Sexuality

Anatomy & Physiology

Female Anatomy

  • Ova

  • Fallopian tubes

  • Uterus

  • Vagina

  • Mons pubis

  • Vulva

  • Clitoris

  • Labia minora/majora

  • Breasts

  • Mammary glands

  • Menstrual cycle

Male Anatomy

  • Testes

  • Reproductive glands

  • Penis

  • Erectile tissue

  • Ejaculation

Note

  • Review anatomy & physiology to better understand content.

Definitions of Sexuality

Sexuality (WHO, 2010)

  • Definition: “Central aspect of being human throughout life and encompasses sex, gender identity and roles, sexual orientation, eroticism, pleasure, intimacy and reproduction.”

Gender Identity (Treas, 2022)

  • Definition: An individual's perception of their gender role.

Sexual Identity (Treas, 2022)

  • Definition: An individual's perception of their sexuality and sexual orientation.

Components of Sexual Health

  • Sexual Self Concept: Value of oneself as a sexual being.

  • Body Image: Sense of self that constantly changes with life (e.g., pregnancy, loss of limb, illness).

  • Gender-Role: Societal norms for gender-appropriate behaviors (e.g., boys=blue, girls=pink).

  • Androgyny: Blend of traditional gender roles (masculine and feminine).

    • Etymology: "andro" means male; "gyn" means female.

Gender Identity Definitions

  • Cisgender: Gender aligns with the sex assigned at birth.

  • Gender-binary: Concept referring to two genders (male & female).

  • Gender-fluid: Individual does not identify with a single gender.

  • Non-binary: Individual that does not identify exclusively as a man or woman.

  • Transgender (Trans): Identity does not conform to the sex assigned at birth; has no bearing on sexuality.

  • Transsexual: An outdated and possibly offensive term referring to individuals undergoing medical interventions like hormone therapy or gender-affirming surgery (GAS).

  • Gender transition: Period during which an individual embodies their identified gender.

  • Intersexed: Ambiguous sex organs at birth.

Sexual Orientation

  • Definition: The tendencies of an individual to experience sexual attraction to specific genders.

Types of Sexual Orientation

  • Homosexuality: Sexual and emotional attraction to the same gender.

  • Heterosexuality: Sexual and emotional attraction to the opposite gender.

  • Bisexuality: Sexual and emotional attraction to both genders.

  • Pansexual: Attraction to all genders and biological sexes.

    • Pansexuality is included under the bisexuality umbrella.

  • LGBTQ+: Represents lesbian, gay, bisexual, transgender, queer, and intersex individuals.

Sexual Development Stages

Birth to 12 Years

  • Sexual response begins before birth.

  • By age 3, children are aware of gender differences.

  • Ages 9-10, first signs of puberty may occur, including menstruation.

  • Education is paramount at this level.

Adolescence (12-18 Years)

  • Ages 12-13, primary and secondary sex characteristics continue to develop.

  • Sexual experimentation begins.

  • Education topics should cover:

    • Menarche (first menstruation)

    • Sexual health (STDs/STIs, birth control)

    • Relationship development

Young Adulthood (18-40 Years)

  • Intimate relationships are frequently formed.

  • Sexual identity is solidified.

  • Education continues to emphasize:

    • STD/STI awareness.

    • Relationship counseling.

    • Contraception considerations.

Middle Adulthood (40-65 Years)

  • Decreased hormone production.

  • Discussion shifts from quantity of sexual encounters to quality.

  • Relationship counseling becomes common.

Older Adulthood (65+ Years)

  • Sexual activity continues but may decline.

  • Physical changes and possible lack of a partner or privacy.

  • Education remains important for this age group.

Factors Affecting Sexuality

  • Cultural influences

  • Religious beliefs

  • Lifestyle choices

  • Knowledge base

  • Health and illness impacts:

    • Physical illnesses (e.g., cardiac issues, diabetes).

    • Mental health disorders.

    • Effects of medications (consult Table 30-1, pg. 1252).

    • Conditions like dysmenorrhea and dyspareunia.

    • Premenstrual syndrome (PMS).

Sexual Response Cycle

  • Stages include:

    • Desire

    • Excitement

    • Plateau

    • Orgasm

    • Resolution

Note

  • Refer to pages 1253-1254 and Table 30-2 for normal changes in the older adult.

Sexual Expression

  • Forms of sexual expression include:

    • Intimate relationships

    • Fantasies/erotic dreams

    • Masturbation

    • Shared touching

    • Sexual intercourse

    • Oral sex

    • Anal sex

    • Celibacy

    • Alternative sexual expressions (paraphilias).

Problems Affecting Sexuality

  • Sexually Transmitted Infections (STIs): Consult Table 30-3, pp. 1257-1258.

