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uLet's Talk About Sex/Sexuality

u Sex is a part of life that can be incredibly rewarding in terms of

pleasurable sensations and creating a close bond in relationships.
u However, many people experience problems that diminish this
pleasure or even prevent them from engaging in sexual intercourse.
u This can cause:
u Distance between partners and even end relationships.
Sometimes, these issues stem from existing trouble in the
SEXUAL DISORDERS relationship.
Other times, they stem from physiological or psychological issues.

Review :

Prepared By: Analisa L. Pepito RN, MN Sexual response Cycle

Sexual Orientation

1 2

uTypes of Sexual Expression/Behavior

1. Sexual Abstinence (Celibacy) is separation from u 2. Masturbation is self-stimulation for

erotic pleasure; it can also be mutually
sexual activity. It is avowed state of certain religious
enjoyable for sexual partners. It offers
orders and is also a way of life for many adults and one sexual release, which may be
that is becoming fashionable among a growing number of interpreted by the person as overall
young adults.(Markham, Tortolero, Peskin, et al.,2012) tension or anxiety relief. Masters et al.
(1998) reported women may find
masturbation to orgasm the most
Advantages: satisfying sexual expression and use it
1. Ability to concentrate on a means of giving and receiving love other more commonly than men.
than through sexual expression.
2. Most effective way to prevent pregnancy or STI.

3 4

Auto-erotic Asphyxia is the

extreme practice of causing
u Children (2-6yo) – discover masturbation as an enjoyable as they
oxygen deficiency(usually by
explore their bodies.
hanging) during masturbation
u Preschoolers – who are under a high level of tension may become with the goal of producing a
accustomed as a means of falling asleep at night or at naptime. feeling of extreme sexual
u School-age and adolescents continue to use masturbation for excitement.
enjoyment or to relieve tension. Adolescents need to be
u After reproductive tract surgery or childbirth –they may cautioned against this because,
not aware of the act can be fatal,
masturbate to orgasm to test whether everything in their body is still
functioning. a number of teenagers are killed
by this practice each year(Byard
& Winskog, 2012).

5 6

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3. Erotic Stimulation is 4. Fetishism is a sexual

deviation which associates
the use of visual materials
sensual feelings with a
such as magazines or certain body part of the
photographs for sexual lover; breasts, thighs, feet,
arousal. Parents of hair etc or with an object or
piece of clothing belonging
adolescents may need to be
to the loved one: lingerie,
assured that an interest in outer clothing, shoes,
this type of material is handkerchief or other
developmental and normal. personal objects.
Respect this type of reading
material when straightening The object of stimulation does
not just enhance a sexual
patients’ rooms in a health experience ; rather, it becomes
care facility. the focus of arousal and a person
may come to require the object or
situation for stimulation. (Wright,
2010).

7 8

5. Transvestism a transvestite is a form of fetishism in Origins of Transvestism

which an individual dresses in the clothes of the
opposite sex.
It involves recurrent, intense sexual arousal from
cross-dressing. This disorder causes significant
distress or substantially interferes with daily
functioning.
Transvestism often occurs temporarily under the influence of
alcohol or other drugs.
It also may be caused by a mother disappointed with her
child’s sex, and who dresses the body and hair of the child to
look more like the opposite sex.

u If this custom continues into adolescence, when sexual

tendencies are being formed, it can lead to transvestism and
gender identity disorder in subjects who do not reach the
level of psychosocial maturity which allows them to
overcome this induced deviation.

9 10

6.Voyeurism is obtaining sexual

arousal by looking at another
person’s body.
Recurring, intense sexual urges u “Peeping Tom” is the
and fantasies related to secretly
observing an unsuspecting person popular English name
who is nude, disrobing, or for a person who has
engaging in sexual activity. difficulty in
If voyeurism is practiced to the establishing a
exclusion of other sexual
heterosexual
experiences, such an extreme
probably reflects insecurity or relationship and who
the inability to feel confident tends to masturbate
enough to relate to others on either during the
more personal levels.
observation or shortly
Stalking, a crime that includes
elements of voyeurism, is illegal afterwards.
(McNamara & Marsil, 2012).

11 12

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Frotteurism – the person Sadism is a perversion named

after Marquis of Sade.
touches or rubs against a non-
consenting person for the purpose The sadist does not need to perform the
sexual act to be completely satisfied.
of sexual arousal and
However, in order to achieve erection
gratification. and orgasm he must intentionally hurt
It involves a man rubbing his his partner and watch him/her suffer. A
great number of sadists would be impotent
genitals against a person’s thighs without the sadistic stimulus
or buttocks in a crowded place
This deviation , in majority of cases, is
where he can claim it was an caused by inferiority complex which as a
accident and get away quickly. reaction, leads to violence giving him the
feeling of power that he lacks. However,
sadists almost always suffer from feelings
of guilt.
In many cases, proper psychotherapy can
cure sadism.

