Human Sexual Response and Disorders

Istanbul Gelisim University - Faculty of Health Sciences

• The university was established in 2008
• The course code is HEY441ET
• The course is called Mental Health and Diseases Nursing-T
• The course duration is 12 weeks
• The course meets Wednesday for 4 hours
• Course Credit: 4 - ACTS : 5
• Midterm Exam: 50%
• Final Exam: 50%
• Instructor: Assist. Prof. Süreyya Türk Ogun
• Instructor's Email: [email protected]
• Instructor's Phone: 0212 422 70 70
• Instructor's Room: B block Ground floor, room 027
• Office Hours: 10:00-12:00 (Tuesday)
• GBS Link: https://gbs.gelisim.edu.tr/ders-detay-17-319-17305-2
• ALMS Link: https://lms.gelisim.edu.tr/Account/LoginBefore
• Avensis Link: https://avesis.gelisim.edu.tr/suturk

Course Contents

• Week 1: The Fundamentals of Mental Health And Disease Nursing
• Week 2: General Symptoms Of Mental Illnesses
• Week 3: Psychological Problems In Childhood And Adolescence
• Week 4: Personality Disorders And The Nursing Approach
• Week 5: Crisis, Stress, Anxiety, And The Nursing Approach
• Week 6: Somatoform Disorders And The Nursing Approach
• Week 7: Affective Disorders (Also Known As Mood Disorders) And The Nursing Approach
• Week 8: Exam
• Week 9: Schizophrenia And Psychotic Disorders, And The Nursing Approach
• Week 10: Alcohol And Substance Addiction, And The Nursing Approach
• Week 11: Eating Disorders And The Nursing Approach
• Week 12: Sexual Dysfunctions And The Nursing Approach
• Week 13: Family And Community Mental Health Nursing
• Week 14: Consultation Liaison Nursing in The Context Of Mental Health And Disease Nursing
• Week 15: Forensic Nursing in The Context Of Mental Health And Disease Nursing
• Week 16: Final Exam

Weekly Learning Outcomes

• Students will define and classify various sexual dysfunctions
• Students will identify biological, psychological, and socio-cultural factors contributing to sexual dysfunction
• Students will describe the human sexual response cycle and how disruptions lead to dysfunction
• Students will discuss appropriate nursing interventions (therapeutic communication, education, referrals)
• Students will apply the nursing process (assessment, diagnosis, planning, implementation, evaluation) to care for individuals with sexual dysfunctions
• Students will explore future directions in treating and managing sexual dysfunctions

Daily Flow

• 09.00-09.50: 1st Hour
• 10.00-10.50: 2nd Hour
• 11.00-11.50: 3rd Hour
• 12.00-12.50: 4th Hour

Sexual Dysfunctions and the Nursing Approach

• Introduction
• The Human Sexual Response Cycle
• Definitions
• Types of Sexual Dysfunctions
• Diagnostic Criteria
• Etiology and Risk Factors
• Common Features and Symptoms
• The Nursing Process
  • Assessment
  • Diagnoses
  • Planning & Interventions
  • Evaluation
• Medical Management
• Collaborative Care
• Ethical Considerations
• Challenges in Nursing Care
• The Nurse's Role in Advocacy
• Conclusion

What is Sexuality?

• A vital human need and an intrinsic part of the total personality
• Influences thoughts, actions, and interactions
• Includes physical and mental health aspects
• Society's attitude towards sexuality is evolving, and many clients are now more open to seeking help for issues concerning sexuality

Nurses and Sexuality

• Nurses should integrate sexuality information into patient care via preventive, therapeutic, and educational interventions to positively impact patient sexual wellness

The Human Sexual Response Cycle

• Understanding the human sexual response cycle is necessary for understanding and treating sexual dysfunctions
• Sexual dysfunction can affect any phase of the response cycle

Phase I-Desire

• Triggered by internal stimuli (thoughts, fantasies) and external stimuli (sensory input)

Phase II - Excitement

• Characterized by sexual arousal and erotic pleasure
• Physiological changes occur in both men and women
• Male: erection and tumescence
• Female: vasocongestion, vaginal lubrication, and external genital swelling

Phase III - Orgasm

• The peak of sexual pleasure and a release of sexual tension
• Marked by rhythmic contraction of the perineal muscles and reproductive organs

Phase IV - Resolution

• If orgasm occurs, there is blood drainage from the genitalia, along with general relaxation and well-being
• If no orgasm, resolution may take several hours
• Potentially causes pelvic discomfort and irritability
• Males experience a refractory period whose length increases with age
• Females have no refractory period and may have multiple orgasms

Definitions of Various Terms according to DSM 5

• Sexual Dysfunction Disorders
• Gender Identity Disorder (Displeasure)
• Sexual Perversion (Paraphilic) Disorders

