UNIT-13

Sexual Disorder
INTRODUCTION

Human beings are sexual beings. Sexuality is a basic human need and an innate part of the total
personality. It influences our thoughts, actions, and interactions, and it is involved in aspects of
physical and mental health.

Society’s attitude towards sexuality is changing. Clients are more open to seeking
assistance in matters that pertain to sexuality. Although not all nurses need to be educated as sex
therapists, they can readily integrate information an sexuality into the care they give by focusing
on preventive, therapeutic, and educational interventions to assist individuals to attain, regain, or
maintain sexual wellness.

TERMINOLOGIES

Parphilias: The term paraphilia is used to identify repetitive or preferred sexual fantasies or
behaviors.

FSAD: Female sexual arousal disorder.

FOD: Female orgasmic disorder.

PE: Premature ejaculation

DEVELOPMENTMENT OF HUMAN SEXUALITY

 Birth through age 12: Although the sexual identity of an infant is determined before
birth by chromosomal factors and physical appearance of the genitals, postnatal factors
can greatly influence the way developing children perceive themselves sexually.
Masculinity and femininity, as well as sex roles, are for the most part culturally defined.
It is not uncommon for infants to touch and explore their genitals. In fact, research on
infantile sexuality indicates that both male and female infants are capable of sexual
arousal and orgasm.
By the age of 2 or 2.5 years, children know what gender they are. They
know that they are like the parent of the same gender and different from the parent of the
opposite gender and from other children of the opposite gender.
By the age of 4 or 5, children engage in heterosexual play. Playing doctor
can be a popular game at this stage. In this age children form a concept of marriage to a
member of the opposite sex.
 Children increasingly gain experience with masturbation during
childhood. Most children begin self exploration and genital self-stimulation at about 15 to
19 months of age.
Late childhood and preadolescence may be characterized by homosexual
play. Generally the activity involves no more than touching the other’s genitals. Girls at
this age become interested in masturbation, and both sexes are interested in learning
about fertility, pregnancy and birth. Interested in opposite sex increases.
Children ages 10 to 12 are preoccupied with pubertal changes and the
beginnings of romantic interest in the opposite sex.
 Adolescence: Adolescence represents acceleration in terms of biological changes and
psychosocial and sexual development. This time of turmoil is nurtured by awakening
endocrine forces and a new set of psychosocial tasks to undertake.
Biologically, puberty begins for the female adolescent with breast
enlargement, widening of the hips, and growth of pubic and ancillary hair. The onset of
masturbation usually occurs between the ages of 11 to 13 years. In the male adolescent,
growth of pubic hair and enlargement of the testicles begin at 12 to 16 years of age.
Penile growth and the ability to ejaculate usually occur from the ages of 13 to 17. There
is a marked growth of the body between ages 11 and 17, accompanied by the growth of
body and facial hair, increased muscle mass and a deeper voice.
Sexuality is slower to develop in the female than in the males. Many
individuals have their first experience with sexual intercourse during the adolescent
period. According to Kaplan and Sadock (1998),
 More adolescents are engaging in premarital intercourse.
 The incidence of premarital intercourse for girls has increased.
 The average age of first intercourse is decreasing.
 Adulthood: This period of the life cycle begins at approximately 20 years of age and
continues to age of 65.
 Marital sex
 Extramarital sex
 Sex and the single person
 The middle years years-40 to 65

SEXUAL DISORDERS

PARAPHILIAS

The term paraphilia is used to identify repetitive or preferred sexual fantasies or behaviors.

