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Chapter 26Sexuality and Sexual
Disorders
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sexuality is determined by anatomy, physiology,
psychology, the culture in which one lives, one’s
relationship with others, and developmental
experiences throughout the life cycle. It includes
the perception of being male or female and all
those thoughts, feelings, and behaviors connected
with sexual gratification and reproduction,
including the attraction of one person to another.
—Sadock & Sadock, 2008
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives
After studying this chapter, you should be able to
• Differentiate the terms sex, sexual acts, and sexuality
• Describe the theories of gender identity development
• Distinguish between the terms gender identity and sexual
identity
• Articulate the attitudes and behaviors of sexuality exhibited by
individuals at various developmental stages: infants and
children, preadolescents and adolescents, and adults
• Identify factors that contribute to sexual aggression in children
and adolescents
• Discuss the phases of the human sexual response cycle
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Learning Objectives (cont.)
• Relate the dynamics of female and male sexual
dysfunctions
• Recognize masochistic and sadistic behavior
• Explain the consequences of sexual addiction
• Analyze the barriers to your taking a sexual history
• Articulate the importance of addressing transcultural
considerations when conducting a sexual history
• Construct a list of various pharmacologic approaches
used to treat female and male clients with clinical
symptoms of a sexual disorder
• Formulate a list of nursing interventions for a female
client with clinical symptoms of a sexual disorder
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Overview of Gender Identity and Sexual
Orientation
• Terminology
– Sexual identity
– Gender identity
– Sexual orientation
– Sexual behavior
• Etiology of gender identity development
– Genetic and biologic theories
– Psychosocial theories
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Overview of Gender Identity Disorders
Individuals who have gender identity disorders:
• Have a strong and persistent cross-gender
identification in which he or she expresses the
desire to be, or the insistence to be, of the
opposite sex
• Experience persistent discomfort about his or her
assigned sex or feel inappropriate in the role of
the assigned sex
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Overview of Sexual Disorders
• Sexual disorders are classified into the following:
– Sexual dysfunctions
– Paraphilias
– Sexual addiction
• Two major factors that impact sexual performance:
– Presence or absence of normal sexuality
– Presence or absence of adequate sexual response
cycle
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Development of Sexuality
• Infancy and childhood
• Preadolescence and adolescence
• Adulthood
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Human Sexual Response Cycle
Five phases of the human sexual response cycle
are the following:
• Desire
• Excitement
• Plateau
• Orgasm
• Resolution
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Clinical Symptoms and Diagnostic
Characteristics of Sexual Disorders
Sexual disorders are categorized as sexual dysfunction
disorders or paraphilias.
• Sexual dysfunction disorders involve an impairment of
the sexual physiologic response.
• Paraphilias refer to disorders involving recurrent intense
sexual urges and sexually arousing fantasies generally
involving nonhuman objects.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sexual Dysfunctions
• Sexual desire disorders
• Sexual arousal disorders
• Orgasmic disorders
• Sexual pain disorders
• Sexual dysfunction due to a general medical condition
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Paraphilias
• Disorders in which unusual or bizarre sexual imagery or
acts are enacted to achieve sexual excitement
– May involve nonhuman objects
– May involve the suffering and humiliation of oneself
or another person
• Sadism: achieving sexual excitement from
psychological or physical suffering of another
• Masochism: act of being injured, bound,
humiliated, or otherwise made to suffer
– May involve children or other nonconsenting persons
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Sexual Addiction
• It is defined as engaging in obsessive–compulsive sexual
behavior that causes severe stress to addicted individuals
and their families.
• Addicts may feel powerless, out of control, and ashamed
about their addiction.
• The addiction creates functional disturbances in everyday
activities.
• Consequences may include loss of relationships, low selfesteem, despair, etc.
• Often sexual addicts have dual diagnoses with substance
abuse or depression.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
The Nursing Process
• Assessment
• Nursing diagnoses
• Outcome identification
• Planning interventions
• Implementation
• Evaluation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Assessment
• Sexual history
– Barriers to taking a sexual history
• Assessment of children and adolescents
• Transcultural considerations
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nursing Diagnoses
• Ineffective sexuality
patterns
• Sexual dysfunction
• Rape trauma syndrome
• Chronic low self-esteem
• Disturbed body image
• Anxiety
• Fear
• Hopelessness
• Social isolation
• Spiritual distress
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Outcome Identification
• Outcomes related to gender identity and sexual
functioning must be developed with input from the client
because the goals of treatment are very personal.
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Planning Interventions
• Planning utilizes an integrated sexual health team model,
involving nurses, sex counselors, medical social workers,
and sexuality educations.
• Interventions are planned to
– Meet the client’s basic human needs
– Provide structured and protective care
– Explore methods to rechannel sexually unacceptable
behavior
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Implementation
• Assistance in meeting basic needs
• Provision of a safe environment
• Medication management
• Interactive therapies
• Support groups
• Client education
–Individual
–Psychotherapy
–Marital or couples
therapy
–Family therapy
–Sex therapy
–Group therapy
–Behavioral therapy
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Evaluation
Effective interventions with a client with sexual dysfunction
include the following:
• Improvement in sexual response cycle
• Increased partner satisfaction
Effective interventions with a client with a gender identity
disorder include the following:
• Positive response to medication if treatment for anxiety
or depression was implemented
• Improved ability to cope with issues related to his or her
gender identity disorder
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Key Terms
• Ambiguous genitalia
• Klinefelter’s syndrome
• Chromosomes
• Male pseudohermaphrodites
• Gender identity
• Masochistic behavior
• Hermaphrodite
• Sadistic behavior
• Hermaphrodism
• Sex
• Homosexuality
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Key Terms (cont.)
• Sexual acts
• Sexual response
• Sexual addiction
• Transgender
• Sexual behavior
• Transsexual
• Sexual identity
• Transvestite
• Sexuality
• Turner’s syndrome
• Sexual orientation
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
Reflection
Review the chapter-opening quote about the development
of sexuality by Sadock & Sadock. In some Middle Eastern
countries, women are not allowed to show their faces in
public, wear Western-style clothes, or drive a car. They
are considered to be second-class citizens.
• What influence do you think
these cultural practices might
have on the development of a
woman’s sexual identity?
• What impact would these
cultural practices have on a
female American citizen
working in such a country?
Copyright © 2012 Wolters Kluwer Health | Lippincott Williams & Wilkins
?