paraphilias and sexual dysfunction

paraphilias

abnormal sexual behaviors or impulses characterized by intense sexual fantasies and urges that keep coming back

exhibitionism “flashing”

exposing their genitals to an unsuspecting stranger

flasher

what do u call an exhibitionist

surprise, shock, or impress

what does a flasher feel the need to do to their victims

fetishism

have sexual urges associated with non-living objects

partialism

becoming sexually aroused by a body part such as the feet, breasts, or buttocks

frottuerism

touching or rubbing their genitals against the body of a non consenting, unfamiliar person

pedophilia

fantasies, urges, or behaviors that involve illegal sexual activity with a child (13 yrs below)

sexual masochism

Individuals with this disorder use the act - real, not simulated -- of being humiliated, beaten, or otherwise made to suffer in order to achieve sexual excitement and climax. These acts may be limited to verbal humiliation, or they may involve being beaten, bound, or otherwise abused.

(receiver)

sexual sadism

Individuals with this disorder have persistent fantasies in which sexual excitement results from inflicting psychological or physical suffering (including humiliation and terror) on a sexual partner. (pain giver)

transvestism

refers to the practice by heterosexual males of dressing in female clothes to produce or enhance sexual arousal. The sexual arousal usually does not involve a real partner but includes the fantasy that the individual is the female partner as well. 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. Cross-dressing as a transvestite is not a problem unless it is necessary for the individual to become sexually aroused or experience sexual climax.

transvestic fetishism

other term for tranvestism

voyeurism

achieving sexual arousal by observing an unsuspecting and non-consenting person who is undressing or unclothed or engaged in sexual activity. This behavior may conclude with masturbation by the voyeur. The voyeur does not seek sexual contact with the person they are observing.

peeping tom

other term for voyeurism

autogynephilia

defined as a male's propensity to be sexually aroused by the thought of himself as a female. It is the paraphilia that is theorized to underlie transvestism and some forms of male-to-female (MtF) transexualism. It encompasses sexual arousal with cross-dressing and cross-gender expression that does not involve women's clothing per se.

asphyxiophilia/hypophilia

practice of self strangulation

• sexual abuse

• if they are repeatedly associated with a pleasurable sexual activity

causes of paraphilia

cognitive behavior therapy - aversive conditioning

using negative stimuli to reduce or eliminate a behavior

covert sensitization

patient is relaxed and made to visualize scenes of deviant behavior followed by a negative event

empathy training

helping the offender take on the perspective of the victim and better identify with them

pharmacologic interventions

may be used to suppress sexual behavior

• antidepressants

• long-acting gonadotropin-releasing hormones

• antiandrogens

• phenothiazines

• mood stabilizers

drugs to treat paraphilia

antiandrogens

medications that reduce testosterone in males to reduce sexual drive

sexual dysfunction

d/o which can be described as an impairment or disturbance in any of the phases of the sexual response cycle

hypoactive sexual disorder

This disorder is defined by the DSM-5 as persistent or recurrently deficient sexual or erotic thoughts, fantasies, and desire for sexual activity.

sexual aversion disorder

This disorder is characterized by a persistent or recurrent extreme aversion to, and avoidance of, all (or almost all) genital sexual contact with a sexual partner. In the development from DSM-IV-TR to DSM-5 (APA, 2013), the diagnosis of sexual aversion disorder (SAD) has been removed.

female sexual arousal disorder

This disorder is identified in the DSM-IV-TR (APA, 2000) as a persistent or recurrent inability to attain, or to maintain until completion of the sexual activity, an adequate lubrication or swelling response of sexual excitement. It is defined in the DSM-5 as lack of, or significantly reduced, sexual interest/arousal.

male erectile disorder

This disorder is defined in the DSM-5 as the recurrent inability to achieve an erection, the inability to maintain an adequate erection, and/or a noticeable decrease in erectile rigidity during partnered sexual activity.

female orgasmic disorder “anorgasmia”

This disorder is defined by the DSM-IV-TR as a persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase. As classified by the DSM-5, female orgasmic disorder is characterized by difficulty experiencing orgasm and/or markedly reduced intensity of orgasmic sensations.

male orgasmic disorder “delayed ejaculation” or “delayed orgasm”

With this disorder, the man is unable to ejaculate, even though he has a firm erection and has had more than adequate stimulation. This disorder is also known as "delayed ejaculation" (DE) or delayed orgasm (DO). Delayed ejaculation (DE) is defined in DSM-5 as a persistent difficulty or inability to achieve orgasm despite the presence of adequate desire, arousal, and stimulation.

premature ejaculation

The DSM-IV-TR describes this disorder as persistent or recurrent ejaculation with minimal sexual stimulation before, on, or shortly after penetration and before the person wishes it. In DSM-5, premature ejaculation is defined as a persistent or recurrent pattern of ejaculation occurring during partnered sexual activity within about one minute following vaginal penetration and before the individual wishes it.

dyspareunia

defined as recurrent or persistent genital pain associated with sexual intercourse, in either a man or a woman, that is not caused by vaginismus, lack of lubrication, another general medical condition, or the physiological effects of substance use.

vaginismus

characterized by an involuntary constriction of the outer third of the vagina, which prevents penile insertion and intercourse. In DSM-5, the spasm-based definition of vaginismus was omitted, and vaginismus was combined with dyspareunia, the other "sexual pain disorder," which resulted in genito-pelvic pain/penetration disorder (GPPPD).

stress

common cause of sexual dysfunction

• sexual trauma

• psychological issues

• diabetes

• heart disease or other medical conditions

• drug use

• alcohol use

• certain medications

causes of sexual dysfunction

• determine stressors

• encourage discussion of disease process

• identify factors that affect client’s sexuality

• be accepting and nonjudgemental

• provide positive reinforcement

nursing interventions for paraphilic disorders and sexual dysfunctions