13 14

uMasochism also owes its name to a famous author, the Sadomasochism a broad term that involves
Austian doctor Leopard Von Sachere Masoch, who described in his inflicting pain(sadism) or receiving pain (masochism)
novels a type of sexuality consisting in the inability to engage in to achieve sexual satisfaction (Wright, 2010). It is a
coitus unless in a position of inferiority, or degradation and cruelty.
practice generally considered to be within the limits
u The masochist needs to suffer whipping, scratching, bites and other of normal sexual expression as long as the pain
violent treatment in order to achieve sexual satisfaction.
involved is minimal and the experience is consensual
u Perhaps due to their nature and their social conditioning, many and satisfying in both sexual partners.
women develop, as a self-defense mechanism, a certain amount of
masochism. Like the sadist, they cannot maintain a normal or
stable marriage relationships unless through psychotherapy, they
overcome this psychosocial deviation

The sadomasochist receives sexual enjoyment

through inflicting and experiencing violence.

15 16

u What excites the exhibitionist is not the usually

Exhibitionism the nudity itself but the lack of consent of the
u Exhibitionistic Disorder involves victim as expressed in her shocked or fearful
recurrent and intense arousal from
exposing one’s genitals to an unsuspecting
reaction.
stranger. These behaviors cause significant u Exhibitionists usually have erections while
social and/or occupational distress and
have occurred for more than 6 months. exposing themselves, and they masturbate either
u The exhibitionist or “flasher” who is then or later, while thinking of the reactions of
usually male, achieves sexual gratification their victims.
from exposing his genitals in public or to
unsuspecting people, who are usually
female. (Murphy & Page, 2008).
u Usually, it begins in the teen years and
decreases as a man ages; however, it may
worsen in times of stress or disappointment
(Murphy & Page, 2008; Seligman &
Hardenburg, 2000).

17 18

3

• The law will not tolerate it.
• It is legally classified as
“indecent exposure”, and it is
the most common sexual
offenses ( along with voyeurism
and pedophilia).
• Exhibitionists always end up
being punished, since even the
most liberal legislatures do not
tolerate this behavior.
• Figures suggest that one fourth
of all exhibitionists is married,
another fourth is widowed or
divorced and the rest is single.
• In spite of fines and even
detention, exhibitionists tend to
re-offend.
• The generally, he is timid and
weak person and is sexually
inhibited.
19
Hypersexuality desire to engage in human
sexual behavior at a level high enough to be
considered clinically significant.
Sexual addictions or hypersexual disorder
involves recurrent and intense sexual
fantasies, sexual urges and sexual behavior,
and excessive time spent on these behaviors
and an inability to control these fantasies.
Nymphomania term used to describe
women who engage in frequent or
promiscuous sex.
Satyriasis or Don Juanism term used to
describe men who engage in frequent and
promiscuous sex.
21
u 3. Spiritual Addiction
u The person with this type is looking for a spiritual
connection in all the wrong places. In recovery, we talk
about our spiritual hole. This person tries sex for this
spiritual void and finds it doesn’t scratch the itch over
time.
u 4. Trauma-Based Addiction
u The person with the trauma-based type has experienced
sexual trauma(s) as a child or adolescent. This trauma
becomes the major repetitive behavior in their
addiction.
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• Exhibitionism is a search for sexual
contact which is not achieved in the normal
way due to fear or anxiety at the thought of
direct contact.
• Verbal exhibitionism( Scatolophilia) -
another form of exhibitionism which does
not include the exhibition of genitals is the
making of obscene telephone calls or
writing of anonymous letters which are
filled with sexual suggestions. Most
scatolophilias have problems in their
relationships and suffer from feelings of
isolation and inadequacy.
• The treatment of this deviation should
be psychotherapeutic in nature.
20
u Six Types of Sex addiction
u 1. Biological Addiction
u A biological sex addict is someone whose excessive masturbation and
pornography viewing has hijacked the sexual response to attaching to images
and fantasy. This person may have challenges with relational sex. Although
most people have the biological type as one component of their addiction,
only about 15 percent (in Dr. Weiss’s experience) are solely biologically based.
u 2. Psychological Addiction
u Research shows that most sexual addicts have suffered some form of past
abuse or neglect. This person finds the combination of the messages in the
fantasy world and the sexual chemical cocktail to the brain to be a salve for
their hurting soul. Simply put, they medicate the past pain in their souls with
sexual acting out, which is their form of medicine. In our clinical experience,
80 percent or more of those who struggle with sex addiction have
abandonment, abuse or neglect issues of some type in their past. These
painful events will ultimately need to be addressed for them to fully heal.
22
u 5. Intimacy anorexia sex addiction
u Many addicts who have been trying to get sober but keep
having what I call “flat tire” recovery (relapsing regularly)
often are identified as intimacy anorexics.
u 6. Mood Disorder Sex Addiction
u In a journal article Dr. Weiss wrote called The Prevalence of
Depression in Male Sex Addicts Residing in the United
States, Weiss discovered that 28% of male sex addicts
suffered from depression. People with depression have
chemical imbalances in adolescence or young adulthood.
This young person finds the as a way sexual release o
medicate or alter their present chemical imbalance. They
then use this sexual response regularly and over time
unexpectedly create an addiction.
24
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Zoophilia also referred to as

bestiality or sexual contact
u Treatment for sexual addiction involves
with animals.
individual or group therapy as part of a 12 It indicates extreme love for
step recovery process( similar to the alcoholic animals.
Anonymous program), originated by Carnes
Sexual behaviors included
(2001). masturbating the animal,
submitting to anal sex
performed by the animal, or
active or passive oral sex with
the animal.

