8 Psychosexual Disorders

PSYCHOSEXUAL DISORDERS
Presented By: Group 8- Section C Marcos, Alyssa Marie V. Marquez, Arianne T. Martinez, Genesis Kaye Mendiola, Juan Carlos I. 3. 4. Pharmacological- Psychiatric, antihypertensive and abused drugs Situational- place, time, partner, emotions.

Sexual Dysfunction
Definition of Terms Sex - One of four primary drives that also include thirst, hunger, and avoidance of pain. Sexual act s- Occur when behaviors involve the genitalia. Sexuality - The result of biologic, psychological, social, and experiential factors that mold an individuals sexual development, self-concept, body image, and behavior. Sexual Response Cycle Desire - The ability, interest, or willingness to receive sexual stimulation. Excitement - Occurs as the result of psychological stimulation. Orgasm -The peak of sexual pleasure, involuntary muscle contraction throughout the body. Resolution -Organs and body systems gradually return to their unaroused state. Sexual Dysfunction Is characterized by a disturbance in the processes of sexual response cycle or by pain associated with sexual intercourse. Dysfunctions are either brought about by psychological or psychophysiological factors. Frequently associated with other mental disorders, such as depressive disorders, anxiety disorders, personality disorders and schizophrenia. Causes 1. Psychological- Childhood or adulthood sexual abuse or trauma, major life changes, relationship stress & poor body image. 2. Physical/Biological- Infections, inflammatory, vascular, neurologic, renal/urological and endocrine, are aging.

Sexual Dysfunction Types Sexual desire disorder Sexual Arousal disorder Orgasmic disorder Sexual pain disorders Sexual dysfunction due to a general medical condition Substance induced sexual dysfunction A. Sexual Desire Disorder Disruption in the desire phase of the sexual response cycle. 1) Hypoactive sexual desire disorder- characterized by a deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty. *An individuals absolute level of sexual desire may not be the problem; rather the problem may be a discrepancy between the partners levels. 2) Sexual aversion disordercharacterized by a persistent or recurrent extreme aversion/avoidance of all or almost all genital contact with a sexual partner. B. Sexual Arousal Disorder Disruption in excitement phase of the sexual response cycle. A. Female sexual arousal disorder o Inability to attain or maintain physiological response (swelling-lubrication response) and/or psychological excitement during sexual activity. o Risk factors may include: receiving negative information about sex, having been sexually assaulted or molested & conflicts. B. Male erectile dysfunction (Impotence) o Inability to attain or maintain an erection sufficient for sexual intercourse and/or

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psychological arousal during sexual activity. The man may feel fully aroused, but he cannot finish the sex act. Some common physical disorders could cause difficulty with sexual activity. include chronic pain syndrome, arteriosclerosis, diabetes, liver disease, hypertension, thyroid disorder, and sexually transmitted diseases.

C. Orgasmic Disorders Inability to achieve an orgasm after entering the excitement phase and receiving adequate sexual stimulation. Female Orgasmic Disorder Inability to achieve orgasm during coitus Anorgasmia or the recurrent delay/complete absence of orgasm. Primary or secondary orgasmic dysfunction Male Orgasmic Disorder Inhibited or inability to ejaculate even with full arousal & penile erection. Primary or secondary orgasmic dysfunction Particularly common in young men who have very high sex drive and havent learned yet to control ejaculation. Ejaculatory incompetence or retarded ejaculation. Premature Ejaculation Inability to delay ejaculation less than 5 minutes of coital entry. D. Sexual Pain Disorder These involve pain associated with sexual activity. Dyspareunia- Genital pain that is not due to lack of vaginal lubrication and thus occurs either before, during or after sexual activity. Vaginismus- Persistent or recurrent involuntary contractions of the perineal muscles surrounding the outer third of the vagina when vaginal penetration with penis, finger, tampon, or speculum is attempted. E. Sexual Dysfunction Due to a General Medical Condition This is the presence of clinically significant sexual dysfunction that is exclusively due to the physiological effects of a medical condition.

F. Substance Induced Sexual Dysfunction This is clinically significant sexual dysfunction resulting in marked distress or interpersonal difficulty caused by the direct physiological effects of a substance. Medications for ulcers, glaucoma, allergies and convulsions as well as intake of alcohol also have effects towards the sex drive. Sexual dysfunction may also occur as a result of treatments used to manage a general medical condition, such as radiation therapy, nerve blocks, or surgical procedures that physically alter the central nervous system.