Paraphilias are sometimes referred to as sexual deviations or perversions. Paraphilias include

fantasies, behaviors, or sexual urges focusing on unusual objects, activities, or situations.
Paraphilias include:
  Sexual urges or sexual fantasies with non-human objects
 Sexual behaviors with non-human objects
 Sexual behaviors involving humiliation or suffering of oneself or another person
 Adult sexual behavior that involves children or nonconsenting adults

Some of the common paraphilias include:

 Exhibitionism
 Fetishism
 Frotteurism
 Pedophilia
 Masochism
 Sadism
 Transvestitism
 Voyeurism

Exhibitionism: Exhibitionism is a tendency to sexually expose oneself to others. For

example, a man’s behavior is exhibitionistic when he exposes part his naked body,
usually his genitals, to a total stranger. The sexual behavior is almost always limited to
the genital exposure, and the person may make no further harmful advances toward the
stranger. Most often exhibitionism begins during adolescence and continues into
adulthood.
Fetishism: People with a fetish experience sexual urges and behavior which are
associated with non-living objects. For example, the object of the fetish could be an
article of female clothing, like female underwear. Usually the fetish begins in
adolescence and tends to be quite chronic into adult life.
Frotteurism: Men have a paraphilia called Frotteurism when the focus of their sexual
urges are related to the touching or rubbing of their body against a non-consenting,
unfamiliar woman. Usually the male rubs his genital area against the female. Most
commonly, the man chooses to attack in a crowded public location and then he
disappears into the throng of people. Frotteurism usually begins in adolescence and the
abnormal behavior tends to decrease when the man reaches his late twenties.
Pedophilia: A pedophile is a person, most frequently a man, who focuses his sexual
fantasies and behavior toward children. People who enjoy child pornography or "kiddie
porn" are pedophiles. Some pedophiles are sexually attracted only toward children and
are not at all attracted toward adults. Pedophilia is usually a chronic condition.

When a pedophile becomes sexually active with a child he/she may:

 Undress the child

 Encourage the child to watch them masturbate
 Touch or fondle the child’s genitals
 Forcefully perform sexual acts on the child
 Masochism: Masochism is the getting of pleasure, often sexual, from being hurt or
humiliated. Sometimes the masochistic acts are limited to verbal humiliation or
blindfolding. However, masochistic behavior might include being bound or beaten.
Masochism may become even more harmful, however, when a person permits another to
use arm or leg restraints accompanied by acts of beating, whipping, or cutting.
Sadism: Sadism is deriving pleasure, often sexual, from mistreating others. Like other
paraphilias, some people have fantasies which are sadistic, but they never act upon them.
Also, some people have sexual urges of a sadistic nature, and they find a willing partner
who agrees to participate in the sadistic activity. There are people, however, who have
sadistic sexual urges who find others whom they victimize with their behavior. Some of
the severe activities involved in sexual sadism include burning, beating, stabbing, raping,
and killing. Usually the thoughts and/or behaviors of sexual sadism begin in adolescence
or early adulthood. The behaviors are not only chronic, but they usually increase in
severity with time.
Transvestitism: Cross-dressing by heterosexual males is called transvestic fetishism or
transvestitism. The male with this fetish usually has a variety of female clothes that he
uses to cross-dress. While some males will wear only one special piece of female apparel,
others fully dress as a female and use full facial make-up to achieve a total female
appearance. Often this disorder begins in childhood. It tends to be chronic in nature.
Voyeurism: Voyeurism is seeking sexual pleasure by secretly observing another.
Another name for the behavior is “peeping” or “peeping Tom”. The activity brings on
sexual excitement and may conclude with masturbation by the voyeur. Voyeurism
usually starts in adolescence and tends to persist into adulthood.

PREDISPOSING FACTORS TO PARAPHILIA

Bilogical Factors: Various studies have implicated several organic factors in the etiology
of paraphilis. Temporal lobe diseases, such as psycho motor seizures or temporal lobe
tumors , have been implicated in some individuals with paraphilis. Abnormal levels of
androgens also may contribute to inappropriate sexual arousal.
Psychoanalytical Theory: The psychoanalytical approach defines a paraphiliac as one
who has failed the normal developmental process toward heterosexual adjustment(Kaplan
and Sadock, 1998). This occurs when the individual fails to resolve the oedipal crisis and
either identifies with the parent of the opposite gender or selects an inappropriate object
for libido cathexis.
Behavioral Theory: The behavioral model hypothesis that whether or not an individual
engages in paraphiliac behavior depends on the type of re-infocement he/she receives the
following behavior.
Transactional Model of Stress Adoptation: Marshall and Barbaree(1990) contend that
one model alone is not suffiecient to explain the etiology of paraphilias. They suggest
that an integration of learning experiences, socio-cultural factors and biologic processes
must occur to account for these deviant sexual behaviors.
TREATMENT MODALITIES

