The document discusses various topics related to sexual health including gender identity, gender roles, transsexualism, paraphilias, sexual addiction, sexual dysfunctions, nursing care for sexual dysfunctions, and sex therapy. It defines key terms and describes characteristics and treatment approaches for various conditions. The overall purpose is to provide information on these topics to healthcare providers.

1. Mr. Vincent Ejakait 1
SEXUAL
DISORDERS

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GENDER IDENTITY
• This is an individual’s personal or private
sense of identity as female or male
• It develops from an interaction of biology,
identity imposed by others and self-identity

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GENDER ROLES
• Refers to learning and performing socially
accepted sex behaviors, i.e., taking on a
feminine or masculine role
• Proponents of andogeny (flexibility in gender
roles), however, view most characteristics and
behaviors as human qualities that should not
be limited to a specific gender

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TRANSSEXUALISM
• Is a gender identity disorder in which a
person has consistently strong feelings of
being trapped in a body of a wrong sex.

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PARAPHILIAS
• A group of psychosexual disorders
characterized by unconventional sexual
behaviors
• These are abnormal expressions of sexuality
• They are not, by definition, pathologic
• They only become so when severe, insistent,
coercive and harmful to the self or others

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NON-COERCIVE PARAPHILIAS
• Fetishism
• Autoerotic Asphyxia
• Sexual Masochism
• Transvestitism

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NON-COERCIVE PARAPHILIAS -
FETISHISM
• Sexual arousal elicited by inanimate objects
(shoes, leather, rubber) or specific body
parts (feet, hair)

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NON-COERCIVE PARAPHILIAS -
AUTOEROTIC ASPHYXIA
• Constriction of the neck to enhance a
masturbation experience; often leads to
accidental death

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NON-COERCIVE PARAPHILIAS -
SEXUAL MASOCHISM
• Erotic interest in receiving psychological or
physical pain, real or fantasized

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NON-COERCIVE PARAPHILIAS -
TRANSVESTITISM
• Using the apparel of the opposite sex

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COERCIVE PARAPHILIAS
• Exhibitionism
• Voyeurism
• Frotteurism
• Obscene Phone Callers / Telephone Scatologia
• Pedophilia
• Urophilia
• Coprophilia
• Sadism

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COERCIVE PARAPHILIAS -
EXHIBITIONISM
• Intentional exposure of the genitals to a
stranger or unsuspecting person
• May be accompanied by arousal and
masturbation either during or after the
exposure

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COERCIVE PARAPHILIAS –
VOYEURISM
• Secret observation of an unsuspecting person
(usually a woman) engaged in a private act,
e.g., undressing or having sex.
• The voyeur often masturbates during or after
the viewing

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COERCIVE PARAPHILIAS - FROTTEURISM
• Intense sexual arousal elicited by rubbing the
genitals against a non-consenting person

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COERCIVE PARAPHILIAS –
OBSCENE PHONE CALLERS
• Calling a non-consenting person and making
sexual noises, using profanity, attempting to
seduce, or describing sexual activity.
• The caller often masturbates during or after
the call

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COERCIVE PARAPHILIAS –
PEDOPHILIA
• Sexual interest in a child
• Behavior ranges from exposure, voyeurism,
and explicit talk to touching, oral sex and
intercourse

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COERCIVE PARAPHILIAS –
UROPHILIA
• Urinating on the sexual partner

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COERCIVE PARAPHILIAS - COPROPHILIA
• Smearing feces on the partner

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COERCIVE PARAPHILIAS –
SADISM
• Erotic interest in inflicting physical pain

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OTHER FORMS OF PARAPHILIA
• Anningulus
• Cunnillingus
• Fellatio
• Partialism

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OTHER FORMS OF PARAPHILIA ANNILINGUS
• Tongue brushing of the anus

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OTHER FORMS OF PARAPHILIA
CUNNILLINGUS
• Tongue brushing of the vulva

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OTHER FORMS OF PARAPHILIA FELLATIO
• Inserting the penis into the mouth

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OTHER FORMS OF PARAPHILIA PARTIALISM
• Inserting the penis into the other parts of
the body

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TYPE OF THERAPY PERFORMED ON
PATIENTS WITH PARAPHILIAS
Behavior Modification
Aversion Therapy
Token Economy

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SEXUAL ADDICTION
• The frequency of sexual activity can be viewed on
a continuum, with most people falling in the
middle range
• Some have sex frequently in a way that enhances
their lives; others have sex infrequently and
report contentment and satisfaction
• A sexual pattern that falls at either extreme of
the continuum, however can signal problems.

