SEXUALITY DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II
SEXUAL DYSFUNCTION
FEMALE: sexual interest/arousal disorder, female
orgasmic disorder, genito-pelvic pain/penetration
disorder.
MALE: erectile disorder, male hypoactive sexual
disorder, premature (early ejaculation); delayed
ejaculation.
SEX / SEXUALITY
Sex is a part of life that can be incredibly rewarding in
terms of pleasurable sensations and creating a close
bond in relationships.
However, many people experience problems that
diminish this pleasure or even prevent them from
engaging in sexual intercourse.
● This can cause:
○ Distance between partners and even
end relationships.
○ Sometimes, these issues stem from
existing trouble in the relationship.
○ Other times, they stem from
physiological or psychological issues.
SEXUAL EXPRESSION / BEHAVIOR
SEXUAL ABSTINENCE (CELIBACY)
is separation from sexual activity. It is avowed state of
certain religious orders and is also a way of life for
many adults and one that is becoming fashionable
among a growing number of young adults. (Markham,
Tortolero, Peskin, et al.,2012)
ADVANTAGES:
1. Ability to concentrate on a means of giving and
receiving love other than through sexual expression.
2. Most effective way to prevent pregnancy or STI.
MASTURBATION
is self-stimulation for erotic pleasure; it can also be
mutually enjoyable for sexual partners. It offers sexual
release, which may be interpreted by the person as
overall tension or anxiety relief.
Masters, et al. (1998) reported women may find
masturbation to orgasm the most satisfying sexual
expression and use it more commonly than men.
EROTIC STIMULATION
is the use of visual materials such as magazines or
photographs for sexual arousal.
Parents of adolescents may need to be assured that
an interest in this type of material is developmental
and normal.
Respect this type of reading material when
straightening patients’ rooms in a healthcare facility.
FETISHISM
is a sexual deviation which associates sensual
feelings with a certain body part of the lover; breasts,
thighs, feet, hair etc or with an object or piece of
clothing belonging to the loved one: lingerie, outer
clothing, shoes, handkerchief or other personal
objects.
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SEXUALITY DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II
The object of stimulation does not just enhance a
sexual experience ; rather, it becomes the focus of
arousal and a person may come to require the object
or situation for stimulation. (Wright, 2010).
TRANSVESTISM
A transvestite is a form of fetishism in which an
individual dresses in the clothes of the opposite sex.
involves recurrent, intense sexual arousal from
cross-dressing. This disorder causes significant
distress or substantially interferes with daily
functioning.
VOYEURISM
is obtaining sexual arousal by looking at another
person’s body.
Recurring, intense sexual urges and fantasies related
to secretly observing an unsuspecting person who is
nude, disrobing, or engaging in sexual activity.
● If voyeurism is practiced to the exclusion of
other sexual experiences, such an extreme
probably reflects insecurity or the inability to
feel confident enough to relate to others on
more personal levels.
● Stalking, a crime that includes elements of
voyeurism, is illegal (McNamara & Marsil,
2012).
FROTTEURISM
the person touches or rubs against a non-consenting
person for the purpose of sexual arousal and
gratification.
● It involves a man rubbing his genitals against a
person’s thighs or buttocks in a crowded place
where he can claim it was an accident and get
away quickly.
SADISM
is a perversion named after Marquis of Sade.
The sadist does not need to perform the sexual act to
be completely satisfied.
● In order to achieve erection and orgasm he
must intentionally hurt his partner and watch
him/her suffer.
● A great number of sadists would be impotent
without the sadistic stimulus
This deviation, in the majority of cases, is caused by
an inferiority complex which, as a reaction, leads to
violence giving him the feeling of power that he lacks.
● Sadists almost always suffer from feelings of
guilt. In many cases, proper psychotherapy
can cure sadism.
MASOCHISM
also owes its name to a famous author, the Austrian
doctor Leopard Von Sachere Masoch, who described
in his novels a type of sexuality consisting in the
inability to engage in coitus unless in a position of
inferiority, or degradation and cruelty.
● The masochist needs to suffer whipping,
scratching, bites and other violent treatment in
order to achieve sexual satisfaction.
Perhaps due to their nature and their social
conditioning, many women develop, as a self-defense
mechanism, a certain amount of masochism. Like the
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SEXUALITY DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II
sadist, they cannot maintain a normal or stable
marriage relationship unless through psychotherapy,
they overcome this psychosocial deviation.
SADOMASOCHISM
a broad term that involves inflicting pain(sadism) or
receiving pain (masochism) to achieve sexual
satisfaction (Wright, 2010).
It is a practice generally considered to be within the
limits of normal sexual expression as long as the pain
involved is minimal and the experience is consensual
and satisfying in both sexual partners.
EXHIBITIONISM
Exhibitionistic Disorder involves recurrent and intense
arousal from exposing one’s genitals to an
unsuspecting stranger.
● These behaviors cause significant social
and/or occupational distress and have
occurred for more than 6 months.
The exhibitionist or “flasher” who is usually male
achieves sexual gratification from exposing his
genitals in public or to unsuspecting people, who are
usually female. (Murphy & Page, 2008).
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).
● 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 (SCATOLOPHILLIA) –
another form of exhibitionism which does not include
the exhibition of genitals, it 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.
HYPERSEXUALITY – desire to engage in human
sexual behavior at a level high enough to be
considered clinically significant. 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.
ZOOPHILIA
also referred to as bestiality or sexual contact with
animals. It indicates extreme love for animals.
sexual behaviors included masturbating the animal,
submitting to anal sex performed by the animal, or
active or passive oral sex with the animal.
NECROPHILIA
is the morbid inclination towards dead bodies or
having sex with the corpse have been found even in
ancient civilizations.
● The Egyptians prohibited embalmers from
taking immediate delivery of corpses of the
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SEXUALITY DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

