SEXUAL DISORDERS

any disorder involving sexual functioning, desire, or performance.

include problems of sexual identity, sexual performance, and sexual aim. The disorder causes marked distress or interpersonal difficulty. The dysfunction is not caused by substance use or a general medical condition.

Psychological causes of sexual disorders include: Interpersonal problems with sexual partner Guilt about sexual activity (often in persons with religious or puritanical upbringing) Fears (pregnancy, rejection, loss of control, etc.)

Main Categories:
A. Sexual Dysfunctions B. Paraphilia C. Gender Identity Disorder

A. A. SEXUAL DYSFUNCTIONS SEXUAL DYSFUNCTIONS

persistent impairment/disturbance of a normal or desired pattern in any phase of the sexual response cycle. cognitive, affective, and / or behavioral problems that prevent an individual or couple from engaging in and / or enjoying satisfactory intercourse and orgasm. Sexual dysfunctions prevent or reduce an individual's enjoyment of normal sex and prevent or reduce the normal physiological changes brought on normally by sexual arousal.

SEXUAL RESPONSE CYCLE

SEXUAL RESPONSE CYCLE

1. DESIRE sexual fantasy & desire

2. EXCITEMENT subjective sense of sexual pleasure with accompanying physical changes that occur during sexual arousal (male: erection // female: vaginal lubrication) 3. ORGASM peaking of the sexual pleasure and the release of sexual tension ; flexive, involuntary contraction of pelvic muscles (penis ejaculates &vagina contracts)
4. RESOLUTION generalized and muscular relaxation & sense of well-being Men refractory period Women no refractory period, multiple orgasms possible

A. SEXUAL DYSFUNCTIONS
Classification: (DSM IV TR) 3) Orgasmic disorder Female orgasmic disorder/inhibited 1) sexual desire disorder female orgasm hypoactive sexual Male orgasmic desire disorder disorder/ejaculatory sexual aversion incompetence disorder Premature ejaculation 2) sexual arousal disorder 4) Sexual pain disorder female sexual arousal Vaginisumns disorder Dyspareunia Erectile dysfunction

A. SEXUAL DYSFUNCTIONS

SEXUAL DYSFUNCTIONS A.A. SEXUAL DYSFUNCTIONS

a. Sexual Desire Disorders Hypoactive sexual desire disorder: persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual activity. It results in a complete or almost complete lack of desire to have any type of sexual relation. This can often result in the participation in intercourse as a simple marital duty. Sexual aversion disorder: avoidance of genital contact with a sexual partner.; sexual activity actually repulses the person or makes them unusually apprehensive.

SEXUAL DYSFUNCTIONS A.A. SEXUAL DYSFUNCTIONS

b. Sexual Arousal Disorders - persons cannot maintain the physiologic requirements for sexual intercourse
Erectile dysfunction: is the inability of males to attain or sustain erection long enough for coitus.

Sexual arousal disorder: persistent or recurrent partial or complete failure to attain or maintain the lubrication swelling response of sexual excitement until the completion of the sexual act; inability of females to become sexually aroused

SEXUAL DYSFUNCTIONS A.A. SEXUAL DYSFUNCTIONS

c. Orgasm Disorders - persons cannot complete the sexual response cycle because of the inability to achieve an orgasm Premature ejaculation: inability to control ejaculation so that it occurs before satisfying sexual relations; persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. Ejaculatory incompetence: the lack or delay of reaching orgasm in males; achieves orgasm with great difficulty
Inhibited female orgasm: the lack or delay of reaching orgasm in females; inability to have an orgasm after a normal excitement phase

SEXUAL DYSFUNCTIONS A.A. SEXUAL DYSFUNCTIONS

d. Sexual Pain Disorders
Dyspareunia: Genital pain before, during, or after sexual intercourse; much higher incidence in women than men; often associated with vaginismus. Vaginismus: Involuntary muscle contraction of the outer third of the vagina during insertion of penis or object (such as speculum or tampon); increased incidence in higher socioeconomic groups and in women of strict religious upbringing.

