The document provides an overview of psychosexual disorders, including: 1. Gender identity disorders involve a person's sense of identity not matching their physical sex which can cause significant distress. Treatments may include counseling, hormone therapy, and sexual reassignment surgery. 2. Sexual dysfunctions refer to problems during the sexual response cycle that prevent satisfaction. Major types for men include erectile dysfunction and premature ejaculation, while major types for women include low sexual desire and inability to orgasm. 3. Paraphilias involve unusual or socially unacceptable sexual interests or behaviors. Treatment involves psychotherapy and sometimes pharmacological interventions. Understanding and properly treating psychosexual disorders can help improve individuals' well-being and relationships.

1. PSYCHOSEXUAL
DISORDERS
Mr Mulundano
BSC NS-UNZA
KCN

2. •WARNING!
•SENSITIVE SEXUAL
INFORMATION

3. INTRODUCTION
• Sex is an important part of
our lives but often much
confusion about what is
going on during sex.
• Easy for sex to get less
exciting but understanding
biological processes can
help find ways to avoid
this
• This is a significant
contributing factor to
marital problems

4. INTRODUCTION
• The best way to
develop a healthy
attitude towards sex
is to demystify it.
Sex is very private
but something we all
do after a certain
age so knowledge is
beneficial.

5. •At the end of the unit the learner
should be able to show an
understanding of psychosexual
disorders and manage a client with
psychosexual disorder.
General objective

6.  At the end of the unit the learner
should be able to:
• Define psychosexual disorder
• Explain the different types of
psychosexual disorders
• Describe the specific management of
a client with psychosexual disorders
Specific objective

7. • Definition of psychosexual disorder
• Psychosexual disorders are defined as the
sexual problems that are psychological in origin
and occur in absence of any pathological
disease.
• Masters & Johnson’s (1970) observes that the
physiological process of sexual intercourse
involves increasing levels of vaso congestion
and myotonia (tumescence) and the
subsequent release of the vascular activity and
muscle tone as a result of orgasm
(detumescence).

8. Sexual Disorders
•Disorders fall into one of three
very broad categories:
1)Gender Identity Disorders
2)Sexual Dysfunction
3)Paraphilia

9. 1. Gender Identity Disorder
•The gender identity disorders (GID)
are defined as disorders in which an
individual exhibits marked and
persistent identification with the
opposite sex and persistent
discomfort (dysphoria) with his or
her own sex or sense of
inappropriateness in the gender role
of that sex.

10. • By 2-3yrs old, a sense that “I’m a boy” or
“I’m a girl” is firmly set;
• Sense of masculinity & femininity develop
based on biology, parental & cultural
attitudes.

11. 1. Gender Identity Disorder
• Gender identity disorder exists when the
person’s sense of identity (male vs.
female) is inconsistent with who they are
physically. “I’m a man trapped in a
woman’s body” or vice versa. Has also
been referred to as transsexualism.
• Not the same as being gay.
• Not the same as intersex individuals, who
have anatomically ambiguous genitalia.

12. 1. Gender Identity Disorder
• Causes are unknown, although
one would assume there is a
biological link
• Ends up undergoing, sexual
reassignment surgery.

13. 1. Gender Identity Disorder
•Sexual orientation is to do with who
an individual is attracted to for
sexual satisfaction which includes
satisfaction in emotional interest,
genitals interest and sexual
physiological excitement.
•Object of person’s sexual attraction -
hetero, homo or bi-.
•Note: sexual orientation is not GID.

