The document provides a detailed overview of various personality and sexual disorders, including classifications, diagnostic criteria, causes, and clinical manifestations. It outlines specific disorders such as paranoid, borderline, and avoidant personality disorders, as well as various paraphilias and sexual dysfunctions, while discussing their treatment options. The document emphasizes the importance of psychotherapy, behavioral therapy, and pharmacological interventions in managing these complex conditions.

1. NURSING MANAGEMENT OF
PATIENT WITH PERSONALITY
AND SEXUAL DISORDER
Dr. Rahul Sharma

2. PERSONALITY INTRODUCTION
•Personality word is a Greek word “persona”. It
was originally used to describe the theoretical
mask worn by some dramatic actor at the time.

3. DEFINITION
• The totality of emotional and behavioral characteristic that are
particular to a specific person and remain some stable and
predictable over time.
• A major difficulty for psychiatrist has been establishment of a
classification of personality disorder. The DSM 4TR group the
personality disorder into three groups. These cluster are –

4. 1. CLUSTER A - Behavior described as odd or eccentric.
A. Paranoid personality disorder.
B. Schizoid personality disorder.
C. Schizotypal personality disorder.
2. CLUSTER B - Behavior describes as dramatic emotional and irritable.
A. Anti social personality disorder.
B. Borderline personality disorder.
C. Histrionic personality disorder.
D. Narcissistic personality disorder.

5. 3. CLUSTER C - Behavior describes anxious or fearful.
A. Avoidant personality disorder.
B. Dependent personality disorder.
C. Obsessive compulsive disorder (OCD).

6. 1. PARANOID PERSONALITY DISORDER
DSM 4TR defined paranoid personality disorder is a
pervasive distrust and suspiciousness of others such that
their motive are interrupted as malevolent beginning by
early adulthood and present in a variety of contrast. This
disorder is more common in male than in women.

7.  CAUSES –
• Stressful environment.
• Childhood traumatic experience.
• Chronic schizophrenia.
• Interpersonal causes.
 CHARACTERISTICS –
• Appear tense, irritable, stressful, suspiciousness, difficulty in maintaining
job, angry.
• Aggressive, feel insecure, violent.

8.  DIAGNOSTIC CRITERIA –
• Suspect with out sufficient basis that others are harming.
• Is preoccupied with unjustified doubt about the loyalty and trust of
friends.
• Read hidden threatening meaning into remark or events.
• It has recurrent suspiciousness without justification regarding fidelity of
spouse or sexual partner.

9. 2. SCHIZOID PERSONALITY DISORDER.
• It is characterized primarily by a profound defect in the
ability to form personal relationship or to respond to
others in any meaningful, emotional way. These
individual display a lifelong pattern of social withdrawal
and there is comfort with common interaction is appear.
Gender ratio of the disorder is unknown.

10.  CLINICAL MANIFESTATIONS –
• Aloof.
• Indifferent to others.
• Isolation will work and unsociable.
• Shyness (Anxious or uneasy).
• Day dreaming.
 CAUSES –
• The role of heredity in the ideology of schizoid personality is unclear.
 DIAGNOSTIC CRITERIA –
• Neither desire nor enjoy close relationship including being part of a family.
• Has little if any interest in having sexual experience with another person.

11. 3. SCHIZOTYPAL PERSONALITY DISORDER
Individual with schizotypal personality disorder are odd and eccentric,
strength but do not meet the criteria of schizophrenia.
 Causes –
• Neurochemical dysfunction.
• Biogenic factor impaired cognitive function.

12.  CHARACTERISTICS –
• Aloof.
• Isolate behavior.
• Magical thinking.
• Illusion.
• Bizarre.
• Stress.
• Eccentric behavior.
• Anxiety vague (unclear).

13.  DIAGNOSTIC CRITERIA –
• Ideas of reference.
• Magical thinking.
• Influence behavior.
• Lack of close friend.
• Excessive social anxiety.

14. 4. ANTI SOCIAL PERSONALITY DISORDER
Individual with this disorder have difficulty in following society
rules and regulation.
 CAUSES –
• Biological influence.
• Family Dynamic.

15.  CLINICAL MANIFESTATION –
• Socially irresponsible.
• Guiltless behavior.
• Very low tolerance for frustration.
• They believe that good days come in last.
• Anxiety and depression.
 DIAGNOSTIC CRITERIA –
• Failure to follow social norms.
• Repeated lying.
• Failure to plan.
• Irritable and aggressiveness.
• Consistent irritability.