wives of important men for fear that the UROPHILIA

embalmers would violate them. (Rosman &
Resnick,1989).
● 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 corpses.
THREE TYPES OF GENUINE NECROPHILIA:
1. NECROPHILIAC FANTASY – in which a
person has persistent fantasies about sex with
the dead bodies without actually engaging in
such behavior.
2. REGULAR NECROPHILIA – which involves
the use of already-dead bodies for sexual
pleasure.
3. NECROPHILIAC
HOMICIDE/EROTOPHONOPHILIA – in which
the person commits murder to obtain a corpse
for sexual pleasure.
COPROPHILIA
is a sexual paraphilia in which a person obtains sexual
arousal from contact with urine.
PEDOPHILIA
Sexual Abuse Against Children – Pedophilia
consists of sexual activity between the adult seducer
and the pre-pubescent child.
● A child is someone under 12yrs of age
● When sexual abuse against a child is
committed by a homosexual adult it is called
pederasty.
SEXUAL HARASSMENT
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.

SEXUAL HARASSMENT INCLUDES:

is a sexual deviation in which sexual excitement
occurs only through seeing either homo or
● Actual or attempted rape or sexual assault.
heterosexual defecation.
● Unwanted pressure for sexual favors.
● Unwanted deliberate touching, leaning over,
COPROPHAGY – an extreme case of coprophilia, is
cornering, or pinching.
manifested by the act of eating or drinking
● Unwanted sexual looks or gestures.
excrement–feces or urine- either alone or with food,
● Unwanted letters, telephone calls, or materials
for example on a piece of bread.
of a sexual nature.
● Unwanted pressure for dates.
● This repugnant and unhygienic deviation was
● Unwanted sexual teasing, jokes, remarks, or
considered a form of masochism by the
questions.
Austrian psychiatrist Kraft Ebing.
● Sexual comments.
● Turning work discussions to sexual topics.
● Sexual innuendos or stories.
● Asking about sexual fantasies, preferences, or
history.

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SEXUALITY DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

● Personal questions about social or sexual life.

● Telling lies or spreading rumors about a
person's personal sex life.
● Neck massage.
● Touching an employee's clothing, hair, or body
● Touching or rubbing oneself sexually around
another person.
● Looking a person up and down (elevator eyes).
● Staring at someone.
● Facial expressions, winking, throwing kisses,
or licking lips.
● Making sexual gestures with hands or through
body movements. PSYCHOLOGICAL FACTORS:

TWO TYPES OF SEXUAL HARASSMENT: a. Inappropriate religious training

b. False beliefs
● QUID PRO QUO – an equal exchange, in c. Traumatic events in childhood
which an employer asks for something in d. Anxiety due to:
return for sexual favors such as hiring or i. Fear of failure
promotion preference. ii. Demand of performance
● HOSTILE WORK ENVIRONMENT – in which iii. Excessive wish to please the partner
an employer creates an environment in which iv. Avoidance of sex or talking about sex
an employee feels uncomfortable and
exploited (such as being addressed as “honey”
or “babe”, or asked to wear revealing clothing,
TYPES OF SEXUAL DYSFUNCTION/DISORDERS
or working where walls are decorated with
sexiest posters.
A. SEXUAL DESIRE DISORDERS
SEXUAL DYSFUNCTION
1. Hypoactive Sexual Desire Disorder –
Disorders related to a particular phase of the sexual decrease sexual fantasies and a
response cycle that cause distress. decreased or absent desire for sexual
activity.
SEXUAL DYSFUNCTION CAN BE:
MEN:
1. Lifelong ● Lack of impulse to masturbate
2. Acquired ● Failure of erection & lack of
3. Situational nocturnal emission

