Introduction

sexual disorders or Paraphillias are disorders of deviant sexuality. As defined in the Diagnostic and Statistical
Manual of Mental Disorders (the clinicians diagnostic bible), they involve recurrent fantasies, urges or
behaviors of a sexual nature that center around children, non-humans (animals, objects, materials), or
harming others or ones self. Para meaning Faulty or Abnormal, and Philia meaning Attraction

Because they are so often associated with abusive sexual practices that generate real victims, many people tend to
regard persons who display sexual deviancies as monsters. Further, many people tend to assume that all sexual
deviants are equivalently awful and repugnant. Neither of these statements are accurate. While they are ultimately
responsible for their choices (including those that harm other people), and should be punished and thereafter closely
monitored to prevent further abusive practices, even predator child-molesting pedophiliac are legitimately suffering
from mental, emotional and spiritual disturbance and should be able to participate in mandated treatment. Whereas
pedophilia (child molestation) is a particularly awful sexual deviancy, there are other forms of sexual deviancy such
as transvestism and many forms of fetishism that harm no one and that do not deserve to be thought of in the same
breath as child molestation.

Types

definition
Paraphilias

Telephone
Scatologia-

Necrophilia-

making
obscene
phone calls, such as
describing
ones
masturbatory activity,
threatening to rape
the victim, or trying to
find out the victims
sexual activities.
deriving
sexual
gratification
from
viewing
or
having
sexual contact with a
corpse.

Zoophilia.
- having sex with
animals
or
having
recurrent fantasies of
sex with animals
Coprophilia-

deriving
sexual
pleasure from contact
with feces.

Klismaphilia-

deriving
sexual
pleasure from the use

treatment

Nursing diagnosis

-Incarceration
and
court
ordered
treatment
are
common
-Often difficult to interpret
outcome from treatment
studies
Studies vary greatly
Many lack control
groups
Drop out rates high
-Denial and minimization of
problem often present
Lack of motivation
for treatment
Some
blame
the
victim
Aversion therapy
Covert sensitization
Satiation therapy
Cognitive therapy
Counter
distorted
thinking
Often combined with
social
skills
and
empathy training
Biological treatments
Castration used in
past

SEXUAL dysfunction/SEXUALITY
PATTERNS, altered
NURSING DIAGNOSIS SEXUAL
dysfunction/SEXUALITY
PATTERNS, altered
May Be Related to:
-Biophysical alteration of
sexuality: ineffectual or absent
role
models; vulnerability;
misinformation; physical/sexual
abuse
-Lack of significant other
-Loss of sexual desire;
disruption of sexual response
pattern
(e.g., premature ejaculation,
dyspareunia)
Conflicts involving values;
conflicts with variant
preferences
-Knowledge/skill deficit about
alternative responses
Possibly Evidenced by:
-Reported difficulties,
limitations/changes in sexual
behaviours or activities
-Alterations in achieving sexual
satisfaction; difficulty

of enemas.

Urophilia-

Medications
-Hormonal agents to reduce
deriving
sexual androgens
pleasure from contact -Depo-Provera
with urine.
-SSRIs

Autagonistophilia

- having sex in front of

others.

Somnaphilia

- having sex with a

sleeping person.

Stigmatophilia

Autonepiophilia

deriving
sexual
pleasure from skin
piercing or a tattoo.
- wearing diapers for
sexual pleasure.

-achieving desired satisfaction

in socially acceptable ways

Pedophilia
Situational
Molesters

Preference
Molesters

Child Rapist

-Normal
Sexual
development
and
interest. But when
stress calls for it, they
sometimes want to
become sexual with a
child
-Pedophillic behavior
is already ingrained in
the
individuals
lifestyle,
clear
preference
for
children, esp. Boys,
and will do anything
(even marry) to hide
his
behavior,
and
clearly sees nothing
wrong
with
his
unusual behavior.
A violent childabuser
whose behavior is an
expression of hostile
sexual drives.

