Ch 24: Human Sexuality

Infancy-Early Childhood

• Gender identity begins forming

• Trust and body exploration are key to development

School-Age

• Same-gender friendships form

• Need accurate, age-appropriate sex education

Adolescence

• Puberty brings emotional & physical changes

• Education needed on STIs, contraception, orientation, and values

Young Adulthood

• Focus on intimacy, relationships, and fertility

• Guidance continues around sexual health

Middle Adulthood

• Life transitions (“empty nest”) impact intimacy

• menopause, illness, or aging may affect sexual function

Older Adulthood

• Sexuality remains important and fulfilling

• Older adults continue to enjoy sexual relationships

External organs of Males

• Scrotum: Sac that holds the testes

• Penis: Contains the urethra (for urine and semen); made
  of shaft and glans

• Glans: Head of the penis; covered by foreskin unless
  circumcised

Internal organs of males

• Testes: Produce sperm and testosterone

• Seminal vesicles & prostate: Produce and store seminal fluid

Function

• Sperm and seminal fluid combine to form semen, which is ejaculated during orgasm

External Organs (vulva) Female

• Includes mons pubis, labia majora/minora, clitoris

• Glands (Skene & Bartholin) provide lubrication during arousal

Internal organs (female)

• Vagina: Connects external genitalia to the uterus; expands for intercourse and childbirth

• Uterus: Muscular, pear-shaped organ for pregnancy; includes cervix and intercourse

• Fallopian tubes: Carry eggs from ovaries to urterus

• Ovaries: Produce eggs and hormones (estrogen & progesterone)

Menstrual Cycle

• Typically every 21-35 days

• Regulated by hormones (FSH, LH, estrogen, progesterone)

• Prepares the body for pregnancy; restarts if pregnancy doesn’t occur

Breasts

• Considered reproductive organs due to hormonal influence

• Produce and release milk (lactation)

• Can be sensitive to sexual stimulation

Sex

•Commonly refers to sexual intercourse
•Also refers to biological sex (based on internal/external genitalia)

Sexuality

• A broad, lifelong part of being human

• Includes sex, gender identity, roles, orientation, intimacy, reproduction, and pleasure

• Influenced by biological, emotional, cultural, and
  social factors

Gender Identity

• A person’s deeply felt sense of being male, female, both, neither, or somewhere in between

• May or may not align with the sex assigned at birth

• Can be expressed through appearance, speech, or
  behavior

Sexual Health

• Not just the absence of disease

• A state of physical, emotional, mental, and social well-being related to sexuality

Sexual Expression

• Varies widely across individuals and life stages

• May include vaginal, oral, or anal sex, masturbation, or abstinence

• Shaped by personal choice, relationships, and cultural norms

Effectiveness Depends on Consistency & Proper Use

• No method is perfect unless used correctly and consistently.
• Most do NOT protect against STIs, with the exception of condoms.

Nonprescription Methods

• Abstinence: 100% effective, but not always realistic.

• Fertility awareness/timing: Avoiding sex during fertile days.

• Barrier methods:
  • Male condom: Covers the penis to block sperm; helps prevent STIs.
  • Spermicides: Foams, jellies, sponges used vaginally to kill sperm.

Prescription Methods

• Hormonal methods (for females):
  • Pill, patch, ring, shot, implant, hormonal IUD
  • Work by regulating hormones to prevent ovulation or change uterine lining.

• Nonhormonal:
  • Copper IUD or vaginal gel that changes pH to immobilize sperm.

• Mechanical barriers:
  • Diaphragm and cervical cap (used with spermicide to block sperm entry)

Surgical Sterilization

• Male (Vasectomy): Cuts vas deferens; no sperm in ejaculate.
• Female (Tubal Ligation): Cuts or seals fallopian tubes to block fertilization.
• Both are highly effective and considered permanent.

STI’s (Sexually Transmitted Infections) or STDs (Sexually Transmitted Diseases)

Are infections caused by bacteria, viruses, or parasites that are passed from one person to another through sexual contact

Can spread by:

• Vaginal, anal, oral sex

• Contact with infected body fluids (semen, vaginal fluids, blood)

• Skin-to skin sexual contact

• Sharing needles

• From a pregnant person to thier baby during pregnancy or childbirth

Symptoms:

*Usually have no symptoms

• Pain or burning during urination

• Unusual vaginal or penile discharge

• Itching or irritation of the genital area, etc.

Diagnosis:

• Medical history and symptoms review

• Physical examination

• Urine test

• Blood tests

• Swabs from affected areas

Why it can be tricky?