Biological Treatment: Biological treatment of individuals with paraphilias has focused

on blocking or decreasing the level of circulating androgens. The most extensively used
androgenic medications are the progestin derivatives that block testosterone synthesis or
block androgen receptors.
Psychoanalytical Therapy: Psychoanalytical approaches have been tried in the
treatment of paraphilias. In this type of therapy, the therapist helps the client identify
unresolved conflicts and traumas from early childhood. The therapy focuses on helping
the individual to resolve these early conflicts.
Behavioral Therapy: Aversion techniques have been used to modify undesirable
behavior. In these therapy the treatment of paraphilias involve paring noxious stimuli
such as electric shocks and bad odours with the impulse which then diminishes.

Do paraphilias affect males, females, or both?

Paraphilias are primarily male disorders.

At what age do paraphilias appear?

Most paraphilic fantasies begin in late childhood or adolescence and continue throughout
adult life. Intensity and occurrence of the fantasies are variable, and they usually decrease as
people get older.
ROLE OF NURSE

Treatment of the person with paraphilia is often very frustrating for both the client and the
therapist. Most individuals with a paraphilia deny that they have a problem and seek psychiatric
care only after inappropriate behavior comes to the attention of others. Nurses may best become
involved in the primary prevention process. The focus of primary prevention in sexual disorders
is to intervene in home life or other facets of childhood in an effort to prevent problems from
developing.

SEXUAL DYSFUNCTION

Sexual dysfunction or sexual malfunction (see also sexual function) refers to a difficulty
experienced by an individual or a couple during any stage of a normal sexual activity, including
desire, arousal or orgasm.
The sexual response cycle

Phase I: Desire
Phase II: Excitement
Phase III: Orgasm
Phase IV: Resolution

TYPES OF SEXUAL DISFUNCTION

SEXUAL DESIRE DISORDER:

Hypoactive Sexual Desire Disorder

Sexual desire disorders or decreased libido are characterized by a lack or absence for some
period of time of sexual desire or libido for sexual activity or of sexual fantasies. The condition
ranges from a general lack of sexual desire to a lack of sexual desire for the current partner. The
condition may have started after a period of normal sexual functioning or the person may always
have had no/low sexual desire.

The causes vary considerably, but include a possible decrease in the production of normal
estrogen in women or testosterone in both men and women. Other causes may be aging, fatigue,
pregnancy, medications (such as the SSRIs) or psychiatric conditions, such as depression and
anxiety.

Sexual aversion disorder

Sexual aversion disorder is characterized by an aversion to or avoidance or dismissal of sexual

prompts or sexual contact. It may be acquired following sexual or physical abuse or trauma and
may be life-long.

Persistent or recurring aversion to or avoidance of sexual activity. The aversion must result in
significant distress for the individual and is not better accounted for by another disorder or
physical diagnosis. When presented with a sexual opportunity, the individual may experience
panic attacks or extreme anxiety. Persistent or recurring aversion to or avoidance of sexual
activity. The aversion must result in significant distress for the individual and is not better
accounted for by another disorder or physical diagnosis. When presented with a sexual
opportunity, the individual may experience panic attacks or extreme anxiety.

SEXUAL AROUSAL DISORDER

Female sexual arousal disorder (FSAD), commonly referred to as frigidity, is a disorder

characterized by a persistent or recurrent inability to attain sexual arousal or to maintain arousal
until the completion of a sexual activity, or an adequate lubrication-swelling response that
otherwise is present during arousal and sexual activity. The condition should be distinguished
from a general loss of interest in sexual activity and from other sexual dysfunctions, such as the
orgasmic disorder (anorgasmia) and hypoactive sexual desire disorder, which is characterized as
a lack or absence of sexual fantasies and desire for sexual activity for some period of time.

