1. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Chapter 26Sexuality and Sexual Disorders

2. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Sexuality is determined by anatomy, physiology, psychology, the culture in which one lives, one’s relationship with others, and developmental experiences throughout the life cycle. It includes the perception of being male or female and all those thoughts, feelings, and behaviors connected with sexual gratification and reproduction, including the attraction of one person to another. —Sadock & Sadock, 2008

3. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives After studying this chapter, you should be able to Differentiate the terms sex, sexual acts, and sexuality Describe the theories of gender identity development Distinguish between the terms gender identity and sexual identity Articulate the attitudes and behaviors of sexuality exhibited by individuals at various developmental stages: infants and children, preadolescents and adolescents, and adults Identify factors that contribute to sexual aggression in children and adolescents Discuss the phases of the human sexual response cycle

4. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Learning Objectives (cont.) Relate the dynamics of female and male sexual dysfunctions Recognize masochistic and sadistic behavior Explain the consequences of sexual addiction Analyze the barriers to your taking a sexual history Articulate the importance of addressing transcultural considerations when conducting a sexual history Construct a list of various pharmacologic approaches used to treat female and male clients with clinical symptoms of a sexual disorder Formulate a list of nursing interventions for a female client with clinical symptoms of a sexual disorder

5. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Overview of Gender Identity and Sexual Orientation Terminology –Sexual identity –Gender identity –Sexual orientation –Sexual behavior Etiology of gender identity development –Genetic and biologic theories –Psychosocial theories

6. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Overview of Gender Identity Disorders Individuals who have gender identity disorders: Have a strong and persistent cross-gender identification in which he or she expresses the desire to be, or the insistence to be, of the opposite sex Experience persistent discomfort about his or her assigned sex or feel inappropriate in the role of the assigned sex

7. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Overview of Sexual Disorders Sexual disorders are classified into the following: –Sexual dysfunctions –Paraphilias –Sexual addiction Two major factors that impact sexual performance: –Presence or absence of normal sexuality –Presence or absence of adequate sexual response cycle

8. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Development of Sexuality Infancy and childhood Preadolescence and adolescence Adulthood

9. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Human Sexual Response Cycle Five phases of the human sexual response cycle are the following: Desire Excitement Plateau Orgasm Resolution

10. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Clinical Symptoms and Diagnostic Characteristics of Sexual Disorders Sexual disorders are categorized as sexual dysfunction disorders or paraphilias. Sexual dysfunction disorders involve an impairment of the sexual physiologic response. Paraphilias refer to disorders involving recurrent intense sexual urges and sexually arousing fantasies generally involving nonhuman objects.

11. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Sexual Dysfunctions Sexual desire disorders Sexual arousal disorders Orgasmic disorders Sexual pain disorders Sexual dysfunction due to a general medical condition

12. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Paraphilias Disorders in which unusual or bizarre sexual imagery or acts are enacted to achieve sexual excitement –May involve nonhuman objects –May involve the suffering and humiliation of oneself or another person Sadism: achieving sexual excitement from psychological or physical suffering of another Masochism: act of being injured, bound, humiliated, or otherwise made to suffer –May involve children or other nonconsenting persons

13. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Sexual Addiction It is defined as engaging in obsessive–compulsive sexual behavior that causes severe stress to addicted individuals and their families. Addicts may feel powerless, out of control, and ashamed about their addiction. The addiction creates functional disturbances in everyday activities. Consequences may include loss of relationships, low self- esteem, despair, etc. Often sexual addicts have dual diagnoses with substance abuse or depression.

14. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins The Nursing Process Assessment Nursing diagnoses Outcome identification Planning interventions Implementation Evaluation

15. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Assessment Sexual history –Barriers to taking a sexual history Assessment of children and adolescents Transcultural considerations

16. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Diagnoses Ineffective sexuality patterns Sexual dysfunction Rape trauma syndrome Chronic low self-esteem Disturbed body image Anxiety Fear Hopelessness Social isolation Spiritual distress

17. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Outcome Identification Outcomes related to gender identity and sexual functioning must be developed with input from the client because the goals of treatment are very personal.

18. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Planning Interventions Planning utilizes an integrated sexual health team model, involving nurses, sex counselors, medical social workers, and sexuality educations. Interventions are planned to –Meet the client’s basic human needs –Provide structured and protective care –Explore methods to rechannel sexually unacceptable behavior

19. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Implementation Assistance in meeting basic needs Provision of a safe environment Medication management Interactive therapies Support groups Client education –Individual –Psychotherapy –Marital or couples therapy –Family therapy –Sex therapy –Group therapy –Behavioral therapy

20. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Evaluation Effective interventions with a client with sexual dysfunction include the following: Improvement in sexual response cycle Increased partner satisfaction Effective interventions with a client with a gender identity disorder include the following: Positive response to medication if treatment for anxiety or depression was implemented Improved ability to cope with issues related to his or her gender identity disorder

21. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms Ambiguous genitalia Chromosomes Gender identity Hermaphrodite Hermaphrodism Homosexuality Klinefelter’s syndrome Male pseudohermaphrodites Masochistic behavior Sadistic behavior Sex

22. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Key Terms (cont.) Sexual acts Sexual addiction Sexual behavior Sexual identity Sexuality Sexual orientation Sexual response Transgender Transsexual Transvestite Turner’s syndrome

23. Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins Reflection Review the chapter-opening quote about the development of sexuality by Sadock & Sadock. In some Middle Eastern countries, women are not allowed to show their faces in public, wear Western-style clothes, or drive a car. They are considered to be second-class citizens. ? What influence do you think these cultural practices might have on the development of a woman’s sexual identity? What impact would these cultural practices have on a female American citizen working in such a country?