sexuality and reproduction

1. Kozier & Erb's Fundamentals of Nursing, 8e
Berman, Snyder, Kozier, Erb
Copyright 2008 by Pearson Education, Inc.
Chapter 40
Sexuality

2. Copyright 2008 by Pearson Education, Inc.
Multimedia Directory
Slide 29 Gender Identity: Sexual Preference Video 1
Slide 30 Gender Identity: Sexual Preference Video 2
Slide 31 Gender Identity: Sexual Preference Video 3

3. Copyright 2008 by Pearson Education, Inc.
Learning Outcomes
1. Describe sexual development and concerns
across the life span.
2. Define sexual health.
3. Discuss the varieties of sexuality.
4. Give examples of how the family, culture,
religion, and personal ethics influence one’s
sexuality.
5. Describe physiologic changes in males and
females during the sexual response cycle.

4. Copyright 2008 by Pearson Education, Inc.
Learning Outcomes
6. Identify the forms of male and female sexual
dysfunction.
7. Identify basic sexual questions the nurse
should ask during client assessment.
8. Formulate nursing diagnoses and interventions
for the client experiencing sexual problems.
9. Recognize health promotion teaching related
to reproductive structures.

5. Copyright 2008 by Pearson Education, Inc.
Pretest
• Use your clickers to complete the following
pretest.

6. Copyright 2008 by Pearson Education, Inc.
Question 1
Clients are least likely to introduce the topic of sex with
health care providers for which of the following
reasons?
1. They assume that health care providers know little
about sexual functioning.
2. Most clients have few, if any, questions or problems.
3. Female clients prefer to discuss problems with female
health care providers.
4. They are too embarrassed to introduce the topic of
sex.

7. Copyright 2008 by Pearson Education, Inc.
Rationales 1
1. Most people assume that providers have a
great deal of information.
2. Many clients have questions and concerns.
3. While talking with someone of the same
gender may make it easier for some women, it
is not a requirement for assessment and
intervention.
4. Correct. Clients still may feel a great deal of
shame and discomfort regarding sexuality.

8. Copyright 2008 by Pearson Education, Inc.
Question 2
A nurse receives information that a client is a
transsexual. Appropriate care is based on this
knowledge. Which of the following is most
representative of this client?
1. Gonadal gender, internal organs, and external genitals
are contradictory.
2. Sexual anatomy is not consistent with gender identity.
3. Sexual attraction is to individuals of both genders.
4. Gender identity is altered by acute psychosis.

9. Copyright 2008 by Pearson Education, Inc.
Rationales 2
1. Option 1 is the definition of intersex.
2. Correct. Transsexuals’ anatomical
gender is not the same gender as they
feel themselves to be.
3. Option 3 is the definition of bisexuality.
4. Transsexuality is a lifelong belief and not
altered by an acute condition.

10. Copyright 2008 by Pearson Education, Inc.
Question 3
A male client is beginning an antidepressant medication. Which of
the following should be included in the teaching?
1. “Your partner will be pleased because your sexual functioning is
going to improve.”
2. “You may find that your desire for sex will decrease while on this
medication.”
3. “Retrograde ejaculation is a common problem when taking
antidepressants.”
4. “Your skin will probably become supersensitive to touch, so you
may need to change your activity during sex.”

11. Copyright 2008 by Pearson Education, Inc.
Rationales 3
1. If the depression lifts, there may be an
improvement but the focus in option 1 is on the
partner rather than where it should be—on the
client.
2. Correct. Orgasmic response and sex drive
are often inhibited by antidepressants.
3. Retrograde ejaculation is associated with
removal of the prostate.
4. Skin hypersensitivity is not a side effect of
antidepressant medications.

12. Copyright 2008 by Pearson Education, Inc.
Question 4
A client who had a hysterectomy 3 days ago, says to
the nurse, “I no longer feel like a real woman.” What is
the best response?
1. “Don’t worry about that. The feeling will probably go
away.”
2. “You should talk to your doctor about how you feel.”
3. “I don’t blame you. I would feel like half a woman also.”
4. “I hear your concern. Tell me more about your
feelings.”

13. Copyright 2008 by Pearson Education, Inc.
Rationales 4
1. Option 1 is an unprofessional response and
false reassurance. The ANA Code of Ethics
indicates that clients are entitled to a timely
and appropriate response to their needs.
2. Option 2 suggests postponing the discussion
and that the physician is the better person to
deal with her concerns, which is untrue.
3. Option 3 represents feeding into her negative
self-concept and inappropriate self-disclosure.
4. Correct. More information is needed before
intervening. Also, the client needs the
opportunity to express her feelings.

