The difference between hypoactive sexual desire disorder and sexual aversion disorder is that A. hypoactive sexual desire disorder involves excessive sexual desire. |
D. sexual aversion disorder involves fear, panic, or disgust brought about by the thought of sex or a brief touch. |
_____ refers to psychological dissatisfaction with one’s biological gender. A. Paraphilia |
B. Gender identity disorder |
_____ describes a group of disorders in which sexual arousal occurs in the context of inappropriate objects or non-consenting people. A. Paraphilia |
A. Paraphilia |
The incidence of _____ shows the largest difference between the genders in sexual behaviors. A. oral sex |
C. masturbation |
The major aspect(s) involved in the assessment of sexual behavior include(s): A. interviewing |
D. all of the above |
Which of the following is not a paraphilia? A. sadistic rape |
A. sadistic rape |
Major biological contributions to the development of sexual dysfunctions include: A. endocrine deficiencies |
B. neurobiological diseases |
Research reports have suggested that homosexuality is A. more likely concordant among monozygotic twins than among dizygotic twins or non-twin siblings. |
D. all of the above |
If a man can obtain a normal erectile response while asleep, but not while with a partner, the cause of his sexual dysfunction likely A. is psychological in nature. |
E. is still unknown. |
_____ is defined as recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts in which the psychological or physical suffering of a victim is sexually exciting to a person. Recurrent, intense sexually arousing fantasies, sexual urges, or behaviors involving acts of being humiliated, beaten, bound, or otherwise made to suffer is characteristic of _____. A. Sexual sadism; sadistic rape |
B. Sexual sadism; sexual masochism |
Which of the following is NOT characteristic of sex disorders involving pain? A. The two types of pain disorders are dyspareunia and vaginismus. |
D. Prevalence of vaginismus does not vary significantly in different cultures. |
Male orgasmic disorder is A. most commonly referred to as retarded ejaculation disorder. |
A. most commonly referred to as retarded ejaculation disorder. |
The development of deviant patterns of sexual arousal may be associated with A. levels of "desired" arousal in consenting adults. |
D. all of the above |
Which of the following is true about sexual practices in the United States? A. There are more females than males engaged in exclusively homosexual activity. |
C. Sexual practices in the United States are very similar to those in Britain and France. |
_____ is a psychosocial treatment carried out entirely in the imagination of the patient. A. Orgasmic reconditioning |
B. Covert sensitization |
Because of the high risk involved, it is disturbing that approximately _____ of men in the United States have had 20 or more sexual partners. A. 5% |
C. 25% |
A likely explanation for the gender differences in frequency of masturbation is A. anatomical differences between men and women. |
A. anatomical differences between men and women. |
What is considered to be "normal" sexual behavior A. is remarkably similar across cultures. |
B. is culture-dependent. |
Unlike most boys his age, young Tim spends most of his time with girls, playing games usually associated with girls. According to one theorist, this pattern may contribute to homosexual development in Tim because A. it makes girls too familiar to consider as sex partners. |
D. all of the above derive from the theory. |
Which of the following sexual disorders are gender-specific? A. vaginismus and sexual arousal disorder |
C. vaginismus and premature ejaculation |
According to the text, each stage of sexual activity has disorders associated with it. These stages,in order, are A. desire, orgasm, arousal. |
C. desire, arousal, orgasm. |
As you prepare to open your own Sexual Disorders Clinic, you need to order some specialized equipment. All of the following devices can be used to measure the ability of individuals to become sexually aroused except A. penile strain gauge. |
C. sphygmomanometer. |
You have a friend who plans to use alcohol as part of a seduction scenario. You warn of the increased risk of unprotected sex in these conditions. You also point out the effect(s) of alcohol on sexual arousal and behavior: A. alcohol increases arousal and facilitates performance. |
B. alcohol suppresses central nervous system functioning, thus making it more difficult for men to achieve erection and for women to achieve lubrication. |
A client you are treating for her sexual dysfunction relates a recent situation where a sexual encounter seemed likely. In that situation she probably A. had excessively high expectations. |
C. underestimated how physically aroused she was. |
Tom thinks he shows his love and worthiness as a sex partner by working hard at the office and keeping the house in good repair. His wife Maria can’t feel sexy unless he woos her with gifts and loving words. Theorist John Gagnon would say they differ in their A. cognitive restructuring. |