16. 5. Borderline personality disorder -
• It is characterized by a pattern of intense and chaotic relationship
between effective instability and fluctuating attitudes towards
other people.
• These individuals are impulsive, direct and indirect self destructive
and lack of clear sense of identity.

17.  CAUSES –
• Traumatic childhood.
• Failing in development task.
• Childhood abuse.
• Substance abuse.
• Defective family environment.
• Chronic stress.

18.  CLINICAL MANIFESTATIONS –
• Unstable IPR.
• Identity disturbance.
• Recurrent suicidal behavior.
• Empty feeling.
• Difficulty in controlling anger.
• Negative emotions.
• Insecure.
• Self mutilation (Deliberate to one’s body part, injury).
 DIAGNOSTIC CRITERIA –
• Personal and family history.
• Physical examination.

19. 6. HISTRIONIC PERSONALITY DISORDER –
• It is characterized by colorful, dramatic and extroverted behavior in excitable
and emotional person.
• They have difficulty in maintaining long lasting relationships.
 CAUSES –
• Environmental influence.
• Childhood relationships.

20.  CLINICAL MANIFESTATION –
• Excessive dramatic, low tolerance power.
• Easily frustrated.
• Failure is usually blamed on others.
• Aggressiveness.
 DIAGNOSTIC CRITERIA –
• Observation of appearance, Behavior.
• Collection of history.
• Psychological evaluation.

21. 7. NARCISSISTIC PERSONALITY DISORDER –
• A person with narcissistic disorder have an exaggerated sense of self. They
lack empathy and are hypersensitive to the evaluation.
 CAUSES –
• Problem or unsatisfactory relationship in parent child relationships.
• Punishing in childhood.
• Young child defends against psychological pain.

22.  CLINICAL MANIFESTATION –
• Live in a dream world of exceptional success.
• Lack of empathy.
• Inability to make relationships.
• Impairment.
• Depression.
 DIAGNOSTIC CRITERIA –
• Collection of client history both from the client and family members.

23. 8. AVOIDANT PERSONALITY DISORDER –
• The individual with avoidant personality disorder is extremely sensitive to rejection and because of
this may lead to a very social withdrawal life.
 CAUSES –
• Actual criticism.
• Interpersonal difficulties.
• A combination of social, biological and genetic factor.
• Temperamental sector characterized by behavioral inhibition.

24.  CLINICAL MANIFESTATION –
• Discomfort in social setting.
• Anxiety and depression.
• Anger.
• Use of avoidance as a primary defense mechanism.
• Easily hurt.
• Uncommunicative in social situations.
• Low self esteem.
• Mistrust of others.
• Avoid occupational activities.
• Chronic substance abuse/dependence.

25.  DIAGNOSTIC CRITERIA –
• Avoid occupational activities.
• Is unwilling to get involved with people.

26. 9. DEPENDENT PERSONALITY DISORDER –
• It is characterized by a pervasive and excessive need to be taken care to
submissive and clinging behavior and fear of separation.
 CAUSES –
• Over protective.
• Discourage.
• Independent behavior.

27.  CLINICAL MANIFESTATION –
• Lack of self confidence.
• Inability to take risk.
• Depression and anxiety.
• Avoid position of responsibility.
• Difficulty in decision making.
• Depend on a parent or spouse to decide where they should.
• Difficulty in initiative projects.
• Feel discomfort.
• Loss self esteem and self doubt.

28.  DIAGNOSTIC CRITERIA –
• Has difficulty in making everyday decision.
• Needs other to assume responsibility.
• Has difficulty expressing.
• Feel uncomfortable or helpless.

29. 10. OBSESSIVE COMPULSIVE DISORDER –
• Individual with OCD are very serious and formal and have difficulty expressing emotions.
• They are disciplined, perfection and preoccupied with rules.
 CAUSES –
• Abnormalities in the brain.
• Neurotransmitter function alteration.
• Psychological factor - unconscious conflict.

30.  CLINICAL MANIFESTATION –
 A fear of contamination.
 Unwanted sexual thoughts.
 Experience difficulty in work situation.
 Unable to throw out work less items.
 Unwelcome thoughts.
 DIAGNOSTIC CRITERIA –
 Is preoccupied with rules, least, details, order, organizations or schedule.
 It show perfectionism that interfere with task completion.
 Is excessive devoted to work.

