1. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins

2. Chapter 17Sexual Disorders

3. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sexuality Defined An innate part of human dynamics integral to our development throughout the life cycle Blend of physical, chemical, psychologic functioning characterized by gender and sexual behavior

4. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sexual Orientation Individual preference or sexual attraction Heterosexuality  preference for members of the opposite sex Homosexuality  preference for members of the same sex Bisexuality  attraction to members of both sexes

5. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sexual Disorders All mental alterations that prevent a person from functioning in a normal healthy relationship within societal norms Categories –Sexual dysfunctions –Paraphilias –Gender identity disorders

6. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Sexual Desire Disorders Hypoactive sexual desire disorder –Low sexual desire to engage in sexual activity Sexual aversion disorders –Avoidance of sexual contact with partner Sexual arousal disorder –Inadequate sexual excitement response Orgasmic disorders –Absence of orgasm following normal activity Sexual pain disorders (dyspareunia) Sexual dysfunction due to general medical condition/medication

7. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Paraphilias Intense, sexually arousing fantasies, urges, or behavior with nonhuman objects –Involve suffering or degradation to self or partner that is sexually exciting –Required for sexual arousal on each encounter –Values are self-centered and power-seeking –Secrecy –In conflict with society and law –Departs from society's traditional and acceptable modes of seeking sexual gratification

8. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Paraphilias (cont.) Incidence and etiology –Not often seen in clinical setting –Treatment commonly connected to entanglements with law –Most prevalent among men –Behaviors tend to be chronic

9. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Gender Identity Disorder Strong and persistent cross-gender identification Insist that he or she is, or has desire to be, of the other sex Continual discomfort with his or her sexual role Different than nonconformity to stereotype –Profound problem in the person’s sense of sexual identity

10. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Gender Identity Disorder (cont.) May adopt dress, habits, and appearance of the opposite sex Social isolation May express wish to be the opposite sex Adults may use hormonal or surgical means to adopt appearance and social role of the opposite sex Onset around age 2-4 –Often mistaken as a “phase”

11. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Sexual Disorders Sexual dysfunction disorders –Hormonal therapy –Medication change –Psychotherapy Paraphilias –Long-term cognitive-behavioral therapy –Social skills training/support groups –Antidepressants/other drugs that alter sex drive

12. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Treatment of Sexual Disorders (cont.) Gender identity disorder –Therapy with family or partner of an adult –Hormonal therapy –Sex-change surgery

13. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied AssessmentPg. 270 –Multidisciplinary –Social and sexual history –Psychosexual and psychologic testing –Physiologic studies of sexual arousal patterns –Possible psychiatric evaluation

14. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) Selected nursing diagnosesPg. 271 Expected outcomes may includePg. 271 –Develops an awareness of the feelings and rights of others –Confronts and resolves traumatic developmental issues

15. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) InterventionsPg. 272 –Discomfort can be perceived by the client as disapproval –Nurturing and caring milieu –Relapse is common during treatment for paraphilia disorders –The client must take daily inventory of thought processes –Participates in treatment plan to change behavior

16. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Nursing Process Applied (cont.) EvaluationPg. 272 –Satisfying, acceptable sexual practices with alternative ways of dealing with sexual feelings –Willingness to change patterns of thinking –Realistic problem solving –Improvement in self-worth

17. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Intense, sexually arousing fantasies, urges, or behavior with nonhuman objects are associated with the sexual disorder category called A. Paraphilias B. Sexual aversion disorders C. Sexual dysfunctions D. Gender identity disorders

18. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer A. Paraphilias Rationale: Sexual disorders are classified under the categories of sexual dysfunctions, gender identity disorders, and paraphilias. The paraphilia disorders encompass all altered mental processes related to sexual expression that prevent functioning within the laws and morals of society.

19. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Tell whether the following statement is true or false. A multidisciplinary approach is most effective in helping a person with a sexual disorder.

20. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer True Rationale: A multidisciplinary approach covers the full range of sexually deviant behaviors. The assessment aspect of the nursing process uses the multidisciplinary approach to gather information so that the client can receive appropriate treatment.

21. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Question Blend of physical, chemical, psychologic functioning characterized by gender and sexual behavior is called A. Sexual orientation B. Sexuality C. Voyeurism D. Dyspareunia

22. Copyright © 2011 Wolters Kluwer Health | Lippincott Williams & Wilkins Answer B. Sexuality Rationale: Sexuality is an innate part of human dynamics and is integral in human development throughout the life cycle.