25 26

Zoophilia tends to be a compensatory sexual activity. When

rejection of normal sexual relations or an inability to practice
u Necrophilia is the morbid
normal relations causes zoophilia, there is an authentic
inclination towards dead bodies
mental illness. or having sex with the corpes
Men prefer to utilize goats, cows, mares, donkeys, llamas and have been found even in ancient
pigs and women prefer cats and dogs. civilizations.
One of the hypotheses recognized for the appearance of AIDS u The Egyptians prohibited
is that it originated in certain African primates which embalmers from taking immediate
delivery of corpse of the wives of
transmitted it to humans who had sexual relations with them. important men to fear that the
An old Peruvian Indian legend attributes the appearance of embalmers would violate
Syphilis to sexual contact with alpaca. them(Rosman & Resnick,1989).

27 28

Rosman & Resnick (1989) suggest that

necrophiliacs desire a partner who is
unresisting and unrejecting; to find
one, many seek out professions that put
them in contact with corpse. Analism is the sexual deviation
which consists in the need to use
the anus to achieve sexual
Three types of genuine necrophilia stimulation. Among homosexuals
1. Necrophiliac fantasy – in which a person it represents about 20% of all
has a persistent fantasies about sex with
sexual practice.
the dead bodies without actually engaging
in such behavior. Autoanalism- manipulation
2. Regular necrophilia – which involves manually or with various objects
the use of already-dead bodies for sexual
pleasure. for the purpose of stimulating
one’s anus.
3. Necrophiliac homicide – in which the
person commits murder to obtain a corpse
for sexual pleasure.
Erotophonophiliac – someone
who gets sexual excitement from
the act of murder.
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Crocophilia is a sexual deviation in which

sexual excitement occurs only through
seeing either homo or heterosexual
defecation.

Coprophagy, an extreme case of

coprophilia, is manifested by the act of
eating or drinking excrement –feces or
urine- either alone or with food, for
example on a piece of bread.

This repugnant and unhygenic deviation Urophilia is a sexual paraphilia in which a person
was considered a form of masochism by obtains sexual arousal from contact with urine.
the Austrian psychiatrist Kraft Ebing.

31 32

Pedophilia: Sexual Abuse Against

Children
Pedophilia consists of sexual activity
between the adult seducer and the
pre-pubescent child.
Throughout history, pedophilia
has been called many thing,
including

Legislation in most countries specifies that:

v Child-love
v a child is someone under 12yrs of age,
v Cross-generational sex
v a minor is someone from 13-15 yrs of
age, v Man-child (or adult-child)
v and normally, someone over 16 is interaction
considered an adult.
v Boy-love

v When sexual abuse against a child is v pederasty and Greek

committed by a homosexual adult it is love(Bullough, 1990)
called pederasty.

33 34

Incidence Known

85% - heteroxesual pedophiliacs are related to the

victims: grandfather, father, brother or uncle, a
friend or someone who is known.
80% - of all cases of man-girl pedophilia occur in
the victims’s own house.
Only 2% of cases are accompanied by violence.
33% of cases, some type of force is exercised.
Practices known:
In general – caressing the genitals of the child
Attempts at intercourse do not seem to make up
to more than 5-6% of all cases and only 2% actually
achieves intercourse.
A large number of pedophiles are impotent
alcoholics and in some cases they are mentally
retarded or senile people who do not experience
enjoyment with adults, but who search for contact
with those on their own intellectual level.
• Pedophiles are often 18yrs or
older at least 5 years older than
their victims (American Psychiatric
Association, 2010).
• Pedophilic behavior is often obsessive.
• Obsessed with their fantasies and they tend
to dominate their lives
• They are also predators –they know
which child they like, and they work hard
to get the trust and support from their
parents or caretakers first.
• They are good at winning the trust of
parents. In fact, parents often trust the
pedophile word over their own child
(O’Grady, 2001).
• Some threaten their victims and tell them
they must keep their sexual activity secret.

