Sexual Disorders

SEXUALITY AND SEXUAL DISORDER ACROSS LIFE SPAN

Developmental Stage Childhood Adolescence

Sexual Issues
Identification with gender Identity development

Young adulthood
Adulthood Middlescence Old Age

Intimate relationship development Generativity, guiding children Redefinition of Identity Changing physical and mental conditions

DESIRE Strong urge of sexual stimulation & satisfaction EXCITEMENT / AROUSAL Prepares both partners for intercourse PLATEAU Full arousal ORGASM Peak of sexual excitement RESOLUTION Body returns to normal unexcited state

HUMAN SEXUAL RESPONSE CYCLE

SEXUAL DISORDERS
1. PARAPHILIAS 2. SEXUAL DYSFUNCTIONS

Sexual desire disorder Sexual Arousal disorder Orgasmic Disorder Sexual Pain Disorder Sexual Dysfunction due to General Medical Condition Substance-Induced Sexual Dysfunction 3. GENDER IDENTITY DISORDER

I. PARAPHILIAS

Are complex psychosexual disorders marked by sexual urges, fantasies, or behaviors that center on :

Inanimate objects (such as clothing) Suffering or humiliation Children or other non-consenting persons

SPECIFIC PARAPHILIAS
1. 2. 3. 4. 5. 6. 7. 8. 9.

EXHIBITIONISM FETISHISM TRANSVESTIC FETISHISM PEDOPHILIA FROTTEURISM SEXUAL MASOCHISM SEXUAL SADISM VOYEURISM RARE PARAPHILIAS

PARAPHILIA-RELATED DISORDERS

COMPULSIVE MASTURBATION

Masturbation is the primary sexual outlet, even if the person has a stable intimate relationship A pattern of repeated sexual conquests in which the person cant maintain a monogamous relationship despite a desire to do so. A repetitive pattern involving the use of pornographic materials. A dependence on discussing sex over the telephone to achieve arousal.

PROTRACTED PROMISCUITY

PORNOGRAPHY DEPENDENCY

TELEPHONE SEX

SEVERE SEXUAL DESIRE

Persons excessive demands burden the partner & interfere with intimate relationships
Marked by repetitive use of sex toys & drugs for sexual arousal

USE OF SEXUAL ACCESSORIES

EXHIBITIONISM
Marked by sexual fantasies, urges, or behaviors involving surprise exposure of the male genitals to strangers primarily female passersby in public places.

FETISHISM

Characterized by sexual fantasies, urges, or behaviors that involve the use of a fetish a nonhuman object or a nonsexual part of the body to produce or enhance sexual arousal.

TRANSVESTIC FETISHISM

A heterosexual male dresses in female clothes (called cross-dressing) to produce or enhance sexual arousal.

PEDOPHILIA

Is marked by sexual fantasies, urges, or activity involving a child, usually age 13 or younger. The pedophile is erotically aroused by children and seeks sexual gratification with them.
During sexual activity with the child, the pedophile may : Undress the child Encourage the child to watch him masturbate Touch or fondle the childs genitals Forcefully perform sexual acts on the child

FROTTEURISM

Becomes sexually aroused from touching or rubbing against a non-consenting person. This behavior frequently occurs in crowded places, where it is easier to avoid detection. Common between ages 15 and 25.

SEXUAL MASOCHISM

A person gets sexual gratification from being physically or emotionally abused. Related disorders:

INFANTALISM another form of sexual masochism, is a desire to be treated as a helpless infant, including wearing diapers. SEXUAL HYPOXYPHILIA relies on oxygen deprivation to induce sexual arousal.

SEXUAL SADISM
A person achieves sexual gratification by inflicting pain, cruelty, or emotional abuse on others. The sexual sadist may verbally humiliate his partner and abuse her physically through torture, whipping, cutting, binding, beating, burning, stabbing or rape.

VOYEURISM

Derives sexual pleasure from looking at sexual objects or sexually arousing situations, such as unsuspecting couple engaged in sex. He may experience an orgasm during the voyeuristic activity or later, in response to the memory of what he witnessed. (- Peeping Tom. )

Telephone Scatologia
Sexual

gratification is obtained from or during lewdness on the phone.

