Sexual disorder

sexual response cycle and sexual disorders with nursing diagnosis

1. SEXUAL DISORDERS PRESENTATION BY MS NEHA BHATT

2. Sexual disorders It refers to the difficulty experienced by an individual or couple during any stage of a normal sexual activity including physical pleasure , desire , preferences arousal or orgasm .

3. THE SEXUAL RESPONSE CYCLE Phase I. Desire Phase II. Excitement Phase III. Orgasm Phase IV. Resolution

4. PHASE I. DESIRE Sexual activity occurs in response to verbal, physical, and/or visual stimulation. Sexual fantasies can also bring about this desire.

5. PHASE II. EXCITEMENT This is the phase of sexual arousal and erotic pleasure. Physiological changes occur. Male responds Penile tumescence and erection. Female changes include vasocongestion in the pelvis, vaginal lubrication and expansion, and swelling of the external genetalia .

6. PHASE III. ORGASM Peaking of sexual pleasure, with release of sexual tension and rhythmic contraction of the perennial muscles and reproductive organs Women is marked by simultaneous rhythmic contractions of the uterus, the lower third of the vagina, and the anal sphincter. Men a forceful emission of semen occurs in response to rhythmic spasms of the prostate, seminal vesicle, vas and urethra.

7. PHASE IV. RESOLUTION creating a sense of general relaxation, well-being, and muscular relaxation. If orgasm does not occur, resolution may take 2 to 6 hours with irritability and discomfort. Refractory period

8. CLASSIFICATION OF SEXUAL DISORDER Gender identity disorder Psychological and behavioural disorders associated with sexual development and maturation Paraphilias Sexual dysfunctions

9. ETIOLOGY AND PSYCHOPATHOLOGY Physical causes Anomalies of the body Irritations of the vagina that cause pain when making love operations on the genitals.

10. Psychological factors Feelings, thoughts and perceptions that cause sexual problems. Negative feelings for the partner or shame for one's own body, Unpleasant events of the past. Fears and restraints related to sex.

11. Social factors May be values and standards that you have received in your education, Traumatic events or the behavior of the partner. Stress factors

12. GENDER IDENTITY DISORDER Strong feelings of being born with the wrong gender. Incidence One out of 11900 men and one out of 30400 women. Types a. Transexualism b. Gender identity disorder of childhood c. Dual role transvestism d. Inter sexuality

13. a) Transsexualism Discomfort regarding one’s anatomic sex and a feeling that it is inappropriate to one’s perceived gender. The person will be preoccupied with the wish to get rid of one’s genitals and to adopt the sex characteristics of the other sex.

14. b. Gender identity disorder of childhood Similar to transsexualism with a very early age of onset. c. Dual – role Transsexualism Being sexually aroused by fantasies about wearing clothes of the opposite sex. d. Inter sexuality The patients have anatomical or physical features of the other sex. (Turner syndrome, congenital adrenal hypoplasia.) Effects - GID can cause depression and other misery.

15. Treatment Transsexual Gender Identity Disorder Psychotherapy (changing the feelings) Sex reassignment surgery, (SRS) (changing the body). Gender identity disorder of childhood Help the child avoid peer ostracism and humiliation, be comfortable with is or her own sex, Avoid the development of adult gender dysphoria.

16. II. PSYCHOLOGICAL AND BEHAVIOURAL DISORDERS ASSOCIATED WITH SEXUAL DEVELOPMENT AND MATURATION Homosexuality Types Obligatory homosexuality Preferred homosexuality Bisexuality Situational homosexuality Latent homosexuality

17. 1. Obligatory homosexuality  Only homosexuality  No heterosexuality 2. Preferred homosexuality  Predominant homosexuality  Occasional homosexuality 3. Bisexuality  Equal to homosexuality & heterosexuality 4. Latent homosexuality  Only hetro sexuality  Fantasies of homosexuality

18. TREATMENT For seeking a change in sexual orientation  Behaviour therapy, aversion therapy (rarely used), covert sensitization, supportive psychotherapy, etc... For seeking removal of distress only  Antidepressants and benzodiazepines Referred by others  No treatment & treat as earl as possible.

19. III. PARAPHILIAS A paraphilia is a recurring sexually exciting fantasy, impulse or behavior related to non-human objects e.g things, fabrics, designs, the suffering or humiliation of oneself or the partner, children or other non-consenting persons. Incidence No statistics available, much more frequently in men than women

20. These disorders includes ♦ Sadism ♦ Masochism ♦ Voyeurism ♦ Pedophilia ♦ Frotteurism ♦ Fetishism ♦ Transvestites ♦ Exhibitionism ♦ Other paraphilia

21. SADISM Getting sexually aroused by fantasies about doing psychological or physical harm to a victim. This can mean getting aroused by humiliating another person, who often consents to this, using pain-causing material during sexual contact, for example whips or chains. The person with whom there is sexual contact is often a sexual masochist.