35 36

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Factors of pedophilic behavior:

u Described as having arrested psychological Solutions to Pedophilia

development, which makes them childlike
with childish emotional needs.
u Low self-esteem
Preventive or protective therapy
for pedophilia usually centers on
u Poor relations with adults, trying to increase normal contact
u May be trying to overcome their own among adults.
humiliations and pains from their childhood.
In some countries surgical or
u Other studies have found out that pedophiles chemical castration is applied to re-
have brain abnormalities that contrite to their
sexual behavior.
offending pedophiles for corruptinh
the formative minds of children and
u Research has found that being a victim of adolescents.
sexual abuse in childhood Kargel et al. 2015;
tembergen et all, 2015) .35%

37 38

SEXUAL
HARRASMENT

Sexual harassment
is unwanted,
repeated sexual
advances, remarks,
or behavior toward
another that is
offensive to the
recipient or
interferes with job
or school
performance.

39 40

According to Master’s and Johnson, sexual harassment

Two Types of Sexual Harassment includes:

1. Quid pro quo – an equal exchange, in which an v Sexual looks

employer asks for something in return for sexual favors
v Insinuating verbal comments
such as hiring or promotion preference.
v Sexual expressions or comments regarding the
2. Hostile work environment – in which an employer
attractiveness of the woman.
creates an environment in which an employee feels
uncomfortable and exploited (such as being addressed as v Touching and pinching
“honey” or “babe”, or asked to wear revealing clothing, v Unwanted caresses
or working where walls are decorated with sexiest
v More intimate contact which can end in penetration.
posters.

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Common effects on the
victims
u Decreased work or school performance; increased
absenteeism
u Loss of job or career, loss of income
u Having to drop courses, change academic plans, or
leave school (loss of tuition)
u Psychosocial consequences : Emotional distress like
anxiety, depression, posttraumatic stress disorder,
substance abuse, interpersonal conflict, and impaired
intimacy and sexual functioning.
43
u Loss of trust in environments similar to where the
harassment occurred
u Loss of trust in the types of people that occupy similar
positions as the harasser or their colleagues
u Extreme stress upon relationships with significant
others, sometimes resulting in divorce; extreme stress
on peer relationships, or relationships with colleagues
45
Defensive Tactics Against Harassment by the
European Commission
v You should never hide the fact that you are suffering from
a situation of sexual harassment. The person who is being
harassed is not to be blamed for it.
v In more serious cases, you should start a legal action
against the harasses, for your own benefit as well as in favor
of other possible victims.
When there is no physical aggression present, there are
various options available to the woman:
1. Write a note. Keep a copy. The note can end more or less
like this: “I am willing to ignore what has happened as long
as there is no repetition and as long as from now on our
relationship remains only a working one”.
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u Having one's personal life offered up for public scrutiny
--the victim becomes the "accused," and his or her
dress, lifestyle, and private life will often come under
attack. (Note: this rarely occurs for the perpetrator.)
u Becoming publicly sexualized (i.e. groups of people
"evaluate" the victim to establish if they are "worth"
the sexual attention or the risk to the harasser's
career)
44
u Weakening of support network, or being
ostracized from professional or academic
circles (friends, colleagues, or family may
distance themselves from the victim, or
shun them altogether)
u Having to relocate to another city, another
job, or another school
u Loss of references/recommendations
46
Defensive Tactics continuation…..
2. Confronting the harasser, either face-to-face or on the
telephone may be appropriate with certain types of
aggressors. However, with other types, any confrontation, no
matter how low-key and non-aggressive, can produce such a
strong reaction on the part of the harasser that a situation of
permanent high tension is created.
3. In some cases the victim can ask an attorney to write a
letter asking the man to stop his actions. A letter from a
lawyer is a warning to the harasser that the woman is willing
to defend her rights.
v A formal complaint should be filed through the
appropriate cannels to the supervisor.
v One should look for support from friends and collegues.
48
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In case of dismissal for not complying with the sexual

demands of the harasser, one must never hide the true
reasons for the dismissal and one should pursue the SEXUAL
matter in a court of law or in the appropriate official
organization.
DYSFUNCTION
u Disorders related to a
The victims rights to unemployment benefits, and other particular phase of the sexual
response cycle that cause
financial payments may be affected if she does not take distress.
such action.
SEXUAL DYSFUNCTION CAN BE:
1.) Lifelong
2.) Acquired
3.) Situational

49 50

u Psychologists define sexual disorders as a group

of dysfunctions caused by a person's inability to fully
engage in and derive pleasure from sex.

u The latest version (Fifth Edition) of the Diagnostic and

Statistical Manual of Mental Disorders (DSM-5) published by
the American Psychiatric Association, acknowledges the
interrelationship between mind, body, and emotion in
sexual response with possible causes of dysfunction in each
realm.

u Sexual dysfunction refers to a problem occurring during any

phase of the sexual response cycle that prevents the
individual or couple from experiencing satisfaction from the
sexual activity.

