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Sexual disorders

Talking about sexuality with our patients


Topic is often ignored Must be open to talking about sexuality issues with patients Tools can facilitate discussion (I.e., Female Sexual Function Index)

Sexual dysfunction

Definition

Disturbance in the sexual response cycle or pain with sexual intercourse

Etiology of sexual dysfunction


Organic Psychogenic Secondary to medications

Overview of sexual response cycle


Desire phase Excitement phase Orgasm phase Resolution phase

Desire phase
Reflects psychiatric concern with motivations, drives and personality Characterized by sexual fantasies and desire to have sexual activity

Excitement phase

Brought on by psychological stimulation, physiological stimulation or a combination of the two

Orgasm phase

Peaking of sexual pleasure with release of sexual tension and rhythmic contraction of perineal muscles and pelvic reproductive organs

Resolution phase

Disengorgement of blood from genitalia, allowing body to return to resting state

DSM-IV Sexual dysfunction disorders


Sexual desire disorders Sexual arousal disorders Orgasm disorders Sexual pain disorders Sexual dysfunction due to a general medication condition Substance-induced sexual dysfunction Sexual dysfunction NOS

Sexual dysfunction associated with desire phase


Hypoactive sexual desire disorder Sexual aversion disorder Hypoactive sexual desire disorder due to a general medical condition Substance-induced sexual dysfunction with impaired arousal

Sexual dysfunction associated with excitement phase


Female sexual arousal disorder Male erectile disorder Male erectile disorder due to a general medical condition Dyspareunia due to a general medical condition Substance-induced sexual dysfunction with impaired arousal

Sexual dysfunction associated with orgasm phase


Female orgasmic disorder Male orgasmic disorder Premature ejaculation Other sexual dysfunction due to a general medical condition Substance-induced sexual dysfunction with impaired orgasm

Sexual dysfunction associated with resolution phase


Postcoital dysphoria Postcoital headache

Sexual dysfunction associated with pain


Dyspareunia (Not due to a general medical condition) Vaginismus (Not due to a general medical condition)

Paraphilias

Definition of paraphilias

A condition in which the sexual instinct is expressed in ways that are socially prohibited or unacceptable or are biologically undesirable (APA, 2000)

Epidemiology
Pedophilia is most common among legally identified cases Most often found in males

Etiology
Psychosocial factors Biological factors

DSM-IV paraphilias

Exhibitionism Fetishism Frotteurism Pedophilia Sexual masochism Sexual sadism Transvestic fetishism Voyeurism Paraphilia NOS

Exhibitionism
Recurrent urge to expose the genitals to a stranger or unsuspecting person Sexual excitement occurs in anticipation of the event Orgasm is brought on by masturbation during or after the event Almost all cases involve men exposing themselves to women

Fetishism
Sexual focus on objects that are intimately associated with the human body Disorder occurs almost exclusively in men

Frotteurism
Recurrent, intense sexually arousing fantasies, sexual urges or behaviors involving touching and rubbing against a nonconsenting person Incident usually occurs in crowded places

Pedophilia
Recurrent intense sexual urges towards, or arousal by, children 13 years or younger Persons with pedophilia are at least 16 years old and are at least 5 years older than the child or children About 60% of victims are male

Sexual masochism
Recurrent preoccupation with sexual urges and fantasies involving the act of being humiliated, beaten, bound or otherwise made to suffer More common among men than women

Sexual sadism
Recurrent sexual fantasies, urges or behaviors in which pleasure is derived from the psychological or physical suffering of another Most persons with this disorder are male

Transvestic fetishism

Fantasies and sexual urges to dress in clothing of the opposite gender as a means of arousal or as an adjunct to masturbation or coitus

Voyeurism

Recurrent preoccupation with fantasies and acts that involve an unsuspecting person who is naked, in the process of disrobing or engaging in sexual activity

Gender identity disorder

Definition
Persistent desire to be, or the insistence than one is, the other sex Person experiences extreme discomfort with assigned sex and gender role

Epidemiology
No information about prevalence Estimates of prevalence based on number seeking sex-reassignment surgery suggests a male preponderance

Etiology
Biological factors Psychosocial factors

Treatment for sexual disorders


Nurse-patient relationship Psychopharmacology Milieu therapy

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