RARE PARAPHILIAS

COPROPHILIA

KLISMAPHILIA

Sexual attraction to feces Sexual attraction to vomit Sexual arousal by people who have committed crimes

EMETROPHILIA

Sexual pleasure from enemas Sexual attraction to corpses Sexual attraction to stuffed toys

NECROPHILIA

HYBRISTOPHILIA

PLUSHOPHILIA

Partialism is sexual

interest exclusively focused on a particular body part

UROLAGNIA/UROPHI LIA

Sexual attraction to urine Sexual attraction to animals

ZOOPHILIA

CAUSES
1. Unknown 2. Behavioral models the child was a victim of or observer of inappropriate sexual behaviors learns to intimidate such behavior and later gains reinforcement for it. 3. Contributing factors come from dysfunctional families marked by isolation and sexual, emotional, or physical abuse.

SIGNS and SYMPTOMSParaphilia

Anxiety

Depression
Development

of a hobby or an occupation change that makes the paraphilia more accessible Disturbance in body image Guilt or shame Ineffective coping

SIGNS and SYMPTOMS- Paraphilia

Multiple

paraphilia at the same time Purchase of books, videos or magazines related to paraphilia Recurrent fantasies about paraphilias Sexual dysfunction Social isolation Troubled social or sexual relationships

Treatments
Behavioral therapy aversive stimuli, such as bad odors or electric shocks. 2. Social skills training 3. Sex offender program 4. group therapy 5. rational thinking group 6. structured sexual disorder process group 7

1.

Treatments
7. Educational sessions 8. therapeutically structured recreational activities adventure based programming, arts and crafts, team sports, and experimental games 9. Resident and parent participation in treatment reviews 10. alcohol and drug awareness programs

Treatments

11. values clarification

12.

Independent living skills 13. Vocational exploration 14. Pharmacologic treatment hormones if with compulsive thinking

Nursing Interventions
Ensure a therapeutic relationship 2. Promote self-knowledge 3. Increase the level of interaction 4. Promote participation in care

1.

Nursing Interventions

. Improve coping skills

6.

Provide referrals 7. Be aware that whenever possible, a primary nurse should be assigned to the patient to ensure continuity of care. 8. if poses a threat, institute safety precautions

II. SEXUAL DYSFUNCTIONS

Are characterized by pain during sex or by a disturbance in one of the phases of the sexual response cycle.

Commonly linked to psychological factors, medical conditions, substance use, or in combination of these factors.

Types of sexual dysfunction

Sexual Desire Disorder/ Hypoactive Sexual Desire Disorder Sexual arousal disorder Orgasmic disorder Sexual dysfunction caused by medical conditions Sexual pain disorder

MEDICAL CONDITIONS THAT AFFECT SEXUAL FUNCTION

Medical

Conditions that result to Secondary Erectile Disorder, Secondary Dyspareunia, Secondary Vaginismus

DRUGS THAT AFFECT SEXUAL FUNCTION

*Usually the substance was ingested within 6 weeks of the sexual problems appearance Tagamet, Alcohol Antianxiety agents Cocaine, MJ, Heroin Anticholinergic agents Antidepressant agents Anticonvulsant agents Antipsychotic agents Antiarrhytmic agents Antihypertensive agents

FEMALE SEXUAL AROUSAL DISORDER AND FEMALE ORGASMIC DISORDER

FEMALE SEXUAL AROUSAL DISORDER

Inability to achieve or maintain an adequate lubrication-swelling response of sexual excitement.

FEMALE ORGASMIC DISORDER

Is the inability to achieve orgasm.

SIGNS and SYMPTOMS

FEMALE SEXUAL AROUSAL DISORDER

Decreased sexual desire Individual or family stress or fatigue Misinformation about sex & sexuality A pattern of dysfunctional sexual response Conceptual problems during childhood & adolescence about sex in general, and specifically about masturbation, incest, rape, sexual fantasies, and homosexual or heterosexual practices Concerns about contraception & reproductive ability Problems in the current sexual relationship Poor self-esteem & body image

SIGNS and SYMPTOMS

FEMALE ORGASMIC DISORDER

Persistent or recurrent delay in or absence of orgasm after a normal sexual excitement phase, during sexual activity deemed to be adequate. Marked distress or interpersonal difficulty because of the disturbance.

TREATMENTS

SEXUAL AROUSAL DISORDER

Help to feel relax and become aware of feelings about sex, and eliminate guilt and fear of rejection. Psychotherapy

Consists of free association, dream analysis, and discussion of life patterns to achieve greater sexual awareness Correct maladaptive patterns through systemic desensitization to situations that provoke anxiety

Behavioral therapy

TREATMENTS

ORGASMIC DISORDER

Decrease or eliminate involuntary inhibition of the orgasmic reflex. Experimental therapy Psychoanalysis Behavior modification Individual or marital therapy Sex therapy Self-stimulation & distraction techniques

Nursing Interventions
Ensure a therapeutic relationship 2. Promote self-knowledge 3. Increase the level of interaction 4. Promote participation in care

1.

