Sexuality - Lecture notes 7 PDF

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Sexuality from nursing 1. Lecture notes...

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Sexuality

A. Sexual Identity a. Encompases a person’s self-identity, biologic sex, gender identity, gender role behavior or orientation, and sexual orientation i. Biologic sex - term used to denote chromosomal sexual development: male XY or female XX, external and internal genitalia, secondary sex characteristics, and hormonal states ii. Gender identity - inner sense a person has of being male or female, which can be the same or different than their biologic gender iii. Gender role behavior - behavior a person conveys about being a male or female which can be the same or different as biologic gender or gender identity B. Sexual Development and Sexual Orientation a. Sexual development i. sexuality changes with each stage of development b. Sexual orientation i. Heterosexual, homosexual, lesbian, bisexual C. Effect of Nurses Attitudes on Patients a. A nurse’s attitudes about sexuality and the human body can directly affect her patient’s experiences and self-concept b. Nurses must be aware of how their negative attitudes or perceptions can affect the response to genitalia-related care. It is the responsibility of nurses to devise strategies of masking their personal view of this procedure, with additional mindfulness as to not cause any discomfort for the patient D. Developmental Stages a. Infancy and early childhood: gender identity b. School-aged years: questions c. Puberty/adolescence: emotional and physical changes d. Young adulthood: emotional maturation e. Middle adulthood: concerns re attractiveness f. Older adulthood: physiological sexual response changes with aging, but aging doesn’t lead to diminished sexuality E. Sexual Development a. Birth to 18 months i. From birth, infants assigned gender of male or female ii. Infant gradually differentiates self from others iii. External genitals are sensitive to touch iv. Males have penile erections v. Females have vaginal lubrication b. Toddler 1-3 yrs i. Continues to develop gender identity ii. Can identify own gender c. Preschooler 4-5 yrs i. Becomes increasingly aware of self ii. Explores own and classmates’ body parts iii. Learns correct name for body parts

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iv. Learns to control feelings and behaviors v. Focuses love on parent of opposite sex d. School Age 6-12 yrs i. Strong identification with parent of same gender ii. Friends of same gender iii. Increasing awareness of self iv. Increased modesty, desire for privacy v. Continues self-stimulating behavior vi. Learns roles and concepts of own gender as part of self-concept vii. Age 8 or 9 have specific concerns about sexuality and reproduction e. Adolescence 12-18 yrs i. Primary and secondary sexual characteristics develop ii. Menarche iii. Develops relationships with interested partners iv. Masturbation common v. May participate in sexual activity vi. May experiment with homosexuality vii. At risk for pregnancy and STDs f. Young Adult i. Sexual activity common ii. Establishes own lifestyle and values iii. Homosexual identity established in mid 20s iv. Couples may share financial and household responsibilities g. Middle Adulthood i. Decreased hormone production ii. Menopause in women between 40-55 years iii. Climacteric occurs gradually in men iv. Quality rather than number of occurrences becomes important v. Individuals establish independent moral and ethical standards h. Late Adulthood i. Interest in sexual activity continues but may be less frequent ii. Women 1. Vaginal secretions diminish 2. Breasts atrophy iii. Men 1. Produce fewer sperm 2. Need more time to achieve erection and ejaculate F. Sexual Health a. According to WHO, sexual health is “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.” b. Nurses help patients achieve sexual health by having a sound scientific knowledge base regarding sexuality. c. Sexual health contributes to an individual’s sense of self-worth and to positive interpersonal relationships. G. Components of Sexual Health a. Sexual Self-Concept b. Body Image c. Gender Identity d. Gender Role Behavior e. Androgyny

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H. Characteristics of Sexual Health a. Knowledge about sexuality and sexual behavior b. Ability to express one’s full sexual potential c. Ability to make autonomous decisions about one’s sexual life d. Experience of sexual pleasure as a source of physical, psychological, cognitive and spiritual well-being e. Capability to express secuality through communication, touch, emotional, expression, and love f. Right to make reproductive choice g. Ability to access sexual health care I. Sexual Development and Sexual Orientation a. Sexual development i. Sexuality changes with each stage of development 1. Adolescence explore their primary sexual orientation b. Sexual orientation i. Describes the predominant pattern of a person’s sexual attraction over time ii. Heterosexual, homosexual, lesbian, gay, bisexual, transgender iii. Same gender, opposite gender, both genders J. Gender Identity a. Transgenderism b. Intersexuality c. Transsexuality d. Cross-dressers K. Sexual Expression a. The methods by which people gain satisfaction through sexual stimulation are varied. Touch, smell, sight, sounds, feelings, thoughts, and fantasy can all contribute to sexual fulfillment in any form of expression chosen by individuals. Feelings of love for another person are closely associated with desire. L. Erotic Preferences a. Sexual fantasies, masturbation, cunnilingus, fellatio, anal stimulation, genital intercourse, anal intercourse, abstinence, others i. Alternate forms of sexual expression 1. Voyeurism - achievement of sexual arousal by looking at the body of another 2. Sadism - the practice of gaining sexual pleasure while inflicting abuse on another person 3. Masochism - gaining sexual pleasure from the humiliation of being abused 4. Sadomasochism - act of practicing sadism and masochism together. It might involve being tied up, biting, hitting, spanking, whipping, pinching, and other activities 5. Pedophilia - practice of adults gaining sexual fulfillment by performing sexual acts with children M. Influences of Sexuality a. Development considerations b. Family c. Culture - every culture has its own norms regarding sexual identity and behavior. To some degree culture dictates the duration of sexual intercourse, methods of sexual stimulation, and sexual positions d. Religion - some have negative effect on the expression of sexuality

