Sexual Dysfunction Characterized by disturbances in the processes of the sexual response cycle or by pain associated with sexual intercourse.

. Broadly defined as the inability to fully enjoy sexual intercourse. These disorders make it difficult for a person to enjoy or to have sexual intercourse. While sexual dysfunction rarely threatens physical health, it can take a heavy psychological toll, bringing on depression, anxiety, and debilitating feelings of inadequacy. A man may have a sexual problem if he: ejaculates before he or his partner desires does not ejaculate, or experiences delayed ejaculation is unable to have an erection sufficient for pleasurable intercourse feels pain during intercourse lacks or loses sexual desire A woman may have a sexual problem if she: lacks or loses sexual desire has difficulty achieving orgasm feels anxiety during intercourse feels pain during intercourse feels vaginal or other muscles contract involuntarily before or during sex has inadequate lubrication Sexual Desire Disorders Involves a disruption in the desire phase of the sexual response cycle. Hypoactive sexual desire disorder Characterized by a deficiency or absence of sexual fantasies and desire for sexual activity that causes marked distress or interpersonal difficulty Sexual aversion disorder Involves avoidance of genital sexual contact with a sexual partner that causes marked distress or interpersonal difficulty. Individual reports anxiety, fear, or disgust when confronted by a sexual opportunity with a partner. The aversion may take a number of different forms; it may be related to specific aspects of sexual intercourse, such as the sight of the partner's genitals or the smell of his or her body secretions, but it may include kissing, hugging, and petting as well as intercourse itself. In some cases the person with sexual aversion disorder avoids any form of sexual contact; others, however, are not upset by kissing and caressing, and are able to proceed normally until genital contact occurs. Sexual Arousal Disorders Disruption of the excitement phase of the sexual response cycle. Female sexual arousal disorder An inadequate lubrication-swelling response of sexual excitement, which causes marked distress or interpersonal difficulty.

Male erectile disorder An inadequate erection, which causes marked distress or interpersonal difficulty. Orgasmic Disorders Disruptions of the orgasm phase of the sexual response cycle. Female orgasmic disorder Persistent or recurrent inability of a woman to achieve orgasm. the woman is unable or has extreme difficulty reaching climax and releasing the tension Male orgasmic disorder Unable to experience an orgasm following a normal sexual excitement phase. Affected man may regularly experience delays in orgasm, or may be unable to experience orgasm altogether. Premature ejaculation Persistent or recurrent onset of orgasm and ejaculation with minimal sexual stimulation Occurs when a man ejaculates sooner during sexual intercourse than they or their partner would like. A common sexual complaint. Sexual Pain Disorder Involve pain associated with sexual activity Dyspareunia genital pain associated with sexual intercourse It can occur in both male and female and symptoms range from mild discomfort to sharp pain. Vaginismus Persistent or recurrent involuntary contractions of the perineal muscles surrounding the outer third of the vagina when vaginal penetration with penis, finger, tampon, or speculum is attempted Sexual dysfunction due to a general medical condition -> Presence of clinically significant sexual dysfunction that is exclusively due to the physiological effects of a medical condition. -> It can include pain with intercourse, hypoactive sexual desire, erectile dysfunction, orgasmic problems, or other problems as previously described. Substance-induced sexual dysfunction -> Clinically significant sexual dysfunction resulting in marked distress or interpersonal difficulty caused by the direct physiological effects of a substance (drug abuse, medication, or toxin). It may involve impaired arousal, impaired orgasm, or sexual pain. PARAPHILIAS Abnormal expression of sexuality. They can range from nearly normal behavior to behaviour that is destructive or hurtful. It is recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors generally involving: 1. Non human objects 2. The suffering or humiliation of ones self or partner 3. Children or other nonconsenting persons

Exhibitionism Exposure of the genitals (may include the breast and buttocks) to a stranger, sometimes involving masturbation Usually occurs before age 18 and is less severe after age 40 aroused by exposing ones genitals to an unsuspecting stranger Childhood trauma (e.g., sexual abuse) or significant childhood experiences can manifest itself in exhibitionistic behavior. Fetishism Use of non living objects (the fetish) to obtain sexual excitement and/or achieve orgasm. Common fetishes include womens underwear, bras, shoes, or other apparel. The person might masturbate while holding or rubbing the object. It begins by adolescence and tends to be chronic. Frotteurism Touching and rubbing against a non-consenting person, usually in a crowded place from which the person with frotteurism can make a quick escape, such as public transportation, a shopping mall, or a crowded sidewalk. The individual rubs his genitals against the victims thighs and buttocks or fondles her breast or genitalia with his hands. Acts of frottage occur most often between the ages of 15 and 25, frequency declines after that. Pedophilia Sexual activity with a prepubescent child (generally 13yrs. Or younger) by someone at least 16 years old and 5 years older than the child. It can include an individual undressing the and looking at the child, exposing him- or herself, masturbating in the presence of the child Sexual Masochism Recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors involving the act of being humiliated, beaten, bound, or otherwise made to suffer. Some individuals act on masochistic urges by themselves, others with a partner. Sexually masochistic behaviors are typically evident by early adulthood, and often start with masochistic or sadistic play in childhood. Sexual Sadism Recurrent, intensely sexually arousing fantasies, sexual urges or behaviors involving acts in which the sexually arousing to the person. It can involve domination (caging the victim or forcing victim to crawl, beg, plead), restraint, spanking, beating, electrical shock, rape, cutting, and in severe cases, torture and death. Sexually sadistic behaviors are typically evident by early adulthood, and often start with masochistic or sadistic play in childhood. Transvestic Fetishism Recurrent, intensely sexually arousing fantasies, sexually urges, or behaviors involving crossdressing by a heterosexual male. This diagnosis is usually used for heterosexual males who have sexually arousing fantasies, urges, or behaviors involving cross-dressing (wearing female clothing). Voyeurism Recurrent, intensely sexually arousing fantasies, sexual urges, or behaviors involving the act of observing an unsuspecting person who is naked, in the process of undressing, or engaging in sexual activity. Usually begins before age 15, is chronic, and may involve masturbation during the voyeuristic behavior

Nursing management: 1. Psychotherapy is almost always treatment of choice for sexual dysfunction disorder. There is a sufficient evidence for specific psychotherapy remedies to be used in certain psychosexual disorder (e.g couple therapy) 2. Psychotropic medications, however, can play a role in alleviating accompanied symptoms like anxiety and depression 3. Explain to the patient that psychotropic medications usually have sexual side effects, most frequently loss of libido and delayed ejaculation. 4. Allow the patient to verbalize feelings.