The Sexual and Gender Identity Disorders are categorized into the following three types: Sexual Dysfunctions, Paraphilias, and Gender Identity Disorders. Sexual Dysfunctions are marked by inhibited sexual desire, social difficulties, and constant, debilitating feelings of distress. People with sexual dysfunctions may avoid sexual opportunities for fear of failure. They also may feel inadequate which can diminish their self-esteem. There are four categories of Sexual Dysfunctions: Sexual desire disorders, Sexual arousal disorders, Orgasmic disorders, and Sexual pain disorders. Paraphilias are sexual urges relating to objects, behaviors, or circumstances not normally associated with sexual activity. People with paraphilias usually feel that their urges are demanding, or compulsory. A psychiatric diagnosis of paraphilia requires that the person have acted on the urges or be distinctly distressed by them. Gender Identity Disorders are marked by intense cross-gender identification with persistent discomfort pertaining to the persons biologically determined sex. These individuals have the anatomic sex of one sex, but feel that they are members of the other.