Principles of Psychiatric Nursing: Sexual Disorders

Principles of Psychiatric Nursing: Sexual Disorders

Overview of the Course

  • Focus on disorders associated with sexual functioning.
  • Primary considerations include:
    • Categories of paraphilias and sexual dysfunction as classified in the DSM-IV-TR.
    • Exploration of various medical treatment modalities for sexual disorders.

Reading List

  • Ndatei, D. M. (2006). The African Textbook Of Clinical Psychiatrist And Mental Health, AMREF, Nairobi
  • Shives, L. B. (1994). Basic Concepts of Psychiatric Mental Health Nursing, J. B. Lippincott Company, Philadelphia
  • Sreevani, R. (2009). A Guide to Mental Health and Psychiatric Nursing, Jaypee Brothers Medical Publishers Ltd. New Delhi.
  • Townsend, C. M. (2007). Psychiatric Mental Health Nursing: Concept of Care in Evidence-Based Practice, Jaypee Brothers Medical Publishers Ltd, New Delhi.
  • Townsend, C. M. (2005). Essentials of Psychiatric Nursing, 3rd ed. E. A. Davis Company, Philadelphia

Goals and Objectives

At the end of the session, the student will be able to:

  • Identify the various types of paraphilias and sexual dysfunction disorders.
  • Evaluate care of patients with sexual disorders.
  • Describe various medical treatment modalities for clients with sexual disorders.
  • Identify appropriate nursing interventions for clients with sexual disorders.

Session Outline

  • A. Sexual Dysfunction (problems)
    • Impotence (male)
    • Frigidity (female)
  • B. Paraphilias (sexual deviation)
    • Homosexuality
    • Transvestic fetishism or transvestism
    • Fetishism
    • Bestiality (zoophilia)
    • Exhibitionism
    • Sadism
    • Masochism
    • Voyeurism (window peeping, peeping tom)
    • Frotteurism
    • Paedophilia
    • Bisexuality
    • Transsexualism

Sexual Disorders (Sexual Dysfunction)

1. Impotence (Male)
  • Ranges from:
    • Absence of sexual feelings (loss of libido)
    • Erectile failure
    • Premature ejaculation
    • Inability to ejaculate
2. Frigidity (Female)
  • Varies in severity from:
    • Lack of climax
    • Total avoidance of intercourse
  • Related conditions:
    • Dyspareunia: Persistent genital pain before, during, or after sexual intercourse.
    • Vaginismus: Persistent involuntary spasm of the musculature of the outer third of the vagina that interferes with coitus.

Paraphilias (Sexual Deviation)

1. Homosexuality
  • Definition:
    • Individuals whose dominant sexual attraction is to others of the same sex, which may or may not culminate in orgasm.
  • Females who are homosexuals identified as lesbians.
  • Equal proportion of women to men are homosexuals.
2. Transvestic Fetishism or Transvestism
  • Description:
    • Compulsion to dress in clothes of the opposite sex to achieve sexual pleasure or orgasm.
    • Primarily affects males; less is known regarding female transvestism.
3. Fetishism
  • Definition:
    • Obtaining sexual excitement or gratification from inanimate objects such as hair, shoes, umbrellas, handbags, etc.
4. Bestiality (Zoophilia)
  • Involves sexual acts performed with animals, typically farm animals or dogs.
5. Exhibitionism
  • Description:
    • Indecent exposure of the genitals (male) typically to young females for sexual arousal and possible orgasm.
6. Sadism
  • Definition:
    • Sexual excitement or gratification derived from inflicting pain on a sexual partner.
7. Masochism
  • Definition:
    • Sexual gratification achieved through being beaten and hurt by a partner.
8. Voyeurism
  • Definition:
    • Sexual gratification achieved by observing others engaged in sexual activities, also known as window peeping or being a peeping tom.
9. Frotteurism
  • Description:
    • Recurrent preoccupation with intense sexual urges, behaviors, or fantasies involving touching and rubbing against a non-consenting person.
    • Almost exclusively males exhibit this behavior.
10. Paedophilia
  • Definition:
    • Recurrent sexual urges, behaviors, or fantasies involving sexual activity with a child.
    • Also referred to as a molester.
    • Most child molestations involve genital fondling or oral sex.
  • More severe cases may involve vaginal or anal penetration of a child, especially in incest cases.
11. Bisexuality
  • Definition:
    • Sexual orientation or attraction to both men and women.
12. Transsexualism
  • Definition:
    • Implies a transition from one sex to another.
  • A transsexual experiences a mismatch between biological sex and gender identity, leading to gender identity disorder.
  • Many seek to change sex through hormone therapy and sex reassignment surgery.
  • Often describe feeling 'trapped in the wrong body' and believe they genuinely belong to the other sex.
  • Experience intense emotional turmoil due to societal stigma.

Management of Paraphilias

  • Assess patient's sexual history and previous level of satisfaction in sexual relationships; assess patient's perception of the problem.
  • Consider cultural, social, ethnic, racial, and religious factors that may contribute to conflicts regarding variant sexual practices.
  • Assess for medications affecting libido.
Additional considerations:
  • Both patients and partners may require assistance if there are severe or unresolved issues in the sexual relationship.
  • Referral for counseling or sex therapy may be necessary.
Drug therapy in appropriate cases:
  • Antipsychotics for schizophrenia.
  • Antidepressants for depression.
  • Anti-androgens (e.g., Depo-Provera) to reduce sexual drive.
Therapeutic Approaches:
  • Cognitive Behavioral Therapy (CBT) to disrupt learned paraphilic patterns and modify behaviors to be socially acceptable.
    • Components include:
    • Social skills training
    • Education
    • Cognitive restructuring
    • Development of victim apathy
Other techniques:
  • Behavioral techniques including desensitization and relational training.
  • Insight-oriented psychotherapy as a longstanding treatment approach to help patients understand the dynamics and events causing the paraphilia, improve life stress management, and enhance relationship capacities.