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22.1 Categories of Sexual Dysfunction

Sexuality and sexual health are central to human well-being. Nurses in all health-care settings must keep in mind that their clients are sexual beings and that they may experience mild, moderate, or severe problems in different aspects of their sexual identity and/or behavior. Psychiatric care settings may provide the greatest opportunity for nurses to view and respond to the symptoms and distress of human sexual dysfunction; nurses and nursing students must first become aware of their own attitudes and beliefs about sexuality, however, before they can become skilled in this aspect of nursing care. Nursing students may need to enhance their educational preparation by taking a human sexuality elective in another department if their nursing curriculum does not provide sufficient information.

22.2 Paraphilias

The paraphilias are a type of sexual interest (i.e., urges, fantasies, behaviors) that are not limited to genital stimulation or fondling between mature, consenting human partners (APA, 2022). This classification of sexual interest is controversial as a psychiatric disorder, but when the urges or fantasies are enacted by an individual on another, nonconsenting individual, they may have dire legal consequences. Paraphilias may be limited to private thoughts and feelings, or they may involve acting out the urges and fantasies that involve other, nonconsenting individuals.

22.3 Gender Dysphoria

Gender dysphoria is characterized by unease or discomfort related to a person’s strong belief or desire to be a gender other than one they were assigned at birth, with associated distress. This strong sense may manifest differently at a very young age than it does in adolescence or adulthood. The dysphoria often results in great distress for the child and the family. Children and adolescents may cope with their distress through many harmful behaviors, including illicit drug use, binge drinking, or exhibiting symptoms of depression. Moreover, they may also have suicidal ideation. The treatment of children and adolescents with gender dysphoria is somewhat controversial, especially in terms of the use of puberty blockers and gender affirmation surgery (usually reserved for adults). Health-care providers, however, are currently expanding what has become known as gender-affirming care to meet clients where they are and provide care as needed to clients who might otherwise avoid engaging in routine health checks.


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