DISORDERS OF SEXUAL

FUNCTIONING

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 DISORDERS OF SEXUAL
FUNCTIONING
Disorders involving sexual functioning
can be lifelong:
✔ (primary) or acquired (secondary).
❑ They can have a psychogenic origin
(produced by psychic rather than organic
factors),
❑ a biogenic origin (produced by biologic
processes), or both.
✔ They occur in both men and women
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 Inhibited Sexual Desire

Lessened interest in sexual relation or

decreased sexual desire.

Treatment
1. Administration of androgen (testosterone)
to women may be helpful at that time,
because it can improve interest in sexual
activity.
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2. A surgical
implant to aid
erection by the use
of vacuum
pressure is a
possible alternative

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3. Testosterone injections may be helpful
in some men.
4. Various herbal products such as
fennel extracts are available for women
that may improve sexual libido.

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5. Vibration or vacuum
devices are also available
to increase clitoral
enlargement and sexual
arousal in women.

6. Sildenafil citrate
(Viagra) can be used with
women taking serotonin
reuptake inhibitors who
notice decreased sexual
arousal (Nurberg, et al.,
2008)
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 Premature Ejaculation
Premature ejaculation is ejaculation
before penile–vaginal contact (Docherty,
2007).

CAUSE
▪ Can be psychological
▪ Masturbating to orgasm
▪ doubt about masculinity
▪ and fear of impregnating
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MANAGEMENT
Sexual counseling for both partners to
reduce stress, as well as serotonergic
antidepressants such as Mirtazapin.

ERECTILE DYSFUNCTION
formerly referred to as impotence, is the
inability of a man to produce or maintain
an erection long enough for vaginal
penetration or partner satisfaction
(Wessells et al., 2007)
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 CAUSES
• physical such as aging, atherosclerosis, or
diabetes, which limit blood supply
TREATMENT
▪ ldenafil (Viagra), tadalafil(Cialis), and vardenafil
(Levitra).

Persistent Sexual Arousal Syndrome (PSAS)

is excessive and unrelenting sexual
arousal in the absence of desire
ask if the person is taking any herbal
remedies such as Ginkgo biloba.
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Nursing Care of Male and Female
Clients with General and Specific
Problems in Reproduction and
Sexuality

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Disorders Caused by Altered
Reproductive development

Ambiguous Genitalia – refers to a genitalia

that are not defined as male or female and
the presence or absence of gonads tissue is
Unknown.

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 Assessment
At Birth Female: Babies who are genetically
female (with two X chromosomes)

▪ An enlarged clitoris which may resembles a 
penis 
▪ Closed labia that include folds and resemble a
scrotum. 
▪ Lumps that feel like testes in the fused labia 

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At Birth MaleBabies who are genetically male (with one
X and one Y chromosome) may have:
➢ Hypospadias ➢ Micropenis
➢ Undescended testes
➢ An absence of one or
both testicles in
what appears
to be scrotum

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 CAUSES

• A lack or deficiency of male hormones in a

genetic male fetus
• Exposure to male hormones during
development results in ambiguous
genitalia in a genetic female.
• Chromosomal abnormalities, such as a
missing sex chromosome

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 TREATMENT

RECONSTRUCTIVE SURGERY – involve

correction of hypospadias, cryptorchidism
for male while for female removal of
labial adhesions and reduction or removal of
an enlarged clitoris(done before 3 years
old).
Clitoroplasty
Vaginoplasty
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 Disorders affecting the penis
Hypospadias – most
common anomally
of the penis.
The urethral opening
is situated on the
ventral side of
the shaft of penis.

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 ETIOLOGY

• Unknown
• Arrested development in fetal life.
• Familial factor
• Gene mutation
• Lack of hormone production during
fetal life due to endocrinopathies

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 Assessment
• Abnormal urine stream
• Downward curve
(chordee) of the penis
• Hooded appearance
of the penis
• Child voids in sitting
position

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 THERAPEUTIC MANAGEMENT
URETHROPLASTY – to bring the urethral
opening to the tip of the penis.
- Preferably done at the age of 6 to 24
mos.

