Chapter 20: Sexual & Gender-Related Disorders

Sexual & Gender-Related Disorders comprehensively explores the critical role of the psychiatric-mental health nurse in addressing complex issues related to sexual dysfunction, gender dysphoria, and paraphilic disorders, emphasizing that sexual health assessment is a necessary component of holistic care, despite discomfort experienced by many healthcare providers. The material begins by reviewing the normal sexual response cycle—composed of the Desire, Excitement, Orgasm, and Resolution phases—as identified by Masters and Johnson. Sexual dysfunctions are defined as disturbances in these phases or pain during intercourse, encompassing seven main categories such as Male Hypoactive Sexual Desire Disorder, Erectile Disorder, and Female Orgasmic Disorder. These conditions are often caused by a combination of biological factors, including age, chronic medical conditions (e.g., diabetes), and medications (like SSRIs), alongside cognitive and relational issues. The nursing process is applied, highlighting the need for sensitive, nonjudgmental assessment and establishing a priority diagnosis of Impaired Sexual Functioning. Treatments include pharmacotherapy, such as Flibanserin for women and PDE-5 inhibitors for men, and targeted psychological therapies like sensate focus exercises and systematic desensitization. The text then examines Gender Dysphoria, characterized by significant distress arising from an incongruence between one's assigned biological sex and their experienced gender identity. While etiology is complex, biological and learning factors are considered. Interventions focus on support, and treatments may involve puberty blockers for adolescents, cross-sex hormone therapy, and, for intractable cases, sex reassignment surgery. Finally, Paraphilic Disorders are detailed as recurrent, intense sexual urges or fantasies involving nonhuman objects, suffering, or nonconsenting partners, with common examples being Pedophilic Disorder, Voyeuristic Disorder, and Exhibitionistic Disorder. Nursing care for these individuals, who are often admitted for comorbid conditions like depression and high suicide risk, prioritizes safety and impulse control, utilizing interventions such as Cognitive Behavioral Therapy (CBT) and off-label pharmacotherapy (e.g., antiandrogens) aimed at reducing compulsive sexual behavior.