WOMEN:
● Lack of masturbation

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SEXUALITY DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

● Failure to respond to sexual 3. assisting/supporting patients in

stimulation focusing on the relational aspect of
their sexuality before resuming sex.
2. Sexual Aversion Disorder – actively
avoids and has a persistent or B. SEXUAL AROUSAL DISORDERS
recurrent extreme aversion to genital
sexual contact with a sexual partner.
FEMALE SEXUAL AROUSAL DISORDER: inability
of a woman to complete sexual activity with adequate
lubrication.
ETIOLOGY OF SEXUAL DESIRE DISORDERS:

MALE ERECTILE DISORDER OR IMPOTENCE:

A. PHYSIOLOGICAL
unable to maintain an erection throughout sexual
1. Hypogonadism
activity.
2. Stress
3. Alcoholism
2 CATEGORIES:
4. Chronic Illness

● PRIMARY – has never been able to attain or

B. PSYCHOLOGICAL
sustain erections due to psychologic or
1. Depression
biogenic factors.
2. Marital strife
● SECONDARY – a man who previously could
3. Anxiety
attain or sustain erections no longer can.
4. Frustrations
5. Sexual trauma
ETIOLOGY OF SEXUAL AROUSAL DISORDERS:
6. Major life changes

● Hormonal disorders
● Neurologic/Medical Disorders i.e., MS, SCI,
MANAGEMENT OF SEXUAL DESIRE DISORDERS:
DM, Heart problems
● Surgical/traumatic disorders
A. Medical/Therapy
● Drug-induced i.e., antihypertensives, diuretics,
1. Testosterone testing
antidepressants or antipsychotic drugs,
2. Individual or group therapy for
alcohol, illegal drugs
alcoholism
● Vascular
3. Hormonal replacement
● Psychogenic- fatigue, anxiety & stress
4. psychotherapy/counseling
5. Sexual therapy
MANAGEMENT FOR SEXUAL AROUSAL
DISORDERS:
B. Nursing Care
1. Gentle probing/open ended questions
● Hormonal therapy
2. Active listening/non-judgmental
● For Vascular Disorders – surgery, injection of
approach
vasodilator (Papverine)
● Mechanical Devices

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SEXUALITY DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

● Psychological Therapy- behavioral therapy and NURSING MANAGEMENT:

counseling.
● Provide a non-pressured, highly stimulating
VACUUM – PUMP DEVICE interaction.
● Encourage couples to explore other
expressions of sexual intimacy.

C. ORGASMIC DISORDERS

FEMALE ORGASMIC DISORDER: occurs when

there is a significant delay or total absence of orgasm
associated with the sexual activity.

MALE ORGASMIC DISORDER: delay or total

absence of orgasm following sexual activity.

● PREMATURE EJACULATION – When

PENILE PROSTHETIC DEVICE minimal sexual stimulation causes orgasm and
ejaculation on a persistent basis. It’s an early
● Nurses should advice to: orgasmic response.
○ Wear elastics briefs
○ Place the penis at 45 degrees angle ETIOLOGY:
from the base ● performance anxiety
○ Instruct to avoid wearing tight slacks or ● anger w/ partner or women in general
boxer shorts. ● Guilt
● degenerative disease i.e., MS
● inflammatory processes

MANAGEMENT OF PREMATURE EJACULATION:

● More frequent sex (or masturbation):

premature ejaculation is more likely if there is a
longer gap between sexual intercourse.
● Using a condom to decrease sensation.
● Sex with the woman on top reduces the
likelihood of premature ejaculation.
● Squeeze and stop-go techniques: stimulating
the penis almost to the point of ejaculation and
then stopping. These techniques are often