Gender Identity Disorders

Gender Identity Disorder (GID) is a disorder in which a person persistently feels extremely uncomfortable about his or her assigned sex and strongly wishes to be a member of the opposite sex. Also known as transsexualism Psychoanalytic Theory. Freud believed that an individuals personality is affected by repressed sexual desires and therefore, an individual with GID may not have properly moved through the psychosexual stages of development. Trait Approach Acceptance Recognize, approve, acknowledge, allow, admit, believe. Confusion Embarrassment, discomfort, distress, mystification. Biological Approach According to the Biological approach GID could be a heritable disorder or one in which a biological trait can be found.

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Humanistic Approach According to the Humanistic approach GID can be viewed one of two ways. A person diagnosed with GID is either not present in the here and now and afraid of becoming true to their gendered body. A person diagnosed with GID is fully present and accepting of the person that they would like to become and therefore they are taking the appropriate steps to be fully engaged in their view of self-actualization. Behavioral And Social Learning Behavior and social theorists believe that GID is a learned behavior that can later be un-learned. Cognitive Approach Possible Selves Struggling with GID is a vision that an individual has that describes the person they wish to become. DSM-IV-TR Definition Strong and persistent cross-gender identification (not merely a desire for any perceived cultural advantages of being the other sex). In children, the disturbance is manifested by four (or more) of the following: repeatedly stated desire to be, or insistence that he or she is, the other sex in boys, preference for crossdressing or simulating female attire; in girls, insistence on wearing only stereotypical masculine clothing strong and persistent preferences for cross-sex roles in make-believe play or persistent fantasies of being the other sex intense desire to participate in the stereotypical games and pastimes of the other sex strong preference for playmates of the other sex Persistent discomfort with his or her sex or sense of inappropriateness in the gender role of that sex. The disturbance is not concurrent with a physical intersex condition. The disturbance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Paraphilias~
What Does It Mean!?! Paraphilia It is a pattern of recurring sexually arousing mental imagery or behavior that involves unusual and especially socially unacceptable sexual practices (as sadism or pedophilia) [MerriamWebster] It May Include: 1. Nonhuman Objects 2. Suffering or Humiliation of ones self or partner 3. Children or other nonconsenting persons How To Does it Get Diagnosed? Pedophilia, Voyeurism, Exhibitionism and Frotteurism Dx is made if the person has acted on these urges / if urges / fantasies causes marked distress Sexual Sadism Dx is made if the person has acted on these urges with a NONCONSENTING PERSON or if it also causes marked distress on the person For the other Paraphilias~ Dx is made if the behavior, sexual urges or fantasies causes clinically significant distress or impairment in social, occupational or other important areas of functioning

Examples of Paraphilias Are: (Ung

naka BOLD TEXT ay ung mga nasa DSM-IV TR) Bestiality or Zoophilia Exhibitionism Fetishism Frotteurism Sexual Masochism Necrophilia

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Pedophilia Sexual Sadism Telephone Scatologia Transvestic Fetishism Voyeurism Bestiality or Zoophilia The practice of sexual activity between humans and non-human animals People who undergo this practice are known as Zoophiles This kind of paraphilia is RARELY SEEN Exhibitionism It is the EXPOSURE of the GENITALS to a STRANGER May involve the act of Masturbation Fetishism Use of NONLIVING OBJECTS (The Fetish) to obtain sexual excitement and or achieve ORGASM Fetishes may include: Womens underwear Bras Lingerie Shoes or other apparel The person might begin to masturbate while holding or rubbing the object Its occurrence is almost exclusive to men who fear rejection by members of the opposite sex. Frotteurism TOUCHING and RUBBING against a NONCONSENTING PERSON Done usually in a CROWDED PLACE Person rubs their genitals against a victims: THIGHS BUTTOCKS or Fondles her BREAST or GENITALIA with his hands Sexual Masochism Sexual pleasure occurs while one is experiencing emotional or physical pain May involve the act of being: Humiliated Beaten Bound or otherwise Made to SUFFER Sexual Sadism Sexual gratification is experienced while the person inflicts physical or emotional pain on others Victims may be consenting or non consenting Necrophilia Sexual arousal occurs while the person is using corpses to meet sexual needs Pedophilia Sexual Activity with a prepubescent child (Generally 13 years or younger) by someone at least 16 years old and 5 years older than the child Pedophilial Acts Include: Undressing the child Exposing himself / herself to the child Masturbation Touching and or Fondling Fellatio Cunnilingus Penetration of Anus, Vagina or Mouth Telephone Scatologia Sexual gratification is achieved by telephoning someone and making lewd or obscene remarks. Also known as: Obscene Phone Call May be considered as a form of SEXUAL HARASSMENT and STALKING Transvestic Fetishism Also Called: Cross-Dressing A heterosexual male achieves sexual gratification through wearing the clothing of a woman An etiology of this may be traced from the individuals childhood, wherein he is considered more attractive when dressed up as a girl Voyeurism

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Also Called: Peeping Toms The achievement of sexual pleasure by looking at unsuspecting persons who are: Naked Undressing Engaging in sexual activity Masturbation may occur during the voyeuristic behavior