31. 11. PASSIVE AGGRESSIVE PERSONALITY
DISORDER –
• In this personality disorder patient have negative attitude and adequate
performance in social and occupational situations that begin by early
adulthood and occur in a variety of contacts.

32. TREATMENT –
1. INTERPERSONAL PSYCHOTHERAPY –
• Depending on the therapeutic goal, this therapy is brief and time limited.
• Long term psychotherapy attempt to understand and modify the behavior, cognition
and effect of client with personality disorder.
• Psychotherapy suggested for client with paranoid, schizoid, schizotypal, borderline,
dependent and narcissistic and OCD personality disorder

33. 2. PSYCHOANALYTIC PSYCHOTHERAPY –
• The treatment of choice for individuals with histrionic personality disorder.
• Treatment focus on the unconscious motivation for seeking total satisfaction for others.
3. MILIEU THERAPY AND GROUP THERAPY.
4. COGNITIVE BEHAVIORAL THERAPY.
5. PSYCHOPHARMACOLOGY THERAPY –
• Clozapine, olanzapine, haloperidol, risperidone.

34. 6. ANTIPSYCHOTIC MEDICINE –
• They are helpful in the treatment of client with paranoid, borderline, schizotypal
personality disorder.
• The selective serotonin reuptake inhibitors and monoamine oxidase inhibitors e.g.
paroxetine sertraline.
7. BEHAVIORAL DIALECTICAL THERAPY –
• As a treatment for the chronic self injury and suicide behavior of client
with borderland personality disorder. Dimeff and Linehan (2001)
identify the following five function -

35. 1. To enhance behavioral capabilities.
2. To improve motivation to change.
3. To ensure that new capabilities generalized to the
natural environment.
4. To structure the treatment environment such client and
therapist capabilities are supported and effective
behavior.
5. To enhance therapist capabilities and motivation to
treat client effectively.

36. The four primary mode of treatment in DBT are following
–
• Group skill training.
• Individual psychotherapy.
• Telephone contact.
• Therapist concentration .

37. SEXUAL DISORDERS

38. PARAPHILIAS
• The term paraphilia is used to identify repeated or referred
sexual fantasy or behavior.
• The preference for use of a non human object.
• Repetitive sexual activity with human.
• Repetitive sexual activity with non consulting partner.

39. Types:
1. EXHIBITIONISM
• It is characterized by recurrent, intense sexual urge,
behavior or sexual arousing fantasies of at least a six
months duration.
• Involving the exposure of one genital or an unsuspecting
stranger, masturbation may occur during the
exhibitionism.

40. 2. FETISHISM
• It is characterized by recurrent intense sexual urge
behavioral or sexual arousing fantasies of at least 6 months
duration involving use of non-living object.
• The sexual focus is commonly on object intimately
associated with human body e.g. shoes, gloves, etc.

41. 3. FROTTEURISM
• It is characterized by recurrent, intense sexual urge
behavioral or sexual arousing fantasies of at least six
months duration.
• Involving touching and rubbing against a non consulting
person.

42. 4. PEDOPHILIA
•It is characterized by recurrent coma intense sexual
urge behavioral or sexual arousing fantasies at least
six months duration involving sexual activity with a
pre pubescent child.

43. 5. SEXUAL MASOCHISM
•It is characterized by recurrent intense sexual urge
behavioral or sexual arousing fantasies of at least 6
months duration involving the act of being beaten,
bound or otherwise made to sufferer.

44. 6. SEXUAL SADISM
•It is characterized by recurrent, intense, sexual urge,
behavioral or sexual arousing fantasies of at least six
months duration, involving act in which the
psychological or physical suffering of the victim is
sexually exciting to the person.

45. 7. VOYEURISM
•It is characterized by recurrent, intense, sexual urge,
behavioral or sexual arousing fantasies of at least 6
months duration, involving the act of observing an
unsuspecting person who is naked in the process of
disrobing or engaging in sexual activity.

46. PREDISPOSING FACTOR
1. BIOLOGICAL DISORDERS –
• Distraction of part of limbic system.
• Temporal lobe disorder such as Psychomotor seizure or temporal lobe
tumor.
• Abnormal level of androgens.
2. A young boy who is sexually abused

47. 3. PARENTAL PUNISHMENT – women clothes
4. Fear of sexual performance.
5. Inadequate counseling.
6. Excessive alcohol intake.
7. Physiological problems.
8. Socio cultural factor.
9. Psycho sexual trauma.