14. Figure. 1: shows a young man who underwent sexual
reassignment and changed to be female

15. Figure 2: Male sexual reassignment to
female

16. DSM-IV-TR Diagnostic Criteria For
Gender Identity Disorder
A. A strong and persistent cross-gender
identification (not merely a desire for
any perceived cultural advantages of
being the other sex).
In children, the disturbance is manifested
by four (or more) of the following:

17. 1. Repeatedly stated desire to be, or insistence
that he or she is, the other sex
2. In boys, preference for cross-dressing or
simulating female attire; in girls, insistence on
wearing only stereotypical masculine clothing
3. Strong and persistent preferences for cross-
sex roles in make-believe play or persistent
fantasies of being the other sex

18. • 4. intense desire to participate in the
stereotypical games and pastimes of the
other sex
• 5.strong preference for playmates of the
other sex

19. • B. Persistent discomfort with his or her
sex or sense of inappropriateness in the
gender role of that sex.
• C. The disturbance is not concurrent with
a physical intersex condition.
• D. The disturbance causes clinically
significant distress or impairment in
social, occupational, or other important
areas of functioning.

20. Treatment
• Treatment can help people who have
gender dysphoria to explore their gender
identity and find the gender role that feels
comfortable for them, easing distress.
But treatment needs to be individualized.
•

21. • The process might or might not involve a
change in gender expression or body
modifications.
• Treatment options might include changes
in gender expression and role, hormone
therapy, surgery, and behavioral therapy.
Coping and support. Behavioral health
treatment.

22. 2. Sexual Dysfunctions
•Sexual dysfunction refers to a
problem occurring during any phase
of the sexual response cycle that
prevents the individual or couple
from experiencing satisfaction from
the sexual activity.

23. 2. Sexual Dysfunctions
•The sexual response cycle
traditionally includes excitement,
plateau, orgasm, and resolution.
•Desire and arousal are both part of
the excitement phase of the sexual
response.

24. Basic physiological process of sexual
responses
The two basic physiological processes that
occur during these stages are vasocongestion
and myotonia.
• Vasocongestion occurs when great deal of
blood flows into the blood vessels in a region,
in thisncase the genitals, as a result of dilation
of the blood vessels in the region.
• Myotonia occurs when muscles contract, not
only in the genitals but also throughout the
body.

25. Excitement Phase
Sexual desire
•thinks about sex
•Fantasizes about having sex
•Feels attracted to a potential
sexual partner

26. Excitement Phase
• Sexual arousal is part of
excitement phase.
• Sexual arousal-
• Feels an increasing need to have
sex
• Erotic stimuli - factors
in the environment that
are sexually arousing.

27. Signs and symptoms
•Muscle tension,
•Some increase in heart rate &
blood pressure, areas of the body
become engorged.
•It may result in a sex flush – a
pink or red rash on the chest and
face.

28. Sexual arousal-
• What turns one
person on may be
totally ineffective in
another person
(certain underwear,
certain music, certain
food, certain smells)
• Often all associated
with past sexual
encounter(s).

29. Sexual arousal-
• Erotic stimuli possible by all senses
• touch, vision, hearing, smell, taste.
• Body is most sexually sensitive in
certain areas called erogenous zones
• Some obvious –> head of penis, clitoris, mons pubis, vagina,
labia, nipples (female)
• Some less obvious –> nipples (male), ear lobes, anus, buttocks
(“cheeks”), inner thighs (esp. women) back of knees, soles of feet,
eyebrows, lower center of back

30. Erogenous zones

31. Erogenous zones

32. •Sexual Arousal –
• Flirting, kissing, foreplay (petting),
seduction
• MILD pain, gentle biting
• Extremely important start of the sexual
response cycle

33. Excitement disorders
• Desire- Hypo-active Sexual Desire
disorder; Sexual aversion disorder;
hypoactive sexual desire disorder due to
a general medical condition (male or
female); substance induced sexual
dysfunction with impaired desire.

34. • Arousal
• Female sexual arousal disorder; male
erectile disorder (may also occur in stage
3 and in stage 4); male erectile disorder
due to a general medical condition;
substance-induced sexual dysfunction
with impaired arousal

35. •Men more commonly have
erectile dysfunction and
premature ejaculation, while
women have hypoactive sexual
desire.

36. ORSGASMIC PHASE
• Peak of sexual arousal, release of
physical, emotional and psychological
build-up.
• In male, it is usually equivalent to
ejaculation.

