Outline

1. Sexual Disorders;
- Types/forms of sexual disorders
- Etiology of sexual disorders
- Pathophysiology of sexual disorders
- Clinical manifestations of sexual disorders
- Management/treatment of sexual disorders
2. Psycho-geriatric Disorders;
- Types/forms of Psycho-geriatric Disorders
- Etiology of Psycho-geriatric Disorders
- Pathophysiology of Psycho-geriatric Disorders
- Clinical manifestations of Psycho-geriatric Disorders
- Management/treatment of Psycho-geriatric Disorders
3. Conclusion
4. References
 Sexual Disorders

Sexual disorders, also referred to as sexual dysfunctions, are conditions that involve
challenges or disturbances in various aspects of sexual function, satisfaction, or pleasure.
(Marianne Belleza, R.N 2024).

Sexual dysfunction refers to difficulties experienced by an individual or partners during any

stage of typical sexual activity, encompassing aspects such as physical pleasure, desire,
preference, arousal, or orgasm.

According to World Health Organization, sexual dysfunction can be defined as a "person's

inability to participate in a sexual relationship as they would wish". The term "sexual disorder"
can refer to both physical sexual dysfunctions and paraphilias; in some cases, this is referred to
as a disorder of sexual preference.

The publication of the second edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-II; American Psychiatric Association, 1968) marked the inclusion of a section
outlining sexual dysfunctions and their brief descriptions. Subsequently, there have been
considerable advancements in comprehending and delineating these issues, ultimately leading to
the release of the third edition of DSM (DSM-III; American Psychiatric Association, 1980). This
chapter details the evolution of the DSM-III delineation of sexual disorders, evaluates its merits
and drawbacks, and discusses the constraints of the current classification system. It then
introduces two approaches for more precisely defining various clinical dysfunctions. The chapter
assesses the societal and individual implications of experiencing sexual dysfunctions.

(Meana et al., 2023) (Parish et al.2021).

Human sexuality is a complex and dynamic experience influenced by psychosocial, biological,

and environmental factors. As such, a comprehensive evaluation of physical and psychological
health should include an assessment of the patient's sexual health. Sexual disorders encompass
difficulties and distress related to different aspects of the sexual response cycle. These disorders
are characterized by an impaired ability to experience sexual pleasure or orgasm, pain or
discomfort during sexual activities, distress related to one's sexual identity, or difficulties in
achieving sexual arousal.

Types/Forms of Sexual Disorders

There are two broad classes of sexual disorders identified. (Bornioli et al.2021) (Dekker et
al.2020).

Sexual Dysfunction

Sexual dysfunctions refer to difficulties experienced by an individual or couple during any stage
of the sexual response cycle, preventing them from achieving sexual satisfaction. The sexual
response cycle consists of four phases: desire, arousal, orgasm, and resolution. Sexual
dysfunction can occur in any of these phases. According to the DSM-IV-TR, a condition is
considered a sexual dysfunction if it results in significant distress and interpersonal difficulties
and has persisted for at least six months. The experience of sexual dysfunction can vary greatly
due to individual differences, levels of sexual experience, or cultural upbringing.

The subtypes of sexual dysfunctions are categorized based on the phase of the sexual response
cycle where the problem occurs. The DSM-IV-TR identifies eight specific sexual dysfunctions,
consistent with the previous edition, DSM-IV, each requiring a minimum duration of six months.
The first four dysfunctions are related to desire and arousal disorders: hypoactive sexual desire
disorder, sexual aversion disorder, female sexual arousal disorder, and male erectile disorder.
The latter four are associated with orgasm and sexual pain disorders: female orgasmic disorder,
male orgasmic disorder, premature ejaculation, and dyspareunia (sexual pain disorder). (Herder
et al.2023) (Chongcharoen et al., 2024).

