SEXUAL DISORDERS

Prepared by:
Mrs.Akila.A, M.Sc (N), M.Sc (psy)

Associate Professor
 INTRODUCTION
• In ICD10 gender identity disorders, disorders of sexual
preference and sexual development and orientation disorders
are listed under disorders of adult personality and behavior
• Sexual dysfunctions are listed under behavioral syndromes
associated with physiological disturbances and physical factors
• It is a disturbances in the sexual desire.
DEFINITION:
Sexuality is the constitution and life of an individual
relative to characteristics regarding intimacy . It reflect
the totally of the person and does not relate exclusively
to the sex organs or sexual behavior.
Sexual disorder is difficulty experienced by an individual
or a couple during any stage of a normal sexual activity,
including physical pleasure, desire, preference, arousal
or orgasm.
Gender identity is a person’s sense of maleness or
femaleness
Sexual identity is the pattern of a person’s biological
sexual characteristics: chromosomes, external and
internal genitalia, hormonal composition, gonads and
secondary sex characteristics
CLASSIFICATION
F64 Gender identity disorders:
• F64.0 Trans sexualism
• F64.1 Dual-role transvestism
• F64.2 Gender identity disorder of childhood
• F64.8 Other gender identity disorders
• F64.9 Gender identity disorder, un specified
F65 Disorders of sexual preference
• F65.0 Fetishism
• F65.1 Fetishistic transvestism
• F65.2 Exhibitionism
• F65.3 Voyeurism
• F65.4 Paedophilia
• F65.5 Sadomasochism
• F65.6 Multiple disorders of sexual preference
• F65.8 Other disorders of sexual preference
• F65.9 Disorder of sexual preference, unspecified
F66 Psychological and behavioural disorders associated
with sexual development and orientation
• F66.0 Sexual maturation disorder
• F66.1 Ego dystonic sexual orientation
• F66.2 Sexual relationship disorder
• F66.8 other psychosexual development disorders
• F66.9 Psychosexual development disorder, unspecified
Definition :

•“Gender identity disorders are characterized by disturbance in

gender identity i.e., the sense of one’s masculinity or feminity
is disturbed.” - Niraj Ahuja-

•“Gender identity disorders as a group whose common

feature is a strong, persistent preference for living is a person
of the other sex.”

- DSM - IV- TR -
 Epidemiology
Children
Among a sample of boys under age 12 reported desire to be the
opposite sex was 10%. Girls under age 12, the reported desire to be
the opposite sex was 5%
The sex ratio - 4 – 5 boys for each girl

Adults
 A sex ratio of 3 – 5 male patients for each female patient
 Etiology

(i) Biological Factors

-Maleness and masculanity depend on fetal and perinatal

androgens.
-Testosterone can increase libido and aggressiveness in women
and estrogen can decrease libido and aggressiveness in men.

.
(ii) Psychosocial factors
•The interaction of children’s temperament, parents qualities
& attitudes
• The quality of mother – child relationship, A
mother’s death.
(i)Transsexualism :
In this, there is a persistent and significant sense of
discomfort regarding one's anatomic sex and a feeling that it is
inappropriate to one's perceived gender.
The person will be preoccupied with the wish to get rid of
one's genitals and secondary sex characteristics and to adopt
the sex characteristics of the other sex.
 Primary transexualism
Onset - early childhood
Course - stable
Category - homogeneous
Primary transexuals are preoccupied with sex change (or)
sex reassignment surgery.
Two main types

Male primary Female primary transexualism

transexualism
 Secondary transexualism
Onset – later in life
Course – severe
Category – homogeneous
The only common feature is a wish to change the anatomic sex.
Treatment :
- Counseling
- Sex change to the desired gender
Sex reassignment surgery(SRS) :
The first procedure was done in 1951 (Denmark) on an
American soldier George Jorgensen who become christine
Jorgensen after SRS. The first female – to – male SRS was
performed in1956
• The procedures include hormonal treatment phallaplasty,
castration, mastectomy, hysterectomy with salphingo -
oopherectomy which have been used in different combinations
Hormonal Treatment :
Biological men are treated with daily doses of oral estrogen for 2
years.
Biological women are treated with monthly or three weekly
injections of testosterone.
(ii)Gender identity disorder of childhood:
This is a disorder similar to trans sexualism, with a very
early age of onset.
This is characterized by
i. persistent and significant desire to be of the other gender
ii. Marked distress regarding the anatomic sex with strong
denial of anatomic sex in transexualism
iii. Involvement in traditional activities games and clothing
pattern of the perceived gender.
iv. Onset before Puberty
iii)Dual-role transvestism:
It is characterized by wearing clothes of the opposite sex
in order to enjoy the temporary experience of membership of
the opposite sex but without any desire for permanent sex
change.
(iv)Intersexuality:
The patients have gross anatomical or physiological
features of the other sex. For example, Turner's syndrome,
congenital adrenal hypoplasia.
 PSYCHOLOGICAL AND BEHAVIOURAL DISORDERS ASSOCIATED WITH SEXUAL
DEVELOPMENT AND MATURATION