A. SEXUAL DYSFUNCTIONS
ETIOLOGY: 1) Psychological causes:
Stress or anxiety from work or family responsibilities Concern about sexual performance Conflicts in the relationship with partner Depression / anxiety Unresolved sexual orientation issues. Previous traumatic sexual or physical experience Body image and self esteem problems.

A. SEXUAL DYSFUNCTIONS
ETIOLOGY: 2) Physical causes :
Diabetes hearts disease liver disease kidney disease pelvic surgery pelvic injury or trauma
neurological disorders medication side effects hormonal changes alcohol or drug abuse fatigue

A. SEXUAL DYSFUNCTIONS
ETIOLOGY: 3) Interpersonal relationship :
Partner performance and technique Lack of partner Relationship quality and conflict Lack of privacy

4) Socio cultural :
Inadequate education Conflict with religious, personal or family values. Societal taboos.

A. SEXUAL DYSFUNCTIONS
ETIOLOGY: 3) Interpersonal relationship :
Partner performance and technique Lack of partner Relationship quality and conflict Lack of privacy

4) Socio cultural :
Inadequate education Conflict with religious, personal or family values. Societal taboos.

A. SEXUAL DYSFUNCTIONS
TREATMENT:
1) Biological treatment a) Pharmacotherapy Sildenafil oral phentolamine alprostadil transurethral alprostadil (erectile disorder) Antianxiety agents Bromocriptive, a dopamine agonist, may improve sexual function impaired by hyperprolocatinemia Dopaminergic agents have been reported to increase libido and improve sex function.

A. SEXUAL DYSFUNCTIONS
TREATMENT: 1) Biological treatment

b) Hormone therapy androgens increase the sex drive. Antiestrogens increases libido

A. SEXUAL DYSFUNCTIONS
TREATMENT:
1) Biological treatment c) Mechanical treatment approaches Vacuum pump: These are mechanical devices that patients without vascular diseases can use to obtain erections. The blood drawn in to the penis following the creation of the vacuum is kept there by a ring placed around the base of the penis. EROS: A device developed to create clitoral erections in women. It is a small suction cup that fits over the clitoral region and drawn blood in to the clitoris.

A. SEXUAL DYSFUNCTIONS
TREATMENT:
1) Biological treatment

d) Surgical treatment:
Male prostheses Vascular surgery Hymenectomy for dyspareunia Vaginoplasty and release of vaginal adhesions

A. SEXUAL DYSFUNCTIONS
TREATMENT:
2) Dual sex therapy: (William masters & Virginia Johnson) Treatment is based on a concept that the couple must be treated when a dysfunctional person is in a relationship. Both are involved in a sexually distressing situation, both must participate in the therapy program.

The keystone of the program is the round table session in which a male and female therapy team clarifies, discusses, and works through problems with the couple.

A. SEXUAL DYSFUNCTIONS
TREATMENT:
3) Hypnotherapy Focus specifically on the anxiety producing situation that is, the sexual interaction that results in dysfunction.

4) Behavior therapy Behavior therapists assume that sexual dysfunction is learned maladaptive behavior, which causes patients to be fearful of sexual interaction. Hierarchy of anxiety provoking situations ranging from least threatening to most threatening Systematic desensitization to reduce fear and avoidance of sex Assertiveness training.

A. SEXUAL DYSFUNCTIONS
TREATMENT: 5) Group therapy Used to examine both intra psychic and interpersonal problems in patients with sexual disorders. Groups can be organized in several ways. 6) Analytically oriented sex therapy The sex therapy is conducted over a longer period than usual, which allows learning or relearning of sexual satisfaction under the realities of patient's day-to-day lives.

A. SEXUAL DYSFUNCTIONS
NURSING MANAGEMENT:
1. Sexual dysfunction

Assess client's sexual history and previous level of satisfaction in sexual relationship. Assess client's perception of the problem. Assess client's level of energy. Review medication regimen, observe for side effects. Provide information regarding sexuality and sexual functioning Refer for additional counseling or sex therapy if required.

