PSYCHOSEXU
AL DISORDER
PSYCHOSEXUAL DISORDER
Psychosexual disorder is a term which
may simply refer to a sexual problem that
is psychological, rather than physiological
in origin.
"Psychosexual disorder" was a term used
in Freudian psychology.
PSYCHOSEXUAL DISORDER
Sigmund Freud has contributed to the idea of
psychosexual disorders and furthered
research of the topic through his ideas of
psychosexual development.
According to Freud's ideas of psychosexual
development, as a child, one will progress
through 5 stages of development.
A psychosexual disorder could arise in an
individual if the individual does not progress
through these stages properly.
TYPES OF Psychosexual
disorder
Gender Identity Disorder
In this disorder , the sense of ones masculinity or
femininity is disturbed. They include
1. Trans sexualism
2. Gender identity disorder of childhood
3. Dual role transvestism
1. Transsexualism
Persistence and significant sense of
discomfort regarding one’s anatomic sex
feelings that it is inappropriate to one’s
perceived gender.
Preoccupied with the wish to get rid of one’s
genital and secondary sex characteristic
Wish to adopt the sex characteristic of other
sex.
2. Gender identity disordered of
childhood
Very rare
Usually first manifest during early
childhood, during preschool years
characterized by a persistent and intense
distress about assigned sex, together with
a desire to be of the other sex.
Persistent preoccupation with the dress
and activities of the opposite sex
3. Dual role transvestism
Characterized by wearing clothes
of opposite sex in order to enjoy
the temporary experience of
membership of the opposite sex but
without any desire for permanent
sex change.
Disorder of sexual preference
( Parahilias)
In Parahilias sexual arousal occour persistently and
significantly in response to object , which are not a
part of normal sexual arousal.
1. Fetishism:
Sexual arousal occour with a non
living object which is usually
intimately associated with human
body
Fetish object may include bras,
underpants , shoes , gloves etc
2. Fetishistic Transvestism
Sexual arousal occour by wearing clothes
of the opposite sex.
Diagnostic guidelines:
Clear association with sexual arousal must
be established
Strong desire to remove the clothing once
orgasm occurs and sexual arousal declines.
3. Sexual sadism
It refers to the "recurrent and intense
sexual arousal from the physical or
psychological suffering of another
person, as manifested by fantasies or
behaviors"
5.Sexual masochism:
Person is sexually aroused by physical or
psychological humiliation or injury inflicted on
self by others.
6.Exhibitionism
Person is sexually aroused by the
exposure of one’s genital to an
unsuspecting stranger.
There is usually sexual excitement at the
time of exposure.
Voyeurism: A recurrent or persistent
tendency to look at people engaging in
sexual or intimate behavior such as
undressing.
Thisusually leads to sexual
excitement and is carried out without
the observed people being aware.
7.Fortteurism
Persistent or recurrent involvement
in the act of touching and rubbing
against an unsuspecting,
nonconsenting person.
7.Pedophilias
Persistent or recurrent involvement of an adult in
sexual activity with prepubertal children.
8. Zoophilia
Involving in sexual activity with animals
9.Other Parahilias
Sexual arousal occour with urine, feces , enemas etc
PSYCHOLOGICAL AND BEHAVIORAL DISORDERS
ASSOCIATED WITH SEXUAL DEVELOPMENT AND
MATURATION
Sexual maturation disorder: The individual suffers from
uncertainty about his/her gender identity or sexual
orientation, with anxiety or depression.
Commonly seen in adolescents who are not certain as to
they are homosexual or heterosexual or bisexual in
orientation.
SEXUAL DYSFUNCTION, NOT CAUSED
BY ORGANIC DISORDER OR DISEASE
Covers various ways in which an individual is
unable to participate in a sexual relationship as
he/she would wish.
There may be lack of interest, lack of enjoyment,
or inability to control or experience orgasm.
Sexual dysfunction, not caused by organic disorder or
disease.
