sexual activity which causes marked distress or

SEXUAL DISORDERS/ DYSFUNCTION

interpersonal difficulty
-- is a disturbance in the process of the sexual response cycle or by pain
B. Male Sexual Arousal DO- persistent or recurrent inability to
associated with sexual intercourse.
attain or to maintain an adequate erection, until completion
of the sexual activity which causes marked distress or
MAIN PHASES OF THE SEXUAL RESPONSE CYCLE
interpersonal difficulty.
BY HELEN SINGER KAPLAN:
1 Desire
TREATMENT FOR SEXUAL AROUSAL DO:
2 Excitement
- Psychotherapy
3 Orgasm
- Behavioral therapy
- Sensate focus exercises (touch, massage, and masturbation)
BY WILLIAM MASTERS AND VIRGINIA JOHNSON:
Excitement (Arousal)
ORGASMIC DO- are disruptions of the orgasm phase of sexual response
1 Plateau
cycle.
2 Orgasm
A. Female orgasmic DO- persistent or recurrent delay in, or
3 Resolution
absence of, orgasm following a normal sexual excitement
phase, which causes marked distress or interpersonal
ACCORDING TO MANY EXPERTS (D E A R):
difficulty.
1. Desire
B. Male orgasmic DO- persistent or recurrent delay in, or
2. 2. Excitement
absence of, orgasm, following a normal sexual excitement
3. Attains Orgasm
phase, which causes marked distress or interpersonal
4. Resolution
difficulty.
C. Premature Ejaculation- persistent and recurrent onset of
-- is a disturbance in the process of the sexual response cycle or by pain
orgasm and ejaculation with minimal sexual stimulation,
associated with sexual intercourse.
before, on, or shortly after penetration and before the
person wishes it, causing marked distress or interpersonal
CLASSIFICATIONS OF THE SEXUAL DYSFUNCTIONS:
difficulty.
1. Sexual Desire Disorders
• Causes of sexual arousal DO and Female orgasmic DO:
A. Hypoactive Sexual Desire
• Depression
B. Sexual aversion DO
• Drugs (CNS depressants, antidepressants, hormonal
2. Sexual (Excitement) Arousal DO
contraceptives, alcohol, or street drugs)
A. Female Sexual Arousal DO
• Discordant Relationship (poor communication, hostility
B. Male Erectile DO
or ambivalence toward the partner, or fear of
3. Orgasmic DO
abandonment or of asserting independence)
A. Female Orgasmic DO
• Diseases (general systemic illness, endocrine or
B. Male Orgasmic DO
nervous system disorders, or diseases that impair
4. Sexual Pain DO
muscle tone or contractility
A. Dyspareunia
• Fatigue
B. Vaginismus
• Gynecologic factors (chronic vaginal or pelvic infection,
5. Sexual Dysfunctions due to a general medical condition
congenital anomalies, or genital cancer, trauma, or
6. Substance- induced sexual dysfunction
surgery)
7. PARAPHILIAS
• Causes of sexual arousal DO and Female orgasmic DO:
• Psychological factors (stress, anxiety, anger ,hostility,
SEXUAL DESIRE DISORDERS- involve a disruption in the desire phase of
boredom with sex, guilt, depression, unconscious
the sexual responsive cycle
conflicts about sexuality, or fear of loosing control of
1. Hypoactive Sexual desire or absence of sexual fantasies and
one’s feelings or behavior)
desire for sexual activity that causes marked distress or
• Pregnancy
interpersonal difficulty.
• Religious or cultural taboos that reinforce guilt feelings
2. Sexual Aversion DO- involves aversion to and active
about sex
avoidance of genital sexual contact with a sexual partner
that causes marked distress or interpersonal difficulty.
TREATMENT FOR ORGASMIC DO:
• Experiential therapy
SEXUAL AROUSAL DO- are disruption of the excitement phase of the
• Behavior modification
sexual response cycle
• Individual psychotherapy
A. Female Sexual Arousal DO- persistent or recurrent inability
• Marital or couples therapy
to attain or to maintain adequate lubrication- swelling
• Sex therapy (self stimulation, focusing on the fantasy)
response of sexual excitement , until completion of the
• Treat underlying physical DO
 CAUSES OF PREMATURE EJACULATION: - (Psychological cause) couple’s therapy, kegel’s exercise,
- Stress sensate focus exercise, progressive use of plastic dilator or
- Performance anxiety finger to progressively stretch the contracted muscles
- Limited sexual experience
- Ambivalence toward or unconscious hatred of women SEXUAL DYSFUNCTION DUE TO GENERAL MEDICAL CONDITION-
- Negative sexual relationships presence of clinically significant sexual dysfunction that is exclusively
- Guilt feelings about sex due to physiological effects of a medical condition.
- Multiple sclerosis SUBSTANCE INDUCED SEXUAL DYSFUNCTION- a clinically significant
- Drug or alcohol use sexual dysfunction resulting in marked distress or interpersonal
difficulty caused by the direct physiological effects of a substance.
Treatment of Premature Ejaculation (Masters and Johnson)
- Insight therapy PARAPHILIAS- are complex psychosexual DO marked by sexual urges,
- Behavioral techniques fantasies, or behavior that centers on:
- Experiential sessions - Inanimate objects (such as clothing)
- mutual physical exploration - The suffering or humiliaton of one’s self or partner
- sensate focus exercise (pleasurable touch sensation) - children or other non consenting persons
- the squeeze technique
- the stop and start technique Causes:
- Behavioral models- victim or observer of inappropriate
SEXUAL PAIN DISORDERS sexual behavior (imitate, gains reinforcement)
A. Dyspareunia- genital pain associated with sexual intercourse - Biological models- relationship among hormones and
causing marked distress or interpersonal difficulty. behavior
B. Vaginismus- persistent or recurrent involuntary contractions - Dysfunctional family (abuse)
of the perineal muscles surrounding the outer third of the - Substance use DO or Personality DO
vagina when vaginal penetration with penis, finger, tampon, - Lack of knowledge about sex
or speculum is attempted, causing marked distress or
interpersonal difficulties PARAPHILIAS
1. Exhibitionism- exposure of the genitals to a stranger,
Causes of Dyspareunia: sometimes involving masturbation. It has three
- Acute or chronic infection of the GUT characteristic feature namely:
- Allergic reactions (diaphragm, condoms and other - It is typically performed by men for unknown women
contraceptives) - it occurs in a place where sexual intercourse isn’t possible
- Benign or malignant reproductive system tumors such as a crowded shopping mall.
- Deformities or lesions of the vagina or its opening - it is meant to be shocking
- Endomeriosis 2. Fetishism- use of non- living objects to obtain sexual
- Genital, rectal, or pelvic scar tissue excitement or achieve orgasm
- Insufficient lubrication( medications, radiation) 3. Frotteurism- touching or rubbing against a non- consenting
- Intact hymen, retroversion of the uterus person
4. Pedophilia- sexual activity with a perpubescent child (gen 13
Treatment Dyspareunia: yrs or younger)by someone at least 16 yrs old and 5 years
- (Physical cause)- creams water soluble jellies fpr inadequate older than the child .
lubrication - undressing the child and looking at the child
- Meds for infections - masturbating in the presence of the child
- Excision for hymenal scars - Touching and fondling the child (fellatio, culliningus)
- Change in coital position to reduce pain in deep penetration - penetration of the child vagina, anus, or mouth with the
- (Psychological cause)- psychotherapy, sensate focus individual’s finger, foreign body or penis
exercises 5. Sexual masochism- recurrent intensely sexually arousing fantasies,
sexual urges, or behaviors involving the act of being humiliated,
Causes of Vaginismus: beaten, bound, or otherwise made to suffer.
- Stems from dyspareunia 6. Sexual sadism- recurrent, intensely sexually arousing fantasies,
- Frightening, unsatisfying and painful sexual experience sexual urges, or behaviors involving acts in which the psychological or
- Strict cultural religious background physical suffering of the victim is sexually arousing to the person.
- Fear and anticipation of pain 7. Transvestic Fehitism- recurrent, intensely sexually arousing
- (psychological factors)- fear of pregnancy, being controlled fantasies, sexual urges, or behaviors involving cross- dressing by a
by the man, heterosexual male
8. Voyeurism- recurrent, intensely sexually arousing fantasies, sexual
Treatment of Vaginismus: urges, or behaviors involving the act of observing an unsuspecting
person who is naked , in the process of undressing, or engaging in • Self-concept
sexual activity. • Perception of an ideal partner
- coprophilia- sexual attraction to feces • External presentation of masculinity through behaviour,
- Emetophilia- sexual attraction to vomit dress, and mannerism.
- Hybristophilia- sexual arousal by people who have
committed crimes; cruel or outrageous crimes CAUSES:
- Klismaphilia- sexual pleasure from enemies • Chromosomal anomalies
- Necrophilia- sexual arousal to corpses • Hormonal imbalances
- Plushophilia- sexual attraction to stuff toys • Pathologic defects in early parent- child bonding and child
- Urolagnia- sexual attraction to urine rearing practices
- zoophilia- sexual attraction to animals • Paraphilias (transvestic fetihism)
- Scatophilia- lewd conversation with phone for sexual arousal • Generalized anxiety disorder
- Nsg. Intervention: behavior modification- resists= REDICISM • Personality DO

