SEXUAL AND GENDER IDENTITY DISORDER

I.Sexual and Gender Identity Disorders e. Allowing judgmental thoughts to

A. Description intervene
1. Disorders of sexual functioning are characterized f. Poor relationship choices that can result in partner
by a disturbance in sexual desire and changes in the rejection
sexual response cycle that causes significant distress g. Lack of trust
and interpersonal difficulty. h. Power struggles
2. The four classifications are sexual dysfunctions, i. Sexual sabotage
gender identity disorder, paraphilias, and sexual
disorder not otherwise specified. C. Types of Sexual Dysfunction
3. Sexual desire disorders are influenced by a
variety of factors, such as age, availability of a 1. Hypoactive sexual desire disorder
partner, health, and leisure. a. Recurrent or persistent deficit or absence of
sexual fantasies and desire for sexual activity
B. Theories of Sexual Disorders b. Not diagnosed for older adults and those who
1. Biological causes have hormonal abnormalities
a. General illness that may contribute c. Primarily developed in puberty to adulthood
1) Influenza d. Disturbance causes marked distress or
2) Colds interpersonal difficulty.
3) Fatigue e. Not explained by a substance abuse or medical
4) Diabetes condition
5) Hepatitis
6) Multiple sclerosis 2. Sexual aversion disorder
7) Arthritis a. Aversion to and active avoidance of genital
8) Back pain sexual contact with a partner
9) Obesity b. Anxiety, fear, or disgust with sexual encounter
10) Vaginal infections ranging from lack of pleasure to extreme
11) Late stages of pregnancy psychological distress
12) Postmenopausal women may need lubrication. c. Criteria to meet the disorder need to cause the
13) Older male responses are slowed. marked distress in interpersonal functioning.
d. Dysfunction is not the result of another sexual
2. Hormonal causes disorder.
a. Medications cause a decrease in androgen levels,
such as hypopituitary problems. 3. Sexual arousal disorders, male and female
b. Feminizing effects of testicular tumors a. May be accompanied by sexual desire disorder or
c. Alcohol, cocaine, and heroine use female orgasmic disorder
d. Use of hypertensive drugs b. Male erectile disorder associated with sexual
e. Use of phenothiazine anxiety
f. Selective serotonin reuptake inhibitors (SSRIs) c. Fear of failure and concerns about sexual
and other antidepressants may cause sexual performance
difficulties. d. Decreased subjective sense of sexual excitement
and pleasure
3. Psychological causes of sexual dysfunction e. Spontaneously remit 15% to 30% of the time
a. Failure to understand the partner’s desires
b. Anxiety due to fear of failure 4. Orgasmic disorders
c. Partner or self-demand for performance or a. Persistent or recurrent delay in or
excessive need to please absence of orgasm
d. Perceptual and intellectual defenses b. Female orgasmic disorder: often not
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interested in orgasm Nursing Interventions
c. Male orgasmic disorder: persistent or current
delay or absence of orgasm after normal sexual 1. Provide sexual counseling consisting of taking a
excitement complete general history.
d. Inhibited desire could be due to an 2. Perform a complete physical examination to rule
endocrinological dysfunction such as an elevation in out organic causes.
the hormone prolactin or a small pituitary tumor 3. Obtain the client’s sexual history.
that may reduce libido or sexual interest. 4. Assess communication patterns and expectations.
Testosterone levels and normal aging also decrease 5. Assess if primary focus is sexual or psychosocial
sexual interest. in origin.
6. Promote anxiety reduction.
5. Premature ejaculations 7. Encourage couple counseling to discuss sexual
a. Male orgasm and ejaculation takes place with needs and desires openly.
minimal physical stimulation and before expected. 8. Promote construction of a healthy relationship.
b. Disturbance causes marked distress or 9. Promote mutual respect.
interpersonal difficulty.
c. Not due exclusively to direct effect of substance II. Nursing Diagnoses
abuse A. Anxiety
B. Ineffective Role Performance
6. Male erectile disorder C. Social Isolation
a. Difficulty achieving or maintaining an erection D. Ineffective Coping
b. Disorder causes marked distress or interpersonal E. Interrupted Family Processes
difficulty.
c. Not explained by the effects of substance abuse III. Gender Identity Disorder
or medical condition A. Description
7. Sexual pain disorder 1. Strong and persistent crossgender identification
a. Found in both males and females; associated with 2. Persistent discomfort with gender
genital pain during intercourse 3. Sense of inappropriateness in gender role
b. Vaginismus consists of contraction of the 4. In adolescents, there is a preoccupation with
peritoneal muscles surrounding the outer third of getting rid of primary and secondary sex
the vagina. characteristics through hormones.
c. May still experience desire and pleasure 5. Disturbance is not concurrent with physical
d. Often found in women who have been sexually intersex condition.
abused or traumatized 6. Disturbance causes clinically significant distress
or impairment in social, occupational, or other
D. Assessment areas of functioning.
1. Overly concerned with 7. Etiology is unknown but childhood patterns seem
physical changes occurring to be fairly consistent.
at puberty 8. Children as early as 2–4 years of age have cross-
2. Prefer opposite-sex behaviors gender interests and activities.
into adulthood 9. Childhood history of gender identity disorder;
3. Desire sexual reassignment may report a homosexual or bisexual orientation
10. May not consider herself to be homosexual and
only wants gender reassignment