-There is no one best

treatment for Pedophilia.
-Clinicians aim the problem
at the endocrine system and
usually use Testosteronereducing drugs to ease
sexual excitement among
males.
-Psychologists
track
the
problem rooting from the
abusers childhood stage,
early life experience, and
others.

Exhibitionism

The
person
has
intense sexual urges
and
arousing
fantasies
involving
the
exposure
of
genitals to a group of
stranger/s.
He/she
does not expect a
sexual reaction from
the stranger but finds
the shock or fear in
the onlooker to be
arousing. Have the
fantasy
that
the
onlooker
will
be
sexually aroused.

-Usually
a
multi-faceted
approach. Involving reliance
on learning principles, like
counter
conditioning
or
aversive conditioning.
-Treatment aims to unlearn
the
connection
between
sexual
behavior
and
exhibitionist behavior.

Fetishism

is where a person
feels
a
strong
recurrent
sexual
attraction
to
a
nonliving object.
People with this are
always
preoccupied
with the object of
desire,
and
they
become dependent to
it as an object for
sexual gratification.
Objects include shoes,
gloves,
underwear,

-Aversion Therapy
Where the individual is
exposed
to a different
sexual stimulus other than
the desired object.
-Orgasmic Reconditioning
behavioral method geared
toward a relearning process.
In
this
procedure,
an
individual is instructed to
arouse
himself
with
a
fantasy of the unacceptable
object,
then
masturbate
while
looking
at
an

stockings,
etc.

Transvestic Fetishism

swimsuits, appropriate sexual stimulus,

such as a picture of an adult
partner.
If
his
arousal
decreases, he may return to
the
fantasy
of
the
unacceptable object, but he
is to attain orgasm only
while
focusing
on
the
acceptable stimulus.

-A syndrome found
only in males.
-A disorder in which a
man
has
an
uncontrollable urge to
wear
a
womans
clothing, as primary
means of achieving
sexual gratification.
-This
sexual
gratification has a
compulsive
quality,
and consumes a lot of
emotional energy.
-Sometimes
accompanied
by
masturbation.
-Has recurrent urges
and desires to wear

womans clothing or
cross
dressing
to
achieve
sexual
gratification.
-The fantasies and
sexual urges cause
significant
distress
and/or impairment.
Partialism

Frotteurism

-Another variant of
Fetishism.
People with Partialism
are soley interested in
the
sexual
gratification from a
specific body part,
examples are feet,
neck,
underarms,
back, etc.
-Treatment
extinction
and
-Derived
from
the conditioning.
word
Frotter
meaning To rub
-Refers
to
the
masturbation
that
involves
rubbing
against
another
person.
-Frotteur has recurrent
sexual
desires
on
rubbing into people.

includes
covert

Targets of Frotteurs
are not consenting
people, rather they
target strangers.

Sexual Masochism

Sexual Sadism

-Disorder marked by
an
attraction
to
achieving
sexual
gratification by having
painful
stimulation
applied to ones own
body, either alone or
with a partner.
-Men and women with
this disorder achieve
sexual satisfaction by
such
means
like
binding, ropes, whips,
or injuries.
-The
converse
of
Sexual Masochism. It
involves
deriving

sexual
gratification
from activities that
harm, or from urges
to
harm,
another
person.
Seeing
or
imagining
anothers
pain
excites
the
sadist. In contrast to
Sexual
Masochism,
which
does
not
require
a
partner,
sexual sadism clearly
requires a partner to
enact
sadistic
fantasies.
-Sadomasochist is the
term where in a
person
does
both
Sadist and Masochist
roles, or inflicting and
receiving pain.

Voyeurism

-The word comes from -Like exhibitionism, Voyeurs

the
term
voir, usually go through counter
meaning To See
conditioning therapy.
-A sexual
disorder
where an individual
compulsively
seeks
sexual
gratification
from observing nudity
or sexual activity of
others
who
are
unaware that they are
being watched.
-This disorder is more
common in men.
-The term Peeping
Tom usually refers to
voyeur.
-Voyeurs often get
sexually
frustrated
and feels incapable of
establishing a regular
sexual
relationship
with the person he
observes. He prefers
to masturbate either
during or after the
voyeuristic activity.