48. TREATMENT
1. BIOLOGICAL TREATMENT –
• Individual with paraphilia’s has focused on blocking and decreasing the level of endogen
hormone.
• The most extensive used of antiandrogenic medications.
2. PSYCHOANALYTIC THERAPY –
• In this type of therapy, the therapist help the client to identify unresolved conflict and trauma
from early childhood.

49. 4. BEHAVIOR THERAPY –
• It include skill training and cognitive restructuring in an effort to change the
individual maladaptive behavior.
5. DRUG THERAPY –
• Antipsychotic drugs.
• Cyproterone Acetate 50-200 mg/day. (It inhibit testosterone.)
• Serotonergies – Fluoxetine. (Reduce anxiety & depression )

50. SEXUAL DYSFUNCTION
• It occur as disturbance in any of the sexual
response cycle.
• A low level of sexual desire and interest manifested
by a failure or be responsive to a partner initiation
of sexual activity.

51. Types:
A. SEXUAL DESIRE DISORDERS
1. HYPO ACTIVE SEXUAL DESIRE DISORDER –
• It is a persistent or recurrent deficiency or absence of sexual fantasies and desire for sexual
activity.
• The clinician consider factor that affect sexual functioning such as age and person life.
• The complaint is more common in women than men.
2. SEXUAL AVERSION DISORDER –
• This disorder is characterized by a persistent or recurrent extreme aversion to and avoidance of all
genital sexual contact with a sexual partner.

52. B. SEXUAL AROUSAL DISORDERS
1. FEMALE SEXUAL AROUSAL DISORDER –
• It is a persistent or recurrent inability to attain or to maintain until completion of sexual
activity, an adequate lubrication / swelling response of sexual excitement.
2. MALE ERECTILE DISORDER –
• It is characterized by persistent or recurrent inability to attain or to maintain until
completion of the sexual activity, an adequate erection.
• Primary erectile dysfunction refers to case in which man has never been able to have
intercourse.
• Secondary erectile dysfunction refers to cases in which man has difficulty getting or
maintaining an erection but has been able to have vaginal or anal intercourse at least once.

53. C. ORGASMIC DISORDERS
1. FEMALE ORGASMIC DISORDER –
• It is a persistent or recurrent delay or absence, orgasm following a normal
sexual excitement phase.
• A woman is considered to have primary orgasmic dysfunction when she has
never experienced orgasm by any kind of stimulation.
• Secondary orgasmic dysfunction exit if the women has experienced at least
one orgasm, means of stimulation but no longer.

54. 2. MALE ORGASMIC DISORDER –
• It is characterized by persistent or recurrent delay or absence,
orgasm following a normal sexual excitement phase during
sexual activity.
• With this disorder, the man is unable to ejaculate.
• The severity of the problem may range from only occasional
problem ejaculating (Secondary Problem) to a history of never
having experienced an orgasm (Primary disorder)

55. 3. PREMATURE EJACULATION –
•It is persistent or recurrent ejaculation with
minimum sexual stimulation, before or shortly
after penetration and before the person wishes it.
•It is particularly common among young men who
have a very high sex desire and have not learned to
control ejaculation.

56. D. SEXUAL PAIN DISORDER
1. DYSPAREUNIA –
• It is recurrent or persistent or genital pain associated with sexual intercourse in
either a man or woman.
• It is not caused by vaginismus (spasm of surrounding muscles f vagina), lack of
lubricant, other general medical conditions or physiological effect of substance use.
• In women the pain may be felt in the vagina, around the vaginal entrance and
clitoris or deep in the pelvic.
• In men the pain is felt in the penis.

57. D. SEXUAL PAIN DISORDER
• Dyspareunia make intercourse very unpleasant.
• Dyspareunia in men is often associated with urinary
tract infection with pain being experienced during
urination as well as during ejaculation.

58. 2. VAGINISMUS –
•It is an involuntary construction of the outer
one third of the vagina that prevent penile
insertion or intercourse.

59. PREDISPOSING FACTORS
A. Biological Factor
1. SEXUAL DESIRE DISORDERS –
• It studies have correlated decrease level of
testosterone with hypoactive sexual desire disorder
in men, evidence also exists this suggests a
relationship between testosterone and increased
female in libido.

60. PREDISPOSING FACTORS
A. Biological Factor
• Medication have also been implemented in the etiology of
hypoactive sexually desire disorder.
• Example – Antihypertensive, antipsychotic,
antidepressant, anticonvulsants.
• Alcohol and cocaine have also been associated with
impaired desire.