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e. Personal and expectations and ethics - healthy sexuality depends on freedom from guilt and anxiety f. Lifestyle g. Childbearing considerations h. Sexually transmitted infections i. Sexual dysfunction i. Male 1. Erectile dysfunction aka impotence 2. Premature ejaculation 3. Retarded ejaculation aka ejaculatory incompetence ii. Female 1. Inhibited sexual desire 2. Dyspareunia - painful intercourse 3. Vaginismus - vaginal opening closes tightly and prevents penile penetration 4. Vulvodynia - chronic vulvar discomfort or pain j. Other health conditions - trauma, stress, etc N. Male and Female Sexual Response Cycle a. Desire Phase i. Men and women 1. Response cycle starts in brain 2. Sexually erotic stimuli may be real or symbolic b. Excitement/Plateau i. Both 1. Muscle tension increases as excitement increases 2. Sex flush (chest) 3. Nipple erection ii. Male 1. Penile erection 2. Increase in glans size 3. Few drops lubricant iii. Female 1. Erection of clitoris 2. Vaginal lubrication 3. Labia increase 2-3 times in size 4. Breasts enlarge 5. Inner ⅔ of vagina widens 6. Outer ⅓ narrows 7. Uterus elevates c. Orgasmic i. Both 1. RR up to 40 bpm 2. Involuntary muscle spasms 3. Diminished sensory awareness 4. Involuntary contractions anal sphincter 5. Peak HR 110-180 bpm 6. SBP 30-88 mmHg above normal 7. DBP 20-55 mmHG above normal ii. Men 1. Rhythmic, expulsive contractions of penis 2. Emission of seminal fluid

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3. Closing of internal bladder sphincter before ejaculation 4. May occur without ejaculation 5. Force varies but diminishes after 2-3 contractions iii. Female 1. 5-12 contractions of muscles of pelvic floor and uterine muscles 2. Varied patterns a. Minor, multiple, simple intense d. Resolution i. Both 1. Reversal of vasocongestion in 20-30 min 2. Disappearance of myotonia within 5 min 3. Genitals and breasts return to pre excitement state 4. sEx flush disappears in reverse order 5. HR, RR, BP return to normal 6. Sleepiness, relaxation, emotional outburst ii. Male 1. Refractory period during which body will not respond to sexual stimulation 2. Varies from moments to days O. Sexual Dysfunction a. May be related to i. Past and current factors 1. Sociocultural 2. Psychological 3. Cognitive 4. Relationship problems 5. Health 6. Medications or street drugs ii. Sexual desire disorder 1. Hypoactive sexual desire 2. Sexual aversion disorders iii. Sexual arousal disorder 1. Female sexual arousal disorder 2. Male erectile dysfunction iv. Orgasmic disorder 1. Female - preorgasmic women 2. Male - retarded ejaculation, rapid ejaculation v. Sexual pain disorder 1. Dyspareunia 2. Vaginismus 3. Vulvodynia 4. Vestibulitis - sever pain on touch or attempted vaginal entry vi. Problem with satisfaction 1. Some people experience sexual desire, arousal, and organsm yet feel dissatisfied with their sexual relationship P. Contraception a. Nonprescription contraceptive methods i. Abstinence, barrier methods, spermicide, rhythm b. Methods that require health care provider interventions: i. Hormonal contraception, intrauterine device, diaphragm, cervical cap, sterilization (tubal ligation or vasectomy)