D. scripts. |
Roderick and his partner are seeking treatment for Roderick’s premature ejaculation. The therapist encourages the couple to stimulate Roderick’s penis to nearly full erection and then to squeeze the penis firmly to quickly reduce arousal. After repeating this process, insertion is to be attempted without thrusting and the penis removed if arousal proceeds too quickly. This treatment is called A. torture. |
D. the squeeze technique. |
About 50% of patients who seek treatment at sexuality clinics complain of A. sexual aversion. |
B. loss of appetite. |
Which of the following statements characterize men with sexual dysfunction? A. They show decreased arousal under "performance demand" conditions. |
E. all of the above |
Which of the following is a procedure used to strengthen more appropriate patterns of sexual arousal? A. the squeeze technique |
D. orgasmic reconditioning |
Gender identity disorders are characterized by dissatisfaction with: A. sexual experiences |
C. one’s biological sex |
Among men surveyed for a CDC study, _____ were sexually experienced: A. almost 100% |
A. almost 100% |
Sexual behavior surveys suggest that: A. almost all men have more than 20 sexual partners |
A. almost all men have more than 20 sexual partners |
Recent studies on sexual practice indicate that sexual practices are: A. consistent all over the world |
A. consistent all over the world |
The largest difference in sexual behavior for men versus women is that: A. men are more likely to engage in premarital sex |
C. men are more likely to masturbate |
Differences in male and female attitudes toward sexuality have generally _____ over the past 40 A. decreased |
A. decreased |
Data from research studies on gender differences in human sexuality reflect all of the following themes EXCEPT: A. men masturbate more than women |
B. men are more permissive about casual premarital sex than women |
Gender differences in attitudes towards premarital sex have been ____ over time A. shrinking |
A. shrinking |
Data from research studies on gender differences in human sexuality (Peplau, 2003) reflect all of the following themes EXCEPT: A. men show more sexual desire and arousal than women |
B. men emphasize committed relationships more than women |
Which of the following is true regarding sexuality? A. Women desire demonstrations of love and intimacy during sex, while men focus on arousal. |
A. Women desire demonstrations of love and intimacy during sex, while men focus on arousal. |
In Sweden, where attitudes toward sexuality are somewhat more permissive than they are in the United States, the percentage of Swedish women reporting use of contraception during their first sexual intercourse was: A. significantly higher than it was for American women |
A. significantly higher than it was for American women |
Research regarding sexual orientation suggests that homosexuality is: A. purely genetic |
D. influenced by biological/genetic, psychological and social factors |
Joe is homosexual and has an identical (monozygotic) twin named Sam. The following statement is true: A. Sam is more likely than the general population to be homosexual. |
A. Sam is more likely than the general population to be homosexual. |
Of those identical (monozygotic) twins where one twin is homosexual, the other twin is also homosexual in 50% of cases. This means: A. homosexuality is determined by genetics |
B. genes are only one influence for sexual orientation |
Which of the following does not support the fact that homosexuality is related to differential hormone exposure in utero? A. Homosexual males are more likely to be left handed or mixed handed than right handed. |
C. Homosexual males have smaller feet than heterosexual males. |
Recent research on the causes of sexual orientation indicates that: A. there is a single genetic cause for the development of one’s orientation |
C. there are many pathways to the development of sexual orientation |
Statistically, homosexual males are more likely to have grown up with: A. older brothers |
A. older brothers |
Gender identity disorder is diagnosed when: A. a person’s physical gender is inconsistent with the person’s gender identity |
A. a person’s physical gender is inconsistent with the person’s gender identity |
According to recent surveys (Diokno et al., 1990), the following statement is true regarding sexual activity of the elderly: A. very few individuals remain sexually active beyond age 70 |
D. 50% of males and 36% of women aged 75 – 79 remained sexually active |
Of the following, the individual who should be diagnosed with gender identity disorder is: A. Joe, who gets sexually aroused by wearing women’s bras |
C. Mark, who feels like a woman trapped in a man’s body |
The incidence of gender identity disorder is: A. very low, with far less than 1% of the population affected |
A. very low, with far less than 1% of the population affected |
The new approaches to understanding and treating intersexed individuals that have been proposed recently (Fausto-Sterling, 2000) are based on the concept of "five sexes" which include all of the following EXCEPT: A. "herms" |
