SEXUALITY AND

SEXUAL DISORDERS

Jeremi I. Cobarde
BSN- III

Wilbert C. Codilla
NCM 105
What is SEX?
Sex is define by a biological features such as a penis, vagina, testicles, or uterus.

What is GENDER?
Gender is described by our behavioral characteristics and how they are perceived in a certain
culture at a certain time. Also be how we interpret ourselves as man, woman, transgender or
transsexual.

What is Gender Identity?

Gender Identity is what we call ourselves. There are many other words for gender other than
“male” and “female”. Other identities can also be described as Transgender and Transsexual.
Transgender- people whose gender identity and or presentation do not fit traditional norms.
*Raised as woman but conduct self like man. (Buy male clothes, cut hair short, grow facial hair,
bind breast, take male hormones.)
*Raised as a man but conduct self like woman. (Take estrogen, get breast implants, wear wigs.)
Transsexual- person who lives as opposite gender,
“...we were born in a body that doesn’t match who we are inside.”
Changing can involve:
Names, use of pronouns, clothes, taking hormones and sex reassignment surgery
(Vaginoplasty= creating vagina out of male genitals, Phalloplasty= creating penis + scrotum out
of female genitals and skin grafts.)
In addition to “He”, “She” or “Him”, “Her” can refer to trasnssexual as “Ze” and “Hir”.

What is Sexual Orientation?

Refers to whom we find attractive.
 Straight/ Heterosexual- women who are sexually attracted men and men sexually
attracted to women.
 Gay/ Homosexual- Women who are sexually attracted to women and men who are
sexually attracted to men.
 Lesbians- women who are sexually attracted to women.
 Bisexual- people who are sexually attracted to men and women.
 Queer- describes an open, fluid sexual orientation.
 Asexual- someone who is not experiencing or is not acting on sexual attraction at given
time.
 Pansexual- someone who is attracted to people across the range of genders.
Coming Out…
To ourselves..
 Accepting + Affirming our sexual orientation to ourselves and deciding how to open up
about it.
 Often a gradual process ( can occur at any age in our life)
To family, friends, & the world…
 Challenging + life-changing experience
 Risk losing family , friends, jobs but also liberating to be open about who truly are
 Additional challenges ( Being from traditional religious/ conservative communities.
People with disabilities, weight issues, or from different racial groups already face
discrimination.)

SEXUAL DISORDERS
Sexual Disorder can be classified into 4 main types
1. Sexual Dysfunctions
2.Gender identity disorder
3.Psychological and behavioural disorders associated with sexual development
and maturation
4.Paraphilias (disorder of sexual preference)

1. SEXUAL DYSFUNCTIONS
The essential features of sexual dysfunctions are an inability to respond to sexual stimulation, or
experience of pain during sexual act
Dysfunctions can be defined by disturbance in the subjective sense of pleasure or desire usually
associated with sex. Or by the objective performance
Sexual dysfunctions can be life long or acquired, generalized or situational and result from
psychological factor. Physiological factor, combined factor and numerous stressors including
prohibitive cultural mores, health and partner issues and relationship conflicts.

In DSM 5 the sexual dysfunctions include male hypoactive sexual desire disorder, female
sexual interest/arousal disorder, erectile disorder, female orgasmic disorder, delayed and
premature ejaculation, genito-pelvic pain/penetration disorder, substance/medication induced
sexual dysfunction other specified sexual dysfunction and unspecified sexual dysfunctions.

Desire, Interest & Arousal Disorders

Male hypoactive sexual desire disorders - characterized by a deficiency or absence of sexual
fantasies and desire for sexual activity for a minimum duration of approximately 6 month. A
report of 6% of men ages 18-24 and 40% of men ages of 66-74 have problems with sexual
desire.
Symptoms
 Persistently or recurrently deficient sexua;/erotic thoughts or fantasies and desire for
sexual activity
 Persistence for a minimum of 6 months
 Causes Significant distress in the individual
Female Sexual Interest/ Arousal Disorder- women may experiencing sexual dysfunction may
experience either/ or both inability to feel interest or arousal, and they may often have difficulty
achieving orgasm or experience pain in addition.
Symptoms
 Lack of, or significantly reduced, sexual interest/ arousal as manifested by at least 3 or
the following:

1. Absent/ reduced interest in sexual activity.

2. Absent/ reduced sexual/ erotic thoughts or fantasies.
3. Reduced initiation of sexual activity and typically unresponsive to partner’s attempts to
initiate.
4. Absent sexual excitement/ pleasure during sexual activity in almost all.
5. Absent sexual interest/ arousal in response to any internal or external sexual or erotic
cues. (written, verbal, visual)
6. Absent/ reduced genital or nongenital sensations during sexual activity in almost all.

