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Ch33 sexual health
1. JUDITH M. WILKINSON LESLIE S. TREAS
KAREN BARNETT MABLE H. SMITH
FUNDAMENTALS OFFUNDAMENTALS OF
NURSINGNURSING
Chapter 33:Chapter 33:
Sexual HealthSexual Health
<<Instructor: Review each bulleted item with the students.>>
<<Instructor: Review each bulleted item while referring to the following notes.>>
Transgender is a broad term used to describe people whose gender identity differs in some way from their apparent biological gender. For example, some people think of themselves as female even though they have male genitalia. Longitudinal studies have shown that transgendered persons may be transsexual, intersexed, or cross-dressing; and heterosexual, homosexual, or bisexual (Dickinson, Cook, Playle, et al., 2012; Walsh, Barnsteiner, De Leon Siantz, et al., 2012).
Transsexual are people who identify with the opposite gender from their biology—for example, a person with the physical appearance and reproductive organs of a woman who “feels” and perceives herself to be a man. It is common for transsexuals to express dissatisfaction with their gender at an early age. They may insist that they will grow up to be the opposite gender. Their preference for dress and play is more typical of those of the other gender.
Intersexed people are born with ambiguous sexual organs.
Cross-dresser (or transvestite) is a person who occasionally or frequently wears the clothing characteristic of the opposite sex, particularly the undergarments, as a form of sexual expression. Often the person carries out this behavior in secret. Cross-dressers may be heterosexual, homosexual, or bisexual.
<<Instructor: Review these definitions with the students.>>
<<Instructor: Select the most appropriate answer to this question using your clicker.>>
<<Instructor: The correct answer is D.>>
<<Instructor: Review each bulleted item while referring to the following notes.>>
Culture: Culture influences our ideas about gender role, gender identity, marriage, sexual expression, and social responsibilities. However, it is not unusual for people to be ethnocentric—that is, to see their own culture and sexual behaviors as the norm for all. Because the United States is a multicultural country, beliefs and practices related to human sexuality vary widely.
Religion: Religious practices restricting premarital sex, birth control, homosexuality, abortion, extramarital relationships, and masturbation are common. Some religions have rules about body coverings, modesty, and restricting opposite gender healthcare providers.
Lifestyle: Family, socioeconomic status, employment factors, and interpersonal relationships shape our lifestyle, although they do not fully determine it.
Knowledge about sex: Community values play a large role in determining how sexuality is viewed and taught. Thus, even if a state mandates sex education, a particular school may limit discussion on reproduction, sexually transmitted infections (STIs), birth control, intimacy, exploitive relationships, domestic abuse, or rape, believing that these topics are best addressed by the family or church.
Health status: Sexuality involves body, mind, and spirit; so, it is not surprising that health status affects sexuality.
<<Instructor: Review these concepts with the students.>>
<<Instructor: Select the most appropriate answer to this question using your clicker.>>
<<Instructor: The correct answer is C.>>
<<Instructor: Review these bulleted items while referring to the following notes.>>
Intimate relationships: This involves a willingness to take risks and offer trust. Intimacy involves openness, mutual respect, caring, commitment, protection, honesty, and devotion. Although we often think of intimate relationships as sexual, they are not necessarily so.
Fantasies/erotic dreams: Sexual fantasies serve to increase self-esteem and sexual arousal and serve as an outlet to explore sexual desires. Fantasies may occur without sexual activity, during masturbation, or during intercourse. People in long-term monogamous relationships may fantasize to bring variety and excitement into a routine sexual encounter. Erotic dreams are also common among both men and women. Nocturnal orgasm may or may not occur.
Self-stimulation: Although there are many techniques, men typically hold and stroke the shaft of the penis, and women typically stimulate the clitoris manually.
Shared touching: This is particularly appealing to individuals who seek to maintain virginity, wish to decrease the risk of sexually transmitted infection, or have mobility or other physical problems that make intercourse difficult. Mutual masturbation is recognized as a form of safer sex because body fluids are not likely to be exchanged.
<<Instructor: Review each bulleted item while referring to the following notes.>>
Oral sex: Both heterosexual and homosexual couples practice oral-genital stimulation (oral sex). Couples in committed relationships may engage in it for sexual variety or as foreplay. Others may engage in oral sex because it provides intimacy yet cannot result in pregnancy, and many believe that it does not affect their virginity status.
Intercourse: This term is used to describe penile penetration of the vagina. People use a variety of positions for intercourse, depending on preference, mobility, cultural and religious influences, the relationship, and other personal beliefs. For some women, manual stimulation of the clitoris is also necessary to achieve orgasm. Partners typically do not reach orgasm at the same time, despite the romantic preoccupation with this phenomenon.
Celibacy: This is a state in which an individual refrains from sexual activity. Traditionally, a celibate is a person who remains unmarried, often for religious reasons, and sublimates sexual desire through prayer, meditation, and service. However, some people choose to remain celibate out of fear of or lack of desire for intimate relationships.
<<Instructor: Review each bulleted item while referring to the following notes.>>
Sexually transmitted infections (STIs): They are spread by direct contact with an open wound or with body fluids, such as semen, vaginal secretions, or blood that contains pathogens. An STI may be caused by bacteria, viruses, fungi, or parasites.