51 52

Types of Sexual
Sexual Dysfunction Dysfunction/Disorders

u Psychological Factors:
a. Inappropriate religious training
b. False beliefs
c. Traumatic events in childhood
d. Anxiety due to
- fear of failure
-Demand for performance
-excessive wish to please the partner
-avoidance of sex or of talking about
sex

53 54

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A) SEXUAL DESIRE DISORDERS 2. SEXUAL AVERSION DISORDER- actively avoids

and has a persistent or recurrent extreme
aversion to genital sexual contact with a sexual
1. Hypoactive Sexual Desire Disorder- decrease
partner.
sexual fantasies and a decreased or absent
desire for sexual activity.

Men
Lack of impulse to
masturbate
Failure of erection & lack
of nocturnal emission
Women
Lack of masturbation
Failure to respond to sexual
stimulation

55 56

A. Medical/Therapy B. Nursing Care

1. Testosterone 1. Gentle
testing probing/open
Etiology A. Physiological B. Psychological Management ended questions
Depression of Sexual 2. Individual or
of Sexual 1. Hypogonadis 1.
group 2. Active
m Marital strife Desire listening/non-
Desire 2.
Disorders
therapy for
judgmental
2. Stress Anxiety alcoholism
Disorders 3.
3. Hormonal
approach
3. Alcoholism 4. Frustrations 3. Assisting/suppor
replacement ting patients in
4. Chronic 5. Sexual
4. Psychotherap focusing on the
illness trauma
y/counseling relational aspect
6. Major life of their
changes 5. Sexual sexuality before
therapy resuming sex.

57 58

2 Categories:
1. Primary- has never been
B. SEXUAL AROUSAL
able to attain or sustain
DISORDERS erections due to
psychologic or biogenic
factors.
1. Female sexual arousal 2. Secondary- a man who
disorder- inability of a
woman to complete Male Erectile previously could attain or
sustain erections no
sexual activity with
adequate lubrication.
Disorder/Impotence longer can.

2. Male erectile disorder

or Impotence- unable to
maintain an erection
throughout sexual activity.

59 60

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Hormonal disorders
Hormonal therapy
Etiology of
Sexual Neurologic/Medical Disorders i.e., MS, SCI,
DM, Heart problems
For Vascular Disorders- surgery,
Arousal Mgt. for injection of vasodilator
(Papverine)
Disorders Surgical/traumatic disorders Sexual
Drug-induced i.e., antihypertensives,
Arousal Mechanical Devices
diuretics, antidepressants or antipsychotic
drugs, alcohol, illegal drugs Disorders
• i.e., Vacuum-pump device- When air is
pumped out of the tube, blood flows into
Vascular the penis and makes an erection.

4. Psychological Therapy-
Psychogenic- fatigue, anxiety & stress behavioral therapy and counseling

61 62

Vacuum-Pump Device Penile Prosthetic device

u Nurses should advice pt. to:
u Wear elastic briefs
u Place the penis at 45 degrees angle from the
base
u Instruct to avoid wearing tight slacks or boxer
shorts

63 64

Female orgasmic
Provide a non- C. disorder- occurs when
pressured, highly ORGASMIC there is a significant delay
or total absence of
stimulating DISORDERS orgasm associated with
interaction. the sexual activity.
NURSING
MANAGEMENT
2. Encourage Male orgasmic disorder-
couple to explore delay or total absence of
other expressions orgasm following sexual
activity.
of sexual intimacy.

65 66

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3 . PREMATURE
EJACULATION
Management of Pre-mature
When minimal sexual Ejaculation
stimulation causes
orgasm and ejaculation
on a persistent basis. It’s
an early orgasmic
response. u More frequent sex (or masturbation): premature
ejaculation is more likely if there is a longer gap
between sexual intercourse.
Etiology:
u Using a condom to decrease sensation.
v performance anxiety
u Sex with the woman on top reduces the likelihood of
v anger w/ partner or
premature ejaculation.
women in general
v guilt
v degenerative disease i.e.,
MS
v inflammatory processes

67 68

u Squeeze and stop-go

techniques:
stimulating the penis
almost to the point of
ejaculation and then
stopping. These D. SEXUAL PAIN
techniques are often
effective but may take DISORDERS
a few months to
produce any benefit
and relapse is 1. Dyspareunia
common.
u Psycho-sexual
* A sexual pain
therapy includes disorder
assessment,
behavioral and * Painful coitus or
educational methods,
psychotherapy in attempted coitus
terms of the
* The pain may have
Management of Pre- relationship, and
sexual timetables. a burning, sharp,
mature Ejaculation searing or
cramping quality

69 70

Physical Causes of Dyspareunia

u For women
u For Men
- PID
- Tight
- Endometriosis
foreskin
- Interstitial cystitis
- Some STDs
- Vaginismus
- Vulvodynia

- Some STDs
Psychological causes Coercive sexual experiences
- UTI u
of painful sex u Anticipating pain
- Vaginal dryness u Lack of interest in having sex

- Physical injury

71 72

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OTHER CAUSES OF PAINFUL 4. Irritation due to the

use of improperly
SEX fitted or inadequately
lubricated condoms

1. Inadequate lubrication, usually secondary to insufficient

foreplay.