-Usually remain hidden for months/years

HIV: human immunodeficiency virus

Cause: Blood-borne virus transmitted through bodily fluids during unprotected sex, sharing IV needles, or transfusions of infected blood.

Phases of HIV:
1.Acute Phase (first month): Flulike symptoms
2.Clinical Latency: No symptoms, but virus is active
3.AIDS: Immune system is severely weakened; can be fatal

Treatment:
Managed with Antiretroviral Therapy (ART)—a combination of 3 or more drugs; ART reduces viral load and improves survival

Sexuality

Broader concept that includes a person’s identity, intimacy, emotional
connection, and sexual expression—not limited to physical acts.

*Key Point for Nurses:
- Understanding the difference helps provide holistic, respectful care that
addresses both physical and emotional aspects of sexual health.

Sexual Function

Physical ability to engage in sexual activity; begins at birth and continues across the lifespan.

Factors Affecting Sexual Function

Influenced by:
◦ Physical factors: illness, aging, hormone levels
◦ Lifestyle factors: stress, substance use, relationship dynamics
◦ Developmental factors: body image, stage of life

◦ Medications: many can reduce desire, performance, or satisfaction
◦ Medications & sexual function side effects may impair sexual response or satisfaction.

◦ Nursing Role: Always ask about current medications during a sexual health history. Educate patients about possible sexual side effects. Advocate for medication changes if issues arise.

Family Dynamics

Key Influences on Communication & Decision-Making: Age, culture, ethnicity, and religion affect how sexual health concerns are viewed and discussed. Embarrassment, fear, or anxiety can block communication within families. Generational gaps in values may create tension or silence around sexual topics.
Belief Systems & Sexual Health Choices: Religious or cultural views can impact decisions about: Abortion Contraception Sterilization Sexual identity & gender roles.

**Always approach these conversations with cultural sensitivity understanding family dynamics helps tailor patient care and communication.

Sexual Health Assessment in Nursing Practice

*Calm and matter of fact approach reduces patient anxiety

*Barriers to Assessment: Lack of knowledge about sexual health, personal
discomfort, perceived time constraints, organizational support issues

*PLISSIT-a way to guide conversations

AS THE NURSE:
◦ privacy and confidentiality is very important
◦ watch for nonverbal cues
◦ *patient advocate

Sexual Harassment

•Confront inappropriate behavior from patients professionally.
•Know your rights and report workplace harassment.
•Support policies that prevent harassment and protect all individuals.

Nursing Diagnosis

Impaired Sexual Functioning
◦ Discomfort during intercourse
◦ Decreased self-esteem and interest in sex
Problematic Sexual Behavior
◦ Lack of role models
◦ Engages in risky sexual behaviors (e.g., sexting, unprotected sex)
Rape Trauma Response
◦ Processing trauma post-assault
◦ Attending counseling and seeking support

Planning

*Planning Phase: Addressing Sexual Health in Nursing Care
*Critical Thinking in Action: Use assessment data, sexual health history, and clinical experience
Consider physical, emotional, psychological, and relational needs
*Maintain Ethical & Legal Standards: Protect privacy, Ensure confidentiality, Provide unbiased, respectful care
*Create Individualized Goals & Outcomes:
Example Diagnosis: Impaired Sexual Functioning (post-surgery)
Goal: Improved sexual functioning in 1 month
Outcomes: Patient will discuss sexual concerns with PCP before discharge
Patient reports improved sexual function at 1-month follow-up
Prioritize & Collaborate Identify short- vs. long-term needs
Collaborate with providers, counselors, therapists

Implementation and Evaluation

Health Education:
◦ Use therapeutic communication to promote trust. Teach at the patient’s developmental level. Provide private and confidential environments.
◦ Educate on preventive screenings: Pap smears, mammograms, breast exams. Testicular self-exams (start age 14+) Prostate exams per guidelines
Risk Prevention:
◦ Teach safe sex practices: STI signs/symptoms. Routine exams & lab testing: Condom use. HPV vaccination. Avoiding multiple/risky partners. No IV drug use
Patient Counseling:
◦ Use therapeutic communication when addressing: Illness-related sexual concerns, Performance or desire issues. Sexual abuse or assault. Know legal/clinical responsibilities Ensure access to a safe, supportive environment
Evaluation:
◦ Ask direct follow-up questions: Was the issue resolved? Is the patient satisfied with the outcome? Use both verbal and nonverbal cues to evaluate