sexual response cycle and sexual disorders with nursing diagnosis

1. SEXUAL
DISORDERS
PRESENTATION BY
MS NEHA BHATT

2. Sexual disorders
• It refers to the difficulty experienced by an individual or
couple during any stage of a normal sexual activity including
physical pleasure , desire , preferences arousal or orgasm .

3. THE SEXUAL RESPONSE CYCLE
•Phase I. Desire
•Phase II. Excitement
•Phase III. Orgasm
•Phase IV. Resolution

4. PHASE I. DESIRE
• Sexual activity occurs in response to verbal, physical,
and/or visual stimulation.
• Sexual fantasies can also bring about this desire.

5. PHASE II. EXCITEMENT
• This is the phase of sexual arousal and erotic pleasure.
• Physiological changes occur.
Male responds Penile tumescence and erection.
Female changes include vasocongestion in the pelvis,
vaginal lubrication and expansion, and swelling of the
external genetalia.

6. PHASE III. ORGASM
• Peaking of sexual pleasure, with release of sexual
tension and rhythmic contraction of the perennial
muscles and reproductive organs
• Women is marked by simultaneous rhythmic
contractions of the uterus, the lower third of the
vagina, and the anal sphincter.
• Men a forceful emission of semen occurs in response
to rhythmic spasms of the prostate, seminal vesicle,
vas and urethra.

7. PHASE IV. RESOLUTION
• creating a sense of general relaxation,
• well-being, and muscular relaxation.
• If orgasm does not occur, resolution may take 2 to 6 hours with
irritability and discomfort.
• Refractory period

8. CLASSIFICATION OF SEXUAL DISORDER
I. Gender identity disorder
II. Psychological and behavioural disorders
associated with sexual development and
maturation
III. Paraphilias
IV. Sexual dysfunctions

9. ETIOLOGY AND PSYCHOPATHOLOGY
• Physical causes
• Anomalies of the body
• Irritations of the vagina that cause pain when making love
• operations on the genitals.

10. • Psychological factors
• Feelings, thoughts and perceptions that cause sexual
problems.
• Negative feelings for the partner or shame for one's
own body,
• Unpleasant events of the past.
• Fears and restraints related to sex.

11. • Social factors
• May be values and standards that you have received
in your education,
• Traumatic events or the behavior of the partner.
• Stress factors

12. GENDER IDENTITY DISORDER
• Strong feelings of being born with the wrong gender.
Incidence
• One out of 11900 men and one out of 30400 women.
Types
a. Transexualism
b. Gender identity disorder of childhood
c. Dual role transvestism
d. Inter sexuality

13. a) Transsexualism
• Discomfort regarding one’s anatomic sex and a feeling that it is
inappropriate to one’s perceived gender.
• The person will be preoccupied with the wish to get rid of one’s
genitals and to adopt the sex characteristics of the other sex.

14. b. Gender identity disorder of childhood
• Similar to transsexualism with a very early age of
onset.
c. Dual – role Transsexualism
• Being sexually aroused by fantasies about wearing
clothes of the opposite sex.
d. Inter sexuality
• The patients have anatomical or physical features of
the other sex. (Turner syndrome, congenital adrenal
hypoplasia.)
• Effects - GID can cause depression and other misery.

15. Treatment
Transsexual Gender Identity Disorder
• Psychotherapy (changing the feelings)
• Sex reassignment surgery, (SRS) (changing the body).
Gender identity disorder of childhood
• Help the child avoid peer ostracism and
humiliation, be comfortable with is or her own sex,
• Avoid the development of adult gender dysphoria.

16. II. PSYCHOLOGICAL AND BEHAVIOURAL DISORDERS
ASSOCIATED WITH SEXUAL DEVELOPMENT AND
MATURATION
Homosexuality
Types
1. Obligatory homosexuality
2. Preferred homosexuality
3. Bisexuality
4. Situational homosexuality
5. Latent homosexuality

17. 1. Obligatory homosexuality
 Only homosexuality
 No heterosexuality
2. Preferred homosexuality
 Predominant homosexuality
 Occasional homosexuality
3. Bisexuality
 Equal to homosexuality & heterosexuality
4. Latent homosexuality
 Only hetro sexuality
 Fantasies of homosexuality

18. TREATMENT
• For seeking a change in sexual orientation
Behaviour therapy, aversion therapy (rarely used), covert
sensitization, supportive psychotherapy, etc...
• For seeking removal of distress only
 Antidepressants and benzodiazepines
• Referred by others
 No treatment & treat as earl as possible.

19. III. PARAPHILIAS
• A paraphilia is a recurring sexually exciting fantasy, impulse or
behavior related to non-human objects e.g things, fabrics, designs,
the suffering or humiliation of oneself or the partner, children or
other non-consenting persons.
Incidence
No statistics available, much more frequently in men than women

20. These disorders includes
♦ Sadism
♦ Masochism
♦ Voyeurism
♦ Pedophilia
♦ Frotteurism
♦ Fetishism
♦ Transvestites
♦ Exhibitionism
♦ Other paraphilia

21. SADISM
• Getting sexually aroused by fantasies about
doing psychological or physical harm to a victim. This
can mean getting aroused by humiliating another
person, who often consents to this, using pain-
causing material during sexual contact, for example
whips or chains. The person with whom there is
sexual contact is often a sexual masochist.