Erectile dysfunction

Erectile dysfunction or impotence is a sexual dysfunction characterized by the inability to

develop or maintain an erection of the penis. There are various underlying causes, such as
damage to the nervi erigentes which prevents or delays erection, or diabetes, which simply
decreases blood flow to the tissue in the penis, many of which are medically reversible.

The causes of erectile dysfunction may be psychological or physical. Psychological impotence

can often be helped by almost anything that the patient believes in; there is a very strong placebo
effect. Physical damage is much more severe. One leading physical cause of ED is continual or
severe damage taken to the nervi erigentes. These nerves course beside the prostate arising from
the sacral plexus and can be damaged in prostatic and colo-rectal surgeries.

ORGASMIC DISORDER

Female orgasmic disorder: Female orgasmic disorder (FOD) is the persistent or recurrent
inability of a woman to have an orgasm (climax or sexual release) after adequate sexual arousal
and sexual stimulation. According to the handbook used by mental health professionals to
diagnose mental disorders, the Diagnostic and Statistical Manual of Mental Disorders , 4th
Edition, Text Revision (also known as the DSM-IV-TR) , this lack of response can be primary (a
woman has never had an orgasm) or secondary (acquired after trauma), and can be either general
or situation-specific. There are both physiological and psychological causes for a woman's
inability to have an orgasm. To receive the diagnosis of FOD, the inability to have an orgasm
must not be caused only by physiological problems or be a symptom of another major mental
health problem. FOD may be diagnosed when the disorder is caused by a combination of
physiological and psychological difficulties. To be considered FOD, the condition must cause
personal distress or problems in a relationship. In earlier versions of the Diagnostic and
Statistical Manual of Mental Disorders, FOD was called "inhibited sexual orgasm."

Male orgasmic disorder: Male orgasmic disorder may be defined as a persistent or recurrent
inability to achieve orgasm despite lengthy sexual contact or while participating in sexual
intercourse. he mental health professional's handbook, the Diagnostic and Statistical Manual of
Mental Disorders (DSM-IV-TR) , includes this disorder among the sexual dysfunctions , along
with premature ejaculation , dyspareunia , and others. The individual affected by male
orgasmic disorder is unable to experience an orgasm following a normal sexual excitement
phase. The affected man may regularly experience delays in orgasm, or may be unable to
experience orgasm altogether.

Premature ejaculation: Premature ejaculation (PE) is a condition in which a man ejaculates

earlier than he or his partner would like him to. Premature ejaculation is also known as rapid
ejaculation, rapid climax, premature climax, or early ejaculation. Masters and Johnson defines
PE as the condition in which a man ejaculates before his sex partner achieves orgasm, in more
than fifty percent of their sexual encounters.

Most men experience premature ejaculation at least once in their lives. Because there is
great variability in both how long it takes men to ejaculate and how long both partners want sex
to last, researchers have begun to form a quantitative definition of premature ejaculation. Current
evidence supports an average intravaginal ejaculation latency time (IELT) of six and a half
minutes in 18-30 year olds. If the disorder is defined as an IELT percentile below 2.5, then
premature ejaculation could be suggested by an IELT of less than about 2 minutes. Nevertheless,
it is well accepted that men with IELTs below 1.5 minutes could be "happy" with their
performance and do not report a lack of control and therefore would not be defined as having PE.
On the other hand, a man with 2 minutes IELT may have the perception of poor control over his
ejaculation, distressed about his condition, has interpersonal difficulties and therefore be
diagnosed with PE.

SEXUAL PAIN DISORDER

Sexual pain disorders affect women almost exclusively and are known as dyspareunia (painful
intercourse) or vaginismus (an involuntary spasm of the muscles of the vaginal wall that
interferes with intercourse).

Dyspareunia may be caused by insufficient lubrication (vaginal dryness) in women. Poor

lubrication may result from insufficient excitement and stimulation, or from hormonal changes
caused by menopause, pregnancy, or breast-feeding. Irritation from contraceptive creams and
foams can also cause dryness, as can fear and anxiety about sex.