22. MASOCHISM Masochism is getting sexually aroused by fantasies about being humiliated, beaten, tied up or otherwise tortured. Sadism is getting sexually aroused by incurring humiliate, beating, tying up or otherwise torturing. Sado-Masochism is the combination of Sadism and Masochism in a complementary manner.

23. VOYEURISM Getting sexually aroused by fantasies about secretly watching others permission during sexual activities, undressing or being naked. Watching pornography not include. PEDOPHILIA Getting sexually aroused by a child in pre-puberty or child younger than13 years old.

24. FROTTEURISM Getting sexually aroused by touching and rubbing oneself against another non-consenting person. (usually other sex) E.g Crowded place and buses FETISHISM Getting sexually aroused by non-living and generally not sexually arousing objects, e.g shoes, lingerie, soft fabrics, etc.

25. TRANSVESTITES Gets sexually aroused by fantasies about wearing clothes of the opposite sex. EXHIBITIONISM Getting sexually aroused by the idea of showing the genitals to an unsuspecting stranger to achieve orgasm. (usually a female Child or adult)

26. OTHER PARAPHILIAS Telephone scatologia: Getting sexually aroused by fantasies about harming or humiliating others through the phone. Necrophilia: Getting aroused by fantasies about sexual activities with corpses. Partialism: Getting aroused by fantasies about certain body parts. Zoophilia: Getting aroused by fantasies about sexual activities with animals.

27. Coprophilia Getting aroused by fantasies about feces. Klismaphilia Getting aroused by fantasies about injecting liquids via the anus. Urolagnia Getting aroused by fantasies about urine.

28. SOCIAL CONSEQUENCES Feelings of shame, contempt or anger towards the person are very frequent.

29. TREATMENT Treatment may be focused on two areas. Space can be created for the development of the paraphilia.  In this case patients get tips for getting in contact with fellow-sufferers and accepting themselves. 2) On the other hand the paraphilia can be suppressed so that it occupies a smaller and more controllable place in the life of the person.

30. BIOLOGICAL TREATMENT Focused on blocking or decreasing the level of circulating androgens.  Testosterone synthesis or block androgen receptors.  It decreases the libido.

31. PSYCHOANALYTICAL THERAPY Therapist helps the client to identify unresolved conflicts and traumas from early childhood. Thus relieving the anxiety that prevents him or her from forming appropriate sexual relationships.

32. BEHAVIOURAL THERAPY Aversion therapy Involve paring noxious stimuli, such as electric shocks and bad odors, with the impulse which then diminishes. Behavioural therapy Includes skills training and cognitive restructuring in an effort to change the individual’s maladaptive beliefs.

33. IV. SEXUAL DYSFUNCTIONS Sexual dysfunction is a significant disturbance in the sexual response cycle, which is not due to an underlying organic cause.

34. CAUSES Physical stimulation This needs certain hormones and the right touch. Hormonal disorders. Certain medication and depression can block this stimulation.

35. Psychological factors Finding your partner unattractive Having negative thoughts about making love Recalling unpleasant fantasies about making love Negative emotions Stress and fear.

36. Social causes May be problems between the partners. Communication problems (one wants to sleep, the other feels rejected by this) Struggle for power between the partners.

37. The common dysfunctions are Frigidity Impotence Premature ejaculation Non-organic vaginismus Non-organic dyspereunia

38. a. Frigidity Absence of desire for sexual activity. b. Impotence Inability to have or sustain penile erection till the completion of satisfactory sexual activity. c. Premature ejaculation Ejaculation before the completion of satisfactory sexual activity for both partners.

39. d. Non- organic vaginismus: An involuntary spasm of lower 1/3rd of vagina, interfering with coitus. e. Non- organic dyspareunia: Pain in the genital area of either male or female during coitus.

40. TREATMENT Both Men and Women There are no standard treatments for a reduced interest in sex. Counseling about reduced desire in stressful situations like death, unemployment, being childless, disease of the partner or stress at work. If all sexual interest has disappeared, the hormonal regulation should be examined.

41. Other therapy includes: Psychoanalysis Hypnosis Group psychotherapy Behavior therapy

42. NURSING INTERVENTIONS FOR CLIENT WITH SEXUAL DISORDER Nursing diagnosis I : Sexual dysfunction related to depression and conflict in relationship; biological or psychological contributing factors to the disorder evidenced by loss of sexual desire or function. Nursing Diagnosis II: Ineffective sexuality patterns related to conflicts with orientation or variant preferences evidenced by expressed dissatisfaction with sexual behaviours (e.g., voyeurism; trasvestism ) Nursing diagnosis III: Low self esteem related to rejection by peers evidenced by difficulty accepting positive reinforcement; self-negating verbalizations; inability to form close personal relationships.

43. Nursing diagnosis IV: Disturbed personal identity related to parenting patterns that encourage culturally unacceptable behaviours for assigned gender evidenced by statements of desiring to be of the opposite gender; exhibiting behaviors culturally associated with the opposite gender. Nursing diagnosis V: Impaired social interaction related to social and culturally unacceptable behaviours evidenced by peer rejection and identification with members of the opposite gender.

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