Nursing Interventions Orgasmic Disorder

5. Improve coping skills

6.

Provide referrals 7. Be aware that whenever possible, a primary nurse should be assigned to the patient to ensure continuity of care. 8. if poses a threat, institute safety precautions

Sexual Desire Disorder/ Hypoactive Sexual Desire Disorder

characterized by a deficient, absent or extreme aversion to and avoidance of sexual activity that caused a marked strain in interpersonal relationships. This disorder affects more women than men Sexual anhedonia (decreased or absent pleasure in sexual activity)

Signs & Symptoms

Lack of interest in sex Infrequent sexual activity Engages in sex often only to satisfy partner

Treatment:

Removing the cause treats the disorder

Sexual Aversion Disorder

It is characterized by persistent or recurrent dislike and avoidance of sexual activity or genital contact with a sexual partner More common in females than in males.

Causes: Traumatic sexual experience ( incest, rape, initial intercourse that caused dyspareunia ) Rigid religious training Repressive childhood

Treatments :
Marital therapy Psychotherapy if due to painful past sexual experiences Behavioral therapy Sexual counseling for client and partner

Premature Ejaculation
orgasm and ejaculation occurring before, during or shortly after penetration and before the man desires. Often cause is a combination of psychological and physiologic factors Treatment with small doses of SSRI is usually successful

TREATMENTS
Insight therapy Behavioral therapy Experiential sessions involving partner Squeeze play Sensate focus exercises Stop-and-start technique

Nursing Interventions

1. Ensure a therapeutic relationship 2. Promote self-knowledge 3. Increase the level of interaction 4. Promote participation in care 5. Improve coping skills 6. Provide referrals 7. Be aware that whenever possible, a primary nurse should be assigned to the patient to ensure continuity of care. 8. if poses a threat, institute safety precautions

III. SEXUAL PAIN DISORDERS

DYSPAREUNIA

Occur in both males and females, unexplained genital pain occurs before, during, or after intercourse that restrict the enjoyment of sex.

VAGINISMUS

Involuntary spasmodic muscle contractions occur at the entrance to the vagina when the male tries to insert his penis.

CAUSES

DYSPAREUNIA

Acute or chronic infections of the GUT Allergic reactions Tumors, deformities, scars & lesions Endometriosis Intact hymen Local trauma
Psychological factor pain Strict cultural and religious background Fears of pregnancy or being controlled by a man Physical after effects of childbirth

VAGINISMUS

TREATMENTS

DYSPAREUNIA

Creams & water-based jellies Medications for infections Excision of hymenal scar Gentle stretching of painful scars Change in coital position
Couples therapy Kegel exercises Sensate focus exercises Plastic dilator or finger

VAGINISMUS

IV. GENDER IDENTITY DISORDER

is a condition with which a person who has been assigned one gender(usually at birth on the basis of their sex, but compare intersexuality), but identifies as belonging to another gender, or does not conform with the gender role their respective society prescribes to them. It is a psychiatric term for what is widely known by terms like transexuality, transgender and transvestism or cross dressing

SIGNS and SYMPTOMS

Believed

SEX Attempts to mask or remove sex organs Cross dressing Depression Disturbance in body image Dreams of cross-gender identification Fear of abandonment by family & friends

they were born the WRONG

SIGNS and SYMPTOMS

Finding ones genitals DISGUSTING Ineffective coping strategies Peer ostracism Preoccupation with appearance Self-hatred Self-medication with hormonal therapy Strong attraction to stereotypical activities of the opposite sex Suicide attempts or ideation

TREATMENTS
Individual and couples therapy Hospitalization if with potential for violence Group or individual psychotherapy Family therapy for a child, role modeling purposes Sex re-assignment surgery through hormonal therapy and sex-change surgery, optional, for concomitant personality disorders

Nursing Interventions

1. Ensure a therapeutic relationship 2. Promote self-knowledge 3. Increase the level of interaction 4. Promote participation in care 5. Improve coping skills 6. Provide referrals 7. Be aware that whenever possible, a primary nurse should be assigned to the patient to ensure continuity of care. 8. if poses a threat, institute safety precautions

Thank you!