SEXUAL DYSFUNCTION

Ω Sexuality Ω

Sexuality is determined by anatomy, physiology, psychology, the culture in which one lives, one’s relationship with others and developmental experiences through out the life cycle. It includes the perception of being male or female and all those thoughts, feelings, and behaviors connected with sexual gratification and reproduction, including the attraction of one person to another. –sadock & sadock,2003

ΩSex – is described as one of four primary drives that also include thirst, hunger, and avoidance of pain.

Ω Sexual act – occur when behaviors involve the genitalia and erogenous zones.

Ω Sexuality is the result of biologic, psychological, social, and experiential factors that mold an individual’s sexual development, self-concept, body image, and behavior.


+Sexuality depends on four interrelated psycho sexual factors.

1. Sexual identity: whether one is male or female based on biologic sexual characteristics.

2. Gender identity: how one views one’s gender as masculine or feminine; socially derived from experiences with the family, friends and society.

HETEROSEXUALITY

[FEMALE] HOMOSEXUALITY [MALE]

TRANSVESTITE

3. Sexual orientation: how one views one’s life in terms of being emotionally, romantically, sexually or affectionately attracted to an individual of a particular gender. (e.g heterosexual [opposite sex], homosexual [same sex], bisexual [both sexes]).

4. Sexual behavior: how one responds to sexual impulses and desires


Ω Normal sexual behavior - refers to a sexual act that is acceptable in our society, occurs between consenting adult, lacks any type of force and is performed in a private setting in the absence of unwilling observers.

ΩAbnormal sexual behavior – any act that does not meet the criteria……..


Transgender is term used to define transsexuals and transvestite.

> Transsexual – individual whose sexual identities are entirely with the opposite sex.

> Transvestite – persons who derive sexual pleasure from dressing or masquerading in the clothing of the opposite sex; (“commonly called “cross-dressers”)
Human Sexual Response Cycle



Sexual response – is a psychophysiologic experience.

Four phases:

Desire – is described as the ability, interest, or willingness to receive sexual stimulation

1. Excitement – sexual or arousal occurs as the result of physical or psychological stimulation. (sight,sound, thought)

2. Plateau-reached before orgasm. The vagina becomes extremely congested. The vasocongestion leads to the full distention of the penis.

3. Orgasm – “climax” phase.
* Women experience several strong, rhythmic contractions of the vagina. The vagina enlarges, the uterus contracts irregularly, increase v/s and the sex flush peak.
* Men experience emission and ejaculation of seminal fluid. Ejaculatory contraction involve the entire length of the penis.

4. Resolution – the organs and body systems gradually return the unaroused state.
- Vital signs return to normal.
- Relaxation and satisfaction are felt




+Predisposing factors for alterations

1. Biological / hormonal – may be associated with medical disorders (DM, neurological disorder)

2. Psychological

a. sexual trauma: rape. Abuse

b. intense emotions

3. Relationships

a. loss of interest in partner
b. marital conflicts
c. fear of commitment


+Clinical symptoms and diagnostic characteristics of sexual disorder Categories:

A. Sexual dysfunction disorder – involves an impairment of the sexual physiologic response or a disorders involve a disturbance in the processes that characterize the sexual response cycle, or the presence of pain during sexual intercourse.

Types:
1. Sexual desire disorders
Hypoactive – the lack of desire causes distress to the client or the client ‘s partner.
- Factors such as age, health, or diminished libido and lifestyle.

Sexual aversion disorder is used if anxiety, fear, or disgust occurs when an individual is confronted with sexual opportunity.

2. Sexual arousal disorder

3.Orgasmic disorders – are used to describe recurrent , persistent inhibited orgasm after an adequate phase of sexual excitement in the absence of any organic cause.

- Psychological factors are associated with female orgasmic disorder.
- Male orgasmic disorders may include premature ejaculation.

4. Sexual pain disorder

- This typically include dyspareunia and vaginismus.
- The diagnosis of dyspareunia is used to describe recurrent, persistent genital pain in the female and male that occurs during or after intercourse and is not used due to a general medical condition.
- Dyspareunia in men is uncommon and is usually associated with Peyronie’s disease- the presence of sclerotic plaques on the penis that cause penile curvature.

