Sexual disorders

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Sexual disorders
Phases in sexual response

      Desire- The phase is characterized by sexual fantasies and the desire to have sexual activity.
      Excitement- Subjective sense of sexual pleasure and accompanying physiological changes leading to penile erection in male and vaginal lubrication in female.
      Orgasm- Peaking of sexual pleasure, with release of sexual tension occurs at this phase. Contraction of the perineal muscles and the pelvic reproductive organs occur followed semen discharge in male and involuntary contractions of the lower third of the vagina in females.
      Resolution-A sense of general relaxation, well-being, and muscle relaxation is experienced in this phase. After this phase men have a refractory period that may last from several minutes to many hours; in that period they cannot be stimulated to further orgasm. Women do not have a refractory period and are capable of multiple and successive orgasms.

Definition
Sexual disorders- Disturbances in sexual preference, development and orientation is called as sexual disorders
Incidence
     Common in 18-59 years
     Paraphilias common in males
     Pedophilia 45%
     Exhibitionism-25%
     Premature ejaculation-27%
Classification
      Gender Identity Disorders
      Psychological and behavioural disorders associated with sexual development and maturation
      Disorders of sexual preferences (Paraphilias)
      Sexual dysfunctions
a.      Gender Identity Disorders
In this a person feels as if their biological gender doesn’t accord with who they feel themselves to be.
      Transsexualism- Strong , persistent feelings of identification with the opposite gender and discomfort with one's own assigned sex.
Treatment
§  Counselling
§  Sexual Reassignment surgery
      GID of Childhood- Children who experience significant discontent with their biological sex, assigned gender, or both.
      Dual role transvestism- The individual wears clothes of the opposite sex in order to experience temporary membership in the opposite sex and does not wish for a permanent change in sex.
      Intersexuality- A person is born with a reproductive or sexual anatomy that doesn’t seem to fit the typical definitions of female or male. For example, a person might be born appearing to be female on the outside, but having mostly male-typical anatomy on the inside.
b.      Psychological and behavioral disorders associated with sexual development and maturation
Homosexuality – In this sexual disturbance, sexual relationships are maintained between persons of same sex. Female homosexuals are called lesbians and males are called gay.
Etiology
Ø  Biological
      Decreased level of testosterone
      Increased level of estrogen
Ø  Psychosocial theories
      Arrest in normal psychosexual development at infant stage
      Negative oedipal position in which the child gets attracted to the same sex parent.
      Dysfunctional family pattern
Treatment
     Behavior therapy: aversion therapy, covert sensitization, systematic de sensitization.
     Psychotherapy: supportive and psychoanalytic
c.       Paraphilias- Sexual arousal occurs persistently and significantly in response to objects which are not a part of normal sexual arousal.
      Fetishism-Sexual arousal occurs usually with non living objects intimately associated with human body like under garments.
      Transvestism-Sexual stimulation occurs by wearing clothes of opposite sex people.
      Sexual sadism- Arousal by physical and psychological humiliation, suffering or injury of partner by beating or creating bruises.
      Sexual masochism- Arousal by physical and psychological humiliation, suffering or injury of self.
      Exhibitionism- Exposure of one’s genitalia to an unsuspecting stranger will result in sexual arousal.
      Voyeurism-Observe unsuspecting people of opposite sex naked or having sex will stimulate sexual arousal.
      Frotteurism- Sexual arousal by involvement in the act of touching and rubbing against non consenting person.
      Pedophilia-Involving in sex with pre pubertal children usually less than 13 years of age.
      Zoophilia-Involving in sexual activities with animals
      Others
Etiological factors
      Biological
     Increased androgen level
     Temporal lobe tumor
     Medications
     Substance use
      Psychological
     Childhood sexual trauma
     Negative perception of one’s body image
     Unresolved oedipal crisis in which attributes the intimacy to opposite sex parent to inanimate objects.
      Behavioral
     Modeling & mimicking the acts of others or which is seen in media.
      Cultural
     Sexual myths
     Religiosity
      Relational
     Financial and family stress
     Ineffective communication
Treatment of paraphilias
      Behaviour therapy
      Psycho analysis
      Antipsychotics

d.      Disturbance in sexual response cycle.
These are disturbances in sexual response cycle without any organic cause .
      Frigidity-Absence of desire involve in sexual activity.
      Impotence-Inability to sustain penile erection for sexual activity.
      Premature ejaculation-Ejaculation of semen before the completion of sexual activity
      Non-organic vaginismus-Involuntary spasm of vagina without any organic cause.
      Non- organic dyspareunia- Pain during sexual activity without any organic cause.
Treatment
      Psycho analysis
      Hypnosis
      Group psychotherapy
      Behaviour therapy
Nursing Management
      Collect sexual history
      Assure confidentiality
      Perception of problem
      Cultural, social and religious factors contributing to conflicts
      Medication history
      Explain human sexuality and cycle of sexual response
      Correct any misconcepts
      Encourage communication within partners
      Counselling
      Non judgmental attitude

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Sexual disorders
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