1. Sexual Dysfunction, Gender Dysphoria, and Paraphilias
Chapter 20
Sexual Dysfunction, Gender Dysphoria, and Paraphilias
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

2. Sexuality Phases of the sexual response cycle Phase 1: Desire
Phase 2: Excitement
Phase 3: Orgasm
Phase 4: Resolution
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

3. Sexual Dysfunction
A disturbance in the desire, excitement, or orgasm phases of the sexual response cycle or pain during sexual intercourse
Major classes of sexual dysfunction
Male hypoactive sexual desire disorders
Female sexual interest/arousal disorder
Erectile disorder
Female orgasmic disorder
Delayed ejaculation
Early ejaculation
Genito-pelvic pain/penetration disorder
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

4. Other Sexual Dysfunctions and Problems
Sexual dysfunction due to a general medical condition
Sexual desire disorders
Orgasm disorders
Sexual pain disorders
Substance-induced sexual dysfunction
Sexual dysfunction not elsewhere classified
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

5. Nursing Process Assessment Assessment guidelines
Setting—private and without distractions
Notetaking kept to a minimum
Interview free from personal biases and judgmental attitudes
Good eye contact, relaxed posture, and friendly facial expressions facilitate patient’s comfort and communicate openness and receptivity on the part of the nurse
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

6. Nursing Process (Cont.)
Nursing diagnosis
Sexual dysfunction
Ineffective sexuality pattern
Outcomes identification
Short and long term
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

7. Nursing Process (Cont.)
Implementation
Pharmacological interventions
Health teaching and health promotion
Advanced practice interventions
Psychoanalytic therapy
Couples therapy
Group therapy
Hypnotherapy
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

8. Gender Dysphoria
Gender identity—established by the time a child is 3 years old
Gender dysphoria—feelings of unease about maleness or femaleness
Etiology
Biological factors
Psychosocial factors
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

9. Paraphilic Disorders Exhibitionistic disorder Fetishistic disorder
Frotteuristic disorder
Pedophilic disorder
Sexual sadism disorder
Sexual masochism disorder
Transvestic disorder
Voyeuristic disorder
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

10. Sexual Disorders Not Otherwise Specified
Telephone scatologia disorder
Necrophilic disorder
Zoophilic disorder
Coprophilic disorder
Klismaphilic disorder
Urophilic disorder
Hypoxyphilia
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

11. Sexual Disorders Not Otherwise Specified (Cont.)
Epidemiology
Comorbidity
Etiology
Biological
Psychosocial
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

12. Nursing Process Assessment Assessment guidelines
Assess potential for self-harm
Focus of assessment on the presenting problem
Elicit patient’s perception of the impact of sexual disorder on current illness
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

13. Nursing Process (Cont.)
Nursing diagnosis
Self-directed violence, other-directed violence, impaired social interaction, anxiety, ineffective sexuality pattern
Outcomes identification
Planning
Focus on safety and crisis intervention
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

14. Nursing Process (Cont.)
Intervention
Health teaching and health promotion
Teamwork and safety
Pharmacological interventions
Advanced practice intervention
Psychotherapy
Evaluation
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

15. Audience Response Questions
A woman complains to the nurse, “It hurts when I have intercourse.” Which diagnostic term applies?
Genitopelvic pain/penetration disorder
Female sexual interest/arousal disorder
Female orgasmic disorder
Voyeurism
ANS: A
Genitopelvic pain/penetration disorder was formerly known as dyspareunia.
REF:
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.

16. Audience Response Questions
In 2012, former Penn State assistant coach Jerry Sandusky was convicted of 48 charges associated with pedophilia and sentenced to life in prison. Do you believe he will ever acknowledge guilt?
Yes No
Not sure
ANS: Answers will vary, but the most likely is B.
Discuss the limited treatment options for paraphilias and the high recidivism rates.
REF: , 397
Copyright © 2014, 2010, 2006 by Saunders, an imprint of Elsevier Inc.