61. 2. SEXUAL AROUSAL DISORDERS –
•Post Menopause women require a longer
period of stimulation for lubrication to occur.
•Various medication, those with antihistamines
and anticholinergic may also contribute to
decrease ability for arousal in women.

62. 2. SEXUAL AROUSAL DISORDERS –
• Arteriosclerosis is a common cause of male erectile
disorder as a result of arterial insufficiency.
• Neurological disorder, temporal lobe epilepsy and
multiple sclerosis, trauma (spinal cord injury pelvic
cancer) can also result in erectile dysfunction.
• Some medications like antihypertensive, antipsychotic,
antidepressants and chronic use of alcohol.

63. 3. ORGASMIC DISORDER –
• Some women report decrease ability to achieve orgasm following
hysterectomy and decrease sexual dysfunction and some
medications.
• Example selective serotonin reuptake inhibitors and some medical
condition such as depression, hypothyroidism and diabetes mellitus
may cause decrease sexual arousal and orgasm.
• Biological factor associated with inhibited male orgasm include
surgery of the genitourinary tract eg. prostectomy various
neurological disorder like Parkinson’s disease. Some medication
include opioids, hypertensive, antidepressants and antipsychotics.

64. 4. SEXUAL PAIN DISORDER –
• A number of organic factor can contribute to painful
intercourse in women’s episiotomy scar, vaginal or
urinary tract infection, ligaments injury, ovarian cyst and
tumor.
• Painful intercourse in man may also caused by various
organic factor example infection caused by poor hygiene
under the foreskin, phimosis, allergic reaction and
various prostate problem may cause pain or ejaculation.

65. B. Psychosocial Factor:
1. Sexual Desire disorder:
• Phillips (2000) has identified a number of individual and
relationship factor that may contribute to hypoactive sexual
desire disorder.
• Individual causes include sexual identity conflict, past sexual
abuse, financial, family or job problems, depression and aging
related concern.
• Common etiological implication for sexual aversion (sexual
phobia) disorder are sexual abuse in women and performance
anxiety in men.

66. B. Psychosocial Factor:
2. Sexual Arousal disorder:
• They include doubt, guilt, fear, anxiety, shame, conflict,
embarrassment, tension, irritation.
• Problem with male sexual arousal may be related to chronic stress,
anxiety or depression.
3. Orgasmic Disorder:
• Psychological factor are associated with inhibited female orgasm.
They include fear of becoming pregnant, rejection by the sexual
partner, damage to the vagina and feeling of guilt regarding sexual
impulses.

67. B. Psychosocial Factor:
Various developmental factor also have relevance to orgasmic
dysfunction. Ex. Negative family attitude towards nude, sex and
traumatic sexual experience during childhood or adolescence
such as rape.
4. Sexual Pain Disorder:
• Involuntary constriction with in the vagina occur inn
response to pain, making intercourse impossible.

68. TREATMENT

69. A. SEXUAL DESIRE DISORDER
1. HYPOACTIVE SEXUAL DESIRE DISORDER –
• It has been treated in both men and women with administration of testosterone hormone.
2. SEXUAL AVERSION DISORDER –
• To reduce the client fear and avoidance of sex, decrease the amount of anxiety generated
by these experienced.
• Successful treatment of sexual phobia has also been reported using tricyclic medication
and psychosexual therapy.

70. B. Sexual arousal disorder –
1. FEMALE SEXUAL AROUSAL DISORDER –
• It is to reduce the anxiety associated with sexual activity.
• The objective is to reduce the goal-oriented demand of intercourse
on both men and women.
2. MALE ERECTILE DISORDER –
• Group therapy have also been used successfully in reducing the anxiety
that may contribute erectile difficulties.
• Various medication including testosterone & yohimbine have been used to
treat male erectile dysfunction. Penile injection of Papaverine or
Prostaglandin have been used to produce erection lasting from 1 to 4
hours.

71. B. Sexual arousal disorder –
• United State Food and Drug Administration for the treatment of erectile
dysfunction they include sildenafil (Viagra).
 Tadalafil (Cialis)
 Vardenafil (Levitra)

72. C. ORGASMIC DISORDER
1. FEMALE –
• Because anxiety may contribute to the lack of orgasmic ability in
women.
• Advise to reduce anxiety increase awareness of physical sensation
and transfer communication skills to from verbal to the nonverbal.
2. MALE –
• A combination of focus and masturbation training has been used
with a high degree success.

