Sexual Dysfunction, Gender Dysphoria, and Paraphilic Disorders

Objectives

oAssess patients with sexual dysfunction.

o

oPlan nursing care for patients with sexual dysfunction.

o

oDescribe therapeutic interventions for patients with sexual dysfunction.

WHat are the phases of sexual response cycle

◦Phase 1: Desire- Desire phase – interest in sexual activity, including age, physical and emotional health, availability of sexual partner, and the context of an individual’s life

◦Phase 2: Excitement- Excitement phase – period of time during which sexual tension continues to increase from the preceding level of sexual desire

◦Phase 3: Orgasm- Orgasm phase – attained only at high levels of sexual tension

◦Phase 4: Resolution-  sexual tension developed in prior phases subsides to baseline levels and sexual stimulation has ceased

What are the types of sexual dysfunction

 Involves the disturbance in the desire, excitement, or orgasm phases of the sexual response cycle or pain during sexual intercourse

˜Female sexual interest/arousal disorder

˜Male hypoactive sexual desire disorders

˜Erectile disorder

˜Female orgasmic disorder

˜Delayed ejaculation

˜Premature ejaculation

˜Genito-pelvic pain/penetration disorder

Asexuality – may not have a desire for sexual relations

What are the risk factors for sexual dysfunction

 Biological

◦Aging

Cognitive

◦Misinformation or ignorance

◦Unconscious guilt and anxiety

◦Anxiety related to performance

◦Poor communication between partners

◦Unacknowledged or unidentified sexual orientation

Epidemiology- More common in women than men

Comorbidity

Psychiatric, depressive, and personality disorders

Obesity and sedentary lifestyle

Etiology

Biological factors

Psychological factors

What general assessment do we do 

 General Assessment

◦Setting—private and without distractions

◦Notetaking kept to a minimum

◦Interview free from personal biases and judgmental attitudes

◦Good eye contact, relaxed posture, and friendly facial expressions facilitate patient’s comfort and communicate openness  and receptivity on the part of the nurse

Self-Assessment

Discomfort, embarrassment

What diagnosis are there for impaired sexual functioning

◦Major Depressive Disorder

◦Intimate Partner Abuse

◦Altered body function from medication

◦Process of Aging

Other Diagnoses:

Relationship problem

Situational or chronic low self-esteem

Negative self-image

Lack of knowledge of sexual functioning

Substance use

Urinary tract infection

Ineffective sexuality pattern

Lack of significant other

Conflicts with sexual orientation

Impaired relationship with significant other

Knowledge deficit about alternative responses to illness

What outcomes do we want

Refer to Table 20.4

What planning and implementation do we do

 Planning

 Implementation

◦Facilitate discussion about sexuality (Nonjudgmental)

◦Health Teaching and Health Promotion

 Evaluation

What tx are there for sexual dysfunction?

 Treatment Modalities

◦Pharmacotherapy

◦Psychological

◦Sensate focus

◦Behavioral therapy

◦Systematic desensitization

◦Masturbation training

What is gender dysphoria 

 Gender identity

◦Sense of “maleness” or “femaleness”

◦Not usually established until a child is 3 years old

 Gender dysphoria

◦Feelings of unease about incongruent maleness or femaleness

Expressions of desire to be the opposite sex.

a sense of unease that a person may have because of a mismatch between their biological sex and their gender identity. This sense of unease or dissatisfaction may be so intense it can lead to depression and anxiety and have a harmful impact on daily life.

What are the RF for gender dysphoria

 Epidemiology

◦Once considered a fairly rare condition, has increased

 Comorbidity

◦May also have anxiety, disruptive and impulse-control problems, and depressive disorders

 Risk Factors

◦Biological factors – hormones, genetics

◦Cognitive factors:

◦absence of same-sex role models

Internally melding

What are the treatments for gender dysphoria

Treatment Modalities:

 Pharmacological interventions - Hormones

 Surgical interventions - Sex reassignment surgery

 Children: Optimize psychological adjustment and well-being; supportive family therapy

 Adolescents and adults: Individual and family therapy; coping skills to deal with harassment; long-term psychotherapy; thorough psychological examination before sex reassignment

What are Paraphilic Disorders

Acts or sexual stimuli that are outside of what society considers normal, but are required for some individuals to experience desire, arousal, and orgasm

◦Intensity of sexual drive

◦Symptoms last at least 6 months

◦Small segment actually commit sexual offenses

Paraphilic disorder exists when recurrent, intense sexually arousing fantasies, sexual urges, or behaviors currently cause distress or impairment

to the individual or whose satisfaction has entailed personal harm, or risk of harm, to others generally involving: non-human objects,

the suffering or humiliation of oneself or one’s partner, children, or non-consenting persons.

 

Compelling urge to get physical with your partner that is an aberration from what is expected of a person, that is to say usual genital arousal for a phenotypically normal, physically of age and consenting human counterpart, is referred to as Paraphilia or sexual perversion. This condition lives up to the standards of a disabling problem when it hampers the overall health of a person, leads to psychological setback or victimization of another individual (read more for healthy sexual life).
 