Male Erectile Disorder- historically c/d impotence. The incidence of erectile disorder increases
with age. It has been reported variously 2-8% of the young adult population. Alfred KInsey
reported that 75% of all men were impotent at the age of 80. It can be organic or psychological
or combination of both, but in young and middle-aged man men the cause is usually
psychological.
Symptoms
Least on of the 3 following symptoms must be manifested
 Difficulty in obtaining an erection during sex
 Difficulty in maintaining an erection until the completion of sexual activity
 Decreased in erectile rigidity

Orgasm Disorder
Male Anorgasmia - Difficulty to have orgasm, despite normal sexual excitement, during coitus.
An uncommon disorder, presents retarded ejaculation (the cause can be biological like post-
prostate surgery, drug induced or psychological like marital conflicts)
Female Anorgasmia - Difficulty to have orgasm, despite normal sexual excitement, during
coitus.
 A woman with lifelong female orgasmic disorder has never been experience orgasm by
any kind of stimulation. A woman with acquired orgasmic, disorder has previously
experienced at least 1 orgasm, regardless of circumstances
 The causes can be biological(endocrine disorders like hypothyroidism, drug induced) or
psychological like marital conflicts

Premature ejaculation- is defined as ejaculation before the completion of satisfactory sexual

activity for both partners. In severe cases, it its characterized by ejaculation either before penile
entry into vagina or soon after penetration. The cause can be biological or psychological(
performance anxiety).

Sexual Pain Disorder

Non-organic dyspareunia- characterized by the pain in the genital area of either male or
female, during coitus. Before a presumption of nonorganic dyspareunia, it is particularly imo to
rule out organic factor(local pathology causing pain)
Non-organic vaginismus- characterized by an involuntary spasm of the lower 1/3rd of vagina,
interfering with coitus. Penile entry is either painful or impossible.

2. Gender Identity Disorder

Characterized by disturbance in gender identity: the same of one’s masculinity or femininity is
disturbed. This group includes:
 Transexualism: male & female: primary & secondary- Normal anatomic sex. Persistent
and significant sense of discomfort. Marked preoccupation with the wish to get rid of
one’s genitals & sec sex characteristics. Diagnosis is made after puberty.
 Gender identity disorder of childhood- similar to Transexualism with a very early age of
onset (2-4 y.o). Persistent & significant desire to be of the other gender. Marked distress
regarding the anatomic sex. Involvement in traditional activities. Onset before puberty.
 Intersexuality- patient’s with this disorder have gross anatomical & physiological aspects
of other sex.
External genitals
Internal sex organs
Hormonal disturbances ( testicular feminisation syndrome)
Chromosomes (turner’s syndrome)

3. Psychological and Behavioural Disorder Associated with Sexual

Development and maturation
include disorder where sexual orientation (heterosexual, homosexual, bisexual) cause
significant distress to the individual or disturbances in the relationships. It is important to
remember that any type of sexual orientation by itself is not a disorder unless it causes distress
or disability. Usually begins in adolescence and is characterised by uncertainty regarding the
gender identity or sexual orientation. The uncertainty often leads to anxiety and depression.

Ego Dystonic Sexual Orientation- the sexual orientation is clear. However the inidividual
wishes to change the orientation because of the associated distress and or psychological
symptoms. Common seen in homosexuality. The prevalence of homosexuality(USA) is 4-6% of
males & 1-2% of females. Another 5-10% may show bisexual orientation.

4. Paraphilias
(sexual deviations: perversions) are disorder of sexual preference in which sexual arousal
occurs persistently and significantly in response to objects which are not a part of normal sexual
arousal.
Symptoms
 Pedophilia- involves recurrent intense sexual urges towards, or arousal by children 13 y.o or
younger over a period of at least 6 month. Most child molestations involve genital fondling or
oral sex. Vaginal or anal penetration occurs infrequently, except in case of incest.

 Frotteurism- characterized by a man’s rubbing his male genital parts against the buttocks or
other body parts of a fully clothed woman to achieve orgasm. The acts usually occur in crowded
places, particularly in subways and buses. Often seen in adolescent males.
  Voyeurism- (Scopophilia) persistent or recurrent tendency to observe unsuspecting
persons(usually of the other sex) naked, disrobing or engaged in sexual activity. Often followed
by masturbation to achieve orgasm without the observed person being aware. Seen in male.

 Exhibitionism- the urge to expose the genitals to a stranger or to unsuspecting person.

 Sexual sadism- recurrent and intense sexual arousal from physical and psychological suffering of
another person.The method used range from restraining by tying, beating burning, cutting,
stabbing, to rape and even killing. To be diagnose a person must have experienced these
feelings for at least 6 months & must acted on sadistic fantasies. Onset before the age of 18
years, mostly male.

 Sexual masochism- recurrent preoccupation with sexual urges and fantasies involving the act of
being humiliated, beaten, bound or otherwise made to suffer. More common on men than
among women. Freud believed masochism resulted from destructive fantasies turned against
the self. Persons with the disorder may have had childhood experiences that convinced them
that pain is a prerequisite for sexual pleasure.

 Fetishism- the sexual focus on objects (shoes, gloves, stocking) that are intimately associated
with the human body or on nongenital body parts. According to Freud, fetish serves as symbol
of the phallus to person with unconscious castration fears.