Paraphilic Disorders

Paraphilic disorders are characterized by distressing, recurrent, intense sexually arousing

fantasies, sexual urges, or behaviors involving adherence to unusual or peculiar sexual
preferences that are not necessarily harmful to others or oneself (DSM-IV; APA, 1994).
However, these disorders can include the use of non-consenting individuals, personal suffering,
or other activities necessary for achieving sexual arousal in inappropriate settings. There is a
dilemma in distinguishing these behaviors, as some activities may be consensual and not harmful
to others, oneself, or family members. The literature refers to some of these consensual activities
as sexual variability (Moser, 2001). Treatment is recommended when such behaviors result in
distress or impair work or interpersonal relationships.

Sexual behaviors or fantasies that cause mental or emotional disturbances have been documented
throughout history. These behaviors have often been labeled as disorders or morally sinful. There
is ongoing debate about whether and when these behaviors should be classified as disorders.

Types of Sexual Disorders include;

1) Arousal Disorders: These disorders involve a lack of mental, emotional, or physical

response to sexual stimulation. In men, erectile dysfunction (ED) is a common concern,
especially as they age. According to the Massachusetts Male Aging Study, over half
(52%) of men aged 40 to 70 experience ED. This condition can be severe and impact
work and home life, and it is associated with an increased risk of suicide.
2) Desire Disorders: Various factors, such as relationship issues and stress, can affect sexual
desire in both men and women. Hormonal changes, like those occurring during
menopause, can decrease sexual desire in women. In men, a decline in testosterone levels
with age can lead to low libido. Symptoms of low libido include a persistent lack of
sexual or erotic thoughts, fantasies, and sexual desire. Often, low desire is linked with
other issues, such as painful sex. When a significant lack of interest in sex causes distress,
it is termed hypoactive sexual desire disorder (HSDD). The latest edition of the American
Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5
controversially combined HSDD with female sexual arousal disorder into a single
condition called female sexual interest/arousal disorder (FSIAD).
3) Orgasmic Disorders: These disorders are characterized by difficulties in achieving
orgasm. In men, orgasmic issues often relate to ejaculation and include:
- Premature Ejaculation: Occurs when ejaculation happens sooner than desired. This is the
most common issue, affecting about 1 in 3 men.
- Retrograde Ejaculation: This occurs when semen enters the bladder instead of exiting
through the penis, resulting in little or no ejaculation. It can lead to male infertility.
- Delayed Ejaculation: Characterized by difficulty reaching orgasm.
4) Painful Sex: Also known as dyspareunia, this condition involves pain during sexual
intercourse or penetration. Some women may suffer from vaginismus, where the muscles
around the vagina involuntarily contract, making penetration painful or impossible. Men
may experience conditions like Peyronie’s disease, which causes curved erections. While
many men with Peyronie’s disease can still have sex, it can be painful and may lead to
erectile dysfunction in some cases.

Etiology of Sexual Disorders

1) Biological Factors:
 Hormonal Imbalances: Conditions such as low testosterone in men or low estrogen in
women can affect sexual desire and function. Menopause in women and andropause in
men can also lead to changes in sexual function.
 Neurological Disorders: Diseases such as multiple sclerosis, Parkinson's disease, or
spinal cord injuries can impair nerve function, leading to sexual dysfunction.
 Chronic Illnesses: Diabetes, cardiovascular diseases, kidney or liver failure, and other
chronic conditions can impact sexual function.
 Medications: Certain medications, including antidepressants, antihypertensives, and
chemotherapy drugs, can have side effects that interfere with sexual desire or
performance.
 Substance Use: Alcohol use disorder and substance use disorder can negatively affect
sexual function and performance.
 Injuries or Surgeries: Trauma or surgeries involving the pelvic region, such as
prostatectomy or hysterectomy, can result in sexual dysfunction.
2) Psychological Factors:
 Mental Health Conditions: Depression, anxiety, and other mental health disorders can
contribute to decreased sexual desire and performance.
 Stress: High levels of stress can reduce libido and interfere with sexual performance.
 Relationship Issues: Marital or relationship conflicts, communication problems, and lack
of emotional intimacy can impact sexual satisfaction and function.
 Body Image Concerns: Negative body image or low self-esteem can lead to reduced
sexual desire or anxiety during sexual activity.
 Past Trauma: A history of sexual abuse or trauma can result in difficulties with sexual
intimacy or trigger sexual dysfunction.
 Performance Anxiety: Worrying about sexual performance can lead to erectile
dysfunction, premature ejaculation, or inability to achieve orgasm.
3) Social and Environmental Factors:
 Cultural and Religious Beliefs: Cultural norms and religious beliefs can influence
attitudes towards sex, potentially leading to guilt or shame about sexual activity.
 Social Stigma: Societal stigma related to sexual orientation, gender identity, or sexual
preferences can contribute to sexual dysfunction.
 Lack of Sexual Education: Inadequate knowledge about sexual health and function can
lead to misconceptions and difficulties in sexual relationships.
 Aging: Natural aging processes can lead to changes in sexual function, including
decreased libido and physical difficulties in engaging in sexual activity.
4) Interpersonal Factors:
 Communication Issues: Poor communication with a partner about sexual needs and
desires can lead to misunderstandings and dissatisfaction.
 Intimacy Issues: Lack of emotional closeness or unresolved conflicts in a relationship can
reduce sexual desire and satisfaction.