It is unclear exactly what causes vaginismus, but it is thought that past sexual trauma (such as
rape or abuse) may play a role. Another female sexual pain disorder is called vulvodynia or
vulvar vestibulitis. In this condition, women experience burning pain during sex which seems to
be related to problems with the skin in the vulvar and vaginal areas. The cause is unknown

SEXUAL DISFUNCTION DUE TO GENERAL MEDICAL CONDITION AND

SUBSTANCE INDUCED SEXUAL DISFUNCTION:

Types of medical conditions that are associated with sexual disfunction include neurological(Ex:
Multiple Sclerosis, neuropathy), endocrine (Ex: Diabetis melliatus, thyroid disfunctions),
vascular(Ex: Atheroclerosis), and genitourinary (Ex: Testicural disease, urethral and vaginal
infections). Substance that can interfere with sexual functioning include alcohol, cocaine, opoids,
sedatives and anxiolytics.

PREDISPOSING FACTORS TO SEXUAL DYSFUNCTION

 Biological Factors:

1. Sexual desire disorders: Studies have correlated decreased levels of serum testostereone
with hypoactive sexual desire disorder in men. Diminished libido has been observed in both
men and women with elevated levels of serum prolactin.

2. Sexual Arousal Disorder: Post menopausal women require a longer period of stimulation
for lubrication to occur and there is generally less vaginal transudate after menopause.
Various medications particularly those with antihistaminic and anticholinergic properties
may also contribute to decreased ability for arousal in women. Arteriosclerosis is common
cause of male erectile disorder as a result of arterial insufficiency.

3. Orgasnic Disorder: Results of research on the increased ability to achieve orgasm in

posthysterectomy women by administering an estrogen-androgen hormone combination have
been mixed. Although the hormone replacement did influence sexual desire and arousal.

4. Sexual pain Disorder: A number of organic factors can contribute to painful intercourse in
women including intact hymen, episiotomy scar, virginal, vaginal urenery tract infection,
ligament injuries, ovarian cysts or tumour. Painful intercourse in men may also be caused by
various organic factors for ex: infection caused by poor hygiene under the foreskin of an
uncircumcised men can cause pain.

Psychosocial factors:

APPLICATION OF THE NURSING PROCESS

ASSESSMENT

Most assessment tools for taking a general nursing history contain some questions devoted to
sexuality. It is a subject about which many nurses feel uncomfortable obtaining information.

DIAGNOSIS

Sex dysfunction related to depression and conflict in relationship or certain biological or

psychological contributing factors to the disorder evidenced by loss of sexual desire.
Ineffcetive sexuality patterns related to conflicts with sexual orientation or variant preferences,
evidenced by expressed dissatisfaction with sexual behaviors ( voyeurism, transvestism).

TREATMENT MODALITIES FOR SEXUAL DYSFUNCTION

Treatment for males

Since in many men the cause of sexual dysfunction is related to anxiety about performance,
psychotherapy can help. Situational anxiety arises from an earlier bad incident or lack of
experience. This anxiety often leads to development of fear towards sexual activity and
avoidance. In return evading leads to a cycle of increased anxiety and desensitization of the
penis. In some cases, erectile dysfunction may be due to marital disharmony. Marriage
counseling sessions are recommended in this situation.

Lifestyle changes such as discontinuing smoking, drug or alcohol abuse can also help in some
types of erectile dysfunction.] Several medications like Viagra, cialis and Levitra have become
available to help people with erectile dysfunction. These medications do work in about 60% of
men. In the rest, the medications may not work because of wrong diagnosis or chronic history.

Another type of medication that is effective in roughly 85% of men is called intracavernous
pharmacotherapy — used by companies such as Boston Medical Group, Performance Medical
Centers and independent doctors — and involves injecting a vasodilator drug directly into the
penis in order to stimulate an erection.

