CHAPTER 34

 Normal sexuality and sexual preference

issue, such as homosexuality, are not
included.
 Individuals engage in a wide range of sexual
activities, resulting in a wide range of sexual
responses.
 Sexual activity might focus on objects or
people; it is unacceptable legally when it
involves a non-consenting individual, a child,
or the use of objects in a way that might
interfere with healthy relationships.

 Sexual activity is unacceptable morally when

it violates the norms, standards, and values,
of the culture.
 Categorizes sexual disorders according to
sexual dysfunction, the paraphilias and
gender identity disorders.
 Sexual dysfunctions are characterized by
the inhibition of sexual appetite or
psychophysiologic changes that compromise
the sexual response cycle.
 PARAPHILIAS are characterized by intense
sexual urges focused on:
- nonhuman objects
- the suffering or humiliation of oneself or
one’s partner or
- children or other non-consenting
individuals.
 GENDER INDENTITY DISORDERS are
characterized by a discomfort with one’s
biologic gender or the desire to have the
characteristics of the other gender.
CAUSES:
 Emotional factors
 Physiologic factors
 Brain Injury
 Medications and chemicals
 Desire Phase

Excitement Phase

Orgasm Phase

Resolution Phase
Phase I: Desire  occurs in response to verbal,
physical, or visual stimulation, as well as
sexual fantasies
Phase II: Excitement  sexual arousal and
erotic pleasure with concurrent physiological
changes
Phase III: Orgasm  peaking of sexual pleasure
with release of sexual tension
Phase IV: Resolution  detumescence
 sense of relaxation/well-being with orgasm
 irritability and discomfort in absence of orgasm
 Effectively stop the sexual response cycle
from beginning
 Individual with these disorders have little or
no sexual desire or have an aversion to
sexual contact.
 Sidetrack the sexual response cycle at the
excitement phase.
 Individuals with these disorders cannot
maintain the physiologic requirements for
sexual intercourse.
 Women cannot maintain the lubrication-
swelling response of sexual excitement and
men cannot maintain an erection.
 Arrest the progression of the cycle in the
orgasm phase.
 Individuals with these disorders cannot
complete the sexual response cycle because
of the inability to achieve an orgasm.
 In premature ejaculation, a man reaches
orgasm with minimal sexual stimulation.
 They can abort the sexual response cycle at
any cycle.
 Individuals with these disorders suffer genital
pain (Dyspareunia) before, during, or after
sexual intercourse.
 Vaginismus is an involuntary spasm of the
outer third of the vagina that interferes with
sexual intercourse.
 Is a condition in which the sexual instinct is
expressed in ways that are socially
prohibited or unacceptable or are
biologically undesirable.
 Do not consider their sexual activities or
interest a disorder and do not seek
psychiatric treatment for them.
 Paraphiliacs might be men or women
 Paraphilic activity might be limited to a
period of stress rather than following a
chronic or repetitive pattern.
 Usually begin in adolescence in conjunction
with the following disorders:
-mood disorders
-anxiety and impulse disorder
-substance-related disorders
-personality disorders (Antisocial-Cluster C)
 Exhibitionism
 Fetishism
 Frotteurism
 Pedophilia
 Sexual masochism
 Sexual sadism
 Voyeurism
 Recurrent, intense sexually arousing
fantasies, sexual urges, or behaviors
involving exposing one’s genitals to
unsuspecting strangers.
 An exhibitionist is stimulated by the effect of
shocking the victim.
 Intense sexually arousing fantasies, sexual
urges, or behaviors using nonliving objects.
 Common fetish objects are bras, underpants,
stockings and shoes.
 Individual with fetishism often masturbates
while holding or rubbing these items.
 Sexual pleasure derived from touching or
rubbing one’s genitals against a non-
consenting individual’s thighs or buttocks.
 The individual with frotteurism might also
attempt to fondle the person’s breasts or
genitals.
 Usually occurs in a crowded places.
 Sexual pleasure derived from being
humiliated, beaten, or otherwise made to
suffer.
 They enjoy being urinated or defecated on
and might pay prostitutes to do so.
 People have died in their search for
enhanced orgasms.
 Hypoxyphilia is the act of enhancing sexual
arousal by strangulation or some other
oxygen-depleting activity.
 Sexual pleasure is derived from inflicting
psychological or physical suffering on
another.
 Partner can be consenting or masochistic.
 Sadistic behaviors includes spanking,
whipping, pinching, beating, burning and
restraining.
 Some sadistic individuals derive great
pleasure from torturing or even killing their
victims and might be sadistic rapists.
 Sexual pleasure derived from observing
unsuspecting people who are naked or
undressing or who are engaged in sexual
activity.
 “ peeping Tom”
 The voyeur might masturbate during peeping
or after returning home.
 Recurrent, intense sexually arousing
fantasies, sexual fantasies, urges or
behaviors that involve sexual activity with a
child or children generally 13 years of age
younger.
 Accept patient’s behaviors
 Express empathy
 Non judgmental attitude
 Keep safe distance while in conversation with sexual
disorders
 Provide private area in which to discuss fears or concerns
about sexuality and victimization.
 Clarification
 Sexual education
 The nurse might also need to intervene with self-esteem,
issues, anxiety, and guilt.
 Setting limits in group setting
 Avoid touching
 Systematic desensitization to reduce fear and avoidance of
sex
 Axis I diagnoses are prescribed
psychotherapeutic medication for their
specific disorders.
 Anti-androgen medications that suppress
pedophilic urges by diminishing sexual desire
and fantasy
 Medroxyprogesterone (Provera) and
lueprolide acetate
 Leuteinizing hormone-releasing hormone
(LHRH)
 SSRI’s
 Patient with sexual disorders and
dysfunctions benefit from groups dealing
with self esteem, assertiveness, anger
management, social and relationship skills,
sex education, and stress management
 Sex Addicts Anonymous
 Multi dimensional treatment plan using a
combination of education, cognitive-
behavioral and family interventions to
reduce recidivism.