This document discusses sexuality and sexual health. It defines sexuality as encompassing various dimensions of being human including gender, sexual orientation, intimacy, and reproduction. Sexual health is defined as a state of physical, emotional, and social well-being related to sexuality. The document outlines factors that influence sexuality and components of sexuality including self-concept, body image, gender identity, and sexual orientation. It discusses the nurse's role in educating patients about sexuality and addressing barriers to providing such education. The effects of various diseases and injuries on sexuality are also summarized.

1. Expressing sexuality
Fundamental of nursing- Unit XIV
B G I S Ariyarathne
RN, Dip in teaching and supervision ,
Bsc Nsg (Hon) 1st class

2. Unit outcome
By the end of this unit students should
be able to applied holistic care for
patients with body changes, which
may effect sexuality

3. Specific outcomes
At the end of this lesson student
should be able to :
• explain the meaning of sexuality
• define the sexual health
• Explain relationship between body image and
sexuality
• describe how body changes affect on sexuality
• explain how nurse can support patients to
gain altered sexual health

4. Sex & Gender

5. Activity 1
• Take your smart phone & find out
what is meaning of sex and gender
• Write differences between sex and
gender

6. If people didn’t have a sex, it
would be the end of humanity

7. Sexuality
What is it?

8. Sexuality
• Sexuality is a natural and healthy
part of life.
• It is everything about being a male or
female.
• Sexuality is more than genital
physical activity
• It worth when sexual understanding
is positive.

9. Definition of Sexuality
sexuality is: “…a central aspect of being
human throughout life encompasses sex,
gender identities and roles, sexual
orientation, eroticism, pleasure, intimacy
and reproduction. Sexuality is experienced
and expressed in thoughts, fantasies,
desires, beliefs, attitudes, values,
behaviours, practices, roles and
relationships.

10. Definition of Sexuality cont…
While sexuality can include all of these
dimensions, not all of them are always
experienced or expressed. Sexuality is
influenced by the interaction of
biological, psychological, social,
economic, political, cultural, legal,
historical, religious and spiritual
factors.” (WHO, 2006a)

12. Sexual Health
• State of physical, mental, and social
well-being, in relation to sexuality. it is
not merely the absence of disease,
dysfunction or infirmity.
(World Health Organization)

14. Sexual health cont….
• Love, affection, and sexual intimacy
contribute to healthy relationships
and individual well-being
• But along with the positive aspects
of our human sexuality, there also
are illnesses, mixed emotions and
unintended consequences that can
affect our sexual health

15. Characteristic of sexually healthy
person:
• Person who have knowledge about
sexuality and sexual health
• One who has positive attitude
towards body image
– Ability to express one’s full sexual
potential
– Capability to express sexuality

16. Characteristic of sexually healthy
person cont…
–Right to make free and responsible
reproductive choice
–Ability to access sexual health
–Maintain balance between life style
and sexual behaviour
–Capacity to develop effective
interpersonal relation with both sexes

17. Characteristic of sexually unhealthy
person
• Jealousy
• Mood changes
• Lack of
communication
• Low self-esteem
• Anxiety
• Fear
• Guilty feelings
• Refuse sexual
activities
• Isolation
• Restlessness

18. Components of sexuality
1. Self concept
• This defines as how one values
oneself as a sexual being
• It determines the gender and a kind
of people a person is attracted to
• values about when, where and with
whom one expresses sexuality

19. Components of sexuality cont..
2. Body -image
• Body image is a person's perception
of the aesthetics or sexual
attractiveness of their own body

21. Components of sexuality cont..
2. Body -image cont..
• It involves how a person sees
themselves, compared to the
standards that have been set by
society
• it is constantly changing

22. some factors that may be related to
Disturbed Body Image:
• Permanent alteration in structure
and/or function (e.g., mutilating
surgery, removal of body part [internal
or external])
• Situational changes (e.g., temporary
presence of a visible drain or tube,
dressing, attached equipment;
pregnancy)

23. 3. Gender identity
• It is one's self image as a male or
female
• Expression of what is perceived as
gender appropriate behaviour

24. 4. Sexual Orientation
• It is defined as one's attraction to
people of
–opposite sex (heterosexual )

25. Same sex (homosexual)
• Lesbian Gay

26. Both sexes (bisexuals)

27. Factors influence sexuality
• Age
• Religious
• Values
• culture
• Personality
• Health Status
• Medication

28. Why nurses educate about sexual
health?
• Sexuality is always part of an
individual
• Professional nurse, as health care
providers, focus on the holistic
nature of care and have
responsibility to provide effective
sexual health care for their clients.