37. • One can almost never get anyone to give
a solid definition of what female orgasm
is.
• Instead, people usually fall back on,
"You'll know what it is when you have
one."
• This evasiveness is probably related to
several factors, most notably that female
orgasm leaves no tangible evidence of
its occurrence like ejaculation.

38. • Also, women often do not reach orgasm as
quickly as men do.
• The main feeling is a spreading sensation that
begins around the clitoris and then spreads
outward through the whole pelvis.
• There may also be sensations of falling or
opening up. The woman may be able to feel
the contraction of the muscles around the
vaginal entrance. The sensation is more
incense than just a warm glow or a pleasant
tingling.

39. Orgasmic disorders
• Female orgasmic disorder; male
orgasmic disorder; premature ejaculation;
other sexual dysfunction due to a general
medical condition (male or female);
substance induced sexual dysfunction
with impaired orgasm

40. •Numerous psychological factors are
associated with female orgasmic
disorder.
•They include fear or guilt concerning
sexual impulses, fear of rejection by
a sex partner, or hostility toward
men.

41. Resolution phase
• Following orgasm is the resolution phase,
during which the body returns
physiologically to the unaroused state.
• Orgasm triggers a massive release of
muscular tension and of blood from the
engorged blood vessels.
• Resolution then represents a reversal of
the processes that build up during the
excitement and plateau stages.

42. Resolution disorders
• Postcoital dysphoria; postcoital
headache.
• Postcoital dysphoria [sometimes
called postcoital tristesse (French for
sadness) or the “post-sex blues”] refers to
feelings of deep sadness or agitation after
consensual sex, even if the encounter was
loving, satisfying, or enjoyable. In some cases,
people become tearful or depressed after
orgasm

43. • Orgasm without discharge of it brings
about repeated buildups of
vasocongestion.
• The result is a chronic vasocongestion in
the pelvis.
• A mild version of this occurs in some
women who engage in sex but are not
able to have orgasms, and it can be quite
uncomfortable.

44. • One of the most common complaints
women bring to sex therapists is a
socially defined dysfunction: they reach
orgasm only through manual or oral
stimulation of the clitoris, or only when
the intercourse is combined with such
direct stimulation. In fact, this is normal.

45. TYPES OF SEXUAL
DYSFUNCTIONS
• Erectile dysfunction or impotence: This
is characterized by an inability to achieve
or maintain an erection sufficient for
successful sexual intercourse. In primary
impotence the man is not able to have
erection at all in his sexual life.
• In secondary impotence, the man has
successfully achieved vaginal penetration
at some time in his sexual life but is later
unable to do so. But In selective
impotence, the man is unable to do so in
certain circumstances but not in others.

46. • Premature ejaculation: This occurs when the
man recurrently achieves orgasm and
ejaculation before he wishes to do so.
• It is more common today among college
educated men than among men with less
education and it is thought to be related to their
concern for partner satisfaction.
• About 40% of men treated for sexual disorders
have premature ejaculation as the chief
complaint.

47. • There are three types of premature
ejaculation known as:
a. Habitual premature ejaculation
b. Acute onset premature ejaculation
c. Insidious onset premature ejaculation

48. • Pleasure dissociative orgasmic disorder,
is a condition in which an individual
cannot feel pleasure from an orgasm. It is
thought to be a variant of hypoactive
sexual desire disorder. Aka Orgasmic
anhedonia.

49. • Frigidity (inhibited sexual excitement)
in female: This is characterized by the
inability of the female to express sexual
satisfaction. Its chief physical
manifestation is a failure to produce the
characteristic lubrication of the vulva and
vaginal tissue during sexual stimulation, a
condition that may make coitus
uncomfortable.

50. • Inhibited Female orgasm
(anorgasmia):
This is characterized by a recurrent and
persistent inhibition of the female orgasm
as manifested by a delay in or absence of
orgasm following a normal sexual
excitement phase during sexual activity, It
refers to the inability of the women to
achieve orgasm by masturbation or coitus.