A. SEXUAL DYSFUNCTIONS
NURSING MANAGEMENT:
2. Ineffective sexuality patterns.

Take sexual history, noting client's expression of areas of dissatisfaction with sexual pattern.
Assess areas of stress in client's life and examine relationship with sexual partner. Note cultural, social, ethnic, racial, and religious factors that may contribute to conflict regarding variant sexual practices.

A. SEXUAL DYSFUNCTIONS
NURSING MANAGEMENT:
2. Ineffective sexuality patterns.

Be accepting and non judgmental Assist therapist in plan of behavior modification to help client decrease variant behaviors. Teach client that sexuality is a normal human response and is not synonymous with any sexual act. Client must understand that sexual feelings are human feelings.

B. PARAPHILIA
Are problems with controlling impulses that are characterized by:
Recurrent and intense sexual fantasies Sexual urges Behaviors involving unusual objects Activities with a non - consenting partner; or situations not considered sexually arousing to others.

B. PARAPHILIA

What Causes Paraphilia?

Certain cause is unknown.
Some experts believe it is caused by a childhood trauma, such as sexual abuse. Others suggest that objects or situations can become sexually arousing if they are frequently and repeatedly associated with a pleasurable sexual activity.

Paraphilias VS. Paraphilic Disorders

Paraphilia denotes any intense and persistent sexual interest other than sexual interest in genital stimulation.
Paraphilic Disorder is a paraphilia that causes distress or impairment to the individual or harm to others.

Paraphilic Disorders
1. Preferences for Non - human Objects
Fetishism Transvestism (Transvestic Fetishism)

2. Preferences for Situations Causing Suffering

Sadism Masochism

3. Preference for Non - Consenting Partners

Exhibitionism Voyeurism Pedophilia Incest Frotteurism

Preferences for Non human Objects

Fetishism Transvestism (Transvestic Fetishism)

Fetishism FETISHISM
It is a sexual arousal caused by inanimate objects.
The person becomes sexually aroused by wearing or touching the object. (e.g. clothing, underwear, shoes)

A related disorder, called partialism, involves becoming sexually aroused by a body part. (e.g. feet, breasts or buttocks)

 The more serious manifestation is when the object substitutes a person and become the sole need for achieving orgasm, mostly by fondling.

Transvestism TRANSVESTISM
(Transvestitism, or transvestic fetishism.) Is when a person derives sexual pleasure by dressing up as a member of the opposite gender. The sexual arousal usually does not involve a real partner, but includes the fantasy that the individual is the opposite partner.

 Some men wear only one special piece of female clothing, such as underwear, while others fully dress as female, including hair style and make-up.

Preferences for Situations Causing Suffering

Sadism Masochism

Sadism SADISM
Is the sexual pleasure derived from harming other people. inflicting psychological or physical suffering (including humiliation and terror)
They may resort to beatings, rape, or other brutal forces to derive sexual pleasure.

 At its most extreme, sexual sadism involves illegal activities such as rape, torture, and even murder, in which case the death of the victim produces sexual excitement This condition intensifies over time.

Masochism MASOCHISM
A person gets sexual pleasure by being harmed. Minor manifestation:
being humiliated pleasure from verbal abuse

Severe manifestations:
person get himself beaten, burned or stabbed from another person.

 Masochists may act out their fantasies on themselves They also may seek out a partner who enjoys inflicting pain or humiliation on others (sadist).

Activities with a partner (sadist) include bondage, spanking, and simulated rape.

 Masochistic activity is autoerotic partial asphyxiation, in which a person uses ropes, nooses or plastic bags to induce a state of asphyxia (interruption of breathing) at the point of orgasm. This is done to enhance orgasm, but accidental deaths sometimes occur.

Preference for Nonconsenting Partners Exhibitionism Voyeurism Pedophilia Incest Frotteurism

Exhibitionism EXHIBITIONISM
Someone with a compulsive desire to expose the genitals in public or to a complete stranger.
the perverse act of exposing and attracting attention to your own genitals It is usually limited to exposure and there are no further manifestations.

