Sexual Issues

Question 1

1. Male Hypoactive Sexual Desire Disorder (HSDD):
   
   • Characterized by persistently low or absent sexual desire.
   • Potential causes may include hormonal imbalances, relationship issues, or psychological factors.

Question 2

2. Sexual Aversion (avoidance) Disorder:
   
   • Involves strong aversion to sexual contact, leading to avoidance of intimate situations.
   • Psychological factors, past trauma, or relationship problems may contribute.

Question 3

3. Female Sexual Interest/Arousal Disorder:
   
   • Involves difficulties with arousal or maintaining interest in sexual activity.
   • Hormonal imbalances, relationship issues, or psychological factors may play a role.

Question 4

4. Erectile Disorder:
   
   • Characterized by difficulty achieving or maintaining an erection.
   • Physiological causes such as diabetes, cardiovascular issues, or medication side effects should be assessed.

Question 5

5. Female Orgasmic Disorder:
   
   • Involves difficulty reaching orgasm despite adequate arousal.
   • Psychological factors, relationship issues, or medical conditions may contribute.

Question 6

6. Premature Ejaculation:
   
   • Involves ejaculation occurring too quickly, often before or shortly after penetration.
   • Psychological and physiological factors may contribute.

Question 7

7. Delayed Ejaculation:
   
   • Characterized by a delay or absence of ejaculation during sexual activity.
   • Psychological factors, medications, or medical conditions may contribute.

Question 8

8. Genito-Pelvic Pain/Penetration Disorder:
   
   • Involves pain during intercourse or difficulty with penetration.
   • Medical conditions, psychological factors, or past trauma may contribute.

Question 9

9. Substance/Medication-Induced Sexual Dysfunction:
   
   • Certain substances or medications can impact sexual function.
   • It’s important to assess for potential side effects and consider alternative treatments when possible.

Question 10

Psychological factors contributing to sexual issues

Answer 10

1. Relationship Problems:
   
   • Conflicts, communication issues, or emotional distance between partners can impact sexual satisfaction.
   • Treatment: Couples therapy, communication skills training, and addressing relationship dynamics.

Question 11

Psychological factors contributing to sexual issues

Answer 11

3. Incompatible Sexual Expression Between Partners:
   
   • Mismatched sexual preferences or desires may lead to dissatisfaction.
   • Treatment: Open communication, compromise, and exploring shared fantasies or desires.

Question 11

Psychological factors contributing to sexual issues

Answer 11

2. Chronic Depression:
   
   • Depression can affect libido, arousal, and overall sexual function.
   • Treatment: Psychotherapy, antidepressant medications, and lifestyle interventions.

Question 12

Psychological factors contributing to sexual issues

Answer 12

4. Fear and Anxiety:
   
   • Unconscious factors, performance anxiety, and specific fears can contribute to sexual issues.
   • Treatment: Cognitive-behavioral therapy (CBT), mindfulness, and addressing underlying fears through therapy.
   • Examples of Fears and Anxiety:
     
     • Unconscious guilt due to strict religious upbringing.
     • Performance anxiety, especially after previous sexual failures.
     • Fear of pregnancy or commitment.
     • Fear of rejection or loss of control, especially in orgasmic disorders.
     • Fear of dying, particularly after a recent myocardial infarction (MI).

Question 13

Treatment: Sexual issues

Answer 13

1. Sex Therapy:
   
   • Focuses on healthy communication, addressing relationship issues, and improving sexual skills.
   • Goal: Enhance intimacy and satisfaction.
2. Cognitive Restructuring:
   
   • Identifying and challenging negative thought patterns related to sex.
   • Goal: Shift in mindset towards positive and realistic sexual expectations.
3. Relaxation and Behavioral Therapy:
   
   • Techniques like the squeeze technique and sensate focus exercises.
   • Goal: Reduce anxiety, improve arousal, and enhance overall sexual experience.
4. Masturbation and Kegel Exercises:
   
   • For women, Kegel exercises can strengthen pelvic floor muscles.
   • Goal: Enhance sexual function and satisfaction.
5. Medications:
   
   • SSRIs: Addressing depression and anxiety.
   • Viagra, Levitra, Cialis: Addressing erectile dysfunction.
   • Yohimbine: Sometimes used for erectile dysfunction.
   • Testosterone and/or Estrogen Replacement: Addressing hormonal imbalances.
6. Surgery:
   
   • Implantation of a prosthetic device may be considered in some cases.
   • Indication: Severe cases of erectile dysfunction not responding to other treatments.
7. Intracorporeal Injections of Vasodilators (Men):
   
   • Medications injected directly into the penis to induce an erection.
   • Indication: Erectile dysfunction not responsive to oral medications.

