Gender and Sexuality week 7
Patient-Centered Terminology: Sexuality
The lexicon of human sexuality includes diverse terms used to describe sexual orientation and identity: - Sexual orientation: The inherent or immutable enduring emotional, romantic, or sexual attraction to other people. - Heterosexuality: Attraction to individuals of the opposite sex. - Homosexuality: Attraction to individuals of the same sex. - Gay: A sexual orientation typically referring to men attracted to men, though it can be used more broadly. - Lesbian: A sexual orientation referring to women attracted to other women. - Bisexual: Attraction to more than one gender. - Pansexual: Attraction to people regardless of their gender identity or biological sex. - Asexual: A lack of sexual attraction to others, or low or absent interest in or desire for sexual activity. - LGBTQIA2+: An acronym representing lesbian, gay, bisexual, transgender, queer or questioning, intersex, asexual, and two-spirited individuals. The "+" indicates the inclusion of additional identities and orientations. - Lesbian: Categorized under sexual orientation. - Gay: Categorized under sexual orientation. - Bisexual: Categorized under sexual orientation. - Transgender: Categorized under gender identity. - Queer or questioning: Related to sexual orientation or gender identity. - Intersex: Related to sexual biology. - Asexual: Categorized under sexual orientation. - 2+ [Two-spirited]: Categorized under gender identity. - Intersex: A general term used for a variety of conditions in which a person is born with a reproductive or sexual anatomy that doesn't seem to fit the typical definitions of female or male. - Sex: Often refers to biological characteristics (chromosomes, hormones, anatomy). - Sexuality: A broad term spanning sexual interest, behaviors, and orientation.
Patient-Centered Terminology: Gender Identity
Gender identity relates to an individual's internal sense of their own gender: - 2+: Refers to "Two-spirited," a gender identity within some Indigenous cultures. - Cisgender: An individual whose gender identity aligns with the sex they were assigned at birth. - Gender dysphoria: A clinical term for the distress caused by a mismatch between a person's gender identity and their sex assigned at birth. - Gender expression: The external manifestation of a person's gender identity, often expressed through clothing, grooming, or behavior. - Genderfluid: A gender identity that is not fixed and may change over time. - Genderqueer: A gender identity that falls outside of the binary of male and female. - Nonbinary: An umbrella term for gender identities that are not solely male or female. - Transgender: An individual whose gender identity differs from the sex assigned at birth.
Influences on Sexuality and Gender Identity
Development and expression of sexuality and gender identity are impacted by various external factors: - Culture: Societal norms and heritage that shape sexual expectations. - Society: General public opinion and social structures. - Law: Legal frameworks that regulate sexual behavior or identity recognition. - Religious institutions: Belief systems that provide moral or ethical guidelines regarding sexuality.
Expression of Sexuality: - Sexuality is expressed in various ways across different individuals. - Adaptive behaviors: These involve respecting the rights and wishes of others and conducting sexual behavior between consenting adults. - Maladaptive behaviors: These involve harm to oneself or others across one or more capacities.
Self-Awareness and Professional Practice
Importance of Self-Awareness: A provider's own self-awareness has a significant influence on their ability to discuss gender and sexuality with clients effectively.
Values Clarification: Professionals should refer to Chapter for the values clarification process to ensure their personal beliefs do not interfere with patient care.
Sexuality and Gender Identity Throughout the Life Cycle
Childhood: - Natal sex is identified at birth. - Newborns are frequently given names traditionally associated with a specific gender. - Natal sex identification by the child typically happens at years old. - Assumptions regarding "traditional" gender roles usually emerge during the middle elementary school years. - Gender expression in childhood may vary and does not always align with later outcomes.
Adolescence and Young Adulthood: - This period is characterized by intense searching and learning. - Influences include peers, various people, the media, and society. - Sexual orientation and gender identity may or may not be solidified during this developmental stage. - Clinical priorities: Educate about contraception and the prevention of Sexually Transmitted Infections (STIs). - Referral: Refer gender-diverse youth to appropriate support systems when necessary.
Adulthood: - Individuals may or may not choose monogamy or marriage. - Intimacy and sexual behaviors often change to accommodate shifting life circumstances and health status. - Clinical Note: Remind patients about the use of condoms even after menopause has occurred. - Individuals may choose to begin or continue transitions to be more congruent with their gender identity. - Gender-affirming surgeries are available medical options. - "Coming out" as an adult is not uncommon; healthcare providers should provide support and a nonjudgmental presence. - Referral: Provide links or resources to credible support organizations.
Sexual Disorders: Dysfunctions and Paraphilias
Sexual Dysfunctions: These are often categorized by natal sex. - Male-Specific Disorders: - Delayed ejaculation. - Erectile disorder. - Male hypoactive sexual desire disorder. - Premature (early) ejaculation. - Female-Specific Disorders: - Genito-pelvic pain/penetration disorder. - Female orgasmic disorder. - Female sexual interest/arousal disorder. - Generic/Shared Disorders: Substance/Medication-induced sexual dysfunction (can affect both males and females).
Paraphilic Disorders: - Exhibitionistic disorder: Related to exhibitionism (exposing genitals to others). - Fetishistic disorder: Sexual focus on inanimate objects or specific non-genital body parts. - Frotteuristic disorder: Touching or rubbing against a non-consenting person. - Pedophilic disorder: Sexual interest in children. - Sexual sadism disorder: Inflicting pain or humiliation for sexual excitement. - Sexual masochism disorder: Receiving pain or humiliation for sexual excitement. - Transvestic disorder: Sexual arousal from cross-dressing. - Voyeuristic disorder: Observed in voyeurism (observing unsuspecting people while they are naked or engaged in sexual activity).
Legal Status of Paraphilias: - Exhibitionism, pedophilia, and voyeurism are illegal. - Others may be considered illegal depending on the specific circumstances and lack of consent.
Compulsive Sexual Behavior: - Often used as a coping mechanism. - Treatment involves medications and psychotherapy.
Therapeutic Interventions and the Nursing Process
Treatment for Sexual Disorders: - Selection of treatment depends on the disorder type, causative agent, signs/symptoms, degree of impairment, and risk to others. - Modalities: - Group or individual therapy. - Hormonal drug therapy. - Other medication therapies (e.g., Selective Serotonin Reuptake Inhibitors [SSRIs], etc.). - Incarceration (applicable in cases of illegal behaviors resulting in conviction).
Psychosexual Assessment: - Providers must be aware of the client's current level of comfort when assessing sexual functioning. - Always obtain the client's consent before performing the assessment. - The 5 P's: The assessment should focus on these five areas (Partners, Practices, Protection from STIs, Past History of STIs, Prevention of Pregnancy).
Nursing/Therapeutic Process: - Problem statements must be based on the individual client's identified concern. - The provider must remain nonjudgmental and accepting at all times. - The core role of the nurse is to: Assess, Treat, Advocate, and Educate.