29. Why nurses educate about sexual
health? cont…
• It is essential that nurses have the
confidence to identify and meet
patients’ sexual health needs.
• Society's attitude towards sexuality is
changing
• Clients are more open to seeking
assistance in matters of pertaining to
sexuality.

30. Why nurses educate about sexual
health? cont..
• nurses can integrate information on
sexuality into the care given by
focussing on preventive, therapeutic,
and educational interventions to
assist individuals to attain, regain or
maintain sexual wellness

31. Why nurses need to know about
sexual behaviors of others
• In nursing care practice, the nurse is
always in contact with the body and
the sexuality of the other
• As it is the case in procedures such as
bed bathing, oral hygiene, intimate
hygiene, bladder catheterizing and
others

32. Why nurses need to know about
sexual behaviors of others cont..
• In view of this reality, better
education in the sexuality theme
would contribute for the knowledge
of the nurse , the client who is the
subject of their care
• It may help to minimize some
difficulties in the nurse -patient
relation

34. Barriers for giving sex education
lack of
–training in answering the patient’s
questions
–concerns about sex and sexuality.
• perceptions that patients do not
expect nurses to address sexuality
concerns.

35. Barriers ……
• lack of knowledge how to address
sexuality issues in patients with
altered body image and disease
conditions

36. Basic skills need for nurse on
sexual health
Self-knowledge and comfort with their own
sexuality
Acceptance of sexuality as an important area
for nursing and willingness to work with
Knowledge of sexual growth and
development according to age
Therapeutic communication skills
Knowledge of basic sexuality
Ability to recognize the need for all clients
and family members

37. Nurse’s role in sexual education
• The nurse should assure the client's
confidentiality of all data on sexuality
• Obtain permission from client before
making a referral for any sexual
problem.
• The nurse must convey to the client
and significant others a willingness to
discuss sexual thoughts and feelings

38. Nurse’s role in sexual education cont..
• Provide information to clients and
significant others on the effects of certain
situations on sexuality and sexual function
• Provide specific instructions that can
facilitate positive sexual functioning.
• Provide adequate permission to a client to
discuss sexual concerns if it is important to
part of client's nursing care.

39. Nurse’s role in sexual education cont..
• The nurse should give permission by
Including sexuality in the initial
health history and addressing
questions on sexuality in a manner
similar to questions on bowel and
bladder function.

40. Nurse’s role in sexual education cont..
• Offering to discuss sexual concerns at
appropriate times during the client's
hospitalization/visit.
• The nurse should refer people who
needs more help to an appropriate
health care professional (eg: sex
therapy, surgery).

41. Disease and Sexual Activity
• Physical health problems, of one’s
own and/or one’s partner, are
frequently the reason for refraining
from sexual activity; even if disease
does not affect sexual organs
themselves

42. Disease and Sexual Activity cont…
• Sexual response depends on the
cooperation of multiple systems of
body – hormonal, circulatory, and
nervous system.
• If any systems are disrupted, sexual
functioning can be affected

43. What psychological changes affect
intimacy & sexuality?
• Depression and anxiety
• Fear and embarrassment
• Grief and loss
• Myths about sex, aging, and illness
• Changes in roles
• Changes in body image

44. Injury, Illness, and Surgery
• Injury, illness, and surgery can affect
sexual function.
• Sexual ability may change
• Most chronic illnesses affect sexual
function

45. Injury, Illness, and Surgery cont..
• Reproductive system surgeries have
physical and mental effects.
• Impotence (erectile dysfunction) can
occur in men
• Changes in sexual function greatly
affect the person

46. Disorders that cause impotence
• diabetes mellitus
• spinal cord injuries
• multiple sclerosis
• alcoholism

47. Disorders affecting the ability to
have sex:
• stroke
• nervous system disorders
• heart disease
• chronic obstructive pulmonary disease
• circulatory disorders
• arthritis or conditions affecting mobility/
flexibility

48. Heart disease:
• People with angina or heart failure
and those who have undergone
coronary bypass surgery or have had
MI may avoid sex because of an
assumed risk to life
• Depression and anxiety are common
up to 1 year after MI
• Avoidance of sexual activity may
reinforce post-MI depression

49. Heart disease cont..
• Antidepressants may further reduce
sexual libido and capacity
• physical exercise and emotional release
associated with sexual activity may
contribute to patients’ improvement.
• Coronary bypass surgery can produce
prolonged sexual problems if the
patient is not closely monitored

50. Heart disease cont..
• Physical symptoms, side effects of
medications, or fear of sudden death
from physical exertion cause many
patients to experience sexual
dysfunction
• Exercise programs to improve cardiac
function( eg, increasingly strenuous
walking) can reassure patients who
are afraid to resume sexual activity

51. Critical thinking
A male client who had a heart attack 3 days
ago, grabs the female nurse’s breast and
buttock. What is her best response?
• You may not touch me in this way. I am
guessing that you may have some sexual
concerns since your heart attack
• Take your hands off of me and act your age.
This is no way for adult man behave.