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SEXUALITY DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

effective but may take a few months to
produce any benefit and relapse is common.
● Psycho-sexual therapy includes assessment,
behavioral and educational methods,
psychotherapy in terms of the relationship, and
sexual timetables.
D. SEXUAL PAIN DISORDERS
1. DYSPAREUNIA – A sexual pain disorder.
Painful coitus or attempted coitus. The pain
may have a burning, sharp, searing or
cramping quality
OTHER CAUSES OF PAINFUL SEX:
1. Inadequate lubrication, usually secondary to
insufficient foreplay.
2. Forceful pressure against a sensitive urethra
during coitus.
3. Thinning of walls caused by aging or
decreased estrogen
4. Irritation due to the use of improperly fitted or
inadequately lubricated condoms
5. Allergic reactions to the contents of
contraceptive foams, jellies & foams.
6. Drugs w/ drying effects (antihistamines, certain
tranquilizers, marijuana).

PHYSICAL CAUSES OF DYSPAREUNIA:

MANAGEMENT OF DYSPAREUNIA:

WOMEN:
● Examination of both partners before marriage
or sexual activity
● PID
● Sex education
● Endometriosis
● Guidance in sexual techniques
● Interstitial cystitis
● Stretching of light hymenal ring by a physician
● Vaginismus
● Temporarily avoiding intercourse
● Vulvodynia
● Soothing ointment
● Some STDs
● Sitz bath
● UTI
● Liberal use of a water-soluble lubricant just
● Vaginal dryness
before coitus
● Physical injury
● Local estrogenic preparation or oral estrogen
replacement therapy
MEN:
● Cyst or abscesses should be excised, inflamed
labia must be kept clean & dry.
● TIGHT FORESKIN
● SOME STDs
2. LICHEN SCLEROSIS – Chronic inflammatory skin
disorder, affects vulva and anal area.
PSYCHOLOGICAL CAUSES OF PAINFUL SEX:
SYMPTOMS: spots→bigger patches→skin
● Coercive sexual experiences
surface becomes thin and crinkled→tears
● Anticipating pain
easily→bright red or purple discoloration due
● Lack of interest in having sex
to bleeding inside the skin.

CAUSES: unknown, genetic tendency,

abnormal hormone levels.

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SEXUALITY DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

○ It is commonly discovered in teenagers

TREATMENT: ultra potent corticosteroids, and women in their early twenties, as
surgery this is when many young women in the
Western world will initially attempt to
use tampons, have penetrative sex, or
undergo a pap smear.
○ Some of the things that may cause
primary vaginismus are:
■ sexual abuse
■ having been taught that sex is
immoral or vulgar
■ the fear of pain associated with
penetration

● 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
3. VAGINISMUS – (the German equivalent of the psychological causes
word Vaginism) is a condition which affects a woman's
ability to engage in any form of vaginal penetration, THREE CAUSES FOR VAGINISMUS ARE:
including sexual penetration, insertion of tampons,
and the penetration involved in gynecological ● fear of painful sex
examinations. ● strict religious
● upbringing where sex was viewed as
This is the result of a conditioned reflex of the wrong or not discussed
pubococcygeus muscle, which is sometimes referred ● early childhood traumatic experiences
to as the 'PC muscle'. The reflex causes the muscles (not necessarily sexual in nature).
in the vagina to tense suddenly, which makes any kind
of vaginal penetration -- including sexual penetration -- PHYSICAL TREATMENT OF THE INTERNAL
either painful or impossible. SPASMS:

TYPES OF VAGINISMUS: ● exploring the vagina through touch, and

desensitization with vaginal dilators.
● Primary vaginismus – occurs when a woman Dilating involves inserting objects,
has never been able to have penetrative sex or usually phallic in shape, into the
achieve any kind of vaginal penetration. vagina.

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SEXUALITY DISORDERS
CNCM 229 Care of Mother and Child-at-risk or with Problem
BS Nursing | Mrs. Melody D. De la Paz, RN, RM, MSN | SEM 2 2022 – 2023
Prepared by: Vivienne Rae A. Amarillo | LEVEL II

CAN SEXUAL DYSFUNCTION IN MEN AND

WOMEN BE PREVENTED OR AVOIDED?

● 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:
● 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.
● Talk with a counselor or mental health
professional if you are depressed, stressed or
having relationship issues.
● Reduce your alcohol consumption, eat healthy,
and get regular exercise.
● Talk to your partner about what you like and
don’t like in your sexual relationship.
● 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.
● For women, Kegel exercises (squeezing and
relaxing the muscles of your vagina) may
increase arousal.
● Try sexual activity other than intercourse, such
as massage, oral sex, or masturbation.
● Do not use recreational drugs or abuse
opioids.

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