Voyeurism (Peeping Tom) VOYEURISM (Peeping Tom)

This disorder involves achieving sexual arousal by observing an unsuspecting and nonconsenting person who is undressing or unclothed, and/or engaged in sexual activity.
A person may engage in masturbation/ejaculation by watching others or simply limit themselves to sexual fantasies

Pedophilia PEDOPHILIA
People with this problem have fantasies, urges or behaviors that involve illegal sexual activity with a prepubescent child or children (generally age 13 years or younger).
Pedophilic behavior includes: undressing the child encouraging the child to watch the abuser masturbate touching or fondling the child's genitals forcefully performing sexual acts on the child

Types of Pedophilia
Infantophilia, or nepiophilia, is used to refer to a sexual preference for infants and toddlers (usually ages 03)

Pedophilia is used for individuals with a primary sexual interest in prepubescent children aged 13 or younger
Hebephilia is defined as individuals with a primary sexual interest in 11-14 year old pubescent

Incest INCEST
Incest is sexual intercourse between closely related people. It includes:
In-laws Stepsiblings Stepparents Nieces Cousins

 It is a punishable offence but as it usually happens between closed doors and is interpersonal, it is hard to enforce the law against incest particularly if it is done with mutual consent.

Frotteurism FROTTEURISM
Frotteur persons experiences great sexual arousal on rubbing his/her private parts, against familiar or unfamiliar persons.
It may involve touching any part of the body including the genital area The person usually chooses crowded places where the act is harder to detect.

Other Paraphilic Disorders

Kleptophilia sexual arousal obtained through theft or breaking and entering. Chremastistophilia sexual arousal is obtained from being robbed, conned, cheated, blackmailed or otherwise forced to lose out fiscally by a partner or complete stranger.

B. PARAPHILIA
CAUSES:
PSYCHOLOGICAL FACTORS Poor social skills History of childhood trauma such as sexual abuse Cognitive disorders Alcohol and negative affect are common trigger objects or situations can become sexually arousing if they are frequently and repeatedly associated with a pleasurable sexual activity
NEUROBIOLOGICAL DISORDERS Male hormones or androgens Dysfunctional Temporal lobe

B. PARAPHILIA
TREATMENT:
1. MEDICATIONS focused on decreasing the libido to interrupt the pattern of compulsive deviant sexual behavior Antiandrogens MOA: drastically lower testosterone levels thus lowers the sex drive in males and reduces the frequency of mental imagery of sexually arousing scenes. Antidepressants (Prozac) decreases the sex drive but have not effectively targeted sexual fantasies.

B. PARAPHILIA
TREATMENT:

2. HORMONES given to block or decrease the level of circulating androgens

cyproterone acetate MOA: reduces sex drive and aggression thus resulting in reduction of frequency of erections, sexual fantasies and initiations of sexual behaviors including masturbation and intercourse.

B. PARAPHILIA
TREATMENT:
3. COVERT CONDITIONING
a behavioral method in which undesirable behavior becomes less desirable and is eventually eliminated entails the patient relaxing, visualizing scenes of deviant behavior followed by a negative event
In the case of paraphilias, the client is asked to imagine feeling shame when friends or family members observe him engaging in the behavior associated with the paraphilia. It can help the client not engage in the behavior or to find the behavior less pleasurable.

B. PARAPHILIA
TREATMENT:
4. AVERSIVE THERAPY
Aversive therapies include pairing arousal to the deviant fantasy with either mild electric shock or unpleasant smells The goal is for the patient to associate the deviant behavior with the foul odor and take measures to avoid the odor by avoiding said behavior. 5. PSYCHOANALYTICAL THERAPY

B. PARAPHILIA
TREATMENT:

6. COGNITIVE THERAPIES
a. Restructuring cognitive distortions involves correcting erroneous beliefs by the patient, which may lead to errors in behavior such as seeing a victim and constructing erroneous logic that the victim deserves to be party to the deviant act. a. Empathy training involves helping the offender take on the perspective of the victim and in identification with the victim, understand the harm that has been done.