D. "andros" and "estros" |
Transsexuals who change gender identity: A. are always attracted to people of their previous sex |
C. vary in who they are attracted to |
The psychosocial treatment of Joe, a young man with gender identity disorder, described in your textbook suggests that: A. gender identity can be influenced with therapy but sexual orientation will not change B. sexual orientation can be influenced by therapy but gender identity will not change |
C. both gender identity and sexual orientation can be influenced by therapy |
Recent twin studies suggest that the majority of the vulnerability for gender identity disorder comes from: A. genetic factors |
A. genetic factors |
Studies suggest that in comparison to other girls and boys, CAH girls are: A. more feminine |
B. more masculine |
Sexual dysfunctions are: A. more common in heterosexuals than homosexuals |
C. equally common in heterosexuals and homosexuals |
The incidence of sexual dysfunctions in the United States is approximately: A. 43% of women and 31% of men |
A. 43% of women and 31% of men |
A boy who consistently behaves in feminine ways is exhibiting: A. gender non-activation |
D. gender non-conformity |
Research suggests that gender non-conformity typically results in: A. gender identity issues |
D. none of the above |
Intersexuality refers to people who: A. are born with the physical characteristics of both sexes |
A. are born with the physical characteristics of both sexes |
Which of the following is not one of the 3 stages of sexual response? A. desire |
C. orgasm |
Which of the following is the most prevalent of any psychological or physiological disorder in the U.S.? A. depression |
D. sexual disorders |
Sexual problems are difficult to diagnose when: A. dysfunction is present and the person is distressed about it |
B. dysfunction is present but the person is not distressed about it |
Happily married couples typically report: A. occasional sexual dysfunction which does not result in sexual dissatisfaction |
A. occasional sexual dysfunction which does not result in sexual dissatisfaction |
Of the following, the individual most likely to receive an appropriate diagnosis of hypoactive sexual desire disorder is: A. Sue, who fantasizes about sex often but is so exhausted when she gets home that she only has sex about twice a month |
D. Fred, who has sex at least once a week to satisfy his wife, but would prefer to be left alone since he is rarely interested in sex |
The individual with the greatest likelihood of hypoactive sexual desire disorder is a(n): A. 18-year-old male |
C. 30-year-old female |
A person who reports low sexual disorder might: A. never think about sex |
D. all of the above |
Just the thought of sex makes Harry anxious. When exposed to sexual images, he reports feeling disgust. Harry would most likely be diagnosed with: A. hypoactive sexual desire disorder |
C. sexual aversion disorder |
Approximately 25% of the patients with sexual aversion disorder also suffer from associated: A. panic attacks |
A. panic attacks |
The main feature of sexual arousal disorders is: A. lack of desire for sex despite normal physical sexual response |
D. lack of physical sexual response despite desire for sex |
Sexual arousal disorders are diagnosed when there is an: A. inability to achieve or maintain an erection in males and a lack of desire for sex in females |
D. inability to achieve or maintain an erection in males and a lack of lubrication in females |
Based on stringent criteria, research data indicate that the percentage of men between the ages of 18 and 59 with erectile dysfunction is: A. 1% |
C. 5% |
What is the percentage of men in their 70s with at least some impairment of erectile function? A. 3% |
D. 70% |
The prevalence of sexual arousal disorders is: A. much higher for men than it is for women |
A. much higher for men than it is for women |
The percentage of women reporting significant difficulty reaching orgasm is: A. 5% |
C. 25% |
One reason that different diagnostic criteria are used for males and females with inhibited orgasm disorder is that: A. the disorder is relatively rare in men |
C. both a and b are correct |
Sandra and Jim have been happily married for several years. Sandra reports that she reaches orgasm from intercourse only about half of the time and she wonders if something is "wrong" with her. Sandra should: A. seek treatment for inhibited orgasm disorder |
C. relax and realize that this is not unusual for women |
Jody and Howard have been happily married for several years. Howard reports that in spite of being sexually aroused and having an erection, he only reaches orgasm from intercourse about half of the time. Howard wonders if something is "wrong" with him. Howard should: A. seek treatment for inhibited orgasm disorder |
A. seek treatment for inhibited orgasm disorder |
The most common of all the male sexual dysfunctions is: A. erectile dysfunction |
C. premature ejaculation |
