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SEXUAL DISORDERS

Sexuality
Human sexuality:
 biologic
 psychologic
 psychosocial
Definition of Terms
• Sexual identity : male or female ; anatomy
and physiology
• Gender identity: individual’s perception and
understanding of self.
• Gender role : person’s expressions of his/her
gender identity by way of behaviors,
attitudes, & emotions appropriate for the
gender.
• Sexual orientation: sexual
preference/feelings & attraction to the male &
female.
Causes of Sexual Disorders
• Medical condition/medication/ other
substances.
• Biologic disorders
• Heredity
• Familial
• Cultural origins (transmission of paraphiliac
disorders/female circumcision & genital mutilations)
• Psychologic
• Psychosocial Causes
Sexual Disorders
The DSM of Mental Disorders
1. Sexual dysfunctions
2. Paraphilias
3. Gender identity disorders
1. Sexual Dysfunctions
A. Sexual desire disorder
B. Sexual arousal disorder
C. Orgasmic disorder
D. Sexual pain disorder
E. Sexual dysfunction d/t medical disorder
Sexual Dysfunction
• A disturbance in the process that
characterize the sexual response cycle or
by pain associated w/ sexual intercourse
• The dysfunction causes – disturbed
interpersonal relationships & marked
distress for the individual, the partner, or
both.
The Human Sexual Responses
Masters & Johnsons 1960’s

1. Sexual desire – interest, intention,


willingness.
2. Excitement/arousal – neurologic & vascular
changes; cognitive & emotional changes
3. Orgasms –height of the arousal phase-
strong rhythmic contractions in the pelvis.
4. Resolution – sense of general relaxation,
well being, & muscle relaxation.
A. Sexual Desire disorders
• For the diagnosis: both of this conditions
must include
a) It causes the person marked distress or
interpersonal difficulty
b) That the disorder is not caused by another
disorder.
a. Hypoactive Sexual Desire
disorder
• Persistent or recurrent absent or deficient
sexual fantasies and desire for sexual
activity.
• Has sexual interest – stress/interpersonal
difficulties – sexual desire is lost.
b. Sexual Aversion Disorder
• Persistent or recurrent extreme aversion
to and avoidance of all or nearly all genital
sexual contact w/ a sexual partner.
• Anxiety, fear, or disgust – for a sexual
encounter
B. Sexual Arousal Disorders
1. Female sexual arousal disorder:
a) may be accompanied by a sexual
desire/female orgasmic disorder
b) Persistent or recurrent partial/complete
failure to attain or maintain lubrication or
swelling response of sexual excitement until
completion of sexual activity;
B. Sexual Arousal Disorders
• Male Erectile Disorder
a) Persistent or recurrent partial or complete
failure to attain/maintain erection until
completion of sexual activity or
b) Persistent or recurrent lack of subjective
sense of sexual excitement & pleasure during
sexual activity.
c) Associated w/ sexual anxiety, fear of failure,
concerns about sexual performance.
C. Orgasmic Disorders
a) Female Orgasmic Disorders
 Persistent /recurrent delay in/absence of orgasm
following a normal sexual excitement phase.
(Age/adequacy/experience)
a) Male Orgasmic Disorder
 Persistent /recurrent delay in or in absence of
orgasm following a normal sexual excitement phase,
considering the person’s age & other factors.
a) Premature Ejaculation
 Persistent /recurrent ejaculation w/ minimal sexual
stimulation/or before on, or shortly after
penetration, and before the desires it ( age, newness
partner/situation/ frequency)
C. Sexual Pain Disorders
1. Dyspareunia
 Persistent/recurrent genital pain in either
male/female before, during/after sexual intercourse,
not caused solely by lack of lubrication or
vaginismus.
1. Vaginismus
 Persistent/ recurrent involuntary spasm of
musculature of the outer third of the vagina. Which
interferes with coitus.
D. Substance Induced Sexual
Dysfunction
 significant sexual dysfunction causing
distress & interference w/ interference w/
interpersonal relationships.
Symptoms of dysfunctions are substance
specific physiologic effects d/t drug abuse,
medications or toxic exposure.
Symptoms:
w/impaired desire
w/impaired arousal
w/ impaired orgasm
w/ sexual pain
E. Sexual Dysfunction not
otherwise Specified
Do not meet criteria for any of the specific
sexual dysfunctions, ff:
No erotic sensation/even complete anesthesia
The female analog of premature ejaculation
Genital pain - masturbation
2. PARAPHILIAS
1. Exhibitionism
2. Fetishism
3. Frotteurism
4. Pedophilia
a) Male;
b) female;
c) both;
d) limited to incest;
e) exclusive type/non exclusive
5. Sexual Masochism
6. Sexual Sadism
7. Tranvestic fetishism
a) With gender dysphoria
8. Voyeurism
9. Paraphilia not otherwise specified
PARAPHILIAS
• Persistent, intense, and recurrent sexual urges,
fantasies, or behaviors that involve nonliving
objects, other non consenting persons
( children/adults), or humiliation or pain ; occur
at least 6 mos.

