📘 Essential for Psychiatric Nursing, Reproductive Health, and Staff Nurse Exams
🔰 Definition:
Sexual dysfunctions are disturbances in a person’s ability to respond sexually or experience sexual pleasure, causing significant distress or interpersonal difficulty.
✅ Classified under Sexual Dysfunctions (DSM-5) and can occur in any phase of the sexual response cycle: desire, arousal, orgasm, or resolution.
“When desire is intact but response is impaired — it’s a dysfunction, not a decision.”
🧭 Phases of Sexual Response Cycle (Masters & Johnson):
Phase
Description
🟩 Desire
Interest or libido
🟨 Arousal
Physical and psychological excitement
🟧 Orgasm
Peak of sexual pleasure
🟥 Resolution
Relaxation and return to baseline
🧪 Classification of Sexual Dysfunctions (DSM-5):
🟩 1. Sexual Desire Disorders:
Male Hypoactive Sexual Desire Disorder 🔹 Lack or absence of sexual thoughts/desire
Female Sexual Interest/Arousal Disorder 🔹 Reduced sexual interest, thoughts, initiation, and arousal
🟨 2. Sexual Arousal Disorders:
Erectile Disorder (males) 🔹 Difficulty achieving or maintaining erection
Female Sexual Arousal Disorder 🔹 Lack of genital or subjective arousal during sex
🟧 3. Orgasmic Disorders:
Delayed Ejaculation (males) 🔹 Marked delay or absence of ejaculation
Female Orgasmic Disorder 🔹 Delay, infrequency, or absence of orgasm
Premature (Early) Ejaculation 🔹 Ejaculation within 1 minute of penetration
Switching antidepressants (from SSRI to bupropion)
🟧 3. Lifestyle Modifications:
Reduce alcohol/smoking
Weight loss
Exercise and stress reduction
Improve relationship intimacy and communication
👩⚕️ Nursing Responsibilities:
Provide private, non-judgmental atmosphere
Take sensitive history with empathy
Educate about normal variations in sexual function
Assist with referral to psychiatrist, urologist, or sex therapist
Provide supportive counseling
Monitor for side effects of medications affecting sexual health
📚 Golden One-Liners for Revision:
🟢 ED = common male sexual arousal disorder, treated with Sildenafil
🟡 Genito-pelvic pain = fear, pain, muscle tension during penetration
🟠 Premature ejaculation = ejaculation <1 minute after penetration
🔴 Hypoactive desire = low libido in both males and females
🟣 SSRIs often cause delayed orgasm or loss of libido
✅ Top 5 MCQs for Practice:
Q1. The most common male sexual dysfunction is: ✅ 🅱️ Erectile disorder
Q2. Which drug is used to treat erectile dysfunction? 🅰️ Fluoxetine ✅ 🅱️ Sildenafil 🅲️ Haloperidol 🅳️ Diazepam Answer: ✅ (b)
Q3. Which disorder involves fear and pain during intercourse in females? 🅰️ Hypoactive desire disorder 🅱️ Female orgasmic disorder ✅ 🅲️ Genito-pelvic pain/penetration disorder 🅳️ Substance-induced disorder Answer: ✅ (c)
Q4. A common side effect of SSRIs is: 🅰️ Increased libido ✅ 🅱️ Delayed ejaculation 🅲️ Premature ejaculation 🅳️ Enhanced arousal Answer: ✅ (b)
Q5. Sensate focus exercises are part of: 🅰️ Occupational therapy 🅱️ Psychoanalysis ✅ 🅲️ Sex therapy 🅳️ Aversion therapy Answer: ✅ (c)
⚠️🧠 Paraphilic Disorders
📘 Essential for Psychiatric Nursing, Mental Health, Forensic, and Staff Nurse Exams
🔰 Definition:
Paraphilic Disorders are mental disorders characterized by intense and persistent sexual interests in atypical objects, situations, or individuals, which cause distress, impairment, or involve non-consenting individuals.
✅ Listed under DSM-5 Sexual Disorders ✅ Not all paraphilias are disorders → Only if they cause distress/harm
“Paraphilia becomes a disorder when it harms self or others.”
🧭 Key Diagnostic Features (DSM-5):
Recurrent, intense sexual arousal (≥6 months) involving atypical targets or behaviors
The person has acted on these urges, or the urges cause distress or interpersonal difficulty
May involve non-consenting individuals, suffering, or humiliation
📚 Types of Paraphilic Disorders (8 in DSM-5):
🟩 1. Exhibitionistic Disorder
Urges to expose genitals to an unsuspecting stranger
Common in adult males
Goal is shock, not contact
🟨 2. Voyeuristic Disorder
Urges to observe unsuspecting person naked, undressing, or engaging in sex
Must be ≥18 years old for diagnosis
Person does not seek interaction
🟧 3. Frotteuristic Disorder
Urges to touch or rub against a non-consenting person
Common in crowded places (buses, trains)
🟥 4. Sexual Masochism Disorder
Arousal from being humiliated, beaten, bound, or made to suffer
🟦 5. Sexual Sadism Disorder
Arousal from the suffering of another person
May cause serious physical or psychological harm
🟪 6. Pedophilic Disorder
Sexual attraction to prepubescent children (usually <13 years)
Must be ≥16 years old and ≥5 years older than the child
One of the most serious types → legal implications
🟫 7. Fetishistic Disorder
Arousal from non-living objects (e.g., shoes, underwear) or specific body parts
Does not involve partners
⬛ 8. Transvestic Disorder
Arousal from cross-dressing
Becomes a disorder only if causes distress or dysfunction
🧠 Etiology / Risk Factors:
Childhood trauma or abuse
Insecure attachments
Brain dysfunction (frontal lobe lesions)
Sexual deprivation or early inappropriate sexual experiences
Comorbid OCD, impulse control, substance use disorders
⚖️ Legal & Ethical Considerations:
Some disorders (e.g., pedophilia, voyeurism, exhibitionism) may involve criminal behavior
Mandatory reporting if harm to others or minors is involved
💊 Management of Paraphilic Disorders:
🟩 1. Psychotherapy:
Cognitive Behavioral Therapy (CBT) – Identify triggers and challenge thoughts
Relapse prevention and empathy development
Group therapy
🟨 2. Behavioral Techniques:
Aversion therapy (pairing arousal with unpleasant stimuli)
GnRH analogues (e.g., leuprolide) – in severe cases
🟥 4. Legal/Protective Actions:
Court-mandated treatment
Monitoring by probation or mental health team
Sex offender registry (in applicable countries)
👩⚕️ Nursing Responsibilities:
Build non-judgmental therapeutic rapport
Maintain confidentiality, except for legal reporting
Monitor for risk to others (e.g., children)
Administer and monitor medication adherence
Provide psychoeducation to patient and family
Collaborate with legal, psychiatric, and social teams
📚 Golden One-Liners for Revision:
🟨 Voyeurism = watching others undress without consent
🟧 Frotteurism = rubbing against strangers
🟥 Pedophilia = sexual focus on children <13 years
🟪 Fetishism = arousal from objects or body parts
🟩 CBT and SSRIs are first-line treatments
🟥 Legal reporting is mandatory in pedophilia cases
✅ Top 5 MCQs for Practice:
Q1. A person who gains sexual pleasure from secretly watching others undress has: ✅ 🅱️ Voyeuristic Disorder
Q2. Pedophilic disorder involves sexual urges toward: ✅ 🅲️ Prepubescent children under 13 years
Q3. The most effective psychotherapy for paraphilic disorders is: ✅ 🅰️ Cognitive Behavioral Therapy
Q4. Which medication is used to reduce libido in paraphilic disorders? ✅ 🅱️ Medroxyprogesterone acetate
Q5. Which of the following is considered criminal and must be reported? ✅ 🅰️ Pedophilic behavior involving minors
⚧️🧠 Gender Dysphoria
📘 Essential for Psychiatric Nursing, Community Health, Pediatric Nursing & Staff Nurse Exams
🔰 Definition:
Gender Dysphoria (GD) is a psychological condition where an individual experiences marked distress or impairment due to a mismatch between their assigned gender at birth and their experienced/expressed gender.
✅ Replaced the term “Gender Identity Disorder” in DSM-5 ✅ Focus is on distress, not identity itself
“It’s not the identity that’s the problem — it’s the distress from not being seen or accepted.”
🧭 Key DSM-5 Diagnostic Criteria:
🟩 In Children (≥6 months duration):
Must have ≥6 of the following, including #1 mandatory:
Strong desire to be the other gender or insistence that one is the other gender
Preference for cross-gender roles in play
Strong dislike of one’s sexual anatomy
Preference for clothing typical of the other gender
Rejection of same-gender stereotypical play
Strong preference for playmates of the other gender
Strong desire for sex characteristics of the experienced gender
🟨 In Adolescents & Adults (≥6 months duration):
Must have ≥2 of the following:
Incongruence between one’s experienced gender and primary/secondary sex characteristics
Strong desire to be rid of sex characteristics
Strong desire to possess the sex traits of the other gender
Strong desire to be the other gender
Strong desire to be treated as the other gender
Strong conviction that one has the typical feelings of the other gender
Clinically significant distress or impairment
🧠 Important Concepts:
Term
Meaning
Sex Assigned at Birth
Biological classification: male/female
Gender Identity
One’s internal sense of being male, female, both, or neither
Transgender
Identity different from assigned sex at birth
Cisgender
Identity same as assigned sex at birth
Non-binary
Not identifying exclusively as male or female
💢 Etiology / Contributing Factors:
Biological: Prenatal hormonal influence, possible brain structure differences
Psychosocial: Parenting style, gender role modeling
Cultural and societal pressures
No single cause; multifactorial in origin
🩺 Associated Challenges:
Anxiety, depression, low self-esteem
Social rejection, bullying, stigma
Risk of substance abuse, self-harm, or suicide
Difficulty accessing gender-affirming healthcare
💊 Management of Gender Dysphoria:
🟩 1. Psychotherapy (Supportive):
Gender-affirmative therapy
Explore identity and address distress
Family therapy (especially for children/adolescents)
Support groups, peer mentoring
🟨 2. Hormonal Therapy:
Initiated by endocrinologists with informed consent
🟣 Support, not conversion, is the core of nursing care
✅ Top 5 MCQs for Practice:
Q1. Gender Dysphoria is characterized by: 🅰️ Same gender identity as birth sex ✅ 🅱️ Distress due to mismatch between gender identity and assigned sex 🅲️ Cross-dressing 🅳️ None of the above Answer: ✅ (b)
Q2. Which of the following is a treatment for Gender Dysphoria? 🅰️ Electroconvulsive therapy ✅ 🅱️ Gender-affirmative therapy and hormonal support 🅲️ Antipsychotics 🅳️ Shock therapy Answer: ✅ (b)
Q3. What is the minimum duration required for diagnosis of Gender Dysphoria in DSM-5? ✅ 🅱️ 6 months
Q4. Which hormone is used for transitioning from female to male? ✅ 🅰️ Testosterone
Q5. A nurse caring for a transgender patient should: 🅰️ Use assigned birth name only ✅ 🅱️ Use preferred name and pronouns 🅲️ Correct the patient’s gender identity 🅳️ Inform family of transition without consent Answer: ✅ (b)
🌈🧠 Sexual Orientation vs Gender Identity
📘 Essential for Psychiatric Nursing, Community Health, Psychology & Staff Nurse Exams
🔰 Key Definitions:
Term
Definition
🟩 Gender Identity
A person’s internal sense of being male, female, both, neither, or another gender
🟨 Sexual Orientation
A person’s emotional, romantic, or sexual attraction to others
✅ These are independent concepts — a person’s gender identity does not determine their sexual orientation.
“Gender identity is about who you are. Sexual orientation is about who you love.”
🧭 Detailed Comparison Chart:
🔹 Feature
⚧️ Gender Identity
❤️ Sexual Orientation
Definition
Internal sense of being male, female, or other
Pattern of romantic or sexual attraction
Examples
Transgender, cisgender, non-binary, agender
Heterosexual, homosexual, bisexual, asexual
Focuses on
One’s own gender self-perception
Whom the person is attracted to
Independent from
Physical sex characteristics
Gender identity
Expressed through
Clothing, behavior, voice, pronouns
Dating, relationships, emotional connections
Recognized in DSM-5?
Gender Dysphoria (if distress present)
Not classified as disorder
Medical/Surgical Options
Hormone therapy, gender-affirming surgery (if desired)
Not applicable
🎯 Examples to Understand the Difference:
A transgender man (assigned female at birth, identifies as male) may be:
Attracted to women → Heterosexual orientation
Attracted to men → Homosexual orientation
A cisgender woman (assigned female, identifies as female) may be:
Attracted to both genders → Bisexual
A non-binary person may identify as:
Pansexual – attracted to people regardless of gender
🧠 Important Concepts:
Term
Meaning
Cisgender
Gender identity matches assigned sex at birth
Transgender
Gender identity differs from assigned sex
Non-binary
Does not identify strictly as male or female
Heterosexual
Attracted to opposite gender
Homosexual (Gay/Lesbian)
Attracted to same gender
Bisexual
Attracted to both male and female
Pansexual
Attracted to all gender identities
Asexual
Experiences little or no sexual attraction
👩⚕️ Nursing Responsibilities:
Use inclusive language (e.g., “partner” instead of “husband/wife”)
Ask and use correct pronouns
Provide non-judgmental care regardless of identity or orientation
Respect confidentiality
Educate peers and reduce stigma
Support mental health, especially for those facing discrimination
📚 Golden One-Liners for Revision:
🟩 Gender identity = who you are,
🟨 Sexual orientation = who you’re attracted to
🟥 They are independent but often confused
🟦 Transgender people can be of any sexual orientation
🟧 Use inclusive and respectful communication in nursing care
✅ Top 5 MCQs for Practice:
Q1. Gender identity refers to: 🅰️ Physical sex ✅ 🅱️ A person’s internal sense of being male, female, or other 🅲️ Whom they are attracted to 🅳️ Legal gender Answer: ✅ (b)
Q2. A person who identifies as male but was assigned female at birth is: ✅ 🅰️ Transgender man
Q3. Sexual orientation includes all EXCEPT: 🅰️ Heterosexual 🅱️ Homosexual ✅ 🅲️ Transgender 🅳️ Asexual Answer: ✅ (c)
Q4. Which of the following is an example of gender identity? 🅰️ Pansexual ✅ 🅱️ Non-binary 🅲️ Bisexual 🅳️ Heterosexual Answer: ✅ (b)
Q5. Which nursing action is appropriate when caring for LGBTQ+ patients? ✅ 🅱️ Use patient’s chosen pronouns and name
⚖️🇮🇳 Transgender Rights in India
📘 Important for Nursing Ethics, Community Health, Psychiatric Nursing & Law-Related MCQs
A transgender person is someone whose gender does not match with the gender assigned at birth. This includes trans-men, trans-women, genderqueer, and those with intersex variations.
Section 377 of IPC decriminalized same-sex relationships
2019
Transgender Persons (Protection of Rights) Act passed
2020
Rules notified for gender identity certificate by District Magistrate
🏛️ Rights Guaranteed under the Transgender Persons Act (2019):
✅ Right to self-perceived gender identity
✅ Prohibition of discrimination in education, employment, healthcare, housing
✅ Access to free healthcare services under Ayushman Bharat Yojana
✅ Right to legal recognition and gender certificate
✅ Welfare schemes, skill development, and rehabilitation
✅ Establishment of Transgender Welfare Boards
🚨 Prohibited Discriminations Include:
Denial of education, employment, public places, healthcare
Forced to leave family or society
Forced medical or psychological intervention
Denial of right to reside in a household
🩺 Role of Nurse in Transgender Rights:
Promote non-discriminatory, respectful care
Maintain privacy and use correct name/pronouns
Educate patients about their legal and health rights
Assist in linking with legal aid, social workers, LGBTQ+ organizations
Report abuse, harassment, or denial of services
🌈👩⚕️ LGBTQ+ Inclusive Nursing Practices
📘 Essential for Ethical Nursing, Communication, Community & Mental Health Nursing
🔰 Why Inclusion Matters:
LGBTQ+ individuals face stigma, fear, discrimination
High risk of mental health disorders, suicidal ideation, HIV/STIs, substance abuse
Many avoid or delay medical care due to fear of judgment
👩⚕️ Inclusive Nursing Practices Checklist:
🟩 1. Use Respectful Language:
Ask for and use correct pronouns (he/she/they)
Address patients by their chosen name
Avoid assumptions about gender, relationships, or sexual behavior
🟨 2. Create Safe Spaces:
Display LGBTQ+ inclusive posters
Ensure confidentiality during history-taking
Offer gender-neutral restrooms if possible
🟧 3. Adapt Communication:
Ask open-ended questions: 👉 “Do you have a partner?” instead of “Do you have a husband/wife?”
Respect their identity without forcing labels
🟥 4. Education and Awareness:
Attend LGBTQ+ sensitivity training
Stay updated on trans health protocols
Include SOGI (Sexual Orientation and Gender Identity) education in nursing curriculum
🟦 5. Advocate for Rights:
Stand against homophobia/transphobia in clinical settings
Support mental health referrals, HIV/STI screenings
Promote inclusiveness in policies and patient charts
📚 Golden One-Liners for Revision:
🟨 NALSA Judgment (2014) = third gender legally recognized
🟧 Trans Act (2019) = anti-discrimination law for transgender persons
🟥 Section 377 decriminalized in 2018
🟩 Use of correct pronouns and names = basic dignity
🟦 Nurses = frontline agents of inclusive care & awareness
✅ Top MCQs for Practice:
Q1. The NALSA judgment is related to: ✅ 🅱️ Recognition of third gender by the Supreme Court
Q2. Section 377 of IPC was related to: ✅ 🅰️ Decriminalization of same-sex relationships
Q3. What is the key focus of LGBTQ+ inclusive nursing care? 🅰️ Cure illness ✅ 🅱️ Provide respectful, non-judgmental, and safe care 🅲️ Change sexual orientation 🅳️ Avoid asking questions Answer: ✅ (b)
Q4. Which of the following is NOT a right guaranteed under the Transgender Persons Act? 🅰️ Right to self-identified gender 🅱️ Right to discrimination ✅ 🅱️ Right to discrimination Answer: ✅ (b)
Q5. In LGBTQ+ care, nurses must: ✅ 🅱️ Use patient’s preferred pronouns and name 🅲️ Use only legal name 🅳️ Ask family to confirm identity Answer: ✅ (b)