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NURSING INTERVENTIONS
POST OPERATIVE CARE
PREOPERATIVE CARE
• Monitor vital signs
• Catheter care should be
Preparing parent’s
given
for child surgery. • Put restraints so that child
Psychological should not take out catheter
or other tubing's.
support should be
• Urine examination should
given to the be done to rule out any
parents infection.
• Support and guidance of
parents is very important.
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 EPISPADIAS

the urethral opening is localized on the

dorsum of the Penis or clitoris.

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SURGERY

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 PHIMOSIS
A condition in which the foreskin cannot be
retracted over the glans in uncircumcised
males.
Balanitis – inflammation of the glans penis
due to accumulation of secretions.

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 How does Phimosis develops
in adults
Poor hygiene or underlying medical conditions such as diabetes
Thickened secretions

Inflammation, edema and constriction

Encrusted with urinary salts and calcify

Calculi in the prepuce

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Severity of Phimosis

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 Severity of Phimosis
there are 5 grade of it which are as
follows:

Grade 1 – full retraction of prepuce but tightly

and with small discomfort.
Grade 2 – half retraction – only half of penis is
visible after retraction.
Grade 3 – little less than half retraction, only
meatus can be seen.
Grade4 – very less open minimal distance
seen between glans and opening of prepuce.
Grade 5 – no retraction foreskin attached to
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 TREATMENT
❑ Application of steroidal (Betnovate-N)
cream to the foreskin to soften and
correct the narrowness resulting in
decreased constriction.

❑ Adult Circumcision
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 PARAPHIMOSIS
Condition in which
the foreskin once
retracted over the
glans cannot be
returned to it’s
usual position

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 TREATMENT

1. Compressing the glans for five

minutes to reduce the edema and
size and then pushing the glans back
while simultaneously moving the
foreskin forward.
2. Incision of constricted skin under
local anesthesia
3. Circumcision
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How does paraphimosis develop
in adult
Poor hygiene

Chronic Inflammation under the foreskin

Formation of a tight ring of skin when the foreskin

is retracted behind the glans

Venous congestion, edema and enlargement

of the glans

Arterial occlusion and necrosis of the glans

may occur
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 TREATMENT
1. Compressing the glans for five
minutes to reduce the edema and
size and then pushing the glans back
while simultaneously moving the
foreskin forward.
2. Incision of constricted skin under
local anesthesia
3. Circumcision
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Disorders affecting the testes
and adjacent tissues
CRYPTORCHIDISM - Failure of one or both
testes to descend from the abdominal
cavity into the scrotum.

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 Risk Factors

1. Maternal smoking and alcohol

exposure
2. Fetal exposure to
diethylstilbestrol
3. Prematurity
4. SGA
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 Pathophysiology
Normal mechanical descent
• Intrauterine life at 28 wk of gestation the testes will
descend into the inguinal canal – mediated by the
testosterone.
• Gubernaculum swells and pulls the testis into the
scrotum along the inguinal canal.

Defective mechanism in the different phases of

descent
• The cause is unknown but it is associated with low
level of testosterone production due to exposure to
hormones which affects the descend of the testis
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 Therapeutic Management
1. Hormone therapy – gonadotropin hormone
2.Orchiopexy – testis
and spermatic cord
are released from the
attachments and
the testis is sutured
in the scrotum.

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• Acute hydroceles primarily develop in
adults older than 40 years - occur in
association with inflammation, infection,
epididymitis, local injury, or systemic
infectious disease.
• Chronic hydroceles may occur related to the
imbalance between fluid secretion and
reabsorption in the tunica vaginalis.

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 During Physical Examination
• Transillumination – a painless extratesticular mass
is found.
• Hydrocele transmit light whereas hernia does not
• Ultrasonography is recommended for large
hydroceles to differentiate them from testicular
tumors.

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 THANK YOU

To be continued next week

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