  • Dysmenorrhea

  • Premenstrual Syndrome (PMS)

  • Negative intimate relationships

  • Sexual harassment

  • Rape

  • Sexual response cycle disorders

  • Low libido

  • Arousal disorders/Orgasmic disorders

Sexual Assessment

  • Integral part of health assessment:

    • Topics to cover:

    • Pregnancy, fertility, contraception, etc.

    • Illnesses affecting sexual health (diabetes, heart disease, etc.).

    • Sexual health disorders.

    • Awareness of one's feelings is important while conducting a sexual assessment.

Common Questions for Sexual Assessment

  • Are you sexually active? With whom?

  • Any issues regarding sexual difficulties? (e.g., arousal, orgasm)

  • Any pain associated with sexual activity?

  • Is your sexuality influenced by your condition?

  • Any concerns unaddressed?

  • Any partner-related concerns?

  • Sexual history?

  • Medications?

Reference

  • See pages 1261-1262 for focused assessment details.

Physical Exam

  • Privacy: Essential during examination.

  • Conditions prompting sexual physical exams include:

    • Potential infertility

    • Lumps, sores, discharges, etc.

  • Inquire about the last sexual health exam (e.g., pap test, testicular exam).

  • Assessments assist nurses in identifying at-risk clients/problems.

Diagnosing (Nursing)

  • Nursing diagnoses related to sexuality may include:

    • Sexual Pattern, Ineffective: Related to conflict of sexual orientation.

    • Sexual Dysfunction: Related to lack of privacy.

Etiologies for Diagnosis

  • Deficient knowledge: Regarding STDs associated with sexual myths.

  • Disturbed body image: Examples include penis removal (penectomy) related to potential sexual rejection by a partner.

Planning Goals

  • Increase knowledge about sexual health.

  • Prevention strategies for pregnancy and STDs.

  • Improvement of sexual self-concept.

  • Maintenance of sexual health.

Nursing Interventions (Implementation)

Six Skills Key for Client Teaching

  • Self-awareness and comfort with one's sexuality.

  • Acceptance of sexuality as crucial education in nursing.

  • Knowledge of sexual growth and development.

  • Understanding common problems and potential interventions.

  • Therapeutic communication skills.

  • Awareness that clients require discussion around sexuality.

Sexual Health Teaching

Education Topics Include

  • Anatomy and physiology of sexual health.

  • Importance of self-examination.

  • Routine screenings.

  • Kegel exercises.

  • Prevention of pregnancy and STDs.

  • Parental counseling on sexual health topics.

  • Promotion of responsible sexual behavior.

  • Adherence to “No means No” policy.

  • Understanding menstruation and menopause.

  • Clarification on douching practices.

PLISSIT Model for Sexual Counseling

  • Permission: Give permission for clients to discuss sexual matters.

  • Limited information: Provide basic education addressing concerns.

  • Specific suggestions: Offer tailored advice based on client inquiries.

  • Intensive therapy: Referral to specialized counseling when required.

Inappropriate Behaviors

Reasons for Inappropriate Sexual Behaviors in Clients

  • Confusion about sexual norms.

  • Neurological disorders.

  • Mental health issues.

  • Poor impulse control.

  • Misinterpretation of nursing care or intent.

  • Power dynamics and control issues.

  • Anxiety related to sexual function.

  • Unrealistic beliefs about nursing roles.

Sexual Abuse

Overview

  • Occurrence: Sexual abuse can happen at any age.

  • Reporting: Obligated to file a report for suspected abuse, following laws that protect both children and elderly individuals.

  • Key takeaway: Nurses must report any occurrences of sexual abuse to the appropriate authorities.

Terminology

  • Dysmenorrhea: Painful menstruation.

  • Dyspareunia: Painful sexual intercourse.

  • Vaginismus: Involuntary muscle contractions during intercourse.

  • Vulvodynia: Chronic pain in the vulvar area.

  • Vestibulitis: Inflammation of the vaginal vestibule.

  • Gonorrhea: Bacterial STD.

  • Syphilis: Bacterial STD with systemic effects.

  • Genital Warts: Virus (HPV) causing lesions.

  • Chlamydia: Common bacterial STD.

  • Trichomoniasis: Parasitic infection causing irritation.

  • Candidiasis: Fungal infection commonly known as a yeast infection.

  • HIV/AIDS: Viral infection impacting immune function.

  • Herpes: Viral infection that causes sores.

Summary of NOF Competencies

Focus of Today's Lecture

  • Emphasis on comprehensive understanding of sexuality as it relates to nursing practices and patient care, aligned with NOF competencies, including:

    • Evidence-Based Practice

    • Quality Improvement

    • Safety

    • Patient-Centered Care

    • Professionalism

    • Leadership

    • Teamwork and Collaboration

    • Communication

    • Technology and Informatics

Questions

  • Open floor for questions and further discussion regarding the material covered.