Sexual Disorders- Lecture

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 phasestrong 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. 2. 3. 4.

Exhibitionism Fetishism Frotteurism Pedophilia a) b) c) d) e)

5. 6. 7.

Sexual Masochism Sexual Sadism Tranvestic fetishism a)

8. 9.

Male; female; both; limited to incest; exclusive type/non exclusive

With gender dysphoria

Voyeurism 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. 2. 3. 4.

Situational crisis Functional crisis Role/relationship crisis 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.