• Pedophilia, exhibitionism, frotteurism or


voyeurism.
1. Exhibitionism - exposure of one’s genitals
to unsuspecting stranger(s), followed by
sexual arousal.
2. Fetishism - use of objects for purpose
sexual arousal and during sexual activity.
3. Frotteurism - touching or rubbing against
a non consenting person, to stimulate
sexual arousal.
4. Pedophilia –
 sexual activity w/ a prepubescent child
/children 13 y/o or below
 at least 16 y/o & at least 5 years older than the
child/ren
 May be homosexual, heterosexual, or bisexual
 May be limited to incest
 Exclusive type –attracted only to children
 Non exclusive – attracted also to adults
5. Sexual Masochism
- the act of being humiliated, beaten ,
bound, or otherwise made to suffer during
sexual activity while alone (masturbating)
or with others.
6. Sexual Sadism –
- acts in which physical or psychologic
suffering of the victim is sexually arousing
to the perpetrator.
7. Transvestic fetishism
- The act of cross dressing by a heterosexual males
- Does not meet the criteria for gender identity
disorder, non transexual type; or transexualism.
8. Voyeurism
- the act of observing an unsuspecting person who is
naked, in the act of disrobing, or engaging in sexual
activity to achieve sexual arousal.
9. Paraphilias not otherwise specified:
 Telephone scatologia – lewdness; obcene phone calling;
sex line telephoning.
 Necrophilia – sexual activities w/ corpses.
 Partialism – exclusive focus on body part that generates sexual
arousal.
 Zoophilia – sexual activity w/ animals; bestiality.
 Coprophilia – sexual arousal on contact w/ feces
 Klismaphilia – sexual arousal generated by the use of enemas
 Urophilia – sexual arousal on contact w/ urine
 Ephebophilia – fondling & other types of sexual activities – dev.
Sexual characteristics 13-18y/o
 Paraphilic coercive disorder – rape, aggressive sexual assault –
against female
3. Gender Identity Disorder
• Persistent, strong desire to be the opposite
sex or insistence that one is the opposite
sex ( cross-gender identification disorder)

• Persistent discomfort w/ own sex &


feelings of inappropriateness in the gender
role of the assigned sex.
NSG. DX: Sexual Dysfunction
1) Client verbalizes loss of interest in and energy for
sexual activity
2) Reports actual/perceived sexual limitations
imposed by mental disorder/physical dysfunctions
3) Seeks relations w/ equally vulnerable clients in
mental health facility
4) Demonstrates difficulty in achieving perceived sex
role.
5) Express lack of knowledge regarding ability to find
satisfactory sexual expressions/alt. gratifying
activities alone /w/ a partner
 Interview in private, caring, thoughtful
manner.
 Use : reflection, voice concerns, use
silence, open ended questions, allow time.
 Offer information – if possible
 Use direct questioning
 Identify possible causes
 Suggest alternative activities –
sublimate/substitute
 Sexual education
Sexual and Gender Identity
Disorder
1. Situational crisis
2. Functional crisis
3. Role/relationship crisis
4. Ineffective coping as a result of a sexual
dysfunction, gender identity disorder, or
paraphilia.
5. Knowledge deficit
Nsg. intervention
• The nurse needs to intervene immediately – vs acts out sexual
fantasies or obsessions – harmful dangerous to client and
others.
• Helping clients w/ sexual problems
• Monitor the family member for signs of physical/sexual abuse
• Interview the family to determine the factors associated w/
sexual problem
• Educate the client & family about the client’s disorder
• Teach r/t prescribed medications
• Assist – medical, psychiatric and stress treatment
• Teach the client & family –healthy human sexuality &
function- culture, spirituality etc.
• Offer expression of feelings towards the disorder.