• Sexual relationship disorder

• Sexual maturation disorder
• Ego dystonic sexual orientation
 HOMOSEXUALITY
• Homosexuality in contrast to heterosexuality is the sexual relationship
between persons of the same sex.
Types
• Male homosexuals- Gay
• Female homosexuals- Lesbians or sapphic
Prevalence :
• In USA 4-6% of males
1-2% of females
5-10% of bisexuals.
 Types of homosexual behaviour
Obligatory • Only homosexuality
homosexuality • No hetero sexuality

Preferred • Predominant homosexuality

homosexuality • Occasionally hetero sexuality

• Equal homosexuality and hetero

Bisexuality sexuality

Situational • Predominant hetero sexuality

homosexuality • Occasional homosexuality

• Only hetero sexuality

Latent homosexuality • Fantasies of homosexuality
TREATMENT
For seeking a change in sexual orientation:
• Psychoanalytic psychotherapy
• Behavior therapy
Aversion therapy
Covert sensitization
Systematic desensitization
• Supportive therapy
• Androgen therapy
For seeking removal of distress only :
• Psychoanalytic and supportive psychotherapy
• Drug therapy
Antidepressant and / or benzodiazepines
DEFINITION
“Paraphilias are disorders of sexual preference in which
sexual arousal occurs persistently and significantly in response to
objects which are not a part of normal sexual arousal.”

“A sexual deviation perversion or paraphilia is defined as

any sexual behaviour that is regarded as significantly different
from the standard establishment of local culture or subculture.”
TYPES
•“
1.Fetishism
The word ‘FETISH’ means magical.
Seen in males
• The sexual arousal occurs either solely or predominantly with a
non-living object which is usually intimately associated with the
human body.”
• Fetish objects - shoes, gloves, bras, underpants, stockings etc.
2. Fetishistic Transvestism
“The person actually or in fantasy wears clothes of the opposite
sex (cross-dressing) for sexual arousal.”
• Occurs in heterosexual males.
3. Exhibitionism
• “Exhibitionism is a persistent (or recurrent) and significant
method of sexual arousal by the exposure of one’s genitalia to
an unsuspecting stranger.”
• Seen in males

4. Voyeurism
• Voyeurism is a persistent or recurrent tendency to observe
unsuspecting persons (usually of the other sex ) naked,
disrobing or engaged in sexual activity.”
• Seen in males.
5.Paedophilia
• Paedophlia is a persistent or recurrent involvement of an adult
(age >16 years and atleast 5 years older than the child) in
sexual activity with pre pubertal children, either heterosexual or
homosexual.”
• Common in males.
6. Sadomasochism
• “The person (the masochist) is sexually aroused by physical
and/or psychological humiliation, suffering or injury inflicted on
self by others (usually sadists).”Most often the masochist is a
female.
7. Sexual sadism
• “The person (the sadist) is sexually aroused by physical and/or
psychological humiliation, suffering or injury of the sexual
partner.”

8. Multiple disorders of sexual preference

• Sometimes more than one disorder of sexual preference occurs
in one person.
• The most combination is fetishism, transvestism and
sadomasochism.
9.Frotteurism
“This is a persistent or recurrent involvement in the act of
touching and rubbing against an unsuspecting, non- consenting
person (usually of other sex).”Seen in adolescent males.
10. Zoophilia:
It is a persistent and significant involvement in sexual activity
with animals.
11.Coprophilia
Coprophilia is sexual pleasure associated with the desire to
defecate on a partner and/or to be defecated on.
12. Urophilia
Urophilia is a form of urethral eroticism, is interest in sexual
pleasure associated with the desire to urinate on a partner and/or
to be urinated on.
13.Klimpsaphilia
Klimpsaphilia is sexual arousal with enemas.
14.Necrophilia
Necrophilia is an obsession with obtaining sexual gratification
from cadavers.
TREATMENT
• Behaviour therapy
• Psychoanalysis
• Drugs:
- Antipsychotics----> Aggression
 SEXUAL DYSFUNCTIONS
• It is a significant disturbance in the sexual response cycle,
which is not due to an underlying organic cause.
• SEXUAL RESPONSE CYCLE:
Phase I - desire
Phase II - excitement
Phase III - orgasm
Phase IV- resolution
 TYPES OF SEXUAL DYSFUNCTION

