Chapter 20
Chapter 20:
Sexual Disorders: Sexual
Dysfunctions and
Paraphilias
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Sexual Dysfunctions
Etiology
Physical/biologic
Disease processes
Medications
Psychologic/behavioral
Earlier experiences
Anxiety/stress
Misinformation
Couple-oriented factors
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Sexual Dysfunctions
Disorders
Sexual desire disorders
Sexual arousal disorders
Female arousal
Male erectile disorder
Orgasmic disorders
Delay or absence of orgasm
Premature ejaculation
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Sexual Dysfunctions
Disorders, cont’d.
Sexual pain disorders
Sexual dysfunction due to medical condition
Substance-induced
Not otherwise specified
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Sexual Dysfunctions
Discharge Criteria
Expresses satisfaction with sexuality
Evidences knowledge of disorder
Uses strategies appropriate to treat disorder
Communicates with partner
Copes with frustrations/setbacks
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Sexual Dysfunctions
Assessment
Nurse: Examine own feelings
Establish rapport before progressing to sexuality information
Sexual history
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Sexual Dysfunctions
Nursing Diagnoses
Anxiety
Risk-prone health behavior
Impaired comfort
Impaired verbal communication
Ineffective coping
Defensive coping
Fear
Hopelessness
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Sexual Dysfunctions
Nursing Diagnoses, cont’d.
Deficient knowledge
Chronic pain
Ineffective role performance
Situational low self-esteem
Sexual dysfunction
Ineffective sexuality pattern
Social isolation
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Sexual Dysfunctions
Client Outcomes
Individualized
Examples:
Verbalize problem.
Identify feelings.
Schedule physical examination.*
Participate in sex therapy.*
Practice recommended strategies.
*If indicated.
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Sexual Dysfunctions
Planning
Based on:
Realistic criteria
Mutually selected goals
Client willingness to participate
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Sexual Dysfunctions
Implementation
View problem as couple-oriented
Education
Counseling
Identification of strategies
Referral
Support
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Sexual Dysfunctions
Nursing Interventions
Teach sexual response cycle.
Teach about sexual dysfunction.
Help enhance communication skills related to intimacy/sexuality.
Support exploration of fears/anxiety.
Encourage positive self-talk, body image, exercises to increase self-esteem.
Refer as appropriate.
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Sexual Dysfunctions
Medical Testing (Male)
Nocturnal penile tumescence
Plethysmography
Testosterone and prolactin levels
Penile brachial index
Ultrasound
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Sexual Dysfunctions
Medical Testing (Female)
Plethysmography
Estradiol level
Testosterone level
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Sexual Dysfunctions
Treatment Modalities (Male)
Sildenafil (Viagra)
Apomorphine (Spontane)
SSRIs
Hormone replacement
Yohimbine
Intracarpal injections
Prosthetic device
Stop-start technique
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Sexual Dysfunctions
Treatment Modalities (Female)
Yohimbine
Estrogen
Testosterone
EROS-CTD
Vaginal dilators and relaxation
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Sexual Dysfunctions
Treatment Modalities (Both)
Sensate focus
Homework assignments
Supportive counseling
Education
Cognitive restructuring
Masturbation training
PLISSIT
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Paraphilias: Sexual Deviations
Recurrent, intense, sexually-arousing fantasies, sexual urges, or behaviors involving nonhuman objects or suffering/humiliation of self, partner, children, or other nonconsenting persons
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Paraphilias
Exhibitionism
Fetishism
Frotteurism
Pedophilia
Sexual masochism
Sexual sadism
Transvestic fetishism
Voyeurism
Not otherwise specified
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Paraphilias
Etiology
Biologic factors
Chromosomal
Hormonal
Experiential factors
History of sexual abuse
Environmental factors
Hereditary predisposition
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Paraphilias
Discharge Criteria
States nature of paraphilia: impact on self and others
Identifies triggers
Develops relapse prevention strategies
Communicates and problem-solves appropriately
Practices coping strategies
Identifies support systems
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Paraphilias
Assessment
Perceptual disturbances
Cognitive distortions
Denial
Rationalization
Disturbances in feelings
Lack of remorse
Relating disturbances
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Paraphilias
Nursing Diagnoses
Ineffective coping
Ineffective denial
Interrupted family processes
Deficient knowledge
Noncompliance
Ineffective sexuality pattern
Impaired social interaction
Risk for other-directed violence
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Paraphilias
Outcome Identification
State two sexually inappropriate behaviors.
Identify triggers.
Describe two coping strategies.
List relapse prevention strategies.
Actively participate in group therapy.
Verbalize two appropriate sexual outlets.
Explain importance of medication compliance.
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Paraphilias
Planning
Involve client
Client-centered outcomes
Mutually agreed on
Realistic
Affected by cognitive distortions
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Paraphilias
Nursing Interventions
Help client confront cognitive distortions:
Direct questions
Confrontation
Journal writing
Educate client and significant others about:
Disorder
Treatment
Methods of relapse prevention
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Paraphilias
Nursing Interventions, cont’d.
Enhance compliance with treatment.
Provide results of research.
Teach coping strategies, assertiveness, and problem solving.
Promote social skills development.
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Paraphilias
Pharmacologic Treatment
Medroxyprogesterone acetate (Depo-Provera)
Leuprolide (Lupron Depot)
Flutamide
SSRIs
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Paraphilias
Psychotherapy/Psychoeducation
Address cognitive distortions
Identify triggers
Relapse prevention strategies
Treatment compliance
Self-esteem
Coping strategies
Problem solving
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