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SEXUAL ADDICTION
• Is a disorder in which the central focus of life is sex
• People with these addictions spend 50% or more of all
waking hours dealing with sex, from fantasy to acting out
behavior.
• Acting out behavior is often victimless, e.g., overindulging
in masturbation, fetishism, pornography use, or commercial
telephone sex; or visiting prostitutes
• Victimizing behaviors (those with a non-consenting
partner) are less frequent and include obscene phone calls,
frotteurism, voyeurism, exhibitionism, child sexual abuse
and rape

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SEXUAL ADDICTION
• Sexual addiction is not simply the frequent
enjoyment of sexual behaviors; rather, it is a
progressive disease in which sex is used to numb
pain.
• The pay off is the same as in any other addiction,
i.e., an intensely pleasurable, short-lived release
from pain, and an escape from the problems of
daily life.
• The consequences are the same in the addict’s life
and eventually becomes unmanageable

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SEXUAL ADDICTION
• Many sexual addicts grew up in homes where
they were emotionally, physically, or sexually
abused
• Most of them suffer from low self-esteem
and believe themselves unlovable.
• They have desperate need for love and they
equate sex with proof of love.

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SEXUAL ADDICTION
• The components have the hallmarks of
obsessive-compulsive behavior:
– Preoccupation
• Spends hours thinking or obsessing about
sex and is so time consuming that the person
cannot fulfill work, school, or family
responsibilities

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SEXUAL ADDICTION
• The components have the hallmarks of
obsessive-compulsive behavior:
– Ritualization
• The individual engages in specific behaviors
done just the “right” way and in the same
sequence at the right time. The ritual seems to
control anxiety; once addicts begin a ritual, they
cannot stop until the cycle is completed

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SEXUAL ADDICTION
• The components have the hallmarks of
obsessive-compulsive behavior:
– Compulsivity
• The individual cannot control sexual behavior
and this behavior becomes the most
important aspect of life

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SEXUAL ADDICTION
• The components have the hallmarks of
obsessive-compulsive behavior:
– Shame and Despair
• At the end of the cycle, the person experiences
guilt and shame at the loss of control. The pain
of despair creates the need to begin the cycle
all over again. Like other addicts, these
individuals want to stop their behavior, promise
to stop, try to stop and are unable to stop
without treatment.

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SEXUAL DYSFUNCTIONS
• These are problems or difficulties with sexual
expression classified according to the phase of
the sexual response cycle that is affected
• This does not include dissatisfaction problems
• Contributory factors actually implicate past and
current factors:
– Lack of sex education
– Internalization of the teaching that sex is dirty
or sinful
– Parental punishment for normal exploration of
one’s genitals
– Severe trauma such as rape or child sexual
abuse

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SEXUAL DYSFUNCTIONS
• Contributory factors actually implicate
past and current factors:
– Negative feelings like guilt anxiety,
anger which interfere with the ability to
experience pleasure and joy

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SEXUAL DYSFUNCTION
• Fear of failure in sexual performance often
becomes a vicious cycle, i.e., fear of failure
creates actual failure, which in turn, produces
more fear.

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CLASSIFICATIONS OF SEXUAL
DYSFUNCTION
Disorders of Sexual Desire
Arousal Disorders
Orgasm Disorders

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DISORDERS OF SEXUAL DESIRE
• Inhibited Sexual Desire
– Persistently low interest or a total lack of
interest in sexual activity
• Sexual Aversion Disorder
– Severe distaste for sexual activity or the
thought of the sexual activity, which then leads
to a phobic avoidance of sex
– The most common cause of sexual aversion
disorder is childhood sexual abuse or adult rape
• Increased Sexual Interest
– Symptomatic of the manic phase of a bipolar
disorder

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AROUSAL DISORDERS
• Physiologic responses and subjective sense of
excitement experienced during sexual activity
– Female Sexual Arousal Disorder
• Lack of vaginal lubrication
– Male Sexual Arousal Disorder
• Occurs when the man has erection problems
during 25% or more of sexual interactions;
cannot attain a full erection or loses erection
prior to orgasm (impotence / erectile inhibition)

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ORGASM DISORDERS
• Inhibited Female Orgasm / Frigid
– Woman is totally incapable of responding sexually
– Sexual response stops before orgasm occurs
• Pre-orgasmic
– Women who have never experienced an orgasm
• Secondarily Non-Orgasmic
– They have had orgasm in the past but are not
currently experiencing them
• Situationally Non-orgasmic
– Have orgasms in some situations but not in others

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ORGASM DISORDERS
• Inhibited Male Orgasm
– Male can maintain an erection for long periods
(e.g., an hour or more) but has extreme
difficulty ejaculating
– Could be organic, e.g., spinal cord injuries,
multiple sclerosis, due to drugs or may be
psychogenic (fear of pregnancy, performance
pressure, fear of losing control, anxiety and
guilt about engaging in sexual activity)