Psychological impacts of going through such a condition

1. The perpetrator of the variation may or may not see this as a condition: The person suffering from this condition may or may not treat it as a problem. In both ways, it is harmful. Knowing it as a problem and not seeking treatment or assistance can be harmful for oneself and others. Not realizing that you are subject to a serious sexual condition might propel you to commit wrong to non- consensual partners while being confident about your ways.
    
2. Social ostracization kills them: Coming in the open with a sexual fantasy that is not acceptable to the society can leave you with varied reactions. People might be incited to attack you for being unusual or they might isolate you. The latter is a probable outcome. Rarely does society guide you towards betterment in such cases. Social ostracization can result in deep rooted hatred for the world at large. 
 
3. Perpetual humiliation can push them more into Paraphilia: Humiliation for being different from the rest can make a person feel shame. Shame and constant regret cannot help an instance of sexual perversion. It can make a man or woman more obstinate. In such a situation a person would strongly cling to his or her condition feeling extremely dejected.

    
4. 'To be or not to be' haunts people suffering from Paraphilia: Many times a sufferer is not able to understand what is wrong in having objectionable sexual behavioral tendencies and fantasies. As long as your fantasies are limited to your own mental domain or are performed on a consensual partner, there are no complications. The minute an obnoxious sexual urge is performed leading to personal or public harm, a threatening hitch arises. 

 

5. Problems in expressing oneself can make a person suicidal: To adhere to societal norms a person might keep his desires on a leash. This kind of compromising over a long span of time will make a person depressive and may also prompt him to commit suicide.

What is  Exhibitionistic disorder

Exhibitionistic disorder is the illegal and intentional display of one’s genitals in a public place.

What is  Fetishistic disorder

is an intense sexual attraction to either inanimate objects or to body parts not traditionally viewed as sexual, coupled with clinically significant distress or impairment.

What is  Frotteuristic disorder

Frotteuristic disorder is a condition defined as recurrent and intense sexual arousal from touching or rubbing against a nonconsenting person, as manifested by fantasies, urges, or behaviors, or by rubbing against non-consenting people for sexual stimulation.

What is  Sexual sadism disorder & Sexual masochism disorder

Sexual sadism is infliction of physical or psychologic suffering (eg, humiliation, terror) on another person to stimulate sexual excitement and orgasm.

Sexual masochism is intentional participation in an activity that involves being humiliated, beaten, bound, or otherwise abused to experience sexual excitement.

What is  Transvestic disorder

Transvestic disorder is when sexual satisfaction is achieved by dressing in the clothing of the opposite gender.

What is  Voyeuristic disorder

Voyeuristic disorder is characterized by seeking sexual arousal through viewing, usually secretly, other people in intimate situations.

What is  Pedophilic disorder

WHat is  Telephone scatologia disorder

What is  Necrophilic disorder

What is  Zoophilic disorder

What is  Coprophilic disorder

Coprophilic disorder s the paraphilia involving sexual arousal and pleasure from feces.

What is  Klismaphilic disorder

Klismaphilia is a sexual disorder under the group of paraphilias where sexual gratification is obtained by the use of enemas.

What is  Urophilic disorder

What is  Hypoxyphilia

hypoxyphilia disorder is sexual fantasy involving arousal obtained by reduction of oxygen flow to the brain. It is a paraphilia

usually involving one person alone (i.e., autoerotic asphyxia) but occasionally involving sexual partners. Is an erotic asphyxia that can result in death or loss of consciousness.

What are risk factors for sexual disorders

 Epidemiology

◦Men more than women (mostly Caucasian)

 Comorbidity

◦Personality disorders commonly co-occur with sexual offending behaviors   

 Risk Factors

◦Biological – head trauma, abnormal levels of androgens

◦Cognitive

◦Psychoanalytic theories

◦Learning theories

Cognitive theories

What assessment do you do for sexual disorders

 General Assessment

◦Assess potential for self-harm or harm to others

◦Differentiate between victims and active agents

◦Focus of assessment on the presenting problem

◦Elicit patient’s perception of the impact of sexual disorder on current illness

Self-Assessment – comfort level, non-judgmental, hostility

What are the risks for these disorders

 Nursing diagnosis

ØRisk for suicide

ØRisk for violence

ØImpaired impulse control

ØProblematic sexuality behavior

 Outcomes identification

Risk for suicide —→ Decreased suicide risk

 Planning

Focus on safety and crisis intervention

What implementation do you do for sexual disorders

 Implementation

◦Health teaching and health promotion

◦Teamwork and safety

 Evaluation

What meds do you give for sexual disorders

Treatment Modalities

◦Pharmacological interventions

◦Antiandrogens

◦Antidepressants

◦Psychotherapy – cognitive behavioral therapy