NURS 380 - Sex. Gender, Paraphilic Disorders

Phase 1: Desire

• 3 components: drive, motive, values

  • drive: biologically motivated interest based in the cerebral cortex and the limbic and endocrine systems; focus on the sexually appealing aspects of another, physiological response, and plotting for a connection

  • motive: more psychological than physiological; based on choices, aspirations, and motives for connection

  • values: familial, religious, and cultural beliefs and guidelines for responses and behaviors

sexual desire disorders

• male hypoactive sexual desire disorder - may be related to physiological or psychological causes or both (low interest in sex)

  • hormonal imbalances (testosterone deficiency)

  • endocrine factors (hyperprolactinemia)\

  • depression

  • occurs frequently in older males

• female sexual interest/arousal disorder - may be caused by neurobiological, hormonal, and psychosocial issues (low interest in sex)

  • emotional distress caused by absent of reduced interest in sexual fantasies, activity, pleasure, and arousal

  • can be present for whole life or develop gradually over time

  • can be a result of abuse, NT, or hormone imbalance, or menopause

  • must cause significant distress

  • depression, thyroid problems, anxiety, urinary incontinence, pain, arthritis, inflammatory bowel conditions

phase 2: excitement

• indicated by vaginal lubrication/penile erection

sexual excitement disorders

• erectile dysfunction

  • 2% for <40 yo; above 60 yo 40%

  • only a disorder if it occurs on 75% of occassions and last at least 6 months

  • may be lifelong or acquired

  • more prevalent with aging

  • diseases that affect the vasculature, neurological, or endocrine systems

phase 3: orgasm

• delayed ejaculation

  • uncommon condition

  • can be caused by substance use, medication, and physical conditions

  • if a lifetime concern, may be related to rigid background in which sex is considered a sin

• premature ejaculation

  • may have physical or psychological factors

  • MDD, DM, late-onset hypogonadism

• genitopelvic pain/penetration disorder

  • pain with intercourse (may occur during gynecological exam)

  • vaginismus - involuntary constriction of vaginal muscles

  • 15% of north american women

  • relationship distress, urinary/vaginal infection, endometriosis, IBS, constipation

• female orgasmic disorder

  • must last at least 6 months and occur during most encounters

  • 10-42% of women

  • fear of pregnancy, rejection, loss of control, cultural/societal restrictions, hostility toward or from men

  • MDD, MS, pelvic nerve damage, spinal cord injuries, SSRIs, pain

risk factors

• biological

  • age

  • physical conditions

  • surgical procedures

  • medications - many psych meds (SSRIs, SNRIs, antipsychotics, lithium, trazadone, etc)

• cognitive

  • anxiety

  • poor communication

nursing interventions

• assessment - private setting with minimal note taking; subjective and objective data

• beware of personal feelings

• maintain eye contact and display a relaxed posture

• nursing diagnosis

  • ineffective sexuality pattern

  • sexual dysfunction

  • intimate partner abuse

  • negative self-image

gender identity

• sense of maleness or femaleness

• usually established around 3 years of age

• only a small percentage of children with gender identity issues in childhood will continue into adulthood

gender dysphoria

• DSM 5 diagnosis: incongruence between experienced/expressed gender and assigned gender

• at least 6 months duration and associated with clinically significant distress or impairment in social, occupational, or other important areas of functioning

• rates have increased in last couple of decades

• no longer considered a psych disorder but often has co-morbid psych disorders of depression, anxiety, substance use disorder, and disruptive and impulse control problems in children

risk factors for gender dysphoria

• biologic

  • hormones (increased or decreased - testosterone)

  • genetic linkage (sex hormone signaling)

• cognitive

  • absence of same sex role models (learning theorists)

  • male children deprived of their mothers (psychoanalytic theorists)

nursing care for gender dysphoria

• biologic

  • pharmacotherapy

    • hormone - puberty blockers, testosterone, estrogen

  • surgical treatment - sex reassignment surgery (only 2%)

• psychological

  • psychotherapy

paraphilic disorders

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

• symptoms must occur for at least 6 months

• characterized by discomfort in the individual or persistent risk or danger to themselves or others

• many do not act on their feelings

paraphilic disorder examples

• exhibitionist disorder

• fetishistic disorder

• frotteuristic disorder (rubbing against each other)

• pedophilic disorder

• sexual sadism disorder and sexual masochism disorder

• transvestic disorder (most heterosexual; wearing other genders clothing)

• voyeurisitc disorder - like seeing other people have sex

• NOS (not otherwise specified)

  • telephone sctatlogia disorder - obscene phone calls

  • zoophilic disorder - incorporation of animals in sexual activity

  • coprophilic disorder - fixation of feces in sexual activity

  • klismaphilic disorder - activity that incorporates enemas

  • urophilic disorder - involves urinating on or from someone else

  • necrophilic disorder - obsession with having sex with a cadaver

  • hypoxyphilia disorder - desiring altered state of consciousness secondary to hypoxia