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Course: Mental Health Nursing

Topic: Sexual Dysfunctions Part II

The Nurses International Community

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Module Goals

Learners will be able to:

Define sexual dysfunctions
List the signs and symptoms
Identify clinical manifestations
Discuss the evidence-based management
Identify the appropriate nursing interventions

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What are Sexual Dysfunction Disorders?

A physical or psychological problem that prevents a person or their partner from experiencing sexual satisfaction.

A problem that prevents someone from wanting or enjoying sexual activity.

All ages experience sexual dysfunction, although more common in those over 40 years of age.

Cleveland Clinic, 2019

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Types of Sexual Dysfunctions

4 Categories:

Desire:Lack of sexual desire or interest in sex

Arousal: inability to become physically aroused or excited during sexual activity

Orgasm: Delay or absence of orgasm (climax)

Pain: Pain during intercourse

Cleveland Clinic, 2020

I

Image by, Michael Mullan

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Critical Thinking Question

The inability to attain or maintain typical physical responses during sexual intercourse is associated with which disorder?

Sexual Desire Disorder.
Sexual Arousal Disorder.
Orgasm Disorder.
Sexual Pain Disorder.

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Symptoms of Sexual Dysfunctions in Males

Erectile dysfunction: Inability to achieve or maintain an erection (firm penis) suitable for intercourse.

Retarded ejaculation: Absent or delayed ejaculation despite enough sexual stimulation.

Early or premature ejaculation (Inability to control the timing of ejaculation).

Cleveland Clinic, 2020

Contact info: info@nursesinternational.org

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Symptoms of Sexual Dysfunction in Women

Inability to achieve orgasm.
Inadequate vaginal lubrication before and during intercourse.
Inability to relax the vaginal muscles enough to allow intercourse.

In Men and Women:

Lack of interest in or desire for sex
Inability to become aroused
Pain with intercourse

Cleveland Clinic, 2020

Contact info: info@nursesinternational.org

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Male Sexual Dysfunctions

Male Orgasmic Disorder:

Persistent difficulty in attaining orgasm.

Premature ejaculation:

Defined as ejaculation with minimal stimulation before the person wishes it.

Erectile Disorder:

Characterized by inadequate erections for sexual activity.
May have difficulty either obtaining or maintaining an erection.

Simons & Carey, 2001

Contact info: info@nursesinternational.org

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Male Sexual Dysfunctions

Hypoactive Sexual Desire Disorder:

Deficient sexual fantasies and desire for sexual activity.

Dyspareunia:

Sexual pain in men appears to be significantly less than in women.

Delayed or Inhibited Ejaculation:

Reaching orgasm too slowly or not at all.

Simons, & Carey, 2001

Contact info: info@nursesinternational.org

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Female Sexual Dysfunctions

Female Orgasmic Disorder: Characterized by unusual difficulty in attaining orgasm.
Female Sexual Arousal Disorder: An insufficient lubrication-swelling response to sexual excitement.
Hypoactive Sexual Desire Disorder (HSDD): Defined as deficient sexual fantasies and desire for sexual activity.
Dyspareunia: Persistent genital pain during sexual intercourse
Vaginismus: Persistent involuntary spasm of the vagina interfering with intercourse.

Simons & Carey, 2001

Contact info: info@nursesinternational.org

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What Would the Nurse Do?

The nurse may encounter clients with concerns about sexuality. Which is the most important factor in managing clients with sexual dysfunctions?

Knowledge about sexuality.
Experience in dealing with clients with sexual problems.
Comfort with one’s own sexuality.
Ability to communicate effectively.

Contact info: info@nursesinternational.org

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Causes of Sexual Dysfucntions in Men

Physical:

Low testosterone levels
Prescription drugs (antidepressants, *high blood pressure medication)
Blood vessel disorders: Atherosclerosis (hardening of the arteries) and high blood pressure
Stroke or nerve damage from diabetes or surgery.
Smoking
Alcoholism and drug abuse

Cleveland Clinic, 2019

Contact info: info@nursesinternational.org

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Causes of Sexual Dysfunctions in Men

Psychological:

Concern about sexual performance
Marital or relationship problems
Depression, feelings of guilt
Effects of past sexual trauma
Work-related stress and anxiety

Cleveland Clinic, 2019

Contact info: info@nursesinternational.org

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Prevention of Sexual Dysfunctions in Men

Adherence to the treatment plan for any medical/health conditions
Limit alcohol intake
Quit smoking
Eat a heart- healthy diet (the Mediterranean diet is often recommended)
Regular aerobic and weight building exercise
Treatment if needed for any emotional or psychological problems such as stress, depression, and anxiety
Communicate better and more often with your partner

Cleveland Clinic, 2019

Contact info: info@nursesinternational.org

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Treatment of Sexual Dysfunctions in Men

Medication:

Sildenafil (Viagra), vardenafil (Levitra), and tadalafil (Cialis) are safe and effective for most men.

Hormone therapy:

Low levels of testosterone raised by hormone replacement therapies (injections, patches, or gels).

Psychological therapy:

Address feelings of anxiety, depression, fear, or guilt that may affect sexual function.