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ORGASM DISORDERS
• Rapid Ejaculation
– One of the most common dysfunction among
men
– Refers to the absence of voluntary control of
ejaculation
– Probably due to:
• Inability to perceive his arousal level accurately
• Lowered sensory threshold due to infrequent sexual
activity
• Early conditioning as a result of hurried masturbation
or hurried sexual intercourse
• Extreme anxiety during sexual interaction, resulting
in ejaculation triggered by the SNS

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SEXUAL PAIN DISORDERS
• Vaginismus
– Involuntary spasms of the outer one third
of the vaginal muscles making penetration
of the vagina painful and sometimes
impossible.
– Cause is mainly psychophysiologic: as
protection against real or imagined pain;
history of sexual trauma; emotional conflict

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SEXUAL PAIN DISORDERS
• Dyspareunia
– Pain during or immediately after
intercourse
– Could be due to skin irritations, vaginal
infection, estrogen deficiency, or drugs;
pelvic disorders, such as endometriosis,
scar tissue, tumors

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PROBLEMS WITH SEXUAL SATISFACTION
• These are more related to the emotional tone
of the relationship than the physiologic
response
• May be situational, due to lack of extragenital
satisfaction, related to the relationship
difficulties, due to lack of intimacy

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NURSING CARE FOR SEXUAL DYSFUNCTIONS
• Reduce anxiety and fear
– Accurate identification of feelings is the first
step
– Help the client identify one anxiety-producing
situation within their sexual interactions
– The nurse and client may analyze the situation
to discover negative anticipatory thoughts that
may be the source of the anxiety.
– Review how the client has handled anxiety in
the past and evaluate the range and
effectiveness of this past coping behavior,
then explore alternative coping behaviors

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NURSING CARE FOR SEXUAL DYSFUNCTIONS
• Decrease spiritual distress
– Because the origin of spiritual distress is
the lack of intimacy or connection within a
sexual relationship, the goal of nursing care
is to help clients achieve and maintain a
level of intimacy each partner finds
comfortable

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NURSING CARE FOR SEXUAL
DYSFUNCTIONS
• Promote more effective family coping
– Apart from setting specific times to share feelings,
and belief, some couples need training in more
effective communication skills.
• Teach couples to avoid the “you” language, which evokes
a defensive response and results in arguments, and
encourage use of the “I” language, which expresses
personal thoughts, feelings and needs.
– Example of “You” language
• “You only have sex on your mind. You are a pervert”
– Example of “I” language
• “I am concerned because we seem to have different
expectations of how often we would like to make love.”

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NURSING CARE FOR SEXUAL
DYSFUNCTIONS
• Promote comfort with personal identity
– A multidisciplinary approach is most
effective in helping transsexuals adjust to
their situation
– Family and friends need support and
counseling to reintegrate this person into
their lives as a person of the other sex

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NURSING CARE FOR SEXUAL
DYSFUNCTIONS
• Promote effective role performance
– Refer sexual addicts to self-help groups
and specialized professional therapy
– Recovery is a long-term process facilitated
by individual, group, couple, family, and
family-of-origin therapy

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NURSING CARE FOR SEXUAL
DYSFUNCTIONS
• Promote non-coercive sexuality patterns
– If practiced with an adult consenting
partner requires no nursing intervention
except for client and partner education and
possible couple negotiation about the
behavior

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NURSING CARE FOR SEXUAL
DYSFUNCTIONS
• Decrease violence against the self and others
– The most important nursing education
regarding autoerotic asphyxia is community
education
– Therapy for sex offenders is a specialized
area that should not be taken lightly
– Behavior modification techniques, group
therapy, hypnosis could be used

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NURSING CARE FOR SEXUAL
DYSFUNCTIONS
• Decrease pain
– Thorough physical examination is necessary
to find and treat the organic cause of the
pain
– Vaginismus is treated with education,
dilators and supportive psychotherapy

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NURSING CARE FOR SEXUAL
DYSFUNCTIONS
• Increase knowledge
– Teach clients sexual anatomy and the
sexual response cycle
– Encourage couples to talk with one another
about their individual responses

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SEX THERAPY
• Common components
– Information and education about sexual
functions
– Experiential and Sensory Awareness
• Therapist helps clients to recognize feelings of
anxiety, anger and pleasure by tuning into bodily
cues
– Insight
• Therapist attempts to learn and understand
what is causing and perpetuating the sexual
problem

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SEX THERAPY
• Common components
– Cognitive Restructuring
• Clients identify and re-evaluate their non-sexual
fears about sexual interaction
– Behavioral Interventions
• Focus is on changing the non-sexual behavior
that contributes to sexual problems
• Assertiveness training, communication training,
stress-reduction exercises and problem-solving
techniques