Sexuality

Sexuality

Tracy F. Scheirer PhD, MSN, RN, CMSRN, CNE

Sexual Health

• Importance of Sexuality: Sexuality is fundamental to a person’s sense of self, making it a critical aspect of overall health and well-being.
• Components of Sexual Identity: Sexual identity includes multiple elements:
    - Self-identity: How individuals identify themselves in the context of sexuality.
    - Biological Sex: The physical characteristics (anatomy and physiology) that designate male or female.
    - Gender Identity: An individual's personal sense of their own gender, which may align or differ from their biological sex.
    - Gender Role Behavior/Expression: The outward expression of gender identity, encompassing behaviors, clothing, and roles traditionally associated with a particular gender.
    - Sexual Orientation: The emotional, romantic, or sexual attraction one feels toward others, which can include heterosexuality, homosexuality, bisexuality, etc.

Sexual Orientation

• Categories of Sexual Orientation:
    - Heterosexual: Attraction to individuals of the opposite sex.
    - Gay or Lesbian: Attraction to individuals of the same sex.
    - Bisexual: Attraction to individuals of both sexes.
    - Transgender: Individuals whose gender identity differs from the sex assigned at birth.
    - Transsexual: Often used to describe individuals who have transitioned or are transitioning from one sex to another.
    - Intersex: Individuals born with physical sex characteristics that do not fit typical definitions of male or female.
    - Non-binary: Individuals who do not identify strictly as male or female.
    - Gender Expression: The external manifestation of gender identity (e.g., clothing, speech, behavior) which may or may not conform to societal expectations of gender based on perceived sex.

Forms of Sexual Expression

• Types of Sexual Expression:
    - Masturbation: Self-stimulation of the genitals.
    - Sexual Intercourse: Penetrative sexual activity.
    - Oral-genital Stimulation: The act of performing oral sex.
    - Abstinence: Choosing not to engage in sexual activity.
    - Alternate Forms:
      - Voyeurism: Gaining sexual pleasure from watching others engage in sexual activities.
      - Sadism: Deriving pleasure from inflicting pain or humiliation on others.
      - Masochism: Deriving pleasure from experiencing pain or humiliation.
      - Sadomasochism: A combination of sexual sadism and masochism.
      - Pedophilia: Sexual attraction to prepubescent children, considered a criminal act.

Factors Affecting Sexuality

• Developmental Considerations: Changes through different life stages impact sexual health and identity.
• Cultural Influences: Cultural background can significantly shape sexual beliefs and behaviors.
• Religious Perspectives: Different religions have unique views on sexuality that can affect individual behaviors and belief systems.
• Ethical Factors: Morals and ethics linked to sexual behavior vary across societies, impacting norms and laws.
• Lifestyle Choices: Choices related to health, substance use, and relationships can affect sexual health.
• Health Status: Physical and mental health issues can impact sexual function and desire.

Menstrual Cycle Overview

• Schematic Representation:
    - Stages of Ovarian Cycle:
      - Folly Development: Primary follicle develops into a mature follicle.
      - Ovulation: The release of the egg.
      - Corpus Luteum: Forms post-ovulation and degenerates if no fertilization occurs.
      - Endometrial Changes: The uterus prepares for potential pregnancy.
• Cycle Length: The guided average for a menstrual cycle is depicted through a schematic layout.

Causes of Menstrual Cycle Irregularities

• Pregnancy or Breast-Feeding: Natural reasons for a cessation of regular cycles.
• Eating Disorders: Conditions like anorexia or bulimia may cause irregularities.
• Extreme Weight Loss or Exercise: Significant changes in body weight or rigorous physical activity can disrupt hormonal balance.
• Polycystic Ovary Syndrome (PCOS): A condition affecting hormone levels and menstrual function.
• Premature Ovarian Failure: Early depletion of ovarian function.
• Pelvic Inflammatory Disease (PID): Infections may cause scar tissue that impacts fertility and cycles.
• Uterine Fibroids: Benign tumors can lead to menstrual irregularities.

Phases of Sexual Response Cycle

• Four Phases:
    - Excitement: Initial stage of sexual arousal.
    - Plateau: Intensification of arousal prior to orgasm.
    - Orgasm: The climax of sexual response.
    - Resolution: The body returns to its resting state, wherein a refractory period occurs, particularly noted in males.
• Differences in Cycle:
    - Male Sexual Pattern: Includes excitement, plateau, orgasm, resolution, and refractory period.
    - Female Sexual Pattern: Similar phases, but often without a refractory period, allowing multiple orgasms.