52. • If you don’t stop touching me like this I
will be forced to have you assigned to a
male nurse
• Say nothing. Leave the room and ask the
charge nurse to reassign you to another
patient

53. Arthritis:
• Osteoarthritis and rheumatoid arthritis
may interfere with sexual desire or
performance
• Because of pain, stiffness, loss of joint
motion, and fatigue
• Such symptoms influences sexual
motivation as well as sexual
positioning and methods

54. Arthritis:
• A program of exercise, rest and warm
baths is especially useful in reducing
arthritic discomfort and in facilitating
sexual performance

55. Surgical Procedure
• Any surgical procedure has the
potential to after a person’s body
image
• specially when the surgery involves
mutilating, removing or altering part
of the body.
Eg, Amputation of leg, colostomy
Mastectomy ,hysterectomy

56. Disfiguring surgery may cause a person
to feel:
• unattractive and ugly to others
• mutilated and deformed
• unworthy of love or affection

57. Surgical Interventions affecting in
females
“Total” hysterectomy
• for cancer, fibroids, were common
for decades—the uterus and ovaries
(i.e., an oophorectomy) were both
removed

58. Hysterectomy:
• oophorectomy decreases
testosterone and other androgen
levels
• If there is injury to the nerves during
the surgery, hysterectomy may have
an adverse effect on sexual arousal
and orgasm

59. Hysterectomy
• Emotional reactions, eg, feelings of
depression, after hysterectomy are
common
• Require psychotherapy.
• Abstinence for 6-8 weeks after
hysterectomy is usually advised

60. Mastectomy:
• For many women, deep psychologic
effects following a mastectomy result
from a sense of sexual mutilation.
• Women may temporarily lose their
sexual desire because of
embarrassment, inability to accept
the loss of the breast or fear that
they have become less attractive to
their sexual partners.

61. Mastectomy cont…
• Periodic depression, with sexual
consequences is common and should
be expected during the first year or 2
postmastectomy.
• Rehabilitation programs help women
and their spouses deal with the
physical, psychologic, and cosmetic
concerns of breast surgery
• Couples should share feelings openly
and support each other emotionally.

63. In males…
Vasectomy
• Sterile, but has no impact on
testosterone levels or masculine
Castration
Treatment for advanced prostate
cancer, used to reduce testosterone
which helps the cancer cells to grow

64. Effects of Castration
Before puberty:
• No facial or body hair; taller
• Not necessarily impotent, but low
libido
• High pitched voices (hence the
“castrati”)

65. Effects of Castration cont…
After puberty:
• Same menopausal symptoms as women
• Reduced sex drive; impotence common
• Loss of body hair, but not facial hair
• No change in voice
• Memory impairment
• Reduced sense of masculinity
• Depression

66. Colostomy and ileostomy:
• Patients who were sexually active
before surgery usually continue to be
so afterward, although adjustment
can be complex.
• Couples should be given medical
guidance and offered psychologic
counselling.

67. Amputation
• Amputation is a life-changing event
that leads to depression along with
the challenges it brings
• It affects the lives of individuals in
terms of various limitations in
professional performances; social,
entertaining and sexual activities

68. Amputation cont…
• But, in all societies, the sexuality of
individuals with disabilities is being
ignored and almost never mentioned
in this field
• need rehabilitation practice and
counseling on sexuality after
amputation

69. Effects of Drugs
• Many drugs adversely affect
sexuality.
• Some interfere with the autonomic
nervous system
• Others affect mood and alertness or
change the production or action of
sex hormones.

70. Effects of Drugs
• Patients who develop sexual problems
and suspect that their medications are
the cause may be tempted to
discontinue the drugs or decrease the
dosages without informing their
physician.
• It is best to discuss this possibility
openly with patients and encourage
them to report any side effects.

71. Summary

73. Assignment
Older adult frequently experience a
change in sexual activity
• Explain this statement

74. References
Kozier, B., Erb, G., Berman, A. & Burke, K. (2007),
Fundamentals of Nursing; Concepts, Process, and
Practice (7th ed.). New York: Pearson Education.
Potter, P. A. & Perry, A. G. (2005). Fundamentals of
Nursing (6th ed.). Missouri: Mosby