Sexuality

Terminology and Concepts

Sexuality is a multifaceted aspect of human health, encompassing biological sex, sexual activity, gender identities and roles, and sexual orientation. Sexual health integrates somatic, emotional, intellectual, and social aspects in ways that enrich individual well-being.

• Sexuality: Includes biologic sex, sexual activity, gender identity, gender roles, and sexual orientation.

• Sexual health: The positive integration of physical, emotional, intellectual, and social aspects of sexuality.

Sexual Identity

Sexual identity is shaped by self-perception, chromosomal development, gender identity, gender role behavior, and sexual orientation.

• Biologic sex: Determined by chromosomal development (XX for female, XY for male).

• Gender identity: Internal sense of being male, female, or another gender.

• Gender role behavior: Expression of gender through actions and appearance.

• Sexual orientation: Pattern of romantic or sexual attraction (e.g., heterosexual, homosexual, bisexual).

Additional Terminology

• Gender expression: How individuals present their gender externally.

• Gender diverse: Individuals whose gender identity or expression differs from societal expectations.

• Gender dysphoria: Distress due to incongruence between assigned sex and gender identity.

• Cisgender: Gender identity matches sex assigned at birth.

• Transgender: Gender identity differs from sex assigned at birth.

• Gender binary: Classification of gender into two distinct forms (male and female).

• Gender fluid: Flexible range of gender expression or identity.

Sexual Orientation

• Heterosexual: Attraction to the opposite gender.

• Gay or lesbian: Attraction to the same gender.

• Bisexual: Attraction to both genders.

• Asexual: Lack of sexual attraction to others.

• Questioning: Exploring or uncertain about sexual orientation.

Sexual Expression

Sexual expression ranges from adaptive to maladaptive behaviors and includes various forms of sexual activity.

• Masturbation

• Sexual intercourse: Vaginal or anal

• Oral–genital stimulation

• Abstinence

• Alternative behaviors: Voyeurism, sadism, masochism, sadomasochism, pedophilia (maladaptive)

Factors Affecting Sexuality

Influencing Factors

Sexuality is influenced by developmental, cultural, religious, ethical, and lifestyle factors.

• Developmental considerations: Age and stage of life affect sexual expression.

• Culture: Cultural norms shape sexual behaviors and attitudes.

• Religion: Religious beliefs may influence sexual practices.

• Ethics: Personal and societal values impact sexual decisions.

• Lifestyle: Choices and habits affect sexual health.

Menstruation and Menstrual Cycle

Phases of Menstruation

Menstruation is normal vaginal bleeding preparing for the possibility of pregnancy. The menstrual cycle consists of four phases:

• Follicular: One follicle produces a mature ovum.

• Proliferation: Endometrium becomes thick and velvety.

• Luteal: Corpus luteum develops.

• Secretory: Endometrial lining disintegrates.

• Menopause: Cessation of menstrual activity.

Causes of Menstrual Cycle Irregularities

• Pregnancy or breast-feeding

• Eating disorders, extreme weight loss, extreme exercise

• Polycystic ovary syndrome (PCOS)

• Premature ovarian failure

• Pelvic inflammatory disease (PID)

• Uterine fibroids

Sexual Response Cycle

Phases of Sexual Response

The sexual response cycle consists of four phases:

• Excitement: Initial arousal, increased heart rate and blood flow.

• Plateau: Heightened arousal, muscle tension increases.

• Orgasm: Climax with involuntary spasmodic contractions of genital organs.

• Resolution: Relaxation and return to baseline.

Sexually Transmitted Infections (STIs)

Common STIs

STIs are infections transmitted through sexual contact. Common examples include:

• HIV

• Bacterial vaginosis (BV)

• Chlamydia

• Cytomegalovirus

• Genital herpes

• Gonorrhea

• Human papillomavirus (HPV)

• Syphilis

• Trichomoniasis

Prevention of STIs

• Delay sexual relations as long as possible

• Have regular checkups for STIs

• Learn common symptoms of STIs

• Avoid sex during menstruation

• Avoid anal intercourse

• Avoid douching

Sexual Dysfunction

Male Sexual Dysfunction

• Erectile dysfunction: Inability to achieve or maintain an erection.

• Premature ejaculation: Ejaculation occurs sooner than desired.

• Delayed ejaculation: Difficulty or delay in ejaculation.

Female Sexual Dysfunction

• Inhibited sexual desire: Reduced interest in sexual activity.

• Dyspareunia: Painful intercourse.

• Vaginismus: Involuntary contraction of vaginal muscles.

• Vulvodynia: Chronic pain in the vulva.

Effects of Illness, Injury, and Medications on Sexuality

• Diabetes mellitus

• Cardiovascular disease

• Diseases of the joints and mobility

• Surgery and body image

• Spinal cord injuries

• Chronic pain

• Mental illness

• Medications

Sexual Harassment

Forms of Sexual Harassment

• Quid pro quo: Something withheld in exchange for something else.

• Environmental (hostile environment): Unwelcome sexually oriented and gender-based behaviors.

Hostile Work Environment

• Sexual bantering

• Sexual joking

• Offensive pictures and language

• Sexual innuendoes

• Sexual behavior

• Unwanted attention

Responding to Patient Advances

• Be self-aware

• Confront and provide feedback to patient

• Set limits

• Enforce stated limits

• Report and document the incident; submit to supervisor

Responding to Harassment by a Coworker

• Confront immediately

• Document date, time, and description

• Consult a supervisor

• File a grievance if behavior does not stop

• Seek legal advice

Sexual Health Assessment

Nursing History

• Reproductive history

• History of STIs

• History of sexual dysfunction

• Sexual self-care behaviors

• Sexual self-concept

• Sexual functioning

The BETTER Model Acronym

• BRING up the topic of sexuality

• EXPLAIN concern with all aspects of patients’ lives affected by disease

• TELL patients that sexual dysfunction can happen and will be addressed

• TIMING is important to address sexuality with each visit

• EDUCATE patients about side effects of treatments

• RECORD assessment and interventions in medical records

Physical Assessment

• Physical examination

• Annual gynecologic exam with pap smear

• Suspected STI

• Suspected pregnancy

• Workup for infertility

• Unusual lump, discharge, or appearance of genital organs

• Request for birth control

• Change in urinary function

Patient Outcomes Regarding Sexuality

• Define individual sexuality

• Establish open communication with significant others

• Develop self-awareness and body awareness

• Describe responsible sexual health self-care practices

• Practice responsible sexual expression

Implementation in Sexual Health Care

• Establish a trusting nurse-patient relationship

• Teach about sexuality and sexual health

• Promote responsible sexual expression

• Contraception

• Facilitate coping with special sexual needs

• Address health care needs of LGBT individuals

• Advocate for patients’ sexuality needs

• Counsel regarding sexuality, abortion, abusive relationships, and rape

Methods of Contraception

Types of Contraception

• Behavioral

• Barrier

• Hormonal

• Intrauterine devices

• Emergency contraception

• Sterilization

Barrier Methods of Contraception

Example: Diaphragm as Barrier Method

• The diaphragm is a barrier method of contraception in which a dome-shaped rubber device is placed in the vagina before sexual activity to prevent semen from coming into contact with the cervix.

Summary Table: Sexual Response Cycle

Summary Table: Common STIs

Additional info: Academic context was added to clarify definitions, expand explanations, and provide self-contained study notes suitable for exam preparation.