Notes: Sexual Disorders (Chapter 29)
Continuum of Sexual Responses
A wide range of sexual behaviors are now considered to be socially acceptable.
Sexual behaviors can be viewed as occurring along a continuum.
Adaptive vs. Maladaptive:
Adaptive: sexual behaviors meet the rights and wishes of others.
Maladaptive: sexual behaviors are harmful to self or others in some manner.
Adaptive Sexual Response (definition)
An adaptive or healthy sexual response meets the following conditions:
Between two consenting adults
Satisfying to both
Not forced or coerced
Conducted in privacy
Self-awareness and Care in Psychosexual Problems
Self-awareness and sexuality:
One’s self-awareness strongly influences discussion of sexual issues with clients.
Developing awareness involves defining and clarifying attitudes and values.
The caregiver’s effectiveness is directly related to levels of personal self-awareness and comfort.
Sexuality Across the Life Cycle
Expression of sexuality begins at birth and ends with death.
Sexuality in Childhood
Young children are unaware that gender is a permanent attribute.
At around 2 years of age, children learn to label themselves according to their gender.
By school age, most children identify with their same-gender parent.
Sexuality in Adolescence
Adolescents encounter expectations for mature gender role behavior from peers and adults.
Teens may believe sex requires love, so each boy–girl attachment is seen as “true love.”
Adolescence is a time of intense searching and learning.
Sexuality in Adulthood
Among adults aged 25–59, relative monogamy appears to be the norm.
Sexual behaviors adapt to the situation.
Middle-aged sexuality patterns have changed recently:
More women in their thirties and forties bearing children and starting families.
Single parenthood is common.
Sexuality in Older Adulthood
The myth of the asexual older adult is prevalent; sexuality persists.
Closeness, intimacy, and sharing become more important than the physical act for many older adults.
Although activity may decrease with age, established sexual patterns continue.
Sexuality and Disability
Many permanently disabled persons can enjoy rich, satisfying sexual lives with adaptation.
Health problems (e.g., diabetes, arthritis, cancer, cardiovascular disease) can affect sexuality but not one’s fundamental sexual identity.
Improving quality of life involves changing social attitudes that limit the disabled population.
Modes of Sexual Expression (Slide 1 of 3)
An individual’s sexual attraction to others is one’s sexual orientation or sexual preference:
Heterosexuality: Individuals express sexuality with members of the opposite gender.
Homosexuality: Sexual desire or preference for members of one’s own gender.
Asexual relationships: Sexual relationships that involve little or no sexual activity (context provided).
Kinsey Rating Scale of Sexual Preference
Kinsey scale ranges from 0 to 6:
0: Exclusively heterosexual experience
1: Predominantly heterosexual, incidental homosexual experience
2: Predominantly heterosexual, more heterosexual than incidental homosexual experience
3: Equal heterosexual and homosexual experience
4: Predominantly homosexual, more than incidental heterosexual experience
5: Predominantly homosexual, incidental heterosexual experience
6: Exclusively homosexual experience
Note: Kinsey’s model describes a continuum of sexual orientation rather than a fixed category.
Modes of Sexual Expression (Slide 2 of 3)
Additional orientations and expressions:
Bisexuality: Individuals are attracted to and engage in sexual activities with members of both genders.
Transgender: Gender identity, expression, or behavior does not conform to the sex assigned at birth.
Transvestism (cross-dressing): Sexual excitement derived from wearing the clothing of the opposite gender.
Theories Related to Psychosexual Variations
Biological theories: Sexual variations result from differences in chromosomes and genetic material.
Psychoanalytical theories: Sexual variations are behaviors with neurotic or psychopathic motivations.
Behavioral theories: Sexual expression is a learned, measurable response.
Sexual Disorders vs Sexual Dysfunction
Sexual disorders: Problems that cause distress and impaired functioning in an individual or others exposed to the sexual behavior.
Sexual dysfunction: A disturbance that occurs at any point in the four stages of the sexual response cycle.
Additional contributing factors: Problems with relationships or unrealistic attitudes about sex may also contribute.
Gender Dysphoria
Children with gender dysphoria are unhappy with their own sexuality and may show intense dislike for their sexual anatomy.
Some people with gender dysphoria transition to the desired gender with sexual reassignment therapy.
Paraphilias
Group of sexual variations that depart from society’s traditional and acceptable modes of seeking sexual gratification:
Pedophilia
Exhibitionism
Fetishism
Voyeurism
Sexual Addiction
Progressive and chronic addiction characterized by patterns of compulsive sexual behavior despite negative consequences.
Impairs work and social relationships.
Tolerance: More and more sexual encounters are needed to relieve emotional pain.
Treatment for Sexual Problems
Treatment depends on cause, distressing signs/symptoms, and disorder type.
Behavioral therapies: Positive reinforcement; Aversive therapy.
Hormonal drug therapy.
Environmental controls.
Incarceration (as a potential intervention in certain cases).
Psychosexual Assessment and Nursing Process
Be aware of the client’s level of comfort when assessing sexual functioning.
Nursing diagnoses for psychosexual disorders are based on each client’s identified problems.
Focus areas: Assessment and treatment; Advocacy and education.
Education and Prevention
Education is within the realm of nursing.
Topics to educate clients on:
Prevention of HIV/AIDS
Prevention of other sexually transmitted diseases
Prevention of unwanted pregnancy
Various means of sexual expression