22. MASOCHISM
• Masochism is getting sexually aroused by fantasies about being
humiliated, beaten, tied up or otherwise tortured. Sadism is getting
sexually aroused by incurring humiliate, beating, tying up or
otherwise torturing.
• Sado-Masochism is the combination of Sadism and Masochism in a
complementary manner.

23. VOYEURISM
• Getting sexually aroused by fantasies about
secretly watching others permission during sexual
activities, undressing or being naked. Watching
pornography not include.
PEDOPHILIA
• Getting sexually aroused by a child in pre-
puberty or child younger than13 years old.

24. FROTTEURISM
• Getting sexually aroused by touching and rubbing
oneself against another non-consenting person.
(usually other sex)
E.g Crowded place and buses
FETISHISM
• Getting sexually aroused by non-living and
generally not sexually arousing objects, e.g shoes,
lingerie, soft fabrics, etc.

25. TRANSVESTITES
• Gets sexually aroused by fantasies about wearing
clothes of the opposite sex.
EXHIBITIONISM
• Getting sexually aroused by the idea of showing
the genitals to an unsuspecting stranger to achieve
orgasm. (usually a female Child or adult)

26. OTHER PARAPHILIAS
Telephone scatologia: Getting sexually aroused by
fantasies about harming or humiliating others through
the phone.
Necrophilia: Getting aroused by fantasies about sexual
activities with corpses.
Partialism: Getting aroused by fantasies about certain
body parts.
Zoophilia: Getting aroused by fantasies about sexual
activities with animals.

27. Coprophilia
• Getting aroused by fantasies about feces.
Klismaphilia
• Getting aroused by fantasies about injecting liquids via
the anus.
Urolagnia
• Getting aroused by fantasies about urine.

28. SOCIAL CONSEQUENCES
• Feelings of shame, contempt or anger towards the person are
very frequent.

29. TREATMENT
Treatment may be focused on two areas.
1) Space can be created for the development of the paraphilia.
 In this case patients get tips for getting in contact with
fellow-sufferers and accepting themselves.
2) On the other hand the paraphilia can be suppressed so that it
occupies a smaller and more controllable place in the life of the
person.

30. BIOLOGICAL TREATMENT
• Focused on blocking or decreasing the level of
circulating androgens.
 Testosterone synthesis or block androgen
receptors.
 It decreases the libido.

31. PSYCHOANALYTICAL THERAPY
• Therapist helps the client to identify unresolved conflicts and traumas
from early childhood.
• Thus relieving the anxiety that prevents him or her from forming
appropriate sexual relationships.

32. BEHAVIOURAL THERAPY
Aversion therapy
• Involve paring noxious stimuli, such as electric shocks and bad odors,
with the impulse which then diminishes.
Behavioural therapy
• Includes skills training and cognitive restructuring in an effort to
change the individual’s maladaptive beliefs.

33. IV. SEXUAL DYSFUNCTIONS
Sexual dysfunction is a significant disturbance in
the sexual response cycle, which is not due to an
underlying organic cause.

34. CAUSES
Physical stimulation
• This needs certain hormones and the right touch.
• Hormonal disorders.
• Certain medication and depression can block this stimulation.

35. Psychological factors
• Finding your partner unattractive
• Having negative thoughts about making love
• Recalling unpleasant fantasies about making love
• Negative emotions
• Stress and fear.

36. Social causes
May be problems between the partners.
• Communication problems (one wants to sleep, the
other feels rejected by this)
• Struggle for power between the partners.

37. The common dysfunctions are
• Frigidity
• Impotence
• Premature ejaculation
• Non-organic vaginismus
• Non-organic dyspereunia

38. a. Frigidity
• Absence of desire for sexual activity.
b. Impotence
• Inability to have or sustain penile erection till the
completion of satisfactory sexual activity.
c. Premature ejaculation
• Ejaculation before the completion of satisfactory
sexual activity for both partners.

39. d. Non- organic vaginismus:
• An involuntary spasm of lower 1/3rd of vagina,
interfering with coitus.
e. Non- organic dyspareunia:
• Pain in the genital area of either male or female
during coitus.

40. TREATMENT
Both Men and Women
• There are no standard treatments for a reduced
interest in sex.
• Counseling about reduced desire in stressful
situations like death, unemployment, being childless,
disease of the partner or stress at work.
• If all sexual interest has disappeared, the hormonal
regulation should be examined.

41. Other therapy includes:
• Psychoanalysis
• Hypnosis
• Group psychotherapy
• Behavior therapy

42. NURSING INTERVENTIONS FOR CLIENT WITH SEXUAL
DISORDER
Nursing diagnosis I : Sexual dysfunction related to depression and
conflict in relationship; biological or psychological contributing factors
to the disorder evidenced by loss of sexual desire or function.
Nursing Diagnosis II: Ineffective sexuality patterns related to conflicts
with orientation or variant preferences evidenced by expressed
dissatisfaction with sexual behaviours (e.g., voyeurism; trasvestism)
Nursing diagnosis III: Low self esteem related to rejection by peers
evidenced by difficulty accepting positive reinforcement; self-negating
verbalizations; inability to form close personal relationships.

43. • Nursing diagnosis IV: Disturbed personal identity related to parenting patterns
that encourage culturally unacceptable behaviours for assigned gender
evidenced by statements of desiring to be of the opposite gender; exhibiting
behaviors culturally associated with the opposite gender.
• Nursing diagnosis V: Impaired social interaction related to social and culturally
unacceptable behaviours evidenced by peer rejection and identification with
members of the opposite gender.

44. THANK YOU