Treatment for females

Although there are no approved pharmaceuticals for addressing female sexual disorders, several
are under investigation for their effectiveness. A vacuum device is the only approved medical
device for arousal and orgasm disorders. It is designed to increase blood flow to the clitoris and
external genitalia. Women experiencing pain with intercourse are often prescribed pain relievers
or desensitizing agents. Others are prescribed lubricants and/or hormone therapy. Many patients
with female sexual dysfunction are often also referred to a counselor or therapist for
psychosocial counseling.

A manual physical therapy, the Wurn Technique, which is designed to reduce pelvic and vaginal
adhesion, may also be beneficial for women experiencing sexual pain and dysfunction. In a
controlled study, Increasing orgasm and decreasing intercourse pain by a manual physical
therapy technique, twenty-three (23) women reporting painful intercourse and/or sexual
dysfunction received a 20-hour program of manipulative physical therapy. The results were
compared using the validated Female Sexual Function Index, with post-test vs. pretest scores.
Results of therapy showed statistically significant improvements in all six recognized domains of
sexual dysfunction. A second study to improve sexual function in patients with endometriosis
showed similar statistical results.

GENDER IDENTITY DISORDER

Gender identity disorder is a conflict between a person's actual physical gender and the gender
that person identifies himself or herself as. For example, a person identified as a boy may
actually feel and act like a girl. The person experiences significant discomfort with the biological
sex they were born.

Causes, incidence, and risk factors

People with gender identity disorder may act and present themselves as members of the opposite
sex. The disorder may affect:

 Choice of sexual partners

  Display of feminine or masculine mannerisms, behavior, and dress
 Self-concept

Gender identity disorder is not the same as homosexuality.

Identity conflicts can occur in many situations and appear in different ways. For example, some
people with normal genitalia and sexual characteristics (such as breasts) of one gender privately
identify more with the other gender.

Some people may cross-dress, and some may seek sex-change surgery. Others are born with
ambiguous genitalia, which can raise questions about their gender.

The cause is unknown, but hormones in the womb, genes, and environmental factors (such as
parenting) may be involved. This rare disorder may occur in children or adults.

Symptoms

Symptoms can vary by age, and are affected by the person's social environment. They may
include the following:

Children:

 Are disgusted by their own genitals

 Are rejected by their peers, feel alone
 Believe that they will grow up to become the opposite sex
 Have depression or anxiety
 Say that they want to be the opposite sex

Adults:

 Dress like the opposite sex

 Feel alone
 Have depression or anxiety
 Want to live as a person of the opposite sex
 Wish to be rid of their own genitals

Either adults or children:

 Cross-dress, show habits typical of the opposite sex

 Withdraw from social interaction

PREDISPOSING FACTORS

1. Biological influences

2. Family influences
3. Psychoanalytical theory

APPLICATION OF THE NURSING PROCESS TO GENDER IDENTITY DISORDERS

Assessment data

 Gender identity disorder in children: The DSM-IV-TR describes the manifestations of

this disorder as the presence of four ( or more) of the following:
1. Repeatedly stated desire to be, or insistence that he or she is, the other sex.
2. In boys, preference for cross – dressing or simulating female attire; in girls,
insistence on wearing only stereotypical masculine clothing.
3. Strong and persistent preferences for cross-sex roles in make-believe play or
persistent fantasies of being the other sex.
4. Intense desire to participate in the stereotypical games and pastimes of the other
sex.
5. Strong preference for playmates of the other sex.

 Gender identity disorder in adolescence: The DSM-IV-TR describes this disorder as

one in which there is a strong and persistent cross-gender identification. Symptomatic
manifestations include a stated desire to be the opposite gender, frequently passing as the
opposite gender, a desire to live or be treated as the opposite gender, or the conviction
that he or she has the typical feelings and reactions of the opposite gender ( APA,2000).

Diagnosis/Outcome identification

Disturbed personal identity related to parenting patterns that encourage culturally

unacceptable behaviors for assigned gender.
Impaired social interaction related to socially and culturally unacceptable behaviors.
Low self esteem related to rejection by peers.

