Sexuality-Reproductive Disorders

Sexuality-Reproductive Disorders

Learning Objectives

• Identify behaviors associated with sexual responses.
• Formulate nursing diagnoses related to sexual responses.
• Identify expected outcomes and short-term nursing goals related to sexual responses.
• Develop a patient education plan to promote adaptive sexual responses.
• Analyze nursing interventions related to sexual responses.
• Evaluate nursing care related to sexual responses.

Sexual Disorder

• Sexual disorders include problems of sexual identity, sexual performance, and sexual aim.
• Three major categories:
  • Sexual dysfunctions,
  • Paraphilia, and
  • Gender identity disorders.

Sexual Dysfunctions

• Prevent or reduce an individual's enjoyment of normal sex.
• Prevent or reduce the normal physiological changes brought on normally by sexual arousal.
• Classified by phase of the sexual cycle in which they occur.
• Diagnosis made only when the disability persists.
• Occasional occurrence may be due to temporary factors like fatigue, sickness, alcohol, or drugs.

Sexual Behavior and Sexual Act

• Erection:
  • First major component of male sexual act.
  • Parasympathetic action potentials from the sacral region of the spinal cord cause arteries that supply blood to the erectile tissues to dilate.
• Ejaculation:
  • Forceful expulsion of secretions accumulated in the urethra to the exterior.

Human Sexual Responses

1. Sexual Desire:
   • Interest, intention, and willingness.
2. Excitement or arousal—occurs in response to sexual stimulation either due to touch (reflexogenic) or imagination (psychogenic) in both male & female
3. Plateau—high level of sexual arousal that precedes the threshold levels required to trigger orgasm
4. Orgasm—believed to be a cortical experience; seems to be mainly dependent upon intactness of sensation associated with muscles of ejaculation
   • Supreme pleasure followed by a feeling of well-being and satiation
5. Resolution—return to pre-arousal state over a period of 5-15 min

The Desire Phase

• Sexual desire disorders involve a disruption in the desire phase of the sexual response cycle.
  1. Hypoactive sexual desire dysfunction
     • Disinterest in sexual activity.
     • Complete or almost complete lack of desire to have any type of sexual relation.
     • Participation in intercourse as a simple marital duty.
  2. Sexual aversion disorder
     • Aversion to and active avoidance of genital sexual contact with a sexual partner that causes marked distress or interpersonal difficulty.
     • Often the result of a traumatic sexual experience, such as molestation as a child or rape.

The Arousal Phase

• Sexual arousal disorders are a disruption of the excitement phase of the sexual response cycle.
  1. Male Erectile disorder
     • Inability of males to attain or sustain erection long enough for coitus.
  2. Female sexual arousal disorder
     • Inability of females to become sexually aroused.

The Orgasm Phase

• Orgasmic disorders are disruptions of the orgasm phase of the sexual response cycle.
  1. Premature ejaculation:
     • Males are unable to control ejaculation, so it occurs before satisfying sexual relations can take place with the partner.
  2. Male orgasmic disorder
     • Persistent or recurrent delay in, or absence of, orgasm following a normal sexual excitement phase, which causes marked distress or interpersonal difficulty.
     • Ejaculatory incompetence is the lack or delay of reaching orgasm in males.
  3. Female orgasmic disorders
     • Inhibited female orgasm: the lack or delay of reaching orgasm in females.

Sexual Pain Disorders

1. Dyspareunia:
   • Pain occurs during intercourse.
   • Predominantly a female complaint, but it does occur in males occasionally.
2. Vaginismus:
   • Female disorder in which involuntary spasmodic muscle contractions occur at the entrance to the vagina when an attempt is made to insert the penis.
   • If intercourse is attempted despite these contractions, a painful sexual experience results.

Biological Factors

• Diseases such as atherosclerosis, multiple sclerosis and spinal cord injury.
• Low level of testosterone or estrogen.
• Heavy alcohol use before sex.
• Chronic alcohol dependence.
• Heavy cigarette smoking.
• Certain medication such as antihypertensive drugs and especially Selective Serotonin Reuptake Inhibitor (SSRI) antidepressant have effect on sexual function including delayed orgasm, decreases libido and diminished lubrication.