51. • Dyspareunia: This is a recurrent and
persistent pain during coitus in either the
man or the women. It often coincides with
vaginismus. It is due to physical factors
like trauma, inflammation, endometritis. It
can also result from psychological cause.

52. • Vaginismus: This is an involuntary
constriction of the outer one third of the
vagina that prevents penetration, insertion
and coitus. It is less prevalent than
anorgasmia. It often affects highly
educated women and those in higher
socioeconomic groups. Sexual trauma as
rape may result in vaginismus.

53. • Nymphomania: This is excessive sexual
derive or desire in females.
• Satyriasis: This is excessive sexual drive
or desire in males.

54. Summary of Sexual Dysfunctions
MEN:
‒Hypoactive sexual disorder,
‒Sexual aversion disorder,
‒Male erectile disorder,
‒Inhibited male orgasm,
‒Premature ejaculation,
‒Dyspareunia-sexual pain

55. WOMEN:
‒hypoactive sexual desire disorder,
‒sexual aversion disorder,
‒female sexual arousal disorder,
‒inhibited female orgasm,
‒dyspareunia, and
‒vaginismus.

56. Predisposing factors
•Restrictive upbringing
•Disturbed family relations
•Traumatic early sexual experiences
•Poor sex education

57. Etiological factors
• Psychologic issues such as depression or drug
addiction, or by
• Physiologic issues such as high levels of
prolactin, low levels of testosterone, use of
• Medications such as SSRI antidepressants and
oral contraceptives, or
• Chronic medical problems such as spinal cord
injury and chronic fatigue syndrome.

58. • Drugs can lead to the following sexual
dysfunctions:
• Impaired ejaculation
- Guanathidine
- Bethamedine
- Thioridazine (Melleraril) .

59. • II) Decreased libido and impotency
- Oral contraceptive
- Sedatives
- Major tranquilizers (e.g. Chlorpromazine
(Largactil).
- Lithium
- Methyldopa
- Clamidine

60. Treatment
1. Proper diagnosis:
2. Psychotherapy:
• Different psychotherapeutic methods are
used.
• Behavioral and cognitive behavioral
psychotherapies are the most widely
used techniques.
3. Pharmacological treatment:

61. • Thorough assessment is a necessity, and is
comprised of clinical interviews, medical
examination, and psychophysiological
assessment procedures.
• Much of what we know about treatment
evolved out of Masters and Johnson’s work in
St. Louis.
• Example of treating erectile
dysfunction/premature ejaculation using
sensate focus and non demand pleasuring.

62. • Sensate focus is a series of intimate
touch exercises that teach one how to be
fully in the body during sex. The
exercises can be done solo or with a
partner and can last from 10 minutes to
one hour.
• Sensate uses non-demand touching,
which means you are touching with no
particular outcome or expectation in
mind.

63. • Sildenafil (Viagra) for erectile
dysfunction
• Local anesthetic sprays for premature
ejaculation
• SSRIs are used for premature
ejaculations, no controlled studies are
available
• Pharmacological treatment of any
underlying psychiatric disorders:
depression, generalized anxiety, phobia

64. • Psychologic approaches to improving orgasmic
function focus on the woman exploring
psychologic factors such as hypoactive sexual
desire disorder, depression, poor arousal,
anxiety, fatigue, emotional concerns, past
trauma and abuse history, cultural and religious
prohibitions feeling excess pressure to have
sex, or a partner’s sexual dysfunction such as
erectile dysfunction or premature ejaculation.

65. •Sex therapy includes teaching the
use by couples of manual or vibrator
stimulation during intercourse, or
using the female-above position as it
may allow for greater stimulation of
the clitoris and it allows the woman
better control of movement.

66. •Sex therapy may focus on
mindfulness strategies and yoga
exercises. Sex therapy also assist
the woman examine and realign
expectations of orgasm. Emotional
intelligence, or knowledge of one’s
own mood or sense of being is
important for orgasm function.