2. Forceful pressure against a sensitive urethra during 5. Allergic reactions to

coitus. the contents of
contraceptive foams,
3. Thinning of walls caused by aging or decreased estrogen jellies & foams.

6. Drugs w/ drying
effects (antihistamines,
certain tranquilizers,
marijuana).

73 74

Examination of both partners

before marriage or sexual
activity
Management
u Take notes
Tips for u Explore on your own
of
dealing u Use plenty of lubrication
Dyspareunia Sex education

with pain u Communicate with your partner

Experiment with different
during sex u
sexual positions
Guidance in sexual techniques

u Consult a doctor or other

healthcare provider Stretching of tight hymenal ring
by a physician

Temporarily avoiding
intercourse

75 76

Soothing ointment
Management 2. Lichen Chronic inflammatory skin disorder, affects vulva
and anal area.

of Sclerosis
Dyspareunia Sitz bath
Symptoms: spots→bigger patches→skin surface
becomes thin and crinkled→tears easily→bright red
or purple discoloration due to bleeding inside the
skin.

Liberal use of a water-soluble

lubricant just before coitus

Causes: unknown, genetic tendency, abnornal

hormone levels.
Local estrogenic preparation or
oral estrogen replacement
therapy

Cyst or abscesses should be Treatment: ultra potent corticosteroids, surgery

excised, inflamed labia must be
kept clean & dry.

77 78

13

Lichen Sclerosis
(Female)
79 80
3. Vaginismus
u (the German equivalent of the word Vaginism) is a
condition which affects a woman's ability to engage
in any form of vaginal penetration, including sexual
penetration, insertion of tampons, and the
penetration involved in gynecological examinations.
u This is the result of a conditioned reflex of the
pubococcygeus muscle, which is sometimes referred
to as the 'PC muscle'. The reflex causes the muscles
in the vagina to tense suddenly, which makes any kind
of vaginal penetration -- including sexual penetration
-- either painful or impossible.
81 82
Secondary vaginismus
occurs when a woman
who has previously been
able to achieve
penetration develops
vaginismus.
This may be due to
physical causes such as a
yeast infection or trauma
during childbirth, or it
may be due to
psychological causes.
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Lichen
Sclerosis
(Male)
Types of Vaginismus
u Primary vaginismus - occurs when a woman has
never been able to have penetrative sex or
achieve any kind of vaginal penetration.
u It is commonly discovered in teenagers and women
in their early twenties, as this is when many young
women in the Western world will initially attempt to
use tampons, have penetrative sex, or undergo a
pap smear.
u Some of the things that may cause primary
vaginismus are:
u sexual abuse
u having been taught that sex is immoral or vulgar
u the fear of pain associated with penetration
u Three causes for vaginismus are:
u fear of painful sex
u strict religious upbringing where sex was viewed as
wrong or not discussed
u early childhood traumatic experiences (not
necessarily sexual in nature).
u Physical treatment of the internal spasms:
u exploring the vagina through touch, and
desensitization with vaginal dilators. Dilating
involves inserting objects, usually phallic in shape,
into the vagina.
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Drugs that Impair sexual u Can sexual dysfunction in men and women be prevented or avoided?

Response Cycle u The process of aging cannot be prevented. Yet, there are many things men
and women can do to reduce the impact of sexual dysfunction. This
includes learning more about your body and how it works. Also:

u Ask your doctor about the side effects of the medicines you take. Talk to him or her about
surgeries and health conditions. Treating underlying health conditions, such as diabetes, may
help.
u Talk with a counselor or mental health professional if you are depressed, stressed or having
relationship issues.
u Reduce your alcohol consumption, eat healthy, and get regular exercise.
u Talk to your partner about what you like and don’t like in your sexual relationship.
u Practice “sensate focus” exercises. This is where one partner gives a massage, while the
other partner says what feels good and requests changes (example: “lighter,” “faster,” etc.).
Fantasizing may increase your desire.
u For women, Kegel exercises (squeezing and relaxing the muscles of your vagina) may increase
arousal.
u Try sexual activity other than intercourse, such as massage, oral sex, or masturbation.
u Do not use recreational drugs or abuse opioids.

85 86

OOOH, AHHHH……OUCH!!!

