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
COMMENTS