Pathophysiology of Sexual Disorders

The pathophysiology of sexual disorders involves multiple factors affecting sexual

response and function. The Central Nervous System (CNS) and Peripheral Nervous System
(PNS) are key, with disruptions in neurotransmitter levels or nerve damage, such as from
diabetes or spinal injuries, impacting desire and arousal. Hormones like androgens,
estrogens, and thyroid hormones play crucial roles; imbalances or fluctuations can lead to
reduced libido and other dysfunctions. Adequate blood flow is essential for normal sexual
function, with conditions like atherosclerosis and hypertension posing significant risks.
Mental health issues, stress, and anxiety can also alter neurotransmitter activity and hormonal
balance, further complicating sexual response. Medications, substance use, and physical
trauma or congenital abnormalities can contribute to sexual dysfunction, while cultural,
religious, and interpersonal factors can shape attitudes towards sex and affect sexual
satisfaction. Additionally, aging naturally brings changes that can affect sexual function.

Clinical Manifestations of Sexual Disorders

1. Erectile Disorder: Erectile disorder (ED): Also known as erectile dysfunction or

impotence, ED is the inability to maintain an erection sufficient for sexual activity. While
occasional loss of an erection is normal, ED becomes a concern when it is chronic,
affecting about 12 million American men. It can lead to stress, low self-confidence,
relationship issues, or indicate serious health conditions. ED has physical, neurological,
or psychological causes and is typically first addressed with lifestyle changes before
medication.
2. Sexual Desire Disorder: This condition involves a prolonged lack of sexual desire,
persisting for at least six months and causing significant distress. It can be generalized or
situational and is usually treated with psychotherapy before considering medication. This
disorder is distinct from asexuality, which is not considered a clinical condition.
3. Orgasmic Disorders: Difficulty having orgasms or experiencing delayed orgasms, both
men and women can be affected by orgasmic dysfunction.
4. Painful Sex: Some individuals experience physical discomfort or pain during sexual
activity. Causes can vary, including vaginal dryness, irritation, or other underlying
conditions.

Management / Treatment of Sexual Disorders

a) Medication: If a medication is causing sexual dysfunction, switching to a different