The following paring is correct based on the ages most affected by the disorders: A. young men – premature ejaculation; older men – sexual aversion |
B. young men – premature ejaculation; older men – erectile dysfunction |
One reason that it is difficult to provide a precise diagnosis of premature ejaculation is that: A. the concept of "too soon" is dependent on the individual and the couple |
A. the concept of "too soon" is dependent on the individual and the couple |
Premature ejaculations are: A. clearly defined by the amount of time between penetration and climax |
B. generally a result of perception of control rather than actual time |
Before diagnosing a sexual pain disorder, it is necessary to rule out: A. relationship issues that could be the cause of the dysfunction |
C. a medical cause of the pain |
The condition called "dyspareunia" is diagnosed: A. when intercourse is uncomfortable or painful |
B. when medical conditions are ruled out as a cause of painful intercourse |
Vaginismus refers to: A. painful pelvic spasms during penetration |
A. painful pelvic spasms during penetration |
The experience of vaginismus is highest in: A. sexually liberal cultures |
B. sexually conservative cultures |
One reason that your text suggests questionnaires be used when assessing sexual behavior is that: A. people may provide more sexual information in writing than during an interview |
A. people may provide more sexual information in writing than during an interview |
One of the most important skills that therapists must possess when conducting an interview regarding sexual behavior is: A. communicating their own sexual values |
C. demonstrating that they are comfortable talking about sexual issues |
Psychophysiological assessment of sexual dysfunction is generally conducted by: A. using a device that measures physical arousal during exposure to an erotic video or audio tape |
A. using a device that measures physical arousal during exposure to an erotic video or audio tape |
A male patient complaining of erectile dysfunction is observed to have a complete lack of nocturnal penile erections while sleeping. We can conclude that: A. more information is needed to diagnose his problem |
A. more information is needed to diagnose his problem |
A situation in which a patient experiences more than one sexual disorder at the same time (for example, erectile dysfunction and premature ejaculation) is: A. very uncommon |
C. common |
Two extremely common medical causes of erectile dysfunction are: A. asthma and diabetes |
B. vascular disease and diabetes |
Approximately 75% of individuals taking ____ medication experience some degree of sexual dysfunction. A. SSRI |
A. SSRI |
Sherri and Leo have been having some sexual difficulties lately. Both have experienced some symptoms of sexual arousal disorders. They decide to have a few glasses of wine before engaging in sex tonight. Is this a good idea or a bad idea? A. It’s a good idea since wine could increase desire. |
C. It’s a bad idea since wine could further impair arousal. |
The effects of alcohol on sexual behavior were well noted by William Shakespeare and can be summarized as: A. alcohol decreases desire and performance |
C. alcohol may increase performance but it decreases desire |
Our current understanding of the psychological causes of sexual dysfunction suggests that the primary psychological factor in sexual dysfunction is: A. anxiety |
B. distraction |
As a typical male with erectile dysfunction, we can expect Bill to show: A. decreased arousal during performance demand and an inaccurate sense of how aroused he is |
A. decreased arousal during performance demand and an inaccurate sense of how aroused he is |
The original concept of performance anxiety as a cause of sexual dysfunction has been replaced with a more modern view that performance anxiety is comprised of: A. distraction, cognition and depression |
D. arousal, cognitive processes and negative affect |
Greg often has problems with premature ejaculation. As he becomes more anxious about his problem, the amount of time between initiating intercourse and ejaculation will most likely: A. increase |
B. decrease |
Research indicates that sexual arousal is strongly determined by: A. cognitive factors |
D. all of the above |
The most accurate description for the condition called erotophobia is: A. negative feelings toward sexuality |
A. negative feelings toward sexuality |
Children or young adults who experience sexual victimization are: A. no more likely to experience sexual dysfunction as adults than anyone else |
D. more likely to experience sexual dysfunction as adults |
Sexual dysfunction is often related to: A. dislike for partner |
… |
An unusually high concern with nocturnal emissions has been reported in where there is a _____ strong culturally held belief that loss of semen causes depletion of physical and mental energy. A. Ireland |
C. India |
Belief in common sexual myths such as "women normally reach orgasm every time they have intercourse" are more commonly held by men: A. who do not have sexual disorders |