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B. Assessment 3. Diagnostic criteria must be present for at least 6
1. Repeatedly stated desire to be the opposite sex months.
2. In males, preference for crossdressing or 4. Fantasies, sexual urges, or behaviors are causing
simulating female attire significant distress or impairment in social
3. Girls’ insistence on wearing only masculine occupational or other areas of functioning.
clothing
4. Strong and persistent preferences for cross-sex B. Types of Paraphilias
roles in play or fantasy
5. Intense desire to participate in the stereotypical 1. Fetishism: presence of intense sexual arousal
games and pastimes of the other sex involving inanimate objects; sexual arousal
6. Strong preference for playmates of the opposite occurring from contact with a nonliving object such
sex as an article of clothing
7. Boys prefer feminine dress and gravitate toward
female friends and activities. 2. Pedophilia involves sexual interest directed
8. Girls exhibit masculine behavior. primarily or exclusively toward children 13 years or
9. Anxiety with body changes further defining younger.
gender a. May only be recurrent fantasies or urges
b. Pedophile generally conservative married male
C. Medical Management but must be at least 16 years old and at least 5 years
1. Hormone therapy is the first step. older than the child
a. Changes bodily characteristics c. Often occurs in families with older male and
b. May require the client to live in crossgender younger female
mode for 1–2 years before reassignment is made d. When it occurs in families, it is called incest.

D. Nursing Interventions 3. Exhibitionism is the intentional display of

1. Encourage the client to verbalize feelings. genitals in public places, often accompanied by
2. Encourage counseling for coping solutions. masturbation, to elicit shock, resulting in sexual
3. Surgical reassignment arousal occurring from exposing genitals to
4. Recognize that legal, social, familial, and strangers.
employment adjustments may be a factor. a. Typical profile is a sedate middle-class male.
5. Accept the client who is happy and productive
without undergoing surgery. 4. Voyeurism is viewing in intimate situations or
6. Accept the client who feels unable to function fantasizing about observing others disrobing, naked,
without surgical reassignment. or involved in sexual activity.

IV. Paraphilias a. Called “peeping tom” and peeping becomes

A. Description compulsive and preferable to other sexual activity
1. Consist of several features b. Usually heterosexual male who wishes no contact
a. Recurrent and intense sexually arousing fantasies, with those he is watching
sexual urges, or behaviors involving inanimate c. Typically shy, socially unskilled, and without
objects close friends
b. Can involve suffering or humiliation of oneself
or one’s partner 5. Transvestitism is sexual satisfaction by means of
c. Can involve use of children or other dressing in the clothing of the opposite gender.
nonconsenting individuals, often triggered by stress a. Usually develops early in life
2. History, culture, and experience play a role. b. Not related to sexual orientation issues and there
is no desire for sex change
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c. Heterosexuals often receive the cooperation and 7. Engage in activities that are repulsive or
support of partners. uncomfortable to please a partner

6. Frotteurism involves the sexual touching, rubbing C. Nursing Interventions

against, or fondling of a nonconsenting individual, 1. Encourage the client to seek out a safe, caring,
usually a stranger, to achieve sexual satisfaction. and understanding community.
a. Usually occurs in public places where there is an 2. Provide the client with individual counseling.
easy escape after the behavior 3. Encourage support groups or friends.

7. Sexual sadism and masochism

a. Giving (sadism) and receiving (masochism)
psychological or physical pain, or both
b. Domination to achieve sexual gratification
occurs.
c. Treatment is usually cognitive and behavioral
therapy with an attempt to help the individual learn
a new sexual response pattern.
d. Positive reinforcement is given for appropriate
object choices.
e. Aversion techniques in which mild electric shock
may be used for inappropriate choices
f. Psychodynamic techniques to help the client
understand the etiology of the disorder

C. Medical Management for

Paraphilias
1. Pharmacological
2. Cognitive therapy
3. Behavioral therapy
4. Psychodynamic therapy

5. Combination therapy is usually effective over an

extended period of time.

V. Sexual Addictions
A. Description: sexual addictions occur when sex
and sexual encounters become the primary way of
attempting to fill emptiness.

B. Assessment
1. Compelled to have frequent sex
2. Bewildered by own sexual behavior
3. Pattern of unsuccessful love relationships
4. Chaos and drama are often present.
5. Sexual encounters involve alcohol, drugs, or
compulsive eating.
6. Need to escape after sex
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