one may help. For individuals with hormone deficiencies, hormone replacement
therapy through injections, pills, or creams may be beneficial. For those assigned
male at birth (AMAB), medications like sildenafil, tadalafil, vardenafil, and avanafil
can aid in achieving erections. For those assigned female at birth (AFAB),
medications that can enhance sexual desire or libido include buspirone, bupropion,
 flibanserin, and bremelanotide. Hormone therapy may also help AFAB individuals
experiencing low sexual desire due to menopause.
b) Mechanical Aids: Devices such as vacuum pumps and penile implants can assist with
erectile dysfunction by helping achieve or maintain an erection. Similar vacuum
devices are available for AFAB individuals. Vaginal dilators can help address vaginal
narrowing that occurs during menopause, and vibrators can enhance sexual pleasure
and facilitate climax.
c) Sex Therapy: Sex therapists can provide valuable support for individuals facing
sexual issues that are not easily addressed by a primary care provider. They can also
offer marital counseling, which can be particularly beneficial for couples looking to
improve their sexual relationship. Working with a trained professional can be a
worthwhile investment for enhancing sexual satisfaction.
d) Behavioral Treatments: These treatments involve techniques such as self-stimulation
to address issues with arousal or orgasm and identifying and modifying harmful
behaviors in relationships.
e) Psychotherapy: Counseling with a trained therapist can help individuals deal with
past sexual trauma, anxiety, fear, guilt, and negative body image—all of which can
impact sexual function.
f) Education and Communication: Learning about sexual behavior and responses can
reduce anxiety related to sexual function. Open communication with a partner about
sexual needs and concerns is crucial for overcoming barriers to a healthy sex life.
 Psycho-geriatrics

Psycho-geriatrics is a medical field and a subspecialty of psychiatry focused on the study,

prevention, and treatment of neurodegenerative diseases, cognitive impairments, and mental
disorders in older adults.

The field of geriatric psychiatry traces its roots to Alois Alzheimer, a German psychiatrist and
neuropathologist. He first observed amyloid plaques and neurofibrillary tangles in a fifty-year-
old woman named Auguste D. These findings were later recognized as the causes of her
behavioral symptoms, short-term memory loss, and psychiatric issues. These brain anomalies
eventually became known as the hallmark features of Alzheimer's disease.

Geriatric psychiatry focuses on mental health issues in older adults. Practitioners are physicians
who specialize in psychiatry after completing training in medicine, concentrating on psychiatric
disorders in the elderly, typically those in their seventies and older. This field covers several key
areas: the accurate diagnosis and assessment of patients, the development and implementation of
effective treatments, and the coordination of healthcare services for older adults, involving a
range of healthcare professionals such as family doctors, community health workers, and
caregivers. The importance of geriatric psychiatry has grown significantly due to the global
demographic shift towards an aging population. According to United Nations predictions from
1998, by 2050, the population aged 60 and over will surpass those under 15, and the number of
individuals aged 80 and older is expected to rise dramatically from 61 million in 1995 to 1,055
million by 2150, particularly in less developed countries. This shift has profound social,
economic, and public health implications, as the very elderly often face poor physical health, an
increased risk of dementia, and a level of disability that requires dependence on others. Thus,
preventing and effectively treating age-related diseases has become increasingly crucial.
The field of geriatric psychiatry encompasses three main areas: clinical practice, the primary
disorders treated, and critical research questions or knowledge gaps. Jeste et al. (1999) highlight
the need for a coordinated response to the challenges posed by an aging population. Effective
geriatric psychiatry practice requires close collaboration with other professionals, including
nurses, social workers, clinical psychologists, family physicians, and specialists.

