Mental Health Nursing II NURS 2310

1. Mental Health Nursing IINURS 2310 Unit 10 Psychiatric/Mental Health Alterations Affecting Sexuality/Reproduction

2. Sexual Development

3. 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

4. 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

5. 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)

6. 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

7. Key Terms

8. 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

9. 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

10. 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

11. Paraphilia

12. 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

13. 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

14. 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

15. 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

16. Sexual Dysfunction

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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

24. 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

25. Nursing Process for Clients with Sexual Dysfunction or Paraphilia

26. 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)