SEXUAL DISORDER Sexual Related Disorder (DSM IV) SEXUAL DYSFUNCTION Characterized by inhibition of sexual appetite Psychophysiological changes

nges that compromise the sexual response cycle PARAPHILIAS Intense sexual urges Nonhuman objects Suffering or humiliation of oneself or ones partner Children or non-consenting person GENDER IDENTITY DISORDER Discomfort with ones biological sex Desire to have the characteristic of the other sex SEXUAL RESPONSE CYCLE 4 PHASES 1. DESIRE PHASE 2. EXCITEMENT PHASE 3. ORGASM PHASE 4. RESOLUTION PHASE TO FREUD: SIMILARITIES TO AGGRESSION (ASSAULT CYCLE) Triggering Escalating Crisis Recovery Postcrisis depression

Sexual Arousal D/O Sidetrack the sexual response cycle at the excitement phase Inability to maintain the physiological requirement for sexual intercourse Lubrication swelling response Erection (erectile dysfunction) Orgasm D/O Arrest the progression of the cycle in the orgasm phase Inability to achieve orgasm Includes fears of rejection, impregnation, or damage to vagina, hostility towards men, and guilty feelings Premature ejaculation, retarded or inhibited ejaculation FRUSTRATION Sexual Pain D/O Abort sexual response cycle at any phase Suffers from genital pain before, during & after DYSPAREUNIA & VAGINISMUS TYPES of PARAPHILIA - Sexual instinct expressed in socially prohibited or unacceptable or are biologically undesirable - May seek inpatient Tx for the wrong reason implication? - Generally, pedophilia, exhibitionism & voyeurism is Tx in OP basis - WHO ARE THEY? -May be MALE or FEMALE - May be related to a period of stress, rather than chronic or repetitive pattern (mostly) there is also chronic - May increase with symptoms of depression They could be the following A. PEDOPHILIA

- Why will this help us in understanding the disorder better? - S.D. are grouped into d/o that compromise one of these phases Types of Sexual Dysfunction: Sexual Desire D/O Stops the sexual response cycle Little or no sexual desire (hypoactive sexual desire d/o) Aversion to sexual contact (sexual aversion disorder)

 Sexual urges/ sexually arousing fantasies involving sexual activity with children --- may act or feel distressed Victims < 13 y.o., pedophile 16 years or older, and @ least 5 years older than victim Pattern: A. Opposite, same or both sex children B. May be limited to INCEST C. Fondling or oral sex

CHILD - a source of GRATIFICATION, INTIMACY, EMOTIONAL FULFILMENT, POWER & CONTROL Perpetrator doesnt have to select occupation C. EXHIBITIONISM Sexual pleasure derived from exposing ones genitals to an unsuspecting stranger Stimulation comes from the EFFECTS OF SHOCKING VICTIMS No other sexual activity is attempted

D. Vaginal or anal penetration are usually incest Personality of Pedophilia: 1. Shyness 2. Sensitivity 3. Isolation in social situations 4. Low self-esteem 5. Dependency 6. Depression 7. Low self-confidence 8. Use of alcohol & drugs 9. Hx of SEXUAL ABUSE 10. POWERLESS compensates ---CONTROL & DOMINATION of victims 11. Nonaggressive or aggressive Usually has satisfactory sexual relationship with adult partner Why Then? - EMOTIONAL CONFLICT - EXCESSIVE FREE TIME D. FETISHISM Sexual pleasure from inanimate objects Common FETISH objects: Bras, underpants, stocking & shoes; urine & feces soaked Individual may often masturbate while holding the fetish object FETISH OBJ.---MASTURBATION---SEXUAL PLEASURE E. FROTTEURISM Sexual pleasure derived from touching or rubbing ones genitals against a non-consenting individuals thighs or buttocks -may fondle victim Often occurs in CROWDED PLACE F. SEXUAL MASOCHISM vs. SEXUAL SADISM SEXUAL MASOCHISM - Sexual pleasure from humiliating, beating, or made to suffer Ex. A. Urinated or defecated by prosti. B. HYPOXIPHILIA

Trickery or Bribery, threat of violence --- actual = CHILD RAPIST 12. Seeks occupation that provides easy access to children B. INCEST Pedophilia with child relationship (includes step parents) Extremely traumatic to children 1. By someone they TRUST, DEPEND, & UNABLE TO ESCAPE Occurs in families that are generally disorganized & exhibit disturbed relationship Sex is always involved

SEXUAL SADISM - Sexual pleasure derived from inflicting psychological or physical suffering on another partners may be consenting or masochistic Some get great pleasure from torturing/ killing victims --- SADISTIC RAPIST

Clarification & education about sexual functioning, effective communication, & healthy relationships Self- esteem issues, anxiety, guilt & empathy for victims HELP PERPETRATOR DEAL with PHYSICAL & EMOTIONAL DIMENSIONS anorexia, insomnia, weight loss, guilt, helplessness, shame, and relief about getting caught SET LIMITS ON HOW PATIENT DISCLOSES IN A GROUP SETTING For victims of sexual assault COORDINATE CARE & PROPER REFERRALS NURSE IS LEGALLY OBLIGATED TO REPORT SUSPECTED ANDACTUAL SEXUAL ABUSE OF CHILDREN PSYCHOTHERAPY Assess all meds that may cause sexual dysfunction 1. ANTIANDROGEN THERAPY 2. SSRIs Flouxetine (Prozac) & Setraline (Zoloft) - Increase in Serotonin = decrease sexual appetite, decrease depression and anxiety MILIEU Mgt Group dealing with Self-esteem, assertiveness, anger management, social & relationship skills, sex education & stress management Multidimensional treatment plan: combination of education, cognitive, behavioral, and family intervention HOMOSEXUALITY Homosexuality is a sexual or romantic desire for people of the same sex. It is a normal variant of sexual orientation. It occurs in 3 to 10% of men and 1 to 5% of women. The etiology of homosexuality is unknown, but genetic or prenatal factors may play a role. Distress about ones sexual orientation is considered a dysfunction that should be treated with individual psychotherapy and/or group therapy.

G. VOYEURISM - Sexual pleasure derived from observing unsuspecting persons who are naked or undressing or who are engaged in sexual activity VOYEUR Peeping Tom may masturbate

GENDER IDENTITY DISORDER -Involves discomfort with ones sex or the gender role of that sex -Adult: desires to live as the other sex or can involve feelings and reactions of the other sex -preoccupation with getting rid of primary and secondary sexual characteristic believes born of wrong sex desires HORMONES and SURGERY ---TRANSEXUALISM Sexual reassignment surgery is not immediately undertaken 6 12 months psychotherapy Hormonal treatment Living and relationship changes Nurse should assess for presence of other psychiatric disorder PSYCHOTHERAPEUTIC MANAGEMENT ACCEPTING, EMPATHIC and NONJUDGMENTAL ATTITUDE Pt feels comfortable to disclose problems VS. discomfort as disapproval PROVIDE PRIVATE AREA Helps discuss pts. Feelings, fears & concerns & victimizations DISCUSS OPTIONS FOR DEALING with SEXUAL ISSUES and PROBLEMS