Sexuality

Developmental Stages of Sexuality

Birth to 12 Years

  • Body Exploration: Children develop a sense of sexuality by exploring their bodies.

  • Gender Awareness: Toddlers begin developing a sense of gender through teachings from family and community.

  • Understanding of Sexual Identity: School-aged children start to understand sexuality and become more private about their bodies, often modeling behaviors from external influences.

  • Puberty Onset: Begins around ages 9 to 10 with physical changes like the growth of pubic hair; affected by genetics.

  • 12-18 months:

    • does not understand difference between male and female gender

    • Assignment of gender to child affects how others interact with infant

    • Differentiates between self and others, develops identity as male or female

    • Self-image is shaped by external beliefs, expectations, attitudes

    • Learning more about physical bodies, self-exploration, including genitals

  • 1-3 years

    • More purposeful body exploration

    • Identification of own gender

    • Early awareness of anatomical differences between males and females

  • 4-5 years

    • Fuller sense of self

    • Explore others’ body parts as well as their own

  • will ask questions

  • 8-9

    • Become concerned about specific sex behaviors

    • May approach parents with concerns about sexuality, reproduction

    • Family role in shaping individual’s view of sex, sexuality

    • Develop gender identity, body image, sexual self- concept, capacity for intimacy within context of family

    • Relationships, gender expression, expectations of others and selves

    • Parents reactions to questions and to child’s genital exploration can affect child’s sexuality into adult years

      • Important for parents to answer questions honestly, use correct names for body parts

      • Important for nurse to provide parents and children with opportunities to express concerns, ask questions

    • Encourage parents to discuss basic information with children

Adolescence (12-18 Years)

  • Early Adolescence (12-13 Years):

    • Development of primary (reproductive organs) and secondary sex characteristics (bodily traits).

    • Females typically reach sexual maturity sooner than males.

  • Changes in Females:

    • Breast development, pubic hair growth, and broader pelvis shape; axillary hair and sweating concerns about personal hygiene begin, rapid growth in height.

  • Changes in Males:

    • Development of pubic hair, larger testes and scrotum, voice deepening, and potential for erections, axillary sweating, scortal sac becomes darker, rapid growth in height and weight; Sense of touch more pleasurable as develop; wet dreams common

  • Notable information gaps often exist between parents and boys regarding puberty discussions.
    Pt. education :

  • menstruation and feminine hygiene

    • how often to change, how long, types

  • signs of onset menstraution

    • tender, swollen breasts, bloating, and water retention

  • appropriate discussions on masturbation and sexual health

  • adolescents and young adults under 25 should be screened yearly for STI’s

  • pregnancy prevention
    Nurse considerations

  • screen for abuse and dating violence

  • teaching on contraceptives and STI’s

Young and Middle Adulthood

Young Adulthood:

  • Peak reproductive health with higher incidences of STIs

  • Emphasis on education about safe sex practices and regular health screenings to reduce risks.

  • Education: prevention of STI, referral for sexually compulsive behaviors
    Middle Adulthood:

  • Hormonal changes lead to climacteric; women early 40’s

  • perimenopause—> menopause (45-55 years)

  • the perception of menopause varies among women

  • Men:

    • Gradual hormone reduction: dec in leydig cells and androgen

    • maintaining spermatogenesis

Pregnancy

  • Sex usually safe

  • Not safe when

    • Is experiencing vaginal bleeding or amniotic fluid leakage

    • Has incompetent or dilated cervix

    • Has partial or total placenta previa- cause bleeding

    • Has history of miscarriage, preterm labor, or premature birth

    • Is carrying multiple fetuses

  • Common for low desire, sex uncomfortable (can suggest different positions

  • Post-partum: avoid for 6 weeks, physical and hormonal changes may make sex uncomfortable

Older Adulthood

Sexual Activity: Many remain sexually active; misconceptions about aging and sexual beings persist

  • dec in sexually activity r/t physical limits, diseases, loss of partner

Hormonal Changes:

  • Women may experience increased desire after menopause but reduced lubrication and elasticity, remain capable of multiple orgasms, phases of sexual response take longer , breasts atrophy, dyspareunia, difficult penetration

  • Men may face a decrease in testosterone, libido, volume of fluid, and intesity of orgasm. May require more direct stimulation and time to achieve erection, fewer sperm

  • Education: STIs and condom use

Intimacy Needs: Continued importance of intimacy beyond sexual activity. Must address individual needs.

Lifespan Considerations in Sexuality

Infants to Adolescents

  • Babies do not distinguish gender; exploration begins in early childhood.

  • By ages 4-5, children understand anatomical differences.

  • Adolescents experience significant physical and emotional changes; relationships become more complex.

Young to Older Adults

  • Young adults engage in active sexual lives; health education is critical.

  • Older adults remain sexually active into late age, but health issues often limit sexual function and desire.

Health Promotion and Education

Preventive Health Strategies

  • Healthy lifestyle: dec risk of illness, and meds that may impair function

  • Cancer Screenings: Regular screening for STIs

  • Female: cervical (pap and HPV) breast, endometrial cancers (usually post-menopause)

  • Male: prostate, testicular, penile cancers

  • Prostate screening involves both a blood test and DRE

Safer Sex Practices:

  • Emphasize mutual monogamy

  • known partner health status

  • condom use to prevent STIs

  • STI testing

  • watersoluble lubricants with condoms

  • No drugs/alcohol

  • No sharing of needles, razors, toothbrushes

Vaccinations