SEXUALLY TRANSMITTED
INFECTION

87 88

ETIOLOGIC CLASSIFICATION DOORWAY TO STD

Bacteria Viruses Other

•Neisseria gonorrhea •HIV type 1 & 2 •Trichomonas vaginalis
•Chlamydia trachomatis •Human T cell lymphotropic •Phthirus pubis
•Haemophilus ducreyi virus type I
•Calymmatobacterium •Herpes simplex virus type 2
granulomatis •Human papillomavirus
•Ureaplasma urealyticum (multiple genotypes)
•Hepatitis B Virus
•Cytomegalovirus
•Molluscum contangiosum
virus

oral genital anal

89 90

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Basic Diagnostic Tools

LABORATORY TESTS
• History
• Physical Examination
u Vulvar exam
uErythema
uDischarge
uUlceration
uWarts
uInguinal lymphadenopathy
u Speculum
uDischarge
•Wet smear •Biopsy
uVaginal mucosa
uCervical lesions •Cytologic smear •Serologic tests

•Gram stain and culture

91 92

Appearance of Vaginal Discharge

Bacterial Vaginosis
Normal Bacterial Trichomoniasis Candidiasis Gonorrhea
Vaginosis
Discharge No Yes Yes No Yes
present at the
introitus
Color White Gray Yellow-gray White Creamy or
Greenish-gray Curd like green,
Frothy pus-like or
bloody
Viscosity High Low Low High Low

Consistency Floccular Homogenous Homogenous Flocular Homogenous

Presence in Dependent Adherent to Adherent to Adherent to Dependent

vagina portion vaginal walls vaginal walls vaginal walls portion

Odor none malodorous malodorous none variable

93 94

Trichomoniasis Yeast Infection

95 96

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Gonorrhea CHLAMYDIA

Chlamydia vaginitis Chlamydia urethritis

keratitis

97 98

Clinical & Laboratory Features ETIOLOGIES OF GENITAL ULCER DISEASE IN INDUSTRIALIZED AND
TROPICAL DEVELOPING COUNTRIES
C. albicans Gardnerella Trichomonas Gonorrhea
Symptom Itch/Burn Odor Discharge Discharge
Dysuria
Diagnosis Industrialized Countries Tropical Developing
Mucosal +++ None Variable Variable
Countries
erythema
Genital herpes 50-70% 10-30%
pH 4-5 5-6 6-7 N/A
Syphilis 10-20% 10-30%
Wet smear/ Budding filaments Clue cells Many white blood Gr (-) diplococci
Chancroid 0-10% 50-60%
Gram stain Spores cell protozoa
Lymphogranuloma <1% 0-5%
Treatment Clotrimazole Co-amoxiclav Metronidazole Cefixime venereum
Miconazole Metronidazole
Clindamycin
Ceftriaxone
Ciprofloxacin
Donovanosis <1% <1%
Ofloxacin
Azythromycin
Other/unknown 5-20% 5-30%
Doxycycline

99 100

CLINICAL FEATURES OF GENITAL LESIONS Cont…..

•Syphilis •Herpes •Chancroid •Lyphogranuloma •Donovanosis •Syphilis •Herpes •Chancroid •Lyphogranu-loma •Donovanosis
Venereum venereum

Incubation 2-4 wks 2-7 days 1-14 days 3 days – 6 wks 1-4 wks Depth Superficial Superficial Excavated Superficial or Elevated
Pd (1-12 wks) (upto 6 or deep deep
mos) Base Smooth, Serous, Purulent Variable Red and
Primary Papule Vesicle Papule or Papule, pustule, Papule non- erythema- rough “beefy”
Lesion pustule or vesicle purulent tous
Induration Firm None Soft Occasionally Firm
Number of Usually one Multiple, may Usually Usually one Variable firm
Lesions coalesce multiple, may Pain Unusual Common Usually very Variable Uncommon
coalesce tender
Diameter 5-15 1-2 2-20 2-10 Variable Lymph- Firm, Firm, tender, Tender, may Tender, may Pseudo-
(mm) adenopathy adenopathy
nontender, often bilateral suppurate, suppurate,
Edges Sharply Erythema- Undermined, Elevated, round Elevated, bilateral usually loculated,
demarcated, tous ragged, or oval irregular unilateral usually
elevated, irregular unilateral
round or Treatment Penicillin Acyclovir Ceftraixone Doxycycline Doxycycline
Ampicillin
oval azythromycin Tetracycline

101 102

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Syphilis
Herpes

103 104

Chancroid ulcers

105 106

Chancroid Male, regional adenopathy

Lymphogranuloma venereum

107 108

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Granuloma Inguinale
Granuloma inguinale with both active and healed lesions

(Donovanosis)

109 110

Scabies
RECOMMENDED REGIMENS FOR DAILY HSV
SUPPRESSIVE THERAPY
• Acyclovir 400 mg orally BID
• Famciclovir 250 mg orally BID

• Valacyclovir 250 mg orally BID

• Valacyclovir 500 mg orally OD

• Valacyclovir 1000 mg orally OD

CDC 1998 guidelines for Treatment of STD, MMWR 47:23, 1997

111 112

Avoid sexual intercourse with an

infected partner

If with new partner, use new

condom with each act
STD -
Clincal Vaginal spermicides reduce
Prevention infections, but NOT HIV

Guidelines
Non-barrier contraceptives offer
no protection

Pre-exposure vaccination
effective
for hepatitis

113 114

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Nursing Care of the Family Having