Sexual desire Sexual arousal Orgasmic disorder

disorder disorder

Due to medical &

sexual pain substance induced
disorder condition
SEXUAL DESIRE DISORDER

• It refers to a low level of sexual interest resulting in a failure to initiate or respond

to sexual intimacy.

PRE DISPOSING FACTORS:

1.Biological factors:
• Levels of serum testosterone

• Increased levels of serum prolactin

• Various medications

• Alcohol and cocaine use

Psychosocial factors:

Individual causes
• Religious orthodory

• Sexual identity conflict

• Post sexual abuse

• Financial, family or job problem

• Depression

• Aging- related concerns

Relationship causes
• Interpersonal conflict

• Current physical, verbal or sexual abuse

• Extramarital affairs

• Desire or practices that differ from those of the partner

 Hypoactive sexual desire disorder

Definition:

Hypoactive sexual desire disorder is defined by the DSM IV

TR( APA,2000) as a persistent or recurrent deficiency or absence
of sexual fantasies and desire for sexual activity.
 SEXUAL AVERSION DISORDER

Definition:

Sexual aversion disorder is characterized by a persistent or

recurrent extreme aversion to, and avoidance of, all (or almost
all) genital sexual contact with a sexual partner.
- APA(2000)
SEXUAL AROUSAL DISORDER

• It is an aberraction during any stage of the sexual response

cycle that prevents the experience of satisfaction through
sexual activity
 PREDISPOSING FACTORS
Biological factors:
Psychosocial factors:
• Postmenopausal women
• Various medication • Psychological factors
• Arteriosclerosis • developmental factors
• Some neurological disorder
oDiabetes • Relationship factors
oTemporal lobe
epilepsy
oMultiple sclerosis
oTrauma
• Chronic use of alcohol
Female sexual arousal disorder
Female sexual arousal disorder is identified in the DSM-IV-TR as a
persistent or recurrent inability to attain, or to maintain until
completion of the sexual activity, an adequate lubrication /
swelling response of sexual excitement.

Male erectile disorder:

Male erectile disorder is characterized by persistent or
recurrent inability to attain, or to maintain until completion of the
sexual activity, an adequate erection.
-APA, 2000
ORGASMIC DISORDERS
• FEMALE ORGASMIC DISORDER(anorgasmia) : It is a persistent or
recurrent delay in, or absence of, orgasm following a normal sexual
excitement phase.
Types:
• Primary orgasmic dysfunction
• Secondary orgasmic dysfunction

• MALE ORGASMIC DISORDER: The man is unable to ejaculate, even

though he has a firm erection and has had more than adequate stimulation.
• PREMATURE EJACULATION: persistent or recurrent ejaculation with
minimal sexual stimulation before, on, or shortly after penetration and
before the person wishes it
SEXUAL PAIN DISORDERS
• A condition in which sexual intercourse and intimacy evoke
discomfort and pain.
1.Dyspareunia: It is recurrent or persistent genital pain associate
with sexual intercourse either a men or a women.
Treatment:
• Physical and gynecological examinations
• Investigate sexual functioning
• Systematic desensitization
2.Vaginismus is an involuntary constriction of the outer one third of
the vagina that prevents penile insertion or intercourse.

- APA,2000
Treatment:
• Education to couples.
• Hypnosis
• Systematic desensitization-Behaviour therapy
• Physical therapy
• Treat relationship problems
• Group therapy
Nursing intervention for the patient with sexual disorders:
• Assess patient’s sexual history .
• Note cultural, socio, ethnic, racial and religious factors that contribute to conflicts
regarding sexual practices.
• Refer for additional counseling or sex therapy if required.
• Provide information regarding sexuality and sexual functioning, correct any
misconceptions if necessary.
• Both the patient and their parents may need additional assistance if problems in sexual
relationship are severe or remain unsolved

• Assist therapist as necessary in plan of behaviour modification to help decrease variant

behaviour

• In all cases, an accepting and non-judgemental attitude on the part of the nurse is highly
essential for the successful resolution of these problems as these are highly sensitive
issues and may be causing significant distress to the patient
THANK YOU