Psychological Factors

• Some sexual dysfunctions can be traced to rape, childhood sexual abuse, or other degrading encounters.
• Depression and Anxiety increase the risk of sexual dysfunctions.
• Negative cognitions such as worries about pregnancy or AIDS, negative attitudes about sex or concerns about the partner interfere with sexual functioning.

Paraphilia

• Paraphilias are sexual behaviors in which unusual objects or scenarios are necessary to achieve sexual excitement.
• Diagnostic and Statistical Manual of Mental Disorders Text Revision (DSM-V-TR) defined it as a “recurrent, intensely sexual arousing fantasies, sexual urges or behaviors generally involving:
  • S-Suffering or humiliating of oneself or partner
  • I-Inanimate objects (non-human objects)
  • N-Non-compensating person
  • C-Children

8 Specific Disorder of Paraphilias

1. Exhibitionism:
   • Exposing one’s genitals to strangers or masturbating in public areas.
2. Fetishism:
   • Inanimate objects to achieve orgasm.
   • Women’s undergarments (brassiere, lingerie, and panty), shoes, and other apparels.
3. Frotteurism:
   • Urges of touching or rubbing against a non consenting.
4. Pedophilia:
   • Sexual activity done with a child 13 years younger is a characteristic of this disorder, at least 16 years old or at least 5 years older than the victim.
5. Sexual Masochism:
   • The intense and persistent sexual urge involving acts of suffering (beaten or bound) and being humiliated.
6. Sexual Sadism:
   • Sexual urge involving acts in which the pain, suffering, or humiliation of a partner is arousing a person.
7. Transvestic Fetishism:
   • Sexual fantasies, urge and behavior involving cross-dressing by a heterosexual male.
8. Voyeurism:
   • Sexual arousal by observing an unsuspecting person who is naked, in the process of undressing, or engaging in sexual activity.

Preferences for Nonhuman Objects

• Two types:
  1. Fetishism
  2. Transvestism

Fetishism

• A fetish exists when a person is sexually aroused by a nonliving object.
• Manifests in two ways:
  • Associates coitus with some object (most frequently women's panties or other undergarments).
    • Relatively harmless if the action is taken playfully and is acceptable to the person's partner.
  • Focus on certain parts of the body (feet, hair, ears, etc.) aside from those part of the pleasurable foreplay, can become fetishistic in its hold on the individual.
  • More extreme form: nonliving object completely substitutes for a human partner, such as underwear, boots, and shoes or such textured objects as velvet or silk. Here, orgasm is achieved when the person is alone, fondling the object.

Transvestism

• Paraphilia where the person achieves sexual excitement by cross-dressing.
• Two different purposes:
  • Intensify sexual excitement in intercourse with a partner by only partially dressing as a woman.
  • Male moves about in full female regalia, which suggests some type of gender identity problem but not necessarily homosexuality.

Preferences for Situations Causing Suffering

• Sadism and Masochism
  • Sadist: derive sexual excitement from the pain of others.
  • Masochist: derive sexual excitement through their own pain.
  • Sadists and masochists go hand in hand, one depending on the need of the other.
  • The danger of these needs is that each may need successively more brutal treatment to satisfy their sexual needs.

Preference for Nonconsenting Partners

• Three types:
  1. Exhibitionism
  2. Voyeurism
  3. Pedophilia

Exhibitionism

• Exposure of one's genitals in a public place.
• Most prominent sexual offense leading to arrest (one-third of all sexual crimes).
• Three characteristic features:
  • Performed for unknown women.
  • Takes place where sexual intercourse is impossible (e.g., a crowded shopping mall).
  • Must be shocking for the unknown woman or it loses its power to produce sexual arousal in the individual.

Voyeurism

• Looking at sexually arousing pictures or situations is a relatively common, apparently normal activity.
• Difference between this and voyeurism is that in normal watching, the viewing is a prelude to normal sexual activity. In the voyeur or