Defining Sexual Dysfunctions

• Impairment or disturbance in any phase of the sexual response cycle
• Causes distress or impairment in social, occupational, or other areas of functioning
• Distinguishing occasional difficulties from persistent, intervention-requiring problems
• Accurate & comprehensive sexual histories are crucial & essential to identify and resolve sexual problems
• Sexual health is vital for physical and emotional well-being

Defining Gender Dysphoria

• Characterized by incongruence between biological/assigned gender and experienced/expressed gender
• Individuals do not identify with the gender assigned at birth
• Originally termed "Gender Identity Disorder" but the name was changed to reduce stigma and emphasize the emotional component of the condition

Defining Paraphilic Disorders

• Recurrent or preferred sexual fantasies or behaviors that involve:
  • Nonhuman objects
  • Suffering or humiliation of oneself or one's partner
  • Nonconsenting people

Types of Sexual Dysfunctions

• Sexual Desire Disorders
• Male Hypoactive Sexual Desire Disorder
• Female Sexual Interest/Arousal Disorder
• Sexual Arousal Disorders
• Erectile Disorder
  • Primary Erectile Disorder
  • Secondary Erectile Disorder
• Orgasmic Disorders
  • Female Orgasmic Disorder
  • Delayed Ejaculation
    • Primary Delayed Ejaculation
    • Secondary Delayed Ejaculation
  • Premature (Early) Ejaculation
• Sexual Pain Disorders
  • Genito-Pelvic Pain/Penetration Disorder
    • Vaginal Penetration during Intercourse
    • Marked Vulvovaginal or Pelvic Pain during Vaginal Intercourse or Penetration
    • Marked Tensing/Tightening of Pelvic Floor Muscles during Vaginal Penetration
    • Dyspareunia
    • Vaginismus

Impact of Gender Dysphoria

• Gender dysphoria can lead to significant distress and impairment in a person's daily life
• Individuals may experience teasing and rejection from peers, disapproval from family members, and difficulty forming relationships
• Treatment includes
  • Therapy for emotional coping and positive self-image
  • Hormone therapy for physical characteristics alignment with gender identity
  • Surgery for physical appearance & genitalia adjustment

Types of Paraphilic Disorders (continued)

• Exhibitionistic Disorder
• Fetishistic Disorder
• Frotteuristic Disorder
• Pedophilic Disorder
• Sexual Masochism Disorder
• Sexual Sadism Disorder
• Transvestic Disorder
• Voyeuristic Disorder

Paraphilic Disorder Characteristics

• Few individuals with paraphilic disorders experience distress
• Treatment is usually sought when pressured by partners or authorities
• Most outpatient treatment for this type of disorder is for pedophilic, exhibitionistic, or voyeuristic disorder
• Paraphilic disorders in males often first emerge during adolescence with peaking between ages 15 and 25, gradually declining after the age of 50

Diagnostic Criteria

• DSM-5 provides specific criteria for diagnosing sexual dysfunctions
• Criteria include symptom duration (typically at least 6 months), distress or impairment caused by symptoms and ruling out other possible medical or psychological explanations

Etiology and Risk Factors

• Biological Factors (Sexual Desire Disorders)

• Decreased levels of serum testosterone

• Elevated levels of serum prolactin

• Conditions specific to each sex

• Medications that negatively affect sexual function

• Biological Factors (Sexual Arousal Disorders)

• Conditions specific to each sex

• Medications likely to negatively affect sexual function

• Biological Factors (Paraphillilic Disorders)

• Destruction of parts of the limbic system

• Temporal lobe diseases

• Abnormal levels of androgens

• Psychosocial Factors (Sexual Desire, Arousal and Pain Disorders)

• Religious orthodoxy

• Conflicts about identity

• Financial and family issues

• Relational conflicts

• Abuse

• Unwanted or problematic affairs

• Embarrassment, guilt, doubt

• Shame

• Hostility

• Sexual abuse (a risk factor noted for several disorders)

• Psychosocial Factors (Orgasmic Disorders)

• Rigid and puritanical backgrounds

• Sinful perception of sex

• Fear of pregnancy

• Psychosocial Factors (Paraphillilic Disorders)

• Failure to resolve Oedipus complex

• Gender Identity issues

Predisposing Sociocultural Factors

• Cultural feelings about adolescent sexuality, fear of STDs
• Controversy around mandatory HPV vaccination
• Promotion of promiscuity
• Negative cultural conditioning towards sexuality
• Rigid religious orthodoxy
• Negative family attitude towards nudity and sex

Common Features and Symptoms

• Symptoms vary depending on the dysfunction type
• Impacts relationships and quality of life
• Decreased intimacy and emotional connection
• Relationship stress, conflict, separation
• Reduced self-esteem, feelings of inadequacy
• Depression and anxiety
• Overall reduced well-being and life satisfaction