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Q. Sexually Transmitted Infections a. About 19 million people in the US are diagnosed each year with a sexually transmitted infection; almost half of them are 15-24 years of age b. STIs are transmitted from infected individuals to partners during intimate sexual contact c. Usually curable STIs: syphilis, gonorrhea, chlamydia, trichomoniasis d. Viral STIs: HPV, genital warts, and herpes type II, HIV, AIDS i. HIV - primary routes of transmission include contaminated IV needles, anal intercourse, vaginal intercourse, oral-genital sex, and transfusion of blood and blood products ii. HPV - most common STI in US aka genital warts’ spread through direct contact with warts, semen, or other fluids iii. Chlamydia (bacterial) - causes infertility, pelvic inflammatory disease, and neonatal complications R. Nursing Knowledge Base: Factors Influencing Sexuality a. Sociocultural dimension of sexuality i. Impact of pregnancy and menstruation on sexuality b. Discussing sexual issues i. Sexual assessment and interventions need to be included in health care ii. Nurses who have difficulty discussing topics related to sexuality need to explore their discomfort and develop a plan to address it S. Decisional Issues a. Contraception i. Factors that influence effectiveness: method of contraception, couple’s understanding of the method, consistency of use, compliance with method’s requirements b. Abortion i. It is essential to choose specialties or places of employment where personal values are not compromised and the care of a patient in need of health care is not jeopardized c. STI prevention: only abstinence is 100% effective T. Alterations in Sexual Health a. Infertility = inability to conceive after 1 year of unprotected intercourse b. Sexual abuse i. nurses must report suspected abuse to the proper authorities c. Conflicts d. Sexual dysfunction = absence of complete sexual functioning i. Affected by illnesses and medications U. Nursing Process a. Assessment i. Factors affecting sexuality 1. Developmental stage 2. Physical and functional factors 3. Lifestyle 4. Relationship and psychological factors 5. Self-esteem factors that influence sexual functioning ii. By including sexuality in the nursing history, the nurse acknowledges that sexuality is an important component of health and creates an opportunity for the person to discuss sexual concerns iii. PLISSIT Assessment of Sexuality 1. Permission to discuss sexuality issues

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2. Limited information related to sexual health problems being experienced 3. Specific Suggestions - only when the nurse is clear about the problem 4. Intensive Therapy - referral to professional with advanced training if necessary iv. Sexual health history 1. Most patients want to know how medications, treatments, and surgical procedures influence their sexual relationship even though they often do not ask questions v. Sexual dysfunction 1. Many illnesses, injuries, medications, and aging changes have a negative effect on sexual health vi. Physical assessment 1. Teach breast and testicular self-examination vii. Client sexual assessment 1. Are you currently sexually active? with men, women, or both? more than one partner? Describe negative and positive aspects of your sexual functioning? do you have difficulty with sexual desire? Do you experience any pain with sexual interaction? 2. If there are problems, how have they influenced how you feel about yourself? How have they affected your partner? 3. Do you expect your sexual functioning to be altered because of your illness? What are your partner’s concerns about your future sexual functioning? b. Diagnosis i. Diagnoses relating specifically to sexuality 1. Ineffective Sexuality Pattern 2. Sexual Dysfunction ii. Sexual problems as etiology 1. Deficient knowledge 2. Pain 3. Anxiety 4. Fear 5. Disturbed body image c. Planning i. Nursing interventions for patients with sexual concerns focus on supporting patients’ need for intimacy and sexual activity ii. Patients often feel overwhelmed and hopeless about returning to the previous level of sexual functioning iii. They usually need time to adapt to physical and psychosocial changes that affect their sexuality and sexual health d. Implementation i. Health promotion 1. Annual health examinations provide an opportunity to discuss contraception and safe sex practices ii. Acute care 1. Illness and surgery create situational stressors that often affect a person’s sexuality iii. Restorative and continuing care 1. In the home environment, it is important to provide information on

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how an illness limits sexual activity and to give ideas for adapting or facilitating sexual activity e. Interventions i. Education ii. Provide privacy during intimate body care iii. Involve the client’s partner in physical care iv. Give attention to the client’s appearance and dress v. Give clients privacy to meet their sexual needs alone or with a partner with physically safe limits vi. Health promotion teaching 1. Sex education 2. Teaching Self examinations - breast and testicular 3. Responsible sexual behavior a. Prevention of sexually transmitted disease b. Prevention of unwanted pregnancies c. Avoidance of sexual harassment and abuse f. Evaluation i. What other questions do you have about your sexual health? ii. Did you experience less pain during sexual intercourse after taking your pain medication iii. What barriers are preventing you from discussing your feelings and fears with your partner? V. Sexual Harassment a. unwelcome behavior that is sexual or gender-based in nature. This type of harassment usually occurs in the context of an asymmetrical relationship where one person has more formal power than the other (e.g., a faculty member over a student) or more informal power (e.g., one peer over another). b. Sexual harassment can be directed toward individuals of any age, either gender, and any sexual orientation. There are two forms of sexual harassment: “quid pro quo” and environmental harassment (also called a “hostile” environment). i.

ii.

Quid pro quo harassment - occurs when an individual’s employment or well-being is dependent on agreeing to unsolicited and unwelcome sexual demands. Typically initiated by a person in a position of authority who offers either direct or indirect reward or punishment based on granting of sexual favors Hostile environment harassment - occurs when behaviors of a sexual or gender-based nature create a hostile, intimidating environment and when this type of environment harms an individual’s work performance, classroom performance, or general sense of well-being

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