Gender
Disorders

Transsexualism

Identity -A condition which

involves
a
discrepancy between
an
individuals
assigned sex and the
persons
gender
identity.
-Experience a strong
and persistent crossgender identification,
which causes a feeling
of discomfort.
-Experience
intense
feeling of distress.

-Refers
to
this in terms of psychotherapy
phenomenon in which
a person has an inner
feeling of belonging to
other sex.
-People involve in this
situation wishes to
live as members of
the other sex.

Sexual Dysfunction

Hypoactive
Desire Disorder

Sexual
Disorder

Sexual -The Individual has an

abnormally low level
of interest in sexual
activity.

-characterized by an
Aversion active
dislike
and
avoidance of genital
contact with a sexual
partner, which causes
personal distress or
interpersonal
problems.

Male Erectile Disorder

Female

-refers
to
an
abnormality
in
an
individuals
sexual
responsiveness
and
reactions.

recurrent partial or
complete failure to
attain or maintain
erection

-inability
Orgasmic orgasm,

to

achieve
or
a

Disorder

Premature Ejaculation

Sexual Pain Disorders

distressing delay
the achievement
orgasm.

in
of

-The male individual

reaches orgasm in a
sexual encounter long
before he wishes to,
perhaps even prior to
penetration,
and
therefore feels little or
no sexual satisfaction.
-involves
experience of
associated
intercourse.
Diagnosed
dyspareunia
vaginismus.

the
pain
with
as
or

ineffective Sexuality Pattern

Defining
characteristics

Scientific basis

Outcomes

Nursing intervention

rationale

Reported
difficulties/
limitations/chan
ges in sexual
behaviors/activit
ies

Sexual
intercourse, or
coitus
or
copulation, is
principally the
insertion and
thrusting of a
male's penis,
usually when
erect, into a
female's
vagina for the
purposes
of
sexual
pleasure
or
reproduction.
[3] This is also
known
as
vaginal
intercourse or
vaginal sex.[2]
[4]
Other
forms
of
penetrative
sexual
intercourse
include
penetration of
the anus by
the penis (anal
sex),

After 8hrs of nurse-patient

interaction,
Patient will be able to:
-Verbalize
understanding
ofsexual anatomy
and function
-erbalize knowledge and
understanding
ofsexual
limitations,difficulties,or
changes that have occurred.
Verbalize
acceptance
ofselfin current (altered)
condition.
Demonstrate
improved
communication
and
relationship skills.

-Obtain
complete
physical,and
sexual
history,as
indicated,including
perception ofnormal
function

-Note
use
ofvocabulary
(assessing
basic
knowledge) and comments/concerns about
sexual identity.

Determine
importance ofsex and
a description ofthe
prob-lem
in
the
clients own words.Be
alert to comments of
client/SO
(e.g.,discount ofovert
or
covert
sexual
expressionssuch
as
Hes just a dirty old
man).

Sexuality is multi-faceted
beginning
with
ones
body,biological
sex,and
gen-der
(biological,social,and
legal status as girls/boys,
women/men)
-Components
ofsexualidentity include
ones gender identity
(how one feels abouthis
or her gender) as well as
ones
sexual
orientation(straight,lesbia
n,gay,bisexual,transgend
ered)

-Sexual
concerns
areoften disguised as
sarcasm,humor,or
in
offhand remarks

-Sense

oftrust/comfort

penetration of
the mouth by
the penis or
oral
penetration of
the
female
genitalia (oral
sex),
sexual
penetration by
the
fingers
(fingering),
and
penetration by
use of a strapon dildo.[5][6]
[7]
These
activities
involve
physical
intimacy
between two
or
more
individuals and
are
usually
used
among
humans solely
for physical or
emotional
pleasure and
commonly
contribute to

-Provide atmosphere
in which discussion
ofsexual
problems
isencouraged/permitt
ed
-Encourage discussion
ofindividual situation
with opportu-nity for
expression offeelings
without judgment

Introduce client to
individuals who have
successfully
managed
a
similar
problem

enhancesability
to
discuss sensitive matters.