14. Copyright 2008 by Pearson Education, Inc.
Question 5
A 75-year-old male client reports decreased frequency
of sexual intercourse although he does not express
dissatisfaction or difficulty. He seems a little
embarrassed by the discussion but is engaged and
asks some questions. An appropriate nursing
diagnosis would be which of the following?
1. Sexual Dysfunction
2. Disturbed Body Image
3. Sedentary Lifestyle
4. Readiness for Enhanced Knowledge

15. Copyright 2008 by Pearson Education, Inc.
Rationales 5
1. It does not suggest pathology.
2. It does not suggest disturbed body image.
3. It would be incorrect to assume his lifestyle is
sedentary merely because the frequency of his
sexual activity has decreased.
4. Correct. A change in sexual frequency is not
abnormal but may suggest an opportunity for
enhanced knowledge if he desires. Further
assessment of the reason for the decrease in
sexual activity is indicated.

16. Copyright 2008 by Pearson Education, Inc.
Sexual Development:
Birth to 18 Months
• From birth, infants assigned gender of
male or female
• Infant gradually differentiates self from
others
• External genitals are sensitive to touch
• Males have penile erections
• Females have vaginal lubrication

17. Copyright 2008 by Pearson Education, Inc.
Sexual Development:
Toddler (1-3 Years)
• Continues to develop gender identity
• Can identify own gender

18. Copyright 2008 by Pearson Education, Inc.
Sexual Development:
Preschooler (4-5 Years)
• Becomes increasingly aware of self
• Explores own and classmates’ body parts
• Learns correct name for body parts
• Learns to control feelings and behaviors
• Focuses love on parent of opposite sex

19. Copyright 2008 by Pearson Education, Inc.
Sexual Development:
School Age (6-12 Years)
• Strong identification with parent of same gender
• Friends of same gender
• Increasing awareness of self
• Increased modesty, desire for privacy
• Continues self-stimulating behavior
• Learns roles and concepts of own gender as
part of self-concept
• Age 8 or 9 often have specific concerns about
sexuality and reproduction

20. Copyright 2008 by Pearson Education, Inc.
Sexual Development:
Adolescence (12-18 Years)
• Primary and secondary sexual characteristics
develop
• Menarche
• Develops relationships with interested partners
• Masturbation common
• May participate in sexual activity
• May experiment with homosexuality
• At risk for pregnancy and STDs

21. Copyright 2008 by Pearson Education, Inc.
Sexual Development:
Young Adulthood
• Sexual activity common
• Establishes own lifestyle and values
• Homosexual identity established in mid-
20s
• Couples may share financial and
household responsibilities

22. Copyright 2008 by Pearson Education, Inc.
Sexual Development:
Middle Adulthood
• Decreased hormone production
• Menopause in women between 40-55
years
• Climacteric occurs gradually in men
• Quality rather than number of occurrences
becomes important
• Individuals establish independent moral
and ethical standards

23. Copyright 2008 by Pearson Education, Inc.
Sexual Development:
Late Adulthood
• Interest in sexual activity continues but
may be less frequent
• Women
– Vaginal secretions diminish
– Breasts atrophy
• Men
– Produce fewer sperm
– Need more time to achieve erection and
ejaculate

24. Copyright 2008 by Pearson Education, Inc.
Sexual Health
• WHO (1975) definition:
“integration of the somatic, emotional,
intellectual, and social aspects of sexual
being, in ways that are positively enriching
and that enhance personality,
communication, and love.”

25. Copyright 2008 by Pearson Education, Inc.
Characteristics of Sexual Health
• Knowledge about sexuality and sexual
behavior
• Ability to express one’s full sexual
potential
• Ability to make autonomous decisions
about one’s sexual life

26. Copyright 2008 by Pearson Education, Inc.
Characteristics of Sexual Health
• Experience of sexual pleasure as a source
of physical, psychologic, cognitive, and
spiritual well-being
• Capability to express sexuality through
communication, touch, emotional
expression, and love
• Right to make reproductive choice
• Ability to access sexual health care

27. Copyright 2008 by Pearson Education, Inc.
Varieties of Sexuality
• Sexual Orientation
• Gender Identity
• Erotic Preferences

28. Copyright 2008 by Pearson Education, Inc.
Sexual Orientation
• Same gender
• Opposite gender
• Both genders

29. Copyright 2008 by Pearson Education, Inc.
Gender Identity:
Sexual Preference Video 1
Click here to view a video on gender identity and sexual preferences.
Back to Directory

30. Copyright 2008 by Pearson Education, Inc.
Gender Identity:
Sexual Preference Video 2
Click here to view a video on gender identity and sexual preferences.
Back to Directory

31. Copyright 2008 by Pearson Education, Inc.
Gender Identity:
Sexual Preference Video 3
Click here to view a video on gender identity and sexual preferences.
Back to Directory

