704 Paraphilic Disorders
rectly to first ejaculation. In many cases, cross-dressing elicits less and less sexual ex-
citement as the individual grows older; eventually it may produce no discernible penile
response at all. The desire to cross-dress, at  the same time, remains the same or grows even
stronger. Individuals who report such a dimi nution of sexual response typically report
that the sexual excitement of cross-dressing has been replaced by feelings of comfort or
well-being.
In some cases, the course of transvestic disorder is contin uous, and in others it is epi-
sodic. It is not rare for men with transvestic d isorder to lose interest  in cross-dressing when
they first fall in love with a woman and be gin a relationship, but such abatement usually
proves temporary. When the desire to cross-dr ess returns, so does the associated distress.
Some cases of transvestic disorder progress  to gender dysphoria. The males in these
cases, who may be indistinguishable from othe rs with transvestic disorder in adolescence
or early childhood, gradually develop desires to remain in the female role for longer pe-
riods and to feminize their anatomy. The de velopment of gender dysphoria is usually ac-
companied by a (self-reported) reduction or e limination of sexual arousal in association
with cross-dressing.
The manifestation of transvestism in penile erection and stimulation, like the manifesta-
tion of other paraphilic as well as normophilic sexual interests, is most intense in adolescence
and early adulthood. The severity of transvestic disorder is highest in adulthood, when the
transvestic drives are most likely to conflict  with performance in he terosexual intercourse