C. who have sexual disorders |
Development of sexual dysfunction can be viewed as a "vicious circle" since the typical case progresses in the following manner: A. initial dysfunction may be triggered by an event such as substance use; concern about the dysfunction then leads to more dysfunction and sex itself becomes associated with negative feelings |
A. initial dysfunction may be triggered by an event such as substance use; concern about the dysfunction then leads to more dysfunction and sex itself becomes associated with negative feelings |
The authors of your textbook suggest that one of the most effective treatments for many sexual dysfunctions is: A. exploration of the patient’s sexual orientation |
C. education regarding normal sexuality |
Sensate focus and non-demand pleasuring were designed by Masters and Johnson to treat sexual dysfunctions primarily through: A. improving a couple’s sexual skills |
D. elimination of psychologically-based performance anxiety |
Maggie and Jim have started sex therapy to deal with Jim’s recent erectile dysfunction. The therapist has instructed them to refrain from intercourse or genital touching but to spend the next several days enjoying each other through hugging, kissing and mutual massage. This is an example of: A. stage one of sensate focus treatment |
A. stage one of sensate focus treatment |
Stage two of sensate focus involves "genital pleasuring" but prohibits intercourse or orgasm. The main purpose of this stage is to: A. allow an individual to communicate his or her desires to the partner |
C. allow sexual experience without the anxiety of performance |
As a couple completes stage two of sensate focus therapy, they are instructed to: A. return to full, prior sexual activity |
B. slowly begin sexual activity, continuing non-demand pleasuring as they progress |
Masters and Johnson reported that the use of sensate focus therapy for the treatment of premature ejaculation was effective in _____ of cases treated. A. 50% |
D. almost 100% |
Treatment effectiveness studies of Masters and Johnson’s sensate focus therapy have indicated that: A. certain aspects of the treatment such as two therapists and daily therapy are not necessary |
A. certain aspects of the treatment such as two therapists and daily therapy are not necessary |
Sex therapy for erectile dysfunction has produced a positive treatment outcome in approximately ____ of the cases treated. A. 25% |
C. 65% |
The sex therapy technique designed specifically to treat premature ejaculation is: A. the squeeze technique |
A. the squeeze technique |
The specific treatment found effective in the treatment of female orgasmic disorder is: A. anti-anxiety medication |
C. explicit training in masturbation procedures |
A woman is sent home from sex therapy with an assignment to purchase a vibrator and practice masturbating. She is likely being treated: A. for vaginismus |
C. for female orgasmic disorder |
Dilators of gradually increasing sizes are used in the treatment of: A. female orgasmic disorder |
B. vaginismus |
According to your textbook, what is the percentage of women who successfully overcome vaginismus? A. less than 30% |
D. 80% to 100% |
The percentage of men with erectile dysfunction who take Viagra and are then able to maintain an erection sufficient for intercourse is between: A. 5% and 40% |
B. 50% and 80% |
What significant side effect is experienced by as many as 30% of Viagra users? A. severe headache |
A. severe headache |
Research studies on Viagra users indicate that: A. most users are able to engage in intercourse and are very satisfied with the results |
C. most users are able to engage in intercourse but only 32% rated the results as "good" or better |
Papaverine and prostaglandin, vasodilating drugs used in the treatment of erectile dysfunction, are delivered to the patient: A. in a capsule taken orally |
C. by injection directly into the penis |
Although vasodilating drugs such as papaverine and prostaglandin are effective in producing an erection for patients with erectile dysfunction, many patients discontinue use of the drugs because of: A. painful side effects |
A. painful side effects |
Which of the following treatments is NOT currently used in the treatment of erectile dysfunction? A. vasodilating drugs |
B. anti-anxiety medication |
One of the reasons that Viagra has become so widely accepted as a treatment for erectile dysfunction is that: A. it is more effective than the other available treatments |
D. an oral medication is less awkward and intrusive than other treatments |
Therapy for sexual dysfunctions such as hypoactive sexual desire disorder can best be described as: A. well-studied and widely available |
C. not well-studied and not available in all locations |
Paraphilia is defined as: A. a dysfunction |
B. an attraction to inappropriate individuals or objects |
The definition of a fetish is sexual: A. dysfunction |
C. attraction to nonliving objects |