5. Gender identity disorder – discomfort with one biological sex (transsexualism)

Ω Paraphilias Ω

An emotional disorder characterized by unusual sexual behavior, including the practice of fetishism and sexual activities with unconsenting humans, or involving suffering and humiliation

A person may experience more than one paraphiliac disorder at the same time or may exhibit clinical symptoms of other mental disorders (personality disorder, schizophrenia)


+Characteristics of paraphiliacs

1. Emotional immaturity
> Seen in pedophile or “peeping Tom” who is unable to engage in a mature sexual relationship because of feelings of inadequacy

2. Fear of a sexual relationship that could result in rejection

3. Shyness ( seen in the voyeur who views others from a distance)

4. The need to prove masculinity, demonstrated by exhibitionist

5. The need to inflict pain on another to achieve sexual satisfaction

6. The need to endure pain to achieve sexual satisfaction

7. Low or poor self concept

8. Depression

NOTE: Not all of the characteristics listed are present in each paraphiliac.




Paraphilias

1. Bestiality (Zoophilia): sexual contact with animals serves as a preferred method to produce sexual excitement.

2. Exhibitionism: an adult male obtains sexual gratification from repeated exposing his genitals to unsuspecting strangers, usually women and children who are involuntary observers
- He has a strong need to demonstrate masculinity and potency.

3. Fetishism: sexual contact with inanimate articles results in sexual gratification. Most often it is a piece of clothing or footwear.
- Its occurrence is almost exclusive to men who fear rejection by members of the opposite sex.

4. Frotteurism: sexual excitement is achieved by touching and rubbing against a nonconsenting person

5. Sexual Masochism: sexual pleasure occurs while one is experiencing emotional or physical pain.
- The willing recipient of erotic whipping is considered to be masochistic

6. Sexual sadism: sexual gratification is experienced while the person inflicts physical or emotional pain on others.
- Severe forms of this behavior may be present in schizophrenia.

7. Necrophilia: sexual arousal occurs while the person is using corpses to meet sexual needs.

8. Pedophilia: the use of prepubertal children is needed to achieve sexual gratification.
- Pedophilia can be an actual sexual act or a fantasy.

9. Telephone Scatologia: sexual gratification is achieved by telephoning someone and making lewd or obscene remarks.

10. Voyeurism: the achievement of sexual pleasure by looking at unsuspecting persons who are naked, undressing, or engaged in sexual activity.

11. Anilingus – tongue brushing anus

12. Fellatio – inserting penis into the mouth

13. Cunnillingus – tongue brushing vulva

14. Partialism – inserting penis into the other parts of the body.

15. Asphyxiaphilis – suffocating oneself or partner while having sex



+Basic principle for performing a Sexual Assessment

1. be comfortable and at ease with the client

2. Present an open and accepting attitude

3. Be empathetic.

4. Avoid personal values and biases during the interview.

5. Ensure a thorough knowledge base.

6. Establish familiar terminology with the client

7. Encourage the client to verbalize any sexual concerns or emotions.

8. Ask specific, open-ended questions eg. What happened? Tell me about it

9. Support the expression of feelings and validate them

10. Approach emotional or more sensitive questions gradually



+Factors that the subject of sex may not be addressed by nurses:

1. May be embarrassing
2. May not believe that sexuality is part of a presenting problem
3. May feel that discussing sex is an invasion of a client’s privacy
4. May feel inadequately equipped to provide appropriate nursing interventions


Intervention are individualized based on the client’s concern about sexual identity, gender identity, identified sexual disorder, causative factors and clinical symptoms.

Nurses must examine feelings about their own sexuality before they are able to provide care for clients who present with issues related to sexuality.


+NURSING MANAGEMENT

1. Assistance in meeting basic needs
- Adequate rest, exercise and nutrition, and good general physical health promote sexual health. - Clients with health problems or who are elderly are assisted in identifying barriers that interfere with sexual functioning

2. Provision of a safe Environment
3. Interactive therapies
4. Support groups
5. Client education

Posted in: Heterosexuality,Homosexuality,Paraphilias,Psychiatric,Sexuality,Transvestite