Mechanical aids:

Vacuum devices and penile implants may help with erectile dysfunction.

Cleveland Clinic, 2019

Contact info: info@nursesinternational.org

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Causes of Female Sexual Dysfucntions

Psychological Factors

Intrapersonal conflicts: Religious taboos, social restrictions, sexual identity conflicts, guilt (i.e., a widow with a new partner).
Past or present abuse: (sexual, verbal, physical), rape, sexual inexperience.
Interpersonal conflicts: Relationship conflict, extra-marital affairs, current physical, verbal or sexual abuse, poor sexual communication
Life stressors: Financial, family, or work problems.

Phillips, 2000

Contact info: info@nursesinternational.org

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Causes of Female Sexual Dysfunctions

Medication:

Psychoactive medications.
Cardiovascular and antihypertensive medications.
Hormonal preparations (Oral Contraceptives).
Gynecologic conditions contribute physically to sexual difficulties.

Phillips, 2000

Contact info: info@nursesinternational.org

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Prevention of Sexual Dysfunctions in Women

Adhere to the treatment plan for any medical/health condition.
Limit alcohol intake.
Quit smoking.
Eat a heart healthy diet (the Mediterranean diet is often recommended).
Get regular aerobic and weight building exercise.
Seek treatment if needed for emotional or psychological problems such as stress, depression, and anxiety.
Improve communication with partner.

Cleveland Clinic, 2019

Contact info: info@nursesinternational.org

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General Treatment for Female Sexual Dysfunctions

Provide Education

About normal anatomy, sexual function.
Provide and encourage reading materials.
Discuss sexual issues associated with existing medical conditions.

Enhance Stimulation and Avoid Routine

Encourage use of erotic materials (videos, books).
Suggest masturbation to maximize familiarity with pleasurable sensations.
Encourage communication during sexual activity.
Discuss varying positions.

Phillips, 2000

Contact info: info@nursesinternational.org

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General Treatment for Female Sexual Dysfucntions

Provide Distraction Techniques:

Encourage erotic or nonerotic fantasy.
Recommend pelvic muscle contraction and relaxation (similar to Kegel exercise) with intercourse.
Recommend use of background music, videos, or television.

Encourage Noncoital Behaviors

Recommend sensual massage.
Sensate-focus exercises (sensual massage with no involvement of sexual areas, where one partner provides the massage and the receiving partner provides feedback as to what feels good.

Phillips, 2000

Contact info: info@nursesinternational.org

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General Treatment for Female Sexual Dysfucntions

Minimize Dyspareunia:

Female astride for control of penetration.
Use of topical lidocaine or lubricant.
Warm baths before intercourse.
Position changes so that force is away from pain and deep thrusts are minimized.
Nonsteroidal anti-inflammatory drugs one hour before intercourse.

Phillips, 2000

Contact info: info@nursesinternational.org

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Critical Thinking Question

Which of the following recommendations should a male follow to prevent sexual dysfunctions? (Select all that apply)

Quit smoking
Limit alcohol intake
Weight bearing exercise
Healthy diet

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Nurse’s Role

Assessment of Sexual Dysfunctions

Determine Stressors: Help the client to identify the onset of the problem and to discuss the situation.
Encourage Discussion:

Encourage the client to discuss conditions/circumstances that may be contributing to sexual dysfunction.
Educate client about exploring alternative methods for achieving sexual satisfaction.

Belleza, 2021

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Nurse’s Role (continued)

Identify factors that affect the client’s sexuality: Note cultural, social, ethnic, racial, and religious factors that may contribute to conflicts regarding variant sexual practices

Be accepting and nonjudgmental: the client is more likely to share this information if they do not feel being judged by the nurse

Provide positive reinforcement

Belleza, 2021

Contact info: info@nursesinternational.org

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Critical Thinking Question

The nurse asks a client to roll up his sleeves to measure his blood pressure. The client replies, “If you want, I can take all my clothes off for you.” The most therapeutic response by the nurse is:

“You’re attractive, but I’m not interested.”
“You wouldn’t be the first person that I have seen naked.”
“This is inappropriate behavior. ”
“I only need access to your arm. Putting up your sleeve is fine.”

Contact info: info@nursesinternational.org

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References

Belleza, M. (2021). Sexual Dysfunctions, Paraphilias, and Gender Dysphoria. https://nurseslabs.com/sexual-dysfunctions-paraphilias-and-gender-dysphoria/

Cleveland Clinic. (2019).Sexual Dysfunction in Male. https://my.clevelandclinic.org/health/diseases/9122-sexual-dysfunction-in-males

Cleveland Clinic, (2020). Sexual Dysfunctions. https://my.clevelandclinic.org/health/diseases/9121-sexual-dysfunction

Phillips, N.A. (2000). Female Sexual Dysfunctions: Evaluation and Treatment. American Family Physicians. https://www.aafp.org/afp/2000/0701/p127.html

Simons, J. S., & Carey, M. P. (2001). Prevalence of sexual dysfunctions: results from a decade of research. Archives of sexual behavior, 30(2), 177–219. https://doi.org/10.1023/a:1002729318254

Contact info: info@nursesinternational.org

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