Treatment

Individual and family therapy is recommended for children. Individual and, if appropriate,
couples therapy is recommended for adults. Sex reassignment through surgery and hormonal
therapy is an option, but identity problems may continue after this treatment.
VARIATIONS IN SEXUAL ORIENTATION:

Homosexuality: Homosexual activity occurs under some circumstances in probably all known
human cultures and all mammalian species for which it has been studied. The term
homosexuality is derived from the greek root homo meaning same and refers to sexual
preference for individual of the same gender. The term lesbianism, used to identify female
homosexuality. Most homosexual prefers the term gay because it is less derogatory in its lack of
emphasis on the sexual aspects of the orientation. A heterosexual is then refers to as a straight.

Transsexualism: Transsexulaism is disorder of gender identity or gender disphoria (unhappiness

or dissatisfaction with ones gender) of the most extreme variety.

Bisexuality: A bisexual person is not exclusively heterosexual or homosexual. He/she engages

in sexual activity with members of both gender. Bisexuals are also referred to as ambisexual.
Bisexuality is more common than exclusive homosexuality.

Journal abstract

International Journal of Impotence Research (2005) 17, S52–S56. doi:10.1038/sj.ijir.3901429

Sexual dysfunction in the elderly: age or disease?

M E Camacho and C A Reyes-Ortiz, Sealy Center on Aging, The University of Texas Medical
Branch, Galveston, Texas, USA

Sexuality is an important component of emotional and physical intimacy that men and women
experience through their lives. Male erectile dysfunction (ED) and female sexual dysfunction
increase with age. About a third of the elderly population has at least one complaint with their
sexual function. However, about 60% of the elderly population expresses their interest for
maintaining sexual activity. Although aging and functional decline may affect sexual function,
when sexual dysfunction is diagnosed, physicians should rule out disease or side effects of
medications. Common disorders related to sexual dysfunction include cardiovascular disease,
diabetes, lower urinary tract symptoms and depression. Early control of cardiovascular risk
factors may improve endothelial function and reduce the occurrence of ED. Treating those
disorders or modifying lifestyle-related risk factors (eg obesity) may help prevent sexual
dysfunction in the elderly. Sexuality is important for older adults, but interest in discussing
aspects of sexual life is variable. Physicians should give their patient's opportunity to voice their
concerns with sexual function and offer them alternatives for evaluation and treatment.

Sexual dysfunction in women partners of men with erectile dysfunction

A Greenstein1, L Abramov2, H Matzkin1 and J Chen, International Journal of Impotence

Research (2006) 18, 44–46. doi:10.1038/sj.ijir.3901367; published online 28 July 2005
We evaluated 113 female partners of men with erectile dysfunction (ED) attending a sexual
dysfunction clinic in order to define sexual dysfunction among these women. In all, 51 (45%)
women denied having any sexual dysfunction. The other 62 (55%) responded to questions
classifying their complaint(s) according to the international classification of female sexual
dysfunction (FSD) in the following topics (40/62, 65%, reported having more than one problem):
decreased sexual desire (n=35, 56%), sexual aversion (none), arousal (n=23, 37%) and orgasmic
disorders (n=39, 63%), dyspareunia (n=19, 31%), vaginismus (n=3, 5%), and noncoital sexual
pain (none). Many female partners of men with ED report having some form of sexual disorder,
mostly orgasmic problems and decreased sexual desire. Therefore, for optimal outcome of ED
treatment, evaluation and treatment of male and FSD should be addressed as one unit within the
context of the couple, and be incorporated into one clinic of sexual medicine.

BIBLIOGRAPHY

1. Harold I Kaplan and Benjamin J sadock, Jack A Grebb. Synopsis of psychiatry. 7th edition.
Williams and wilkins publication; Baltimore. Page No-336-362.
2. Benjamin James Sadock and Virginia Alcott Sadock. Synopsis of psychiatry. 10th edition.
Lippincott publication: New Delhi, 2007.
3. Mary C Townsend. Essentials of psychiatric nursing. Philadelphia; F.A Davis
publication:2003.
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