that while these offer some useful ways of framing therapy they also constrain therapy practice in important ways. Through a critical review of the sex therapy literature and accounts of practice from those interviewed, I contend that contemporary sex therapy tends to reify dominant cultural and sexological norms rather than challenge them. My analyses show that the dominant discourses informing constructions of sex therapy and heterosexual sexual relations produce particular types of sex as normal whilst marginalizing sexual acts or practices that fall outside of such restrictive parameters. In particular, I argue that the genital-coital-orgasm construct that is hegemonic within sex therapy restricts possibilities for alternative erotic pleasures and possibilities amongst heterosexuals whilst contributing to the invisibilization of sexual identities other than heterosexual. Accounts of sex therapy practice that were able to contest such framings are also highlighted. Because these came from sex therapists drawing on radical feminist or feminist poststructuralist discourses, I suggest that these discourses offer important possibilities for a deconstructive (sex) therapy practice that is able to challenge an often inequitable sexual status quo. Attention is also drawn to the significant constraints which act to restrict clients’ choices and possibilities for sex therapists to practise in more critically questioning ways. I conclude this thesis with an ‘invitation to reflection’ where I briefly discuss some deconstructive approaches that I have found useful for developing ongoing reflexive analysis of my own taken-for-granted assumptions in the area of sexuality, and for aiding my thinking about therapeutic practices that support my political and theoretical commitments and that attend to some of the issues outlined in this thesis. / Whole document restricted, but available by request, use the feedback form to request access.