Rnsg 1413 Sexuality Fall 2006[1]

Chapter 27 Sexuality

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Sexual Development • Pre-school–becomes aware of the differences of the sexes and perceives that he or she is male or female. This is characterized by an interest in his or her genitalia. Spend more time with the parent of the same sex. • School-age years- this is when a child may learn how and why his or her anatomy differs from that of other children. Mosby items and derived items © 2005 by Mosby, Inc.

Sexual Development • Puberty/adolescence- strong emotional and physical changes. Peers influence defining behavior. Explore primary sexual orientation. • Young adulthood– sexuality is often described as a basic need, but sexual can also be channeled into other intimacy. Want to do Kegel exercises. May have changes when children are born. May have changes due to medications. Mosby items and derived items © 2005 by Mosby, Inc.

Sexual Development • Middle adulthood- when children leave home this will change the intimacy dynamic either for the better of the worse. If taking antihypertensives this may lead to impotence. Some women may experience dyspareunia. These conditions are not to be expected or normal. Mosby items and derived items © 2005 by Mosby, Inc.

Sexual Development • Older adulthood: should expect sexuality. May have decrease lubrication due to decreased estrogen in older females. Orgasms may not last as long.

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Sexual Response Cycle Kaplan (1979) identified three phases of the sexual response. • Desire • Arousal • Orgasm These phases are a result of vasocongestion and myotonia(neuromuscular tension) Mosby items and derived items © 2005 by Mosby, Inc.

Sexual Orientation • Heterosexual-70% • Homosexual– 10% of the population • Bisexual- 20%

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Contraception • Nonprescription methods – Abstinence- only sure thing – Barrier methods- condoms and diaphragm, these must be used in combination with contraceptive cream or jelly. – Timing methods- not recommended

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Contraception (cont'd) • Prescription/health care intervention methods – Hormonal– pills/patch/IUD, implants, injections – Intrauterine devices-- IUD – Diaphragm/cervical cap- use with spermicidal jelly or cream – Sterilization- tubal or vasectomy Mosby items and derived items © 2005 by Mosby, Inc.

Sexually Transmitted Diseases • Syphilis • Gonorrhea • Chlamydia • Trichomoniasis • Human papillomavirus (HPV) • Herpes simplex virus (HSV) Bacterial STD’s can be treated with a full course of antibiotics. Viral infections can not be treated. Mosby items and derived items © 2005 by Mosby, Inc.

Sexually Transmitted Diseases (cont'd) • Human immunodeficiency virus (HIV) • AIDS – Transmission – Exposure categories – Education

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Decisional Issues Related to Sexuality • Contraception • Abortion • STD prevention

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Alterations in Sexual Health • Infertility- choices of adoption or medication. • Sexual abuse- may begin, continue, or even intensify during pregnancy. • Personal and emotional conflicts • Sexual dysfunction- medications, impotence, vaginismus Mosby items and derived items © 2005 by Mosby, Inc.

Assessment • If the patients asks a question about it. • Inappropriate sexual advances from a patient • If patient partner mentions it • If patient needs education on contraception and STD’s. Mosby items and derived items © 2005 by Mosby, Inc.

Planning • Goals and outcomes– what would be an appropriate outcome expected with sexual dysfunction due to use of anti-depressants? • Priorities • Continuity of care

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Case Study Your current clinical experience is in a community health care setting. You are conducting the initial interview with a 48-year-old man who started taking antihypertensives 2 weeks ago. You take his blood pressure and find it to be 136/74 mm Hg. You ask him how he has been doing since his last visit. He looks down at the floor and says, “Oh, OK, I guess. Seems like I’m just getting old now.” What kind of follow-up would be indicated based on this information? Mosby items and derived items © 2005 by Mosby, Inc.

Possible Answer •

The client’s verbal response and nonverbal behavior (looking down at the floor) suggest that he may have concerns. You might want to make an opportunity for him to discuss any concerns. Possible openings could be “You sound kind of discouraged” or “Sometimes when people begin antihypertensive medications they notice various side effects. Have you noticed anything different since you began the medicine?” Mosby items and derived items © 2005 by Mosby, Inc.

Case Study You are assigned to care for a 15-year-old girl who was admitted after a motor vehicle accident. Yesterday she had an internal fixation of a fractured ankle. In gathering her nursing history, you explore sexuality and learn that she has just recently become sexually active with her boyfriend of 3 months. When you ask about safe sex and the use of birth control, she tells you that she knows she does not have to worry about STDs with him because he is just not one of those kinds of boys. In regard to birth control, she says that her boyfriend has reassured her that because he is pulling out before ejaculation, there is no risk of her becoming pregnant. How would you proceed, given these assessment data? Mosby items and derived items © 2005 by Mosby, Inc.

Possible Answer •

Two issues are evident here. One issue is her assumption that she is not at risk for STDs, and the second is her misconception about pregnancy risk. Because she has shared this information with you, she likely trusts you enough to continue with some discussion regarding sexuality. No one way exists to approach this situation. Several approaches may be successful. One approach would be to inquire about her knowledge of STDs. When you have a sense of her background, you could either provide information to clarify or fill in missing information regarding her possible risk for STDs.

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Continuation • Another valuable intervention would be to inquire about sexual history, safe sex, and/or contraception with her partner. Often adolescents are uncomfortable discussing sexually related issues with a partner. Providing her with an opportunity to role play how she might ask these questions could be very helpful to her. Finding the words to say it and the concern about how the conversation might flow are often the most difficult aspects of bringing up a sexually related topic with a partner. Once the topics are openly discussed, you can provide information and referral, as appropriate. (let’s role play)

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Case Study You are working on a rehabilitation unit and caring for a 67-year-old man who had a stroke 3 weeks ago. He shares a room with another man who is recovering from a stroke. He has been progressing in his self-care skills and is now able to get around with a cane, feed himself, and do most of his bath. His wife is in fairly good health, and the plan is for him to return home within the next 1 to 2 weeks. As you work with him one morning, he says to you, “You know, one of the things that is hardest about being here is not being able to sleep in the same bed as Greta. I miss her so much. Even though she visits every day, it is just not the same.” How would you explore his comment, and what planning would you consider? Mosby items and derived items © 2005 by Mosby, Inc.

Possible Answer •

First, you would want to gather information to determine what aspects of sleeping with his wife he misses. You might say something like “What part of sleeping with her do you miss most?” or something that acknowledges more clearly a possible sexual concern such as “Many couples are sexually active after one partner has had a stroke. Is sexuality part of your concern?” The tactic that you use will likely depend on several factors: your own comfort with discussing sexuality; the amount of assessment data that you have gathered thus far; trust and comfort level; and observations that you have made about the couple’s relationship (i.e., presence of touching and closeness). Mosby items and derived items © 2005 by Mosby, Inc.

Continuation • If privacy for physical intimacy (whether it is touching or more intimate sexuality) is part of what he misses, you will want to explore the possibilities for privacy within the facility. In a rehabilitation situation, privacy for sexual expression is likely an issue for clients. The facility may have made arrangement for private space. If a private space is unavailable, exploring how to make his room available while providing an acceptable space for the roommate may be a viable option. Mosby items and derived items © 2005 by Mosby, Inc.