Difficulty Conceiving a Child INFERTILITY/ SUBFERTILITY
u Infertility is defined as the inability to conceive (or impregnate)
after one year of regular vaginal intercourse without the use of any u The inability to
form of contraception( if a woman is older than 35, usually infertility
is diagnosed after 6 months of not being able to conceive. conceive a child or
sustain a pregnancy to
u Women and men who delay pregnancy may experience infertility childbirth.
because of the decreasing quality of their ova and sperm (Coccia &
Rizzello, 2008).
u Exist when a
pregnancy has not
occurred after at least
1 year of engaging in
unprotected coitus.
(Hamilton, 2012)

115 116

u FERTILITY TESTING
TYPES OF
INFERTILITY/SUBFERTILITY
Basic Fertility testing is geared toward answering three
Primary questions:

No previous conception
1. Is there sperm of good quality and number available?
Secondary 2. Are ova(eggs) available (i.e., woman is ovulating)?
There has been a previous viable pregnancy but
the couple is unable to conceive at present. 3. Is it possible for the sperm and egg to meet in a receptive
environment.
Sterility
Inability to conceive .Problems diagnosed,
management done, no pregnancy.

117 118

FACTORS THAT CAUSE FEMALE

SUBFERTILITY

1. Limited production of FSH or LH, which

interfere with ova growth.
ALE
FEM LITY 2. Anovulation(faulty or inadequate
RTI 3. Problems of ova transport through the
INFE ORS fallopian tubes to the uterus.
T
FAC 4. Uterine factors, such as poor endometrial
development.
5. Cervical and vaginal factors, which
immobilize spermatozoa.
6. Poor nutrition, increased body weight, and
lack of exercise.

119 120

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Semen Allergy
LE
MA Y
LIT
F E RTI S
Generalized IN TOR
Known as itching FAC
Produces Hives
human
antibodies
seminal
which kill or Swelling or
plasma blisters
disable
hypersensiti
sperm cells
-vity Vaginal
redness

121 122

Low Sperm Count

(Oligospermia)
The causes of low sperm count include,
but are not limited to, the following:
• Overheating of the testicle
• Stress (emotional, psychological,
and physical)

Low Sperm Motility

Abnormal Sperm Germ-Cell Aplasia
Shape azoospermic (devoid of
• the sperm’s capacity for A very large round head sperm cells).
swimming forward and An extremely small pinpoint head
A tapered head
penetrating the egg is A crooked head
diminished. Two heads

123 124

OBSTRUCTION Abnormal Semen

• Seminiferous tubule obstruction
• Mumps orchitis, Epididymitis, Epispadias
u Yellow or greenish
and hypospadias
u Red or brown
u Strong fowl odor
Ejaculation Problems u Abnormally thick
ejaculate
• Erectile dysfunction u Low volume
• Premature ejaculation u Watery ejaculate

125 126

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Fertility Testing for Woman

FERTILITY ASSESSMENT Ovulation Test

Ovulation Cervical
Serum
Ovulation determina- Mucus
progeste-
monitoring tion by test Assess-
strips rone test
ment

127 128

TUBAL PATENCY TESTING SURGICAL PROCEDURE

Sonohysterography
• Inspect the uterus

Hysterosalpinography Uterine Hysteroscopy Laparoscopy

• Inspect uterus and fallopian tube Endometrial
Biopsy

129 130

Fertility Testing for Man Infertility Management

Sperm penetration
assay and antisperm
antibody testing

Reducing
Increasing
the
sperm Hormone
presence Surgery
count and therapy
Post-coital test of
motility
infection

131 132

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DESCRIPTION:
IVF (In Vitro Fertilization)
Advance Reproductive u Eggs are retrieved
Techniques and fertilized in vitro
u one or more
embryo(s) are placed
in the uterus.
INDICATION:
u fallopian tube
occlusion and
endometriosis.
u sperm abnormalities

133 134

DESCRIPTION: DESCRIPTION:
u Spermatozoa and u Fertilized eggs are
eggs are placed placed in the
directly into the fallopian tubes at a
fallopian tubes where certain stage of
fertilization can embryo development
occur. (zygote).

INDICATION: INDICATION:
u Infertility due to u Can only be practiced
endometriosis and if fallopian tubes are
cervical mucus healthy.
disorders.

135 136

DESCRIPTION: DESCRIPTION:
ICSI
(Intracyto- plasmic Sperm Injection) u Single sperm is MESA (Microsurgical Epididymal u Spermatozoa are
Sperm Aspiration)
selected and injected retrieved directly
into an egg. from the epididymis
(area in the testes
where spermatozoa
INDICATION: mature and are
u Male infertility when stored).
very few normal INDICATION:
sperm are available
u Severe male

137 138

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DESCRIPTION:
u Biopsy of the testes Alternative Childbirth
is performed in order
to obtain u Surrogate mothers- a woman carries a pregnancy to term for an
infertile couple.
spermatozoa directly
u Adoption
from testicular
Child-free living
tissue. u

INDICATION:
u Severe male
infertility. Absence
of sperm in
epididymis. Absence
of epididymis.

139 140

141

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