NURSING INTERVENTIONS IN SEXUAL RESPONSES OF PATIENTS TO Transsexualism- gender identity disorder that results in a person
NURSES: believing he or she is really the opposite sex.
1. Ensure a therapeutic/ trusting relationship if considering sexual transplantation in the future, should
- Be a responsive listener, especially to feelings and begin hormonal therapy (estrogen therapy) to develop beast, and has
needs that patient may not be able to express directly. crossed dressed and lived as the opposite sex for several years.
- Reinforce purpose of professional, therapeutic nurse-
patient relationship. ATTEND PSYCHOTHERAPY
2. Be aware of your own feelings and thoughts - If talking about suicide indirectly “I would rather die than live
- Identify any specific patient interaction or behavior that with this body”. Ask about suicide question.
influences your feelings and thoughts - At risk- adolescents
3. Decrease patient’s expression of sexual feelings and
behavior
- Set limits on patient’s sexual behavior
- Use a calm matter- of- fact approach without implying
judgment
4. Expand patient’s insight into his sexual feelings and behavior
- Clarify misconceptions about any feeling patient may
have about you as possible sexual partners.
- Redirect patient’s energies toward appropriate health
care issues.

NURSING INTERVENTIONS FOR PATIENTS WITH SEXUAL DISORDERS:

1. Listen to sexual concerns implied and expressed.
2. Help the patient explore sexual beliefs, values and
questions.
3. Encourage open communication between the patient and
the partner.
4. Provide specific education about sexual health practices,
behaviors, and problems.
5. Give professional permission to continue sexual behavior
that is not physically or emotionally harmful
6. Reinforce positive attitudes of the patient.
7. Encourage relaxation techniques , redirection of attention,
positional changes, and alternative ways of sexual
expression as appropriate.
8. Become familiar with the sex therapy resources available in
the community.
9. Refer the patient to a qualified sex therapist as needed.

GENDER IDENTITY DO- when an individual has a strong cross gender

identification and there is discomfort with one’s apparent or assigned
gender. GENDER is first ascribe when the baby is born....

Three components: