Trial

• Disorders of sexual functioning


  Disorders involving sexual functioning that can be lifelong (primary) or acquired (secondary), with a psychogenic or biogenic origin, occurring in both men and women
• Hypoactive sexual desire disorder (HSDD) in men


  Low sexual desire/interest - diminished or absent feelings of sexual interest or desire, absent sexual thoughts or fantasies, and lack of responsive desire; motivations for sexual arousal are scarce or absent
• Desire


  The motivation or inclination to be sexual, with drive (biological component), motivation (psychological component), and wish (cultural component)
• Relationship dimensions, psychological adaptation, cognitive factors and biological determinants have all been related to sexual desire
• HSDD limited to a single partner is not sexual dysfunction but a relationship problem
• Manifestation of desire


  Masturbation, attempts to initiate sexual behavior, erotic fantasies, sexual attractions and responses, spontaneous genital sensations of arousal
• Physiology of desire


  Sexual desire is the result of interplay between internal cognitive processes, affective components, and neurophysiological mechanisms involving dopamine
• Definition of HSDD - DSM V


  Persistently or recurrently deficient/absent sexual/erotic thoughts or fantasies and desires for sexual activity, causing clinically significant distress, not better explained by other factors
• Level of sexual interest appears quite stable from late teens to about age 60
• Disorders such as depression or erectile dysfunction frequently coexist with HSDD
• Main causes of HSDD in men

  Depression and its treatment, permanent overload and stress, long-term presence of erectile dysfunction
• Assessment of HSDD


  Determine if lifelong or acquired, global or situational, primary problem or secondary, sexual function and concerns, sexual "secret", variant arousal pattern, past trauma, medical and iatrogenic factors
• Acquired HSDD in men

  Probably the commonest type, often concealed, unrecognised and underdiagnosed due to social and cultural mores regarding desire in men
• Treatment of acquired HSDD

  Encourage the recreational and hedonistic aspect of sexuality, stimulate abandonment to the erotic experience
• Inhibited sexual desire


  Lessened interest in sexual relation or decreased sexual
• Treatment of inhibited sexual desire

  Administration of androgen (testosterone) to women, surgical implant for erection, testosterone injections for men, herbal products, vibration/vacuum devices, sildenafil citrate (Viagra)
• Premature ejaculation


  Ejaculation before penile-vaginal contact, can be psychological or due to masturbating to orgasm, doubt about masculinity, fear of impregnating
• Management of premature ejaculation

  Sexual counseling for both partners to reduce stress, serotonergic antidepressants such as Mirtazapin
• Erectile dysfunction


  Inability to produce or maintain an erection long enough for vaginal penetration or partner satisfaction, can be caused by physical or psychological factors
• Treatment of erectile dysfunction

  Sildenafil (Viagra), tadalafil (Cialis), vardenafil (Levitra)
• Persistent sexual arousal syndrome (PSAS)


  Excessive and unrelenting sexual arousal in the absence of desire, may be caused by herbal remedies like Ginkgo biloba
• Ambiguous genitalia


  Genitalia that are not defined as male or female, can occur in genetically female or male babies due to hormonal or chromosomal abnormalities
• Treatment of ambiguous genitalia


  Reconstructive surgery like clitoroplasty and vaginoplasty, done before 3 years old
• Hypospadias


  Most common penis anomaly, where the urethral opening is situated on the ventral side of the penis shaft, caused by arrested fetal development or lack of hormones
• Treatment of hypospadias


  Urethroplasty to bring the urethral opening to the tip of the penis, done at 6-24 months
• Nursing interventions for hypospadias

  Monitor vital signs, provide catheter care, restrain the child, check for urinary infection, support and guide the parents
• Epispadias


  Condition where the urethral opening is on the dorsum of the penis or clitoris, can be penopubic, penile or glanular
• Phimosis


  Condition where the foreskin cannot be retracted over the glans, can lead to balanitis and other complications
• How phimosis develops in adults

  Poor hygiene, underlying medical conditions like diabetes, thickened secretions, inflammation, edema, constriction, calculi formation
• Severity of phimosis is graded from 0 to 4
• Epispadias


  A congenital abnormality in which the urinary meatus is located on the upper surface of the penis or clitoris
• Types of epispadias


  • Penopubic epispadias
  • Penile epispadias
  • Glanular epispadias
• Penopubic epispadias


  The urinary meatus is found close to the body, potentially not on the penis but near the pubic bone at the base of the penis
• Penile epispadias


  The urinary meatus is found on the shaft of the penis, anywhere before the head of the penis but above the base where the shaft meets the body
• Glanular epispadias


  The urinary meatus is found on the head of the penis, but on the top rather than in the standard location at the tip
• Phimosis


  A condition in which the foreskin cannot be retracted over the glans in uncircumcised males
• Balanitis


  Inflammation of the glans penis due to accumulation of secretions
• How phimosis develops in adults

  1. Poor hygiene or underlying medical conditions such as diabetes

  2. Thickened secretions
• Phimosis


  • Inflammation, edema and constriction
  • Encrusted with urinary salts and calcify
  • Calculi in the prepuce
• Severity of phimosis


  • Grade 0
  • Grade 1
  • Grade 2
  • Grade 3
  • Grade 4
  • Grade 5