Types/Forms of Psycho-geriatric Disorder

1) Dementia:
- Alzheimer's Disease: The most prevalent form of dementia, noted for gradual memory
decline, difficulties in language, and impaired judgment.
- Vascular Dementia: Arises from reduced cerebral blood flow, often post-stroke, resulting
in cognitive deterioration.
- Lewy Body Dementia: Identified by the presence of Lewy bodies in the brain, causing
symptoms like visual hallucinations, motor issues, and variable cognition.
- Frontotemporal Dementia: Involves the degeneration of frontal and temporal brain
regions, affecting personality, behavior, and language abilities.
2) Mood Disorders:
- Depression: Frequently found in older adults, often underdiagnosed. Symptoms include
prolonged sadness, disinterest in activities, and changes in appetite or sleep.
- Bipolar Disorder: Features episodes of mania and depression, potentially presenting
differently in older adults compared to younger individuals.
3) Anxiety Disorders:
- Generalized Anxiety Disorder (GAD): Characterized by chronic worry about various life
aspects, often intensified by health concerns or life transitions.
- Panic Disorder: Involves sudden episodes of intense fear accompanied by physical
symptoms like heart palpitations and shortness of breath.
- Phobias: Specific fears that may become more significant or problematic in later life.
4) Psychotic Disorders:
- Schizophrenia: Rarely begins in older age, but existing symptoms can worsen.
 - Late-Onset Psychosis: Psychotic symptoms, such as delusions and hallucinations, emerge
in older adults without a prior history.
5) Substance Use Disorders:
- Alcohol Use Disorder: Alcohol misuse in older adults can be complicated by medication
interactions and chronic health conditions.
- Prescription Medication Misuse: Misuse of medications like painkillers or sedatives,
leading to dependency or harmful effects.
6) Delirium:
- Acute Confusional State: Sudden confusion, disorientation, and consciousness
fluctuations, often caused by infections, medications, or metabolic issues.
7) Personality Disorders: While usually developing earlier in life, aging-related stressors can
exacerbate symptoms in older adults.
8) Sleep Disorders:
- Insomnia: Difficulty falling or staying asleep, possibly due to physical discomfort,
medication, or anxiety.
- Sleep Apnea: Breathing interruptions during sleep, common in older adults, and linked to
cognitive decline.
9) Adjustment Disorders:
- Emotional or behavioral symptoms triggered by significant life changes or stressors, like
retirement, relocation, or loss of a loved one.
10) Somatic Symptom and Related Disorders:
- Disorders characterized by an excessive focus on physical symptoms, which may or may
not have a medical explanation, including hypochondriasis or somatization disorder.

Etiology of Psycho-geriatrics Disorder

The causes of psychological disorders in older adults are complex and influenced by various
factors, including physical and social environments, cumulative life experiences, and aging-
related stressors. Exposure to adversity, loss of intrinsic capacity, and declining functional
abilities can all contribute to psychological distress in this population. Common mental health
conditions among older adults include depression and anxiety. Additionally, social isolation,
loneliness, and abuse (often by caregivers) are significant risk factors for mental health issues in
later life. Approximately 14% of adults aged 60 and over experience a mental disorder, which
accounts for 10.6% of the total disability in this age group.

Etiology of psycho-geriatric disorders: Factors contributing to psycho-geriatric disorders can be

divided into three major categories: (i) Biological factors; (ii) Social factors; and (iii)
Psychological factors.

1. Biological Factors: Conditions such as Alzheimer's disease, Parkinson's disease, and

other forms of dementia can cause significant cognitive decline and behavioral changes.
Age-related changes in brain structure and function, including neurotransmitter
imbalances, may predispose individuals to depression, anxiety, and other psychiatric
disorders.
2. Social Factors: Lack of social interaction and support can lead to feelings of isolation,
which are linked to depression and anxiety. The death of a spouse, friends, or family
members can result in grief and depression. Also, the stigma surrounding aging and
mental health can prevent older adults from seeking help.
3. Psychological Factors: Memory loss, decreased problem-solving abilities, and other
cognitive impairments can contribute to mental health issues. Pre-existing personality
traits or disorders can increase the risk of developing mental health issues in later life.

Pathophysiology of Psycho-geriatrics

The aging process often brings about a multitude of health issues. As individuals grow
older, the functionality of their bodily organs diminishes due to various factors. Alzheimer's
disease, a prevalent neurodegenerative condition categorized as a psycho-geriatric disorder, is
primarily associated with the aging process, owing to the extended life expectancy of
individuals. Many psycho-geriatric disorders stem from a combination of causes, resulting in
multifactorial etiologies. These diverse etiological factors contribute to the pathophysiology of
psycho-geriatric disorders. In recent years, significant strides have been made in comprehending
the risk factors and pathophysiology of these disorders, leading to advancements in both
antemortem and postmortem diagnosis. All these disorders are linked to substantial brain
atrophy, which significantly impacts cognitive, emotional, and behavioral capacities. Their
pathologies are primarily characterized by senile plaques and neurofibrillary tangles. It has been
proposed that the amyloid-beta plaques present in Alzheimer's disease are also present in the
brains of cognitively normal elderly individuals. Additionally, the accumulation of these
amyloid-beta peptides in the brain may reach a threshold that affects cognitive and emotional
abilities, offering the potential for treating cognitive dysfunction in both normal and diseased
individuals. This represents a positive development for any society.