Dysmenorrhea: This is painful menstruation caused by strong uterine contractions that cause ischemia of the uterus. It is most common among adolescents and women experiencing perimenopause. The patient may experience cramping, lower abdominal pain, back and upper thigh pain, headache, vomiting, and diarrhea. Treatments include bedrest, application of heat to the back and abdomen, and analgesics such as aspirin and other nonsteroidal anti-inflammatory drugs (NSAIDs), for example, ibuprofen or naproxen.
Premenstrual syndrome (PMS): This is characterized by physical and emotional changes occurring 3 to 14 days before the onset of the woman’s menstrual period. Physical symptoms include headaches, constipation, breast tenderness, and weight gain associated with bloating, abdominal swelling, or swelling of the hands and feet. Some women feel as though they are on an emotional roller coaster, with periods of depression, anxiety, irritability, tension, and an inability to concentrate.
Negative intimate relationships: Couples may be involved in a celibate or loveless union for financial security, social status, for “the sake of the children,” or because of cultural or religious restrictions regarding divorce. The most negative relationships involve domestic violence (also called intimate partner violence), which may include physical and/or emotional intimidation, assault, and rape.
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Sexual harassment occurs when a person in power makes unwanted sexual advances that implicitly or explicitly relate to the victim’s employment, academic status, or success. “Advances” can take the form of sexual comments or behaviors (such as touching). Because of the power imbalance, the victim may keep silent and suffer physically and psychologically. Sexual assault includes contact with or without penetration, and touching sexual or intimate parts, and any unwanted sexual activity in situations of intoxication, coercion, or misconception.
Rape is nonconsensual vaginal, anal, or oral penetration. It occurs through force, by the threat of bodily harm, or when the victim is incapable of giving consent. In all states, laws consider rape within a marriage a crime.
Low libido may affect both men and women. Factors contributing to hypoactive sexual desire include sexual trauma, a negative attitude toward sex, negative relationships, and biological factors, including hormone deficiencies, perimenopause, and side effects of various medications. Low sexual desire, in both men and women, in some cases may respond positively to testosterone administration.Arousal disorders: In women, arousal disorders manifest as minimal or absent pelvic congestion and vaginal lubrication even though desire may be present. Hormonal changes, the aging process, tampons, and medications, including antihistamines, also cause vaginal dryness. Vaginal dryness may result in dyspareunia, or painful intercourse, which further decreases sexual desire. A water-based lubricant or saliva helps to resolve vaginal dryness.
Orgasmic disorders are a delay in or absence of orgasm after a normal sexual excitement phase.
<<Instructor: Review each bulleted item with the students and encourage discussion on each point.>>
<<Instructor: Select the most appropriate answer to this question using your clicker.>>
<<Instructor: The correct answer is C.>>
<<Instructor: Review each bulleted item while referring to the following notes.>>
Body function/reproduction: Explore your client’s knowledge base by asking open-ended questions such as “What questions do you have about sex?” As part of your general discussion on sexuality and bodily function, you may wish to discuss common myths and misconceptions about sex.
Menstruation: Some women enjoy sex more during menstruation because the increased vascularity and lubrication in the pelvic region increases their pleasurable sensations, and orgasm may relieve their menstrual cramps. Some men, too, enjoy the warm, wet sensations.
Premenstrual syndrome: Nonpharmacological treatments include getting adequate sleep; eating small, frequent meals; reducing sugar, caffeine, alcohol, and salt in the diet; taking vitamin and mineral supplements; and exercising. Selective serotonin reuptake-inhibiting drugs (SSRIs) such as fluoxetine (Prozac) and sertraline (Zoloft) are increasingly being used as a front-line therapy for managing symptoms of PMS.
Perimenopause: Counsel women to discuss the risks and benefits of hormone replacement therapy (HRT) with their primary care provider, and inform them that there are some natural remedies and bioidentical therapies that may provide symptom relief.
<<Instructor: Review each bulleted item while referring to the following notes.>>
Breast and testicular self-exam: The American Cancer Society (2012, updated 2013) recommends self-breast exams as an option for women in their 20s. Women should have yearly mammograms to screen for breast cancer after age 40.
The American Cancer Society (ACS) (2012) advises men to be aware that a lump in the testicle could be a sign of testicular cancer. However, because the benefit of testicular self-exams has not been studied enough to show they reduce the death rate from this cancer, the ACS does not make a recommendation about monthly self-exams.
Preventing STIs: Teach your clients the proper use of condoms and encourage them to discuss sexual feelings, activity, and safety with their partners.
Contraception: For clients who are heterosexual or bisexual, your sexual health teaching may include methods for preventing unwanted pregnancies.
Counseling for sexual problems: Nurses may do the first three stages of the PLISSIT.
Permission: You communicate an open, accepting attitude so that the client feels free to ask open-ended questions and express concerns and feelings about engaging in sexual behaviors with a consenting partner.
Limited information: Supplying limited information may include teaching about normal sexual functioning, expected changes in sexual functioning, medication side effects, and medical and surgical impacts on sexuality.
Specific suggestions: You make specific suggestions for self-care.
Intensive therapy: If these interventions do not relieve the client’s concerns, you should refer the client to someone with specialized knowledge of sexual health.
<<Instructor: Encourage student discussion regarding the identified question.>>