 Transvestism- exclusively in heterosexual males. Fantasies and sexual urged to dress in opposite
gender clothing as means of arousal and ad a adjust to masturbation or coitus.To diagnose a
patient must have been acted upon at least 6 months. , may have fetishism disorder if aroused
by fabrics, materials, or garments; with autogynephilia if patient is sexually aroused by thought
or images of himself as a female.

Other Paraphilia’s

 Zoophilia- persistent and significant involvement in sexual activity with animal is rare.

 Urophilia- sexual arousal with urine.

 Coprophilia- sexual arousal with feces.

 Necrophilia- obsession and obtaining sexual gratification from cadaver.

 Hypoxyphilia- desire to archive an altered state of consciousness secondary to hypoxia while

experiencing oragasm.

 Telephone or computer scotolgia- characterized by obscene phone calling & involving an

unsuspected partner. Tension and arousal begin in anticipation of phoning; the recipient of the
call listens while the telephoner verbally exposes his preoccupations or induces her to talk about
her sexual activity.
  Mastubation- abnormal when it is only type of sexual activity performed in adulthood if a
partner is or might be available.

SEXUAL ADDICTION

Sexual addiction is best described as a progressive intimacy disorder characterized by compulsive sexual
thoughts and acts. No one factor is thought to cause sexual addiction, but there are thought to be
biological, psychological and social factors that contribute to the development of these disorders.

There are no distinct categories but sexual addictions can come in different forms, including addiction
to:

 Phone and/ or Cybersex

 Pornography

 Prostitution

 Compulsive Masturbation or fantasy

 Sadistic or masochistic behavior

 Illegal activities ( exhibitionism, voyeurism, obscene phone calls, childe molestation or rape.

 Other excessive sexual pursuits

If you are addicted to sex, you might become easily involved with people sexually or emotionally
regardless of how well you know them. Because most sex addicts fear being abandoned, they might stay
in relationships that aren’t healthy, or they may jump from relationship to relationsip. When alone, they
might feel empty or incomplete. They might also sexualize feelings like guilt, loneliness or fear.

Effects of a Sex Addiction can be Severe.

 According to Departmental Management of the USDA, about 38% of men and 45% of women
with sex addictions have a venereal disease as a result of their behavior. 40% of female Internet
users engage in problematic cybersex.

 39% - 42% of people struggling with sexually acting out are also struggling with substance abuse
issues.

 Pregnancy is also a common side effect that can occur due to risky behavior. In one survey,
nearly 70% of women with sex addictions reported they’d experienced at least one unwanted
pregnancy as a result of their addiction.
  Occupational consequences include decreased work performance or attendance due to the
preoccupation with the addiction

 If the behaviors result in unwanted sexual advances on others, legal problems like sexual
harassment or rape perpetration may result.

 Depending on the financial demands of the addiction, the sufferer of a sexual addiction may
incur a great deal of debt or engage in illegal or otherwise unsafe activity associated with the
behavior.

 The other side of the sex addiction "coin" are folks who exhibit a lack of interest, low interest in
sex, or are avoidant altogether all of which can indicate a medical problem or psychiatric illness.

Nursing Process
Assessment Nursing Diagnosis Client Goal Nursing Intervention Rationale Outcome Criteria Actual Evaluation
S: Sexual Dysfunction Patient’s Independent: After nursing Goal has been met
Patient may r/t altered body knowledge interventions, as evidenced by the
verbalized: structure and about >Establish nurse-client -To promote treatment patient will following:
-problem function sexual relationship and facilitate sharing of manifest the
sucah as loss dysfunctions feelings and problems in following:
of sexual will be regard to his condition -Verbalized
desire Scientific Basis: improved -Verbalize understand of
-inability to Due to the body >Obtain sexual history -To maximize understand of sexual anatomy
achieve structure done by including usual patterns of communication and sexual anatomy function and
desired the removal of the functioning and level of understanding function and alteration that may
satisfaction parts of the sexual desires alteration that may affect the functions
-conflicts organ in results to affect the functions
involving loss of sexual desire >Be alert to comments of -Sexual concerns are
values and satisfaction client often disguised as humor, -Verbalize
sarcasm, or offhand understanding of
O: Reference: remarks individualized -Verbalized
Nurse’s Labs.com >Identify current stressors in reasons for sexual understanding of
Alteration in individual situations -These factors may be problems individualized
relationship
producing enough reasons for sexual
with SO -Discuss concern
-change of >avoid making value anxiety to cause about body image problems
interest in judgements depression and sex role about
self and partner
others -They do not help client
-Discuseds concern
about body image
and sex role about
Dependent:
partner

Collaborative:
>Refer to physical and - These are helpful in
occupational therapy, identifying ways/devices
vocational counselor, to regain and maintain
psychiatric counseling, independence. Patients
clinical specialist psychiatric may need further
nurse, social services, and
assistance to resolve
psychologist as needed
persistent emotional
problem