B. PARAPHILIA
NURSING PRIORITIES: 1. Assist client to understand the nature of the behavior (disorder/dysfunction). 2. Encourage use of acceptable methods for reduction of anxiety. 3. Help to recognize the legal/interpersonal consequences of paraphilic behaviors. 4. Explore options for change. 5. Encourage involvement of client/family (significant other) in treatment regimen

C. GENDER IDENTITYDisorder C. Gender Identity DISORDER

a conflict between a person's actual physical gender and the gender that person identifies himself or herself as.

C.

GENDER IDENTITY DISORDER

As gender identity develops in children, so do sex-role stereotypes.

Sex-role stereotypes are the beliefs, characteristics and behaviors of individual cultures that are deemed normal and appropriate for boys and girls to possess. These "norms" are influenced by family and friends, the mass-media, community and other socializing agents.

C.

GENDER IDENTITY DISORDER

1. HOMOSEXUALITY

1. HOMOSEXUALITY

is a romantic or sexual attraction or behavior between members of the same sex or gender. Scientific and medical understanding is that sexual orientation is not a choice, but rather a complex interplay of biological and environmental factors. The most common terms for homosexual people are lesbian for women and gay for men.

C.

GENDER IDENTITY DISORDER

2. TRANSSEXUALISM
disorder of gender identity or gender dysphoria of the most extreme variety; the individual has the self-perception of being of the gender opposite to his or her anatomical characteristics

C.

GENDER IDENTITY DISORDER

3. 3. BISEXUALITY BISEXUALITY
person who is not exclusively heterosexual or homosexual; engages in sexual activity w/both genders

C.

GENDER IDENTITY DISORDER

4. TRANSVESTISM

4. TRANSVESTISM

psychosexual disorder in which erotic pleasure is derived from wearing clothing designed for members of the opposite sex (a.k.a cross-dressing). Transvestite refers to a person who cross-dresses.

When cross-dressing occurs for erotic purposes over a period of at least six months and when it causes significant distress or impairment, the behavior is considered a mental disorder called transvestic fetishism(It differs from crossdressing for entertainment or other purposes that is uncorrelated to occurrence of gender identity disorder).

C.

GENDER IDENTITY DISORDER

Etiology:
The exact cause of gender identity disorder is not known, but several theories exist. These theories suggest that the disorder may be caused by: genetic abnormalities hormone imbalances during fetal and childhood development defects in normal human bonding and child rearing, or a combination of these factors.

C.

GENDER IDENTITY DISORDER

Symptoms:
Children: Are disgusted by their own genitals Are rejected by their peers, feel alone Believe that they will grow up to become the opposite sex Have depression or anxiety Say that they want to be the opposite sex

C.

GENDER IDENTITY DISORDER

Symptoms:
Adults: Dress like the opposite sex Feel alone Have depression or anxiety Want to live as a person of the opposite sex Wish to be rid of their own genitals Either adults or children: Cross-dress, show habits typical of the opposite sex Withdraw from social interaction

C.

GENDER IDENTITY DISORDER

Possible Complications:
Depression or anxiety Emotional distress Feeling alone Poor self-concept

C.

GENDER IDENTITY DISORDER

Treatment:
Individual and family therapy is recommended for children couples therapy is recommended for adults. mutual responsibility information and education attitude change Sex reassignment through surgery and hormonal therapy is an option, but identity problems may continue after this treatment.

C.

GENDER IDENTITY DISORDER

Nursing Responsibilities:
1. Help client reduce level of anxiety. 2. Promote sense of self-worth. 3. Encourage development of social skills/comfort level with own sexual identity/preference. 4. Provide opportunities for client/family to participate in group therapy/other support systems. 5. Be accepting and non judgmental.

THANK YOU! :D
Estoesta, Neil Julienne Arguta, Louisse Charlotte Balangue, Renee Felinne Caday, Astrud Bernadeth Yee, Gail Anika

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