Sexuality also includes

feelings,attitudes,relation
ships,selfimage,ideals,and
behaviors,and influences
how one experiencesthe
world
-Provides positive
model/support
problem solving

role
for

human
bonding.

Name
of
drug
Generic
name:
Medroxypro
gesterone
Acetate
Trade name:
Curretab
- Tablets 10
mg

Classificatio
n
Progestins
and
estrogens
Hormonal
drugs

Mechanism
of action

indication

contraidication

Adverse reaction

Ng responsibilities

Progestins
diffuse freely
into
target
cells in the
female
reproductive
tract,
mammary
gland,
hypothalamus,
and
the
pituitary and
bind to the
progesterone
receptor.
Once bound
to
the
receptor,
progestins
slow
the
frequency of
release
of
gonadotropin
releasing
hormone
(GnRH) from
the
hypothalamus
and blunt the
pre-ovulatory
LH surge

Treatment of

Hypersensitivity

secondary

to

amenorrhea

current or history

and

of

abnormal

thrombophlebitis,

uterine

thromboembolic

bleeding

disorders,

Cardiovascular
Thrombophlebitis;
edema.
CNS
Depression;
headache;
nervousness;
dizziness; insomnia;
fatigue;
somnolence.
Dermatologic
Rash; acne;
melasma;
chloasma; alopecia;
hirsutism;
photosensitivity;
pruritus; urticaria.
GI
Abdominal pain or
discomfort; nausea.
Genitourinary
Breakthrough
bleeding; spotting;
change in
menstrual flow;
amenorrhea;
decrease in libido;
changes in cervical
erosion and
secretions.
Hepatic
Cholestatic
jaundice.
Respiratory
Pulmonary

Advise patient to read

patient information
leaflet before using
the first time and with
each refill.
Instruct diabetic
patient taking
estrogen and
medroxyprogesterone
to monitor blood
glucose more
frequently when
therapy is started and
to inform health care
provider of significant
changes in readings.
Teach patient proper
method of breast selfexamination, and
remind patient to
perform monthly.
Instruct patient to
immediately report
any of the following
symptoms to health
care provider: pain in
groin or calves; sharp
chest pain, coughing
blood, or sudden
shortness of breath;
crushing chest pain or
heaviness in chest;
abnormal vaginal
bleeding; breast

caused

by

progestins;

cerebrovascular

hormonal

disease,

or

imbalance;

cerebral

reduction of

hemorrhage;

incidence of

impaired

liver

endometrial

function;

breast

hyperplasia

or genital organ

in

cancer;

nonhysterect

undiagnosed

omized

vaginal bleeding;

postmenopa

missed abortion;

usal women

diagnostic test for

receiving

pregnancy;

conjugated

known

estrogen

suspected

0.625 mg.

pregnancy.

or

embolism.
Miscellaneous
Breast tenderness;
masculinization of
female fetus;
edema; weight
changes, especially
weight gain;
anaphylactoid
reactions; bone
mineral density
changes, increasing
risk of osteoporosis;
hyperglycemia;
pyrexia;
galactorrhea.

lumps; sudden severe

headache; dizziness
or fainting; tremors or
seizure; vision or
speech problems;
weakness or
numbness of arms or
legs; severe
abdominal pain;
depression; yellowing
of the skin or eyes;
persistent pain, pus,
or bleeding at
injection site.
Advise patient that
follow-up visits and
examinations,
including Pap smear,
at least once a year,
will be required to
monitor therapy and
to keep appointments.
Tablets
Advise patient to take
each dose without
regard to meals but to
take with food if
stomach upset occurs.