Charles gets very sexually excited by women’s shoes. While he used to fantasize about women wearing particular shoes, he now focuses almost exclusively on the shoes themselves. Charles has a(n): A. sexual dysfunction |
C. fetish |
Greg and Diana often begin their sexual activity with Greg putting on a striptease show for Diana. They both report great satisfaction and excitement with this activity. In fact, Greg says that he gets aroused by exposing himself and Diana reports getting aroused when she watches him undress. Which of the following statements is true? A. Greg is an exhibitionist and Diana is a voyeur. |
D. Neither Greg nor Diana should be diagnosed with a fetish because these behaviors involve consenting individuals. |
One psychological aspect of voyeurism and exhibitionism that seems to maintain the disordered behavior is: A. some anxiety about getting caught |
A. some anxiety about getting caught |
All of the following are true statements regarding transvestic fetishism EXCEPT: A. transvestic fetishists are either homosexual or transsexual |
A. transvestic fetishists are either homosexual or transsexual |
____ are individuals who receive a sexual thrill from inflicting pain on others and ____ are individuals who receive a sexual thrill from receiving physical pain. A. Sadists; masochists |
A. Sadists; masochists |
According to the authors of your textbook, the concurrent existence of masochistic and sadistic fetish within the same individual is: |
D. common |
"Opportunistic" rape differs from sadistic rape in that the rape in the latter is committed by an individual: A. who meets the criteria for antisocial personality disorder |
B. with a particular pattern of sexual arousal |
When the term paraphilia is used to describe the behavior of a rapist, it means that the rapist is aroused by: A. images of forced sex |
A. images of forced sex |
Which of the following is true about most rapists? A. They are sexually aroused only by violence. |
B. They are aggressive and have little regard for others. |
Victims of incest tend to be _____ and victims of pedophilia (who are not also incest victims) tend to A. male; female |
C. girls who are beginning to mature physically; young children |
Research with both non-incestuous pedophiles and perpetrators of incest (Marshall, et al., 1986 and Marshall, 1997) suggests that: A. non-incestuous pedophilia is generally influenced by paraphilia, where incest may be more opportunistic |
A. non-incestuous pedophilia is generally influenced by paraphilia, where incest may be more opportunistic |
The typical adult who molests a child: A. is violent and aggressive |
C. does not use physical force |
Inappropriate sexual arousal, e.g., fetishism, appears to be learned through: A. exposure to pornography |
B. masturbatory fantasies about the object |
The classical conditioning model of learning predicts that the following boy might grow up to be a voyeur: A. Tim whose father is a voyeur |
C. Sid who masturbates while peeping at his neighbor |
Of the various hypothesized influences of paraphilia, the ones that we know the least about involve: A. biological influences such as genetics and neurotransmitters |
A. biological influences such as genetics and neurotransmitters |
The procedure that is carried out entirely in the patient’s imagination and used to reduce the inappropriate sexual arousal that exists in fetishistic behavior is called: A. classical conditioning |
D. covert sensitization |
The basic concept behind the covert sensitization method of treating unwanted sexual arousal is to: A. create empathy for the victim of the behavior |
B. replace the immediate reinforcement of the behavior with the unpleasant consequences that ordinarily take longer to be experienced |
Patients undergoing the procedure called orgasmic reconditioning are instructed to: A. masturbate to their usual fantasies but to substitute more desirable ones just before ejaculation |
A. masturbate to their usual fantasies but to substitute more desirable ones just before ejaculation |
The procedure called orgasmic reconditioning works according to the principle of: A. punishment of inappropriate arousal |
C. reinforcement of appropriate arousal |
Research regarding the success of treating paraphilias with procedures such as orgasmic reconditioning and covert sensitization indicates that: A. treatment is generally not successful |
D. treatment is generally effective |
A poor prognosis associated with the treatment of paraphilia is related to all of the following factors EXCEPT: A. having multiple paraphilias |
B. having had the paraphilia for more than 10 years |
Which of the following is true regarding drugs currently available for the treatment of paraphilias? A. The drugs eliminate sexual desire but are only effective while they are being taken. |
A. The drugs eliminate sexual desire but are only effective while they are being taken. |
In the study reported by Federoff, et al., 1999, the women had all the following types of paraphilias EXCEPT: A. fetishism |
A. fetishism |
PSY 240 Chapter 10 – Sexual and Gender Identity Disorders
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