Sexual Disorder

NCM 117/ PSYCHIATRIC NURSING/ LECTURE

SEXUAL DISODERS • Feelings, thoughts and perceptions that cause
• It refers to the difficulty experienced by an sexual problems.
individual or couple during any stage of a normal • Negative feelings for the partner or shame for
sexual activity including physical pleasure, desire, one’s own body,
preferences arousal or orgasm. • Unpleasant events of the past
• Fears and restraints related to sex.
SEXUAL RESPONSE CYCLE Social Factors
PHASE I DESIRE
PHASE II EXCITEMENT • May be values and standards that you have
PHASE III ORGASM received in your education
PHASE IV RESOULUTION • Traumatic events or the behavior of the partner
• Stress factors
Phase I. Desire
• Sexual activity occurs in response to verbal, I. GENDER IDENTITY DISORDER
physical and/or visual stimulation • Strong feelings of being born with the wrong
• Sexual fantasies can also bring about these gender.
desires. Incidence
Phase II. Excitement • One out if 11,900 men and one out of 30,400
• This is the phase of sexual arousal and erotic women
pleasure
• Physiological changes occur Types
1. Transsexualism
Male response: penile tumescence and erection
Female changes: vasocongestion in the pelvis, vaginal • Discomfort regarding one’s anatomic sex and a
feeling that it is inappropriate to one’s perceived
lubrication and expansion, and swelling of the external
gender.
genitalia.
• The person will be preoccupied with the wish to
Phase III. Orgasm get rid of one’s genitals and to adopt the sex
• Peaking of sexual pleasure, with release of sexual characteristics of the other sex.
tension and rhythmic contraction of the perennial 2. Gender identity disorder of childhood
muscles and reproductive organs.
• Similar to transsexualism with a very early age of
Women is marked by simultaneous rhythmic contractions onset.
of the uterus, the lower third of the vagina, and the anal
sphincter. 3. Dual role transsexualism

Men a forceful emission of semen occurs in response to
rhythmic spasms of the prostate, seminal vesicle, vas and
urethra.
Phase IV. Resolution
• Creating a sense of general relaxation
• Well-being, and muscular relaxation
• If orgasm does not occur, resolution may take 2-6
hours with irritability and discomfort
• Refractory period
Classification of Sexual Disorder
I. Gender identity disorder
II. Psychological and behavioral disorders associated with
sexual development and maturation.
III. Paraphilias
IV. Sexual Dysfunctions
ETIOLOGY AND PSYCHOPATHOLOGY
Physical Causes
• Anomalies of the body
• Irritations of the vagina that cause pain when
making love
• Operations on the genitals
• Being sexually aroused by fantasies about
wearing clothes of the opposite sex.
4. Intersexuality
• The patients have anatomical or physical features
of the other sex (Turner syndrome, congenital
adrenal hypoplasia)
Effects: GID can cause depression and other misery
TREATMENT
1. Transsexual Gender Identity Disorder
• Psychotherapy (Changing the feelings)
• Sex reassignment surgery, (SRS) (Changing the
body)
2. 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.
II. PSYCHOLOGICAL AND BEHAVIORAL DISORDERS
ASSOCIATED WITH SEXUAL DEVELOPMENT AND
MATURATION
Homosexuality
1. Obligatory homosexuality

Psychological Factors • Only homosexuality

Sexual Disorder
NCM 117/ PSYCHIATRIC NURSING/ LECTURE
• No heterosexuality
2. preferred homosexuality
• Predominant homosexuality
• Occasional homosexuality
3. Bisexuality
• Equal to homosexuality and heterosexuality
4. Latent homosexuality
• Only heterosexuality
• Fantasies of homosexuality
TREATMENT
For seeking a change in sexual orientation
• Behavior therapy, aversion therapy (rarely used),
covert sensitization, supportive psychotherapy,
etc.
For seeking removal of distress only
• Antidepressants and benzodiazepines.
Referred by others
• No treatment and treat as early as possible.
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.
These disorders include:
1. 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
consents to this, using pain causing material during sexual
contact, for example whisps or chains. The person with
whom there is sexual contact is often a sexual masochist.
2. Masochism – 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.
3. Voyeurism – getting sexually aroused by fantasies about
secretly watching others permission during sexual
activities, undressing or being naked. Watching
pornography not included.
4. Pedophilia – getting sexually aroused by a child in pre
puberty or child younger than 13 years old.
5. Frotteurism – getting sexually aroused by touching and
rubbing oneself against another non-consenting person
(usually other sex) e.g., crowded place and buses.
6. Fetishism – getting sexually arouses by non-living and
generally not sexually arousing objects. (e.g., shoes,
lingerie, soft fabrics, etc.)
7. Transvestites – gets sexually aroused by fantasies
about wearing clothes of the opposite sex.
8. Exhibitionism – getting sexually aroused by the idea of
showing the genitals to an unsuspecting stranger to
achieve orgasm. (Usually a female child or adult)
9. Other paraphilia
• 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.
• 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.
Social consequences
• Feelings of shame, contempt or anger towards the
person are very frequent.
Treatments
1. space can be created for the development of the
paraphilia
• In this case patients get tips for getting I 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.
Biological Treatment
3. Focused on blocking or decreasing the level of
circulating androgens
• Testosterone synthesis or block androgen
receptors.
• It decreases the libido.
Psychoanalytical therapy
4. Therapist helps the client to identify unresolved conflicts
and traumas from early childhood.
5. Thus, relieving the anxiety that prevents him or her from
forming appropriate sexual relationships.
Behavioral Therapy
1. Aversion therapy – involve paring noxious stimuli, such
as electric shocks and bad odors, with the impulse which
then diminishes.
Sexual Disorder
NCM 117/ PSYCHIATRIC NURSING/ LECTURE
2. Behavioral therapy – includes skills training and
cognitive restructuring in an effort to change the
individual’s maladaptive belief.
IV. SEXUAL DYSFUNCTIONS
• Sexual dysfunction is a significant disturbance in
the sexual response cycle, which is not due to an
underlying organic cause.
Causes
• This needs certain hormones and the right touch.
• Hormonal disorders
• Certain medication and depression can block this
stimulation.
Psychological Factors
• Finding your partner unattractive
• Having negative thoughts about making love
• Recalling unpleasant fantasies about making love
• Negative emotions
• Stress and fears
by expressed dissatisfaction with sexual
behaviors (e.g., voyeurism, trasvestism)
• Low self esteem related to rejection by peers as
evidenced by difficulty accepting positive
reinforcement; self-negating verbalization;
inability to form close personal relationships.
• Disturbed personal identity related to parenting
patterns that encourage culturally unacceptable
behaviors for assigned gender as evidenced by
statements of desiring o be of the opposite
gender; exhibiting behaviors culturally associated
with the opposite gender.
• Impaired social interaction related to social and
culturally unacceptable behaviors evidenced by
peer rejection and identification with members of
the opposite gender.

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.

Common Dysfunctions are:

• Frigidity – absence of desire for sexual activity
• Impotence – inability to have or sustain penile
erection till the completion of satisfactory sexual
activity.
• Premature ejaculation – ejaculation before the
completion of satisfactory sexual activity for both
partners.
• Non-organic vaginismus – an involuntary spasm
of lower 1/3 of vagina interfering with coitus.
• Non – organic dyspareunia – pain in the genital
area of either male or female during coitus.

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.
Other therapies include:
• Psychoanalysis
• Hypnosis
• Group psychotherapy
• Behavior therapy
Nursing Intervention for Client with Sexual Disorder
• 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.
• Ineffective sexuality patterns related to conflicts
with orientation or variant preferences evidenced