Question 14

Nursing Process: Assessment:

Answer 14

Assessment:
1. Self-awareness:
- Nurses should reflect on their own feelings, beliefs, and attitudes about sexuality to provide nonjudgmental care.

2. Attitude:
   
   • Maintain an open, nonjudgmental, and professional attitude to create a safe space for the patient.
3. Questioning:
   
   • Start with basic and less sensitive questions, gradually progressing to more personal inquiries.
   • Assess for any medical conditions and medication side effects that could contribute to sexual dysfunction.

Question 15

Nursing Process: Nursing Diagnoses:

Answer 15

1. Anxiety:
   
   • Related to fear of sexual performance, relationship issues, or concerns about sexual function.
2. Disturbed Body Image:
   
   • Related to perceptions of inadequacy or dissatisfaction with one’s own body in a sexual context.
3. Impaired Verbal Communication:
   
   • Related to difficulty expressing thoughts, feelings, or concerns about sexuality.
4. Deficient Knowledge:
   
   • Related to lack of information about the sexual response cycle, sexual dysfunction, or available treatments.
5. Ineffective Role Performance:
   
   • Related to difficulties in fulfilling one’s role in a sexual relationship.
6. Sexual Dysfunction:
   
   • Related to difficulties in one or more phases of the sexual response cycle.
7. Ineffective Sexuality Patterns:
   
   • Related to maladaptive patterns of sexual behavior or response.

Question 16

Nursing Process: Planning:

Answer 16

Planning:
1. Identifying Stressors:
- Patient will identify stressors contributing to sexual dysfunction.

2. Exploring Feelings:
   
   • Patient will identify and express feelings about sex, such as disgust or fear.
3. Practicing Techniques:
   
   • Patient will practice using relaxation and behavioral techniques to manage anxiety.
4. Reporting Satisfaction:
   
   • Patient will report satisfaction with their sexual response or pattern.

Question 17

Nursing Process: Interventions:

Answer 17

1. Communication:
   
   • Teach and model positive communication techniques to enhance dialogue about sexual concerns.
2. Education:
   
   • Provide education on the human sexual response cycle, sexual dysfunction, and available treatment options.
3. Support:
   
   • Support the client in exploring fears and anxieties related to sex, addressing concerns in a safe environment.
4. Referrals:
   
   • Facilitate referrals to a sex therapist for psychological support and a medical doctor for a physical examination to identify and address any underlying medical conditions.

Question 18

Paraphilias: atypical sexual interests

Paraphilias are characterized by the preferential use of unusual objects of sexual desire or engagement in unusual sexual activities over a period of more than six months, causing impairment in occupational or social functioning. It’s important to note that having occasional fantasies is not considered a paraphilia unless they are recurrent and intense, significantly interfering with an individual’s life.

Answer 18

The term “paraphilia” has its roots in Greek etymology. It is derived from the Greek words “para,” meaning “beside” or “beyond,” and “philos,” meaning “loving” or “fond of.” The combination of these elements suggests a deviation from what is considered normative or typical in terms of sexual interests or arousal patterns.

Question 19

Paraphilias:

Answer 19

Key Points:
1. Recurrence and Intensity:
- Paraphilias involve recurrent and intense fantasies, urges, and behaviors that preoccupy the individual and significantly interfere with their daily life.

2. Not Normal Components of Healthy Sexuality:
   
   • While sexual fantasies are normal components of healthy sexuality, paraphilic fantasies become concerning when they are intense, recurrent, and disruptive to a person’s functioning.
3. Gender Distribution:
   
   • Most paraphilias occur almost exclusively in men, but there are exceptions. Pedophilia, sexual sadism, and masochism can be occasionally seen in women.