Sexually Transmitted Infections (STIs)

• Key Points:
    - STIs affect individuals across demographics.
    - Rates of STIs are increasing, necessitating awareness and prevention.
    - Often, STIs can be asymptomatic, leading to complications such as PID or cancers.
    - Transmission can occur from mother to child during childbirth.
    - Populations at increased risk in the U.S. include young people and men who have sex with men (MSM).

Male Sexual Dysfunction

• Common Issues:
    - Erectile Dysfunction: The inability to achieve or maintain an erection.
    - Premature Ejaculation: Ejaculating before the desired point during sexual intercourse.
    - Retarded Ejaculation: Difficulty in ejaculation, which might cause distress.
• Causes of Erectile Dysfunction:
    - Physical Causes: Such as heart disease, diabetes, surgical interventions, and psychological stress.
    - Psychological Causes: Including relationship issues, anxiety, and depression.
    - Lifestyle Factors: Alcohol and drug use, smoking can contribute to sexual dysfunction.

Female Sexual Dysfunction

• Common Issues:
    - Inhibited Sexual Desire: Low libido or lack of interest in sexual activities.
    - Dyspareunia: Painful intercourse, which can have both psychological and physical causes.
    - Vaginismus: Involuntary contraction of pelvic floor muscles, making penetration painful or impossible.
    - Vulvodynia: Chronic vulvar pain without an identifiable cause.

Health States Affecting Sexuality

• Diabetes Mellitus: Can affect libido and physiological function.
• Cardiovascular Disease: Impacts blood flow and can lead to erectile dysfunction.
• Diseases Affecting Mobility: Such as arthritis can impact sexual health and practices.
• Surgery and Body Image: Surgical alterations can affect self-perception and sexual function.
• Spinal Cord Injuries: Can significantly alter sexual response and function.
• Chronic Pain: Can reduce sexual desire and ability.
• Mental Illness: Conditions such as anxiety and depression may affect sexual health.
• Medications: Various medications can have side effects that impact sexual function.

Responding to Harassment

• By Colleagues:
    - Confront unacceptable behaviors immediately.
    - Document any harassment behavior.
    - Consult with supervisors about continuing issues.
    - If unresolved, consider filing a grievance with administration.
    - Seek legal advice if necessary.

Forms of Sexual Harassment

• Types:
    - Quid Pro Quo: An exchange where something is withheld to obtain something else, often linked to power dynamics.
    - Environmental Harassment: A hostile work environment that creates discomfort due to inappropriate actions or discussions.

Responding to Patient Advances

• Strategies:
    - Maintain self-awareness regarding personal boundaries.
    - Provide direct feedback to the patient regarding their behavior.
    - Clearly set and enforce personal and professional limits.
    - Document and report incidents to a supervisor for further action.

Categories of Patients Requiring Sexual History

• Patients Seeking Care for:
    - Pregnancy, STIs, infertility, or contraception requests.
    - Those experiencing sexual dysfunction.
    - Patients whose illnesses may impact sexual functioning.

The BETTER Model

• Acronym for Sexual Health Discussions:
    - Bring up the topic of sexuality.
    - Explain that you are concerned with all aspects of patients’ lives affected by disease.
    - Tell patients that sexual dysfunction can happen, addressing their concerns.
    - Timing is important for discussing sexuality, aiming for each visit.
    - Educate about treatment side effects which may be temporary.
    - Record assessments and interventions in medical records (source: Mick, Hughes, and Cohen, 2003).

Patient Outcomes Regarding Sexuality

• Goals for Patients:
    - Define their individual sexuality clearly.
    - Establish open communication patterns with significant others.
    - Enhance self-awareness and body awareness.
    - Describe and engage in responsible sexual health self-care practices.
    - Practice responsible sexual expression in a healthy context.

Methods of Contraception

• Types:
    - Behavioral: Methods that are based on tracking fertility cycles; e.g., rhythm method.
    - Barrier Methods: Physical barriers like condoms or diaphragms preventing sperm from reaching an egg.
    - Hormonal Methods: Using hormones to regulate or prevent ovulation (e.g., birth control pills).
    - Intrauterine Devices (IUDs): T-shaped devices inserted into the uterus to prevent pregnancy.
    - Emergency Contraception: Pills like Plan B that prevent pregnancy after unprotected intercourse.
    - Sterilization: Permanent methods such as tubal ligation in females or vasectomy in males.

Prevention of STIs

• Preventative Measures:
    - Delay the onset of sexual relations whenever possible.
    - Regular check-ups for STIs to monitor health.
    - Learn and recognize common symptoms of STIs.
    - Avoid sexual activity during menstruation to reduce risk of infection.
    - Avoid anal intercourse unless precautions are taken.