Lack or loss of sexual desire
Sexual aversion and lack of sexual enjoyment
Failure of genital response
Orgasmic dysfunction
Premature ejaculation
Nonorganic vaginismus
Non organic dyspareunia
Excessive sexual drive
LACK OR LOSS OF SEXUAL DESIRE
Lack of Sexual interest . Refers to
persistent deficits in sexual interest
(sexual fantasies or urges).
SEXUAL AVERSION AND LACK OF SEXUAL ENJOYMENT
Lack of Sexual enjoyment . Refers to persistent
extreme unwillingness to and avoidance of sexual
contact with partner is associated strong negative
feelings and produce fear and anxiety.
Causes
History of sexual molestation in children.
Unsatisfactory past sexual experience
Past history of sexual trauma
SEXUAL AROUSAL DISORDER
Sexual arousal disorder in women.
Refers to persistent deficits in sexual
interest , biological arousal in form of
lack of lubrication or vaginal dryness.
Male erectile disorder . Refers to failure
to attain or maintain an erection through
completion of the sexual activity.
ORGASMIC DISORDERS
orgasmic disorder. Refers to the persistent
absence of orgasm after sexual excitement.
Two orgasmic disorder for men:
Early ejaculation disorder. Defined by
ejaculation that occurs too quickly.
Delayed ejaculation disorder. Define by
persistent difficulty in ejaculating.
4. Non organic vaginismus
Involuntary spasm of lower 1/3 of vagina following
sexual activity
5. Non organic dysparenria
Pain in the genital area of either male or female
during sexual activity.
PREVALENCE
More common in boys than in girls.
More than 30% of the boys suffer from sexual
dysfunction.
Etiological
Biological Factors
Temporal lobe diseases such as
temporal lobe tumors.
Abnormal levels of androgens
may contribute to inappropriate
sexual arousal(Paraphilias)
decreased levels of serum
testosterone is seen with
hypoactive sexual desire disorder
in men
Variousmedications such as
antipsychotics, antidepressants,
anxiolytics and anticonvulsants
may lead to hypoactive sexual
desire.
Psychoanalytical Theory
Thepsychoanalytical approach defines a paraphilic as
one who has failed the normal developmental
process(Fixed in phallic stage of psychosexual
development)
Psychological factors
fears of becoming pregnant,
rejection by the sexual partner,
damage to the vagina
feelings of guilt regarding sexual impulses
Relationship problems such as a
stressful marriage
anxiety over intimacy
lack of comfort in the sexual relationship
Behavioral Theory
modeling behavior of others who have carried
out paraphilic acts
mimicking sexual behavior depicted in the
media
Diagnosis
Complete history (Sexual history)
MSE
Investigationto find out hormonal changes.
Based on behaviour.
ICD 11 Criteria
Treatment Modalities for Paraphilias
Biological Treatment
decreasing the level of circulating androgens.
Antiandrgenic medications :progestin
derivatives
Antipsychotic used for aggression associated
with Paraphilias.
Psychoanalytical Therapy
Therapist helps the client identify unresolved
conflicts and traumas from early childhood.
Thetherapy focuses on helping the individual
resolve these early conflicts thus relieving the
anxiety that prevents him or her from forming
appropriate sexual relationships.
Behavioral Therapy
Aversion techniques
Aversion therapy is a psychological treatment in
which the patient is exposed to a stimulus which
cause some form of discomfort. E.g. electric shock
Individual Counseling
NURSING MANAGEMENT
Complete assessment should be done.
Complete history (Sexual history) should be taken.
An attempt is made to create a situation which reduces
anxiety
Attention is given to general quality of relationship,
particularly to emotional interaction.
Assessment of underlying psychiatric disorder
NURSING MANAGEMENT
Education regarding normal sexual functioning.
Open communication regarding sexual activity.
Find out the patient level of knowledge about sexual
matters and provide information about sexuality.
Counsel about stressor in his life.
Reassurance to patient.
THANK YOU