Gender Dysphoria Symptoms

• Insistence on being the opposite gender
• Disgust with one's own genitals
• Belief in transforming into the opposite gender
• Refusal to wear clothing assigned to their birth gender
• Desire for the genitals of the opposite gender
• Refusal to participate in typical activities matching their birth gender

The Nursing Process: Assessment

• Detailed sexual history vital for certain clients (e.g., medical conditions, infertility issues, pregnancy, or psychological counseling)
• Non-directive approach is best to allow the client to naturally express feelings and concerns
• Important to address emotional & psychological factors like anxiety & depression, and relational dynamics

The Nursing Process: Diagnoses

• NANDA-I Diagnoses (for sexual dysfunction)
• Sexual Dysfunction: dissatisfaction or inadequacy in sexual function
• Ineffective Sexuality Pattern: expressions of concern regarding one's own sexuality
• Possible additional relevant diagnoses like anxiety, low self-esteem, and ineffective coping

The Nursing Process: Planning & Interventions

• Outcome Criteria:
• Clients should be able to correlate stress with diminished sexual desire
• Clients should be able to communicate with sexual partners about sexual needs without discomfort
• Clients should be able to verbalize methods for increasing sexual desire
• Clients should verbalize resumption of satisfactory sexual activity for self and partner
• Clients should correlate variant sexual behaviors with stress
• Clients should identify the inappropriateness of their sexual behaviors and express fear about them

Interventions-1

• Collaboration with interdisciplinary team
• Educate about the sexual response cycle and common dysfunction causes
• Provide accurate information
• Encourage open communication between partners
• Teach stress management and relaxation techniques
• Address relationship issues
• Review medications and their side effects

Interventions-2

• Encourage discussion of the possible causes of sexual dysfunctions
• Explain alternative methods of achieving sexual satisfaction
• Provide information & correct misconceptions about sexuality and sexual functioning
• Reduce anxiety, powerlessness, and promote problem resolution
• Make referrals for appropriate specialized professional help (sex counseling/therapy), if required
• Encouraging clients and partners to actively pursue help

The Nursing Process: Evaluation

• Reassessment to evaluate the effectiveness of interventions
• Questions to ask:
• Has the client identified life situations that exacerbate decreased sexual desire?
• Can the client express the ways to deal with the stress?
• Can the client communicate satisfactorily with their sexual partner about their sexual needs?
• Can the client verbalize the return of sexual desire or the ability to perform sexually?
• Has the client reached a satisfactory level of sexual functioning for themselves and their partner

Medical Management

• Collaborative work with physicians
• Discussing potential medical treatments (medications for erectile dysfunction or hormonal therapies)
• Counseling on potential side effects of medications contributing to sexual dysfunctions

Collaborative Care

• Multi-disciplinary approach (physicians, psychologists, sex therapists, social workers)
• Addressing psychological issues
• Seeking assistance for social and environmental factors
• Involving partners and support systems

Ethical Considerations

• Paramount importance of confidentiality and privacy when discussing sensitive sexual health
• Ethical and legal obligation to protect patient privacy
• Informed consent is vital for any medical/therapeutic interventions
• Sensitivity towards cultural and religious beliefs

Challenges in Nursing Care

• Addressing shame & embarrassment
• Overcoming communication barriers (language, culture, discomfort)
• Providing support and encouragement (validating feelings & concerns, reinforcing progress, navigating treatment challenges)

The Nurse's Role in Advocacy

• Promote open communication: creating a safe & non-judgmental environment for client discussions about concerns
• Reduce stigma: educate the public & other healthcare providers and challenge negative attitudes & beliefs
• Advocate for policies: support policies that ensure access to quality sexual health care and resources

Conclusion

• Sexual dysfunction is common and affects all genders and ages
• Effective treatments are available & still evolving
• Untreated sexual dysfunction can lead to significant distress, relationship problems, and decreased quality of life
• A holistic & compassionate nursing approach is essential
• Nurses play a key role in the following:
  • Assessment and identification
  • Education and counseling
  • Referral to appropriate resources
  • Support & Advocacy

Recommended Weekly Studies

• Film: Mystic River (2003): explores sexual abuse and its long-term effects on victims

References

• Various books on mental health, disease nursing care, and sexual activity

Next Week

• Family and Community Mental Health Nursing

Important Note:

• Course presentations are considered private
• Usage of content without permission from the instructor is against the regulations.

This quiz covers various aspects of human sexual response, focusing on the resolution phase, orgasm distinctions between genders, and the terminologies related to sexual disorders. It also addresses paraphilic disorders, hypoactive sexual desire, and specific sexual interest or arousal disorders. Test your knowledge on these important topics in human sexuality.