Download Mental Health Nursing II NURS 2310

Mental Health Nursing II
NURS 2310
Unit 10
Psychiatric/Mental Health
Alterations Affecting
Sexuality/Reproduction
Sexual Development
Birth – Age 12
Culturally defined gender roles
 Exploration of genitals
 Growing awareness of anatomical
differences
 Masturbation and experimentation

Adolescence
Acceleration of sexual development
 Puberty: appearance of sex characteristics
 Exploration and experimentation
 Psychosocial development hinges on sexual
intimacy

Adulthood
Marital sex
 Extramarital sex
 Sex and the single person

– Casual or committed sex
– Independence without sexual intimacy
Middle Years (40 – 65)
Decrease in hormonal production
 Menopause

– Hot flashes
– Insomnia
– Depression
Middle Years (cont’d)
Painful intercourse due to decrease in
vaginal lubrication
 Less forceful ejaculation
 Increased refractory period (8-24 hours)
 Decrease in biological drive

The Elderly
Decline in estrogen and testosterone
production
 Physiological changes may result in painful
intercourse for women (thinning vaginal
wall, spastic uterine contractions)

The Elderly (cont’d)
Erections occur more slowly and require
more stimulation to achieve
 Sexual interest and behavior declines
somewhat
 Positive attitude toward sex during youth
translates to continued active and satisfying
sex life during the later years

Key Terms
Sexuality = the constitution and life of an
individual relative to characteristics
regarding intimacy; reflects the totality of
the person and does not relate exclusively
to the sex organs or sexual behavior
Reproduction = the process by which one
gives rise to offspring and which
fundamentally consists of the segregation
of a portion of the parental body by a
sexual process and its subsequent growth
and differentiation into a new individual
Gender = the condition of being male or
female; one’s masculinity or femininity
– Gender identity is usually established by age 3,
whereas sexual identity may continue to evolve
Gender dysphoria = incongruence between
biological (or assigned) gender and
experienced (or expressed) gender
Homosexuality = sexual preference for
individuals of the same gender
Bisexuality = a person who is not exclusively
heterosexual or homosexual; engages in
sexual activity with both genders
Paraphilia = repetitive or preferred sexual
fantasies or behaviors that involve one or
more of the following:
– the preference for use of a nonhuman object
– repetitive sexual activity with humans that
involves real or simulated suffering or
humiliation
– repetitive sexual activity with nonconsenting
partners
Sexual Dysfunction = an impairment or
disturbance in any of the phases of the
sexual response cycle
Paraphilia
Characterized by recurrent, intense sexual
urges, behaviors, or sexually arousing
fantasies that are considered to be aberrant
 Personal distress related to the sexual
behavior is not generally experienced
 Treatment usually obtained due to pressure
from partner or the authorities
 Outpatient treatment most often sought for
pedophilia, exhibitionism, or voyeurism
 Most paraphiliacs are male
 Symptoms generally develop in adolescence

Types of Paraphilia

Exhibitionism = exposure of one’s genitals
to an unsuspecting stranger

Fetishism = use of nonliving objects

Frotteurism = touching and rubbing against
a nonconsenting person

Pedophilia = sexual activity with a
prepubescent child

Masochism = sexual excitement resulting from
being beaten, bound, or humiliated

Sadism = sexual excitement resulting from
the physical/psychological suffering of another

Transvestism = dressing in the clothes of the
opposite gender

Voyeurism = observing an unsuspecting
person who is naked, disrobing, or engaging
in sexual activity
Treatment Modalities
Hormones given to block or decrease the
level of circulating androgens
 Medications focused on decreasing the
libido to interrupt the pattern of compulsive
deviant sexual behavior
 Psychoanalytical therapy

– Unresolved conflicts/childhood trauma

Aversion techniques
– Paring of noxious stimuli with the impulse

Cognitive restructuring
Sexual Dysfunction

Widespread prevalence
– 50% of all couples in the U.S. suffer from some
type of sexual dysfunction
– 25% of the U.S. population will experience a
sexual dysfunction at some time in their lives

Causes (results in an interference of one or
more stages of the sexual response cycle)
– Low levels of serum testosterone
– Neurological disorders (erectile dysfunction)
– Organic factors such as endometriosis (painful
intercourse for women)
– Depression, anxiety, past sexual abuse
Sexual Response Cycle
Phase I: Desire  occurs in response to verbal,
physical, or visual stimulation, as well as
sexual fantasies
Phase II: Excitement  sexual arousal and
erotic pleasure with concurrent physiological
changes
Phase III: Orgasm  peaking of sexual
pleasure with release of sexual tension
Phase IV: Resolution  detumescence
– sense of relaxation/well-being with orgasm
– irritability and discomfort in absence of orgasm
Types of Sexual Dysfunction

Sexual Desire Disorders
– Hypoactive sexual desire disorder
– Sexual aversion disorder

Sexual Arousal Disorders
– Female sexual arousal disorder
– Male erectile disorder

Orgasmic Disorders
– Female/male orgasmic disorder
– Premature ejaculation

Sexual Pain Disorders
– Dyspareunia, vaginismus
Sexual Desire Disorders:
Hypoactive sexual desire disorder = a
persistent or recurrent deficiency or
absence of sexual fantasies and desire for
sexual activity in the absence of factors
associated with age or situation; implies
neutrality or indifference to sexual activity
Sexual aversion disorder = persistent or
recurrent extreme aversion to, and
avoidance of, all (or almost all) genital
sexual contact with a sexual partner;
implies fear or anxiety of sexual activity
Sexual Arousal Disorders:
Female sexual arousal disorder = persistent
or recurrent inability to attain, or to
maintain until completion of the sexual
activity, an adequate lubrication/swelling
response of sexual excitement
Male erectile disorder = persistent or
recurrent inability to attain, or maintain
until completion of the sexual activity, an
adequate erection
– Primary = intercourse has never been achieved
– Secondary = intercourse achieved at least once
Orgasmic Disorders:
Female orgasmic disorder = persistent or
recurrent delay in, or absence of, orgasm
following a normal sexual excitement
phase; may be referred to as anorgasmia
Male orgasmic disorder = (as above);
sometimes referred to as retarded
ejaculation
Premature ejaculation = persistent or
recurrent ejaculation with minimal sexual
stimulation before, on, or shortly after
penetration and before the person wishes it
Sexual Pain Disorders:
Dyspareunia = recurrent or persistent genital
pain associated with sexual intercourse in
either a male or a female; may lead to
abstention from sexual activity due to
discomfort
Vaginismus = involuntary constriction of the
outer one-third of the vagina that prevents
penile insertion and intercourse
Treatment Modalities
Testosterone administration
 Cognitive therapy
 Behavioral treatment

– Exercises to enhance sexual pleasuring and
communication

Relationship therapy
– Deals with use of sex as a method of control
Systematic desensitization to reduce fear and
avoidance of sex
 Treatment of anxiety associated with sex

Nursing Process for Clients
with Sexual Dysfunction or
Paraphilia

Assessment (General client history)
– Depression
– Anxiety
– Decreased sexual desire

Diagnosis
– Sexual dysfunction; Ineffective sexuality patterns

Planning
– Concept mapping; nursing care plan

Implementation
– Patient and family education
– Referral to support services

Evaluation (Reassessment of problem)