NURSING PROCESS
ASSESSMENT In reality, Sexual health is often the exception (Warner, Rowe, & Whipple, 1999, p. 34). The statement was made regarding the lack of emphasis in sexual history as part of assessment in nursing process. SEXUAL HISTORY During the assessment, ask the patient permission to discuss his or her sexual life, emphasizing that all information provided is confidential. Use simple words and phrases when asking question to the patient to avoid any misunderstanding and confusion. Gather data regarding the patients sexual behavior and experiences, attitude about sex and gender identity. Present the question in order from sensitive to most sensitive materials. Be sure to the words and use closed ended question to get a specific response. Explore both past and present, patients role in sexual relationships Determine whether additional data, including history and physical, genital or pelvic examination, and laboratory tests, are indicated Children and adolescence require sensitivity. A cultural consensus remains concerning certain sexrole distinctions that children are expected to master in early development. If cross-gender behavior is observed in a child or adolescent over a 6-month period, a careful assessment should be made regarding the significance of the behavior to the child or adolescent. A patient's ethnic, cultural, religious, and social back ground influences sexual attitude, desire, and expectations. As a nurse, be as familiar as possible with the customs of each client's culture.

The Following Paraphilias Are Not Included in the DSM-IV TR

(Trip ko lang isama din haha)
Abasiophilia: love of (or sexual attraction to) people who use leg braces or other orthopaedic appliances Acousticophilia: sexual arousal from certain sounds Aquaphilia: arousal from water and/or in watery environments, including bathtubs or swimming pools Agalmatophilia: sexual attraction to statues or mannequins or immobility Urolagnia: sexual attraction to urine Amaurophilia: sexual arousal by a partner whom one is unable to see due to artificial means, such as being blindfolded or having sex in total darkness Emetophilia (a.k.a. vomerophilia): sexual attraction to vomit Eproctophilia: sexual attraction to flatulence Gerontophilia: sexual attraction towards the elderly Hematolagnia: sexual attraction to blood Retifism: sexual arousal from shoes

Characteristics of Paraphiliacs
A person may experience more than one paraphiliac disorder at the same time Or may even exhibit clinical symptoms of mental disorders (Personality Disorders, Schizophrenia) Emotional Immaturity Fear of sexual relationship Shyness Need to prove masculinity Need to inflict pain on others to satisfy sexual satisfaction Need to inflict pain on self to achieve sexual satisfaction Low or Poor Self Concept Depression

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BARRIERS TO TAKING A SEXUAL HISTORY Failure to view the patient's sexual history as relevant to the plan care Inadequate training of the health care professional Embarrassment to health care professional Fear of offending the patient by asking personal questions and the perception by the health care provider that any sexual concern of the client will be overly complex and time-consuming for the provider to assess, less manage (Postlethwaite, Stump, Bielan, & Rudy, 2001). BASIC PRINCIPLES FOR PERFORMING A SEXUAL ASSESSMENT Be comfortable and at ease with the patient. Present an open and accepting attitude. Be empathetic. Avoid personal values and biases during the interview. Ensure a thorough knowledge base. Establish familiar terminology with the patient Encourage patient to verbalize any sexual concerns or emotions. Support the expression of feelings and validate them. Ask specific, open-ended questions. Approach emotional or more sensitive questions gradually. Progress from how information was learned, to attitudes, then behaviors. State that certain sexual behaviors are common before asking questions them. NURSING DIAGNOSES Sexual Dysfunction Ineffective Sexuality Patterns Rape-Trauma Syndrome Chronic Low Self-Esteem Disturbed Body Image Anxiety Fear Hopelessness Social Isolation Spiritual Distress PLANNING Focuses on the individual patient's specific problems or complaints and respects the client's age, sex, and cultural and religious preferences. The nurse assumes the role of patient advocate to ensure the promotion of gender identity sexual health in the plan of care. Involvement of a spouse, significant other, family may be necessary. IMPLEMENTATION Interventions are individualized based on the patient's concerns about sexual identity, gender identity, identified sexual disorder, causative factors, and clinical symptoms. The nurse also considers the patient's needs, nursing diagnosis or diagnoses, problem severity, and the nurse's own competence (Krozy, 1998). knowledge of psychosexual development is imperative. Assistance in Meeting Basic Needs Provision of a Safe Environment Medication Management Support Groups Client Education Interactive Therapies Individual Psychotherapy Marital or Couples Therapy Family Therapy Sex Therapy Group Therapy Behavioral Therapy EVALUATION Focuses on whether the expectations of the client are realistic and whether the client feels a need to continue with supportive therapy. Some clients may not want to change their behavior or are not ready to change. Partners be resistant to new suggestions.

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