73. 3. PREMATURE EJACULATION –
• Treatment focus is used with progressive to genital stimulation when the
man reached the point of imminent ejaculation, the woman is instructed
to apply the squeeze technique – applying pressure at the base of glance
penis with her thumb and first two finger. Pressure is hold for about 4
second and then released.
• This technique is practiced during subsequent period of sexual
stimulation.
• No medication has been approved by FDA (Food and Drug
Administration) for the treatment of premature ejaculation.

74. D. SEXUAL PAIN DISORDER
1. DYSPAREUNIA –
• Treatment for the pain of intercourse begin with a throuugh physical and
gynecological examination.
2. VAGINISMUS –
• Treatment begins of this disorder begin with education of women and her
sexual partner regarding the anatomy and physiology of this disorder.

75. GENDER IDENTITY DISORDER
GENDER –
• The condition of being either male or female.
DEFINITION –
• A condition in which a person’s assigned, a gender on the basis of
their sex at birth but identifies as another gender and feel significant
distress, discomfort or being unable to deal with their condition.

76. CAUSES
•Idiopathic.
•Prenatal hormonal imbalance.
•Problem in the individual, family interaction.
•Chromosomal abnormalities or genetic cause.

77. SYMPTOMS
• Persistent uncomfortable with their biological sexual role and
organ.
• Transsexual alter their physical appearance.
• Refuse to dress.
• Strongly believe that they will grow as an opposite sex.
• Dressing of opposite sex.
• May become severe depressed, anxious or social withdrawal.
• Distress, impairment in the functioning of individual.

78. DIAGNOSTIC CRITERIA –
• History collection – A history preference for friends and
playmates of opposite sex.
TREATMENT –
• Hormone replacement therapy.
• Psychosocial therapy.
• Individual or family therapy.
• Counseling.

79. VARIATION IN SEXUAL ORIENTATION
1. HOMOSEXUALITY –
• The term homosexuality derived from the Greek world Homo
means same and refers to sexual preference for individual of the
same gender.
• The term lesbianism used to identify female homosexuality is
traced to Greek poet ‘Sappho’ who lived on the island of ‘lesbos’
and is famous for the love poem. She write to other women.
• Most homosexual prefer the term gay.

80. 2. TRANSGENDERISM –
• It is a disorder of gender identity or gender dysphoria
(unhappiness or dissatisfaction with one gender) of the
most extreme variety.
• The anatomical characteristics of a given gender has
been self perception of being of the opposite gender.
• Individual with this disorder do not feel comfortable
wearing the cloth of their assigned gender and engaged
in cross dressing.

81. 2. TRANSGENDERISM –
• Special concern:
• Treatment is a complex process . The true transgender
individual desire to have the genitalia & physical
appearance of the assigned gender changed to conform
to his or her gender identity.
• This change require a great deal more than surgical
alteration of physical features.

82. 2. TRANSGENDERISM –
• Special concern:
• In most cases, the individual must undergo extensive
psychological testing and counseling as well as live in the
role of the desired gender for upto 2 years before
surgery.
• Hormonal treatment is initiated during this period. Male
client receive estrogen, which result in a readjustment of
body fat in a more feminine (looking like women)
pattern

83. 2. TRANSGENDERISM –
• Special concern:
• Enlargement of the breast, a softening of the skin and
reduction in body hair.
• Women receive testosterone, which also cause a
redistribution of body fat, growth of facial and body
hair, enlargement of the clitoris & deepening of the
voice. Amenorrhea occur with a few months.

84. 2. TRANSGENDERISM –
• Special concern:
• Surgical treatment for male to female transgender
reassigned involve removal of penis , testes and creation
of an artificial vagina. Care is taken to preserve sensory
nerves in the area so that the individual may continue to
experience sexual stimulation.
• Surgical treatment for female to male transgender
reassigned is more complex.

85. 2. TRANSGENDERISM –
• Special concern:
• A mastectomy & some times a hysterectomy are
performed. A penis and scrotum are constructed from
tissue in the genital and abdominal area, the vaginal
orifice is closed. A penile implant is used to attain
erection.
• Both men and women continue to receive maintenance
hormone therapy following surgery.

86. 3. BISEXUALITY –
•A bisexual person is not heterosexual and
homosexual.
•He or she engaged in sexual activity with members
of both gender.
•Bisexual is more common than exclusive
homosexuality. It suggests that approximately 75%
of all men are exclusively heterosexual and only 2%
are exclusively homosexual.