1. Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Chapter 34 Sexuality

2. 2Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Sexual Health  According to WHO, sexual health is “a state of physical, emotional, mental and social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity.”  Nurses help patients achieve sexual health by having a sound scientific knowledge base regarding sexuality.  Sexual health contributes to an individual’s sense of self-worth and to positive interpersonal relationships.

3. 3Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Scientific Knowledge: Sexual Development and Sexual Orientation  Sexual development  Sexuality changes with each stage of development.  Sexual orientation  Describes the predominant pattern of a person’s sexual attraction over time  Heterosexual, homosexual, lesbian, gay, bisexual, transgender

4. 4Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Developmental Stages  Infancy and early childhood: gender identity  School-aged years: questions  Puberty/adolescence: emotional and physical changes  Young adulthood: emotional maturation  Middle adulthood: concerns re attractiveness  Older adulthood: physiological sexual response changes with aging, but aging does not lead to diminished sexuality

5. 5Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Adolescence

6. 6Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study  Nikki is a nursing student who volunteers at a free health clinic in a medium-sized college town. Nikki enjoys volunteering at the clinic because the nurses allow her to provide health care education to the young women who frequent the clinic. Much of Nikki’s teaching involves education about sexually transmitted infections (STIs) and reliable birth control methods.

7. 7Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Scientific Knowledge: Contraception  Nonprescription contraceptive methods:  Abstinence, barrier methods, spermicide, rhythm  Methods that require health care provider interventions:  Hormonal contraception, intrauterine device (IUD), diaphragm, cervical cap, sterilization (tubal ligation or vasectomy)

8. 8Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)  Nikki is educating Ms. Tamika Jones, a 16- year-old mother of three, regarding the benefits of practicing safe sex and using effective contraception. Nikki explains to Ms. Jones that sterilization is the most effective birth control measure aside from abstinence.  In females, sterilization is referred to as __________ __________, whereas in males, it is referred to as __________.

9. 9Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Scientific Knowledge: Sexually Transmitted Infections  About 19 million people in the United States are diagnosed each year with a sexually transmitted infection (STI); almost half of them are 15 to 24 years of age.  STIs are transmitted from infected individuals to partners during intimate sexual contact.  Usually curable STIs: syphilis, gonorrhea, chlamydia, trichomoniasis  Viral STIs: human papillomavirus (HPV) (genital warts) and herpes simplex virus (HSV) type II (genital herpes), human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS)

10. 10Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Treatment Barriers  Locating and treating people with STIs  Some people do not know that they are infected because symptoms may be absent or may go unnoticed.  Common symptoms include discharge from the vagina, penis, or anus; pain during sex or when urinating; blisters or sores in the genital area; and fever.  Any contact with another person’s body fluids around the head or an open lesion on the skin, anus, or genitalia can transmit an STI.  Embarrassment

11. 11Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Scientific Knowledge: Sexually Transmitted Diseases  Human immunodeficiency virus (HIV):  Primary routes of transmission include contaminated IV needles, anal intercourse, vaginal intercourse, oral-genital sex, and transfusion of blood and blood products.  Human papillomavirus infection (HPV):  Most common STI in United States; aka genital warts; spread through direct contact with warts, semen, or other fluids  Chlamydia (bacterial)  Causes infertility, pelvic inflammatory disease (PID), and neonatal complications

12. 12Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Nursing Knowledge Base: Factors Influencing Sexuality  Sociocultural dimension of sexuality  Impact of pregnancy and menstruation on sexuality  Discussing sexual issues Sexual assessment and interventions need to be included in health care. Nurses who have difficulty discussing topics related to sexuality need to explore their discomfort and develop a plan to address it.

13. 13Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Nursing Knowledge Base: Decisional Issues  Contraception  Factors that influence effectiveness: method of contraception, couple’s understanding of the method, consistency of use, compliance with method’s requirements.  Abortion  It is essential to choose specialties or places of employment where personal values are not compromised and the care of a patient in need of health care is not jeopardized.  STI prevention: only abstinence is 100% effective

14. 14Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)  Ms. Jones tells Nikki that she doesn’t think she’s at risk for STI.  Which of the following populations have the highest incidence of STI? (Select all that apply.) A. Hispanic women aged 15 to 24 B. African American men aged 15 to 24 C. Caucasian men aged 50 to 58 D. Caucasian women aged 42 to 53

15. 15Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Nursing Knowledge Base Alterations in Sexual Health  Infertility = Inability to conceive after 1 year of unprotected intercourse  Sexual abuse  Nurses must report suspected abuse to the proper authorities.  Conflicts  Sexual dysfunction = Absence of complete sexual functioning  Affected by illnesses and medications

16. 16Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Quick Quiz! 1. Upon admission, when gathering a patient’s sexual history, nurses should A. Focus only on physical factors that affect sexual functioning. B. Discuss sexual concerns only if the patient raises questions or concerns. C. Use emotionally laden terms when discussing sexual concepts. D. Include questions related to sexual function.

17. 17Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Case Study (cont’d)  Nikki informs Ms. Jones that she has tested positive for Chlamydia.  True or False: Chlamydia is the most common STI in the United States.

18. 18Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Nursing Process: Assessment  Factors affecting sexuality  Developmental stage  Physical and functional factors  Lifestyle  Relationship and psychological factors  Self-esteem factors that influence sexual functioning  By including sexuality in the nursing history, the nurse acknowledges that sexuality is an important component of health and creates an opportunity for the person to discuss sexual concerns.

19. 19Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Nursing Process: Assessment (cont’d)  PLISSIT Assessment of Sexuality:  Permission to discuss sexuality issues  Limited Information related to sexual health problems being experienced  Specific Suggestions—only when the nurse is clear about the problem  Intensive Therapy—referral to professional with advanced training if necessary

20. 20Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Assessment  Sexual health history  Most patients want to know how medications, treatments, and surgical procedures influence their sexual relationship even though they often do not ask questions.  Sexual dysfunction  Many illnesses, injuries, medications, and aging changes have a negative effect on sexual health.  Physical assessment  Teach breast and testicular self-examination.

21. 21Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Nursing Diagnosis AnxietyIneffective copingSocial isolation Interrupted family processes Deficient knowledge (contraception/ STIs) Sexual dysfunction Ineffective sexuality pattern Risk for other-directed violence Risk for self- directed violence

22. 22Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Planning  Nursing interventions for patients with sexual concerns focus on supporting patients’ need for intimacy and sexual activity.  Patients often feel overwhelmed and hopeless about returning to the previous level of sexual functioning.  They usually need time to adapt to physical and psychosocial changes that affect their sexuality and sexual health.

23. 23Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Implementation  Health promotion  Annual health examinations provide an opportunity to discuss contraception and safe sex practices.  Acute care  Illness and surgery create situational stressors that often affect a person’s sexuality.  Restorative and continuing care  In the home environment, it is important to provide information on how an illness limits sexual activity and to give ideas for adapting or facilitating sexual activity.

24. 24Copyright © 2013, 2009, 2005 by Mosby, an imprint of Elsevier Inc. Evaluation  What other questions do you have about your sexual health?  Did you experience less pain during sexual intercourse after taking your pain medication?  What barriers are preventing you from discussing your feelings and fears with your partner?