Question 20

Examples of Paraphilias:

Answer 20

1. Exhibitionism:
   
   • Sexual arousal achieved through exposing one’s genitals to an unsuspecting stranger.
2. Fetishistic Disorder:
   
   • Sexual arousal or gratification through the use of nonliving objects or a highly specific focus on non-genital body parts. (Examples include: foot fetishism, leather fetishism, or object fetishism.)
3. Frotteurism:
   
   • Sexual arousal through rubbing against or touching a non-consenting person in a crowded public place.
4. Necrophilia:
   
   • Sexual arousal or attraction to corpses.
5. Pedophilia:
   
   • Sexual attraction to prepubescent children.
6. Sexual Sadism or Masochism:
   
   • Sadism involves deriving sexual pleasure from inflicting pain on others, while masochism involves deriving pleasure from experiencing pain.
7. Telephone Scatologia:
   
   • Making obscene phone calls for sexual arousal.
8. Voyeurism: (Voir/regarder les autres)
   
   • Gaining sexual pleasure from observing others, often without their knowledge or consent.

Question 21

Treatment of Paraphilias:

Answer 21

1. Aversive Conditioning:
   
   • Involves forming an association between unwanted behaviors and aversive stimuli (e.g., mild electric shock) to decrease the likelihood of engaging in the paraphilic behavior.
2. Medications:
   
   • SSRIs (Selective Serotonin Reuptake Inhibitors): Used to reduce obsessive-compulsive and impulsive symptoms associated with paraphilias.
   • Female Sex Hormones and Antiandrogens: Medications like Lupron Depot and Depo-Provera can reduce testosterone levels, potentially decreasing sexual drive.
3. Psychotherapy:
   
   • Focuses on addressing cognitive distortions related to the paraphilia and helping the client identify and manage triggers that lead to inappropriate sexual behaviors.

Question 22

Predictors of Poor Prognosis Paraphilia:

Answer 22

1. Inability to Have Sexual Intercourse Without the Paraphilia:
   
   • Difficulty engaging in sexual activity without the paraphilic behavior may indicate a more challenging prognosis.
2. Lack of Guilt About the Paraphilia:
   
   • Absence of guilt or remorse regarding the paraphilic behavior may suggest a more resistant or ingrained condition.
3. Referral by Law Enforcement Authorities Instead of Self-Referral:
   
   • Individuals referred by law enforcement authorities may have legal issues complicating treatment and a potentially more challenging prognosis.
4. Onset at a Young Age:
   
   • The earlier the onset of paraphilic behavior, the more challenging it may be to treat. Early intervention is crucial.

Question 23

Gender Dysphoria:

Answer 23

• Transgender:
  
  • Refers to a person’s subjective feeling that they have been born the wrong sex despite having normal physiology.
• Gender Dysphoria: (Greek, Dysphoria: abnormal or difficult mental state.)
  
  • When an individual with transgender feelings experiences persistent distress and unease about the incongruence between their biological sex and gender identity.

Important Note:
- **Not Pathological:**
- Being transgender in itself is not considered pathological. However, the distress associated with the incongruence (Discrepancy, التناقض) is termed gender dysphoria and may benefit from intervention and support.

Question 24

Squeeze Technique:

Purpose: The squeeze technique is primarily used to address premature ejaculation, a common sexual concern for some individuals.
Procedure: During sexual activity, when a person feels they are approaching climax too quickly, they or their partner applies pressure to the base of the penis, just below the glans (head). This pressure is maintained for about 30 seconds, with the goal of delaying or preventing ejaculation.
Mechanism: The squeeze technique aims to interrupt the sexual response cycle and help the individual gain better control over their ejaculation.
Sensate Focus Exercises:

Purpose: Sensate focus exercises are often used in sex therapy and relationship counseling to enhance intimacy and communication between partners.
Procedure: This set of exercises involves a series of structured activities designed to increase awareness of one’s own and their partner’s body sensations without a focus on sexual performance or goals. It often begins with non-genital touching and progresses to more intimate touch over time.
Mechanism: The goal of sensate focus is to shift the focus away from performance anxiety and goal-oriented sex to a more mindful and sensory experience. It encourages couples to communicate openly about their desires, boundaries, and preferences.