Clinical Manifestations of Psycho-geriatrics

a. Cognitive Symptoms: This includes memory loss or impairment, especially in short-term

memory. Difficulty with language, such as finding the right words or following
conversations. Impaired executive function, leading to difficulties in planning,
organizing, or problem-solving. Confusion and disorientation, particularly with time and
place. Reduced ability to focus and pay attention.
b. Affective Symptoms: Persistent sadness or feelings of hopelessness (depression),
increased anxiety or agitation, mood swings or emotional instability, apathy or lack of
interest in previously enjoyed activities, and feelings of guilt, worthlessness, or excessive
worry.
c. Behavioral Symptoms: This includes changes in personality or behavior, such as
becoming more withdrawn or aggressive, social withdrawal or reduced social
interactions, changes in sleep patterns, such as insomnia or excessive sleeping, appetite
changes, leading to weight loss or gain, and repetitive behaviors or compulsions.
d. Psychotic Symptoms Such as; Hallucinations, which can be visual, auditory, or other
types, delusions, such as false beliefs about being persecuted or having grandiose
abilities, and paranoia or suspiciousness.
e. Physical Symptoms: This includes unexplained aches and pains, often associated with
depression or anxiety, changes in mobility or coordination, sometimes seen in
 neurodegenerative conditions, fatigue or loss of energy, somatic complaints without a
clear medical cause.
f. Functional Decline: This includes difficulty performing daily activities, such as dressing,
bathing, or managing finances, increased dependency on others for basic needs, loss of
independence in activities of daily living (ADLs) and instrumental activities of daily
living (IADLs).
g. Social and Environmental Indicators: This includes isolation and lack of engagement
with others, signs of neglect or poor self-care, and evidence of abuse or mistreatment.

Management and Treatment of Psycho-geriatric Disorders

Psycho-geriatric issues present a unique challenge, often necessitating tailored approaches

for effective management. Such strategies encompass environmental adjustments, the
revitalization or customization of interests and abilities, bolstering interpersonal connections and
communication proficiency, troubleshooting day-to-day personal obstacles, extending aid and
encouragement for depression, pharmaceutical intervention, and alternative therapies. The
elderly can be assisted through acclimatization to new circumstances, achieved through
counseling, educational problem-solving initiatives, and the facilitation of small group
interactions. Adjusting medication as needed is a crucial aspect of elder care. While medications
like sedatives and tranquilizers can be beneficial, it is imperative to steer clear of excessive
reliance and overmedication.

Managing psycho-geriatric issues requires a comprehensive understanding of both the biological

and psychological changes experienced by individuals as they age, along with providing a
supportive environment. Counseling can assist patients in adapting to new life situations.
Educational programs focusing on the physical and mental changes associated with aging, as
well as coping strategies for patients and their families, can significantly enhance quality of life.
Consistent, personalized attention from staff during institutional stays is crucial, as is the
development of trusting relationships between staff and residents.
 Conclusion

Sexual disorders and psycho-geriatric disorders represent critical areas in healthcare that
require comprehensive understanding and nuanced approaches to treatment. Sexual disorders,
ranging from dysfunctions affecting desire, arousal, and orgasm to paraphilic disorders,
significantly impact individuals' quality of life and can be influenced by a range of biological,
psychological, and social factors. Similarly, psycho-geriatric disorders, which include conditions
such as dementia, mood disorders, and anxiety, present unique challenges in older adults. These
disorders often require specialized care that addresses the complex interplay of aging-related
changes in cognitive, emotional, and physical health. Effective management and treatment of
both types of disorders necessitate an integrated approach that includes medication, therapy,
education, and support systems to improve patient outcomes and enhance overall well-being. As
the population ages, the importance of addressing these disorders with empathy and expertise
becomes increasingly paramount.
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