67. • NEXT PARAPHILIAS

68. PARAPHILIAS
•When the weird get going, the going
gets weird…
•Focus of sexuality is on something
or someone other than a consenting
adult.

69. Paraphilias
• Includes the following:
1) Fetishism
2) Voyeurism/Exhibitionism
3) Transvestic Fetishism
4) Sexual Sadism and Sexual
Masochism
5) Sadistic Rape
6) Pedophilia and Incest

70. Paraphilias
• Zoophilia- performing sex acts with non-
human animals
• Coprophilia- abnormal interest and
pleasure in feces and defecation.
• Urophilia- Urolagnia (also urophilia, golden
shower and watersports) is a paraphilia in
which sexual excitement is associated with the
sight or thought of urine or urination.

71. • Telephon scatologia- an individual
obtains sexual pleasure by making
obscene telephone calls. See scatophilia.
Scatologia- deviant sexual practice in
which sexual pleasure is obtained through
the compulsive use of obscene language
aka (coprolalia).

72. Paraphilias
• Fetishism: sexual attraction to nonliving
objects, i.e., shoes and undergarments.
• Voyeurism(scopophilia): involves
observing individuals in a state of
undress without their knowledge
(peeping), while
• Exhibitionism involves exposing oneself
to strangers. Has a thrill-seeking
component.

73. Paraphilias
• Transvestic Fetishism: sexual excitement is related
to the act of cross-dressing. Spouses are often
quite supportive.
• Sexual Sadism
• Sadism involves sexual excitement when hurting
others, while
• Sexual Masochism involves sexual excitement
when one is on the receiving end of the hurt. Wide
range of activities are involved and seems to lie on
a continuum. According to Barlow a subset of
rapists appear to be highly sadistic and meet
criteria for a paraphilia

74. Paraphilias
• Pedophilia and Incest: Sexuality is
focused on children, and can involve
either or both sexes. Now aware of the
widespread nature of childhood sexual
abuse in our country, and it’s long term
impact on both women as well as men.
• The majority of perpetrators are men.
Speculation as to why?

75. • Frotteurism is usually characterized by a
man's rubbing his penis against the
buttocks or other body parts of a fully
clothed woman to achieve orgasm
• Necrophilia is an obsession with obtaining
sexual gratification from cadavers. Most
persons with this disorder find corpses in
morgues, but some have been known to rob
graves or even to murder to satisfy their sexual
urges.

76. Paraphilias-Causal Factors
•Inability to access “normal” sexual
outlets may result in accessing other
sexual outlets.
•Early sexual fantasies may be
repeatedly reinforced through
repeated masturbation, resulting
ultimately in a paraphilia.

77. Treatment
•Psychosocial treatments have been
largely unsuccessful; the Barlow text
is quite misleading. The success
rates he quotes have not been found
in most clinical settings.

78. MANAGEMENT OF CLIENTS WITH
PSYCHOSEXUAL DISORDERS
• The nurse must examine their feelings
about her/his own sexuality before she
/he is able to care for the patients who
sexually act out or present symptoms of
sexual disorders.
• Nurses are not immune to the
development of identity disorders, an
unresolved Oedipal or Electra complex,
or psychosexual dysfunction.

79. • Feelings of disgust, contempt, anger or fear
need to be identified and explored so that they
do not interfere with the development of a
therapeutic relationship.
• This is one of the reasons patients do better
with a team approach rather than with
individual therapy. The quality of nursing care
will depend on the nurse’s ability to be
nonjudgmental and to understand the
behavior of a patient who is sexually acting
out.

80. • Nursing intervention for patients who
exhibits symptoms of sexual disorders
also includes planning care to meet the
basic human needs, providing a
protective care for the patient, exploring
methods to re-channel sexually
unacceptable behaviour and participation
in a variety of therapies, including
behavior therapy, and psychotherapy.

81. Assignment
• Explain the diference between Gender
identity and sexual orientation.

82. • THE END