32. Copyright 2008 by Pearson Education, Inc.
Gender Identity
• Transgenderism
• Intersexuality
• Transsexuality
• Cross-dressers

33. Copyright 2008 by Pearson Education, Inc.
Erotic Preferences
• Sexual fantasies
• Masturbation
• Cunnilingus
• Fellatio
• Anal stimulation
• Genital intercourse
• Anal intercourse
• Others

34. Copyright 2008 by Pearson Education, Inc.
Influences on Sexuality
• Family
• Culture
• Religion
• Personal expectations and ethics

35. Copyright 2008 by Pearson Education, Inc.
Male and Female
Sexual Response Cycle
• Excitement/Plateau
• Orgasmic
• Resolution

36. Copyright 2008 by Pearson Education, Inc.
Desire Phase
• Men and women
– Response cycle starts in brain
– Sexually erotic stimuli may be real or symbolic

37. Copyright 2008 by Pearson Education, Inc.
Excitement/Plateau
• Both
– Muscle tension
increases as
excitement increases
– Sex flush (chest)
– Nipple erection
• Male
– Penile erection
– Increase in glans size
– Few drops lubricant
• Female
– Erection of clitoris
– Vaginal lubrication
– Labia increase 2-3
times in size
– Breasts enlarge
– Inner 2/3 of vagina
widens
– Outer 1/3 of vagina
narrows
– Uterus elevates

38. Copyright 2008 by Pearson Education, Inc.
Orgasmic Phase
• Both
– RR up to 40 bpm
– Involuntary muscle spasms
– Diminished sensory awareness
– Involuntary contractions anal sphincter
– Peak HR 110-180 bpm
– SBP 30-80 mm Hg above normal
– DBP 20-50 mm Hg above normal

39. Copyright 2008 by Pearson Education, Inc.
Orgasmic Phase
• Men
– Rhythmic, expulsive
contractions of penis
– Emission of seminal fluid
– Closing of internal bladder
sphincter before ejaculation
– May occur without
ejaculation
– Force varies but diminishes
after first 2-3 contractions
• Female
– 5-12 contractions of
muscles of pelvic floor and
uterine muscles
– Varied patterns
• Minor
• Multiple
• Simple intense

40. Copyright 2008 by Pearson Education, Inc.
Resolution
• Both
– Reversal of vasocongestion in 20-30 min.
– Disappearance of myotonia within 5 min.
– Genitals and breasts return to preexcitement
state
– Sex flush disappears in reverse order
– HR, RR, BP return to normal
– Sleepiness, relaxation, emotional outbursts

41. Copyright 2008 by Pearson Education, Inc.
Resolution
• Male
– Refractory period during which body will not
respond to sexual stimulation
– Varies from moments to days

42. Copyright 2008 by Pearson Education, Inc.
Sexual Dysfunction
• May be related to:
– Past and current factors
– Sexual desire disorder
– Sexual arousal disorder
– Orgasmic disorder
– Sexual pain disorder
– Problem with satisfaction

43. Copyright 2008 by Pearson Education, Inc.
Influence of Past and Current
Factors
• Sociocultural
• Psychological
• Cognitive
• Relationship problems
• Health
• Medications or street drugs

44. Copyright 2008 by Pearson Education, Inc.
Sexual Desire and Arousal
Disorders
• Sexual Desire
Disorders
– Hypoactive sexual
desire
– Sexual aversion
disorders
• Sexual Arousal
Disorders
– Female sexual arousal
disorder
– Male erectile
dysfunction or erectile
dysfunction (ED)

45. Copyright 2008 by Pearson Education, Inc.
Orgasmic Disorders
• Female orgasmic disorder
– Preorgasmic women
• Male orgasmic disorder
– Retarded ejaculation
– Rapid ejaculation

46. Copyright 2008 by Pearson Education, Inc.
Sexual Pain Disorders
• Dyspareunia
• Vaginismus
• Vulvodynia
• Vestibulitis

47. Copyright 2008 by Pearson Education, Inc.
Problems with Satisfaction
• Some people experience sexual desire,
arousal, and orgasm yet feel dissatisfied
with their sexual relationship

48. Copyright 2008 by Pearson Education, Inc.
Client Sexual Assessment
• Are you currently sexually active? With
men, women, or both?
• With more than one partner?
• Describe positive and negative aspects of
your sexual functioning
• Do you have difficulty with sexual desire:
Arousal? Orgasm? Satisfaction?
• Do you experience any pain with sexual
interaction?

49. Copyright 2008 by Pearson Education, Inc.
Client Sexual Assessment
• If there are problems, how have they
influenced how you feel about yourself?
How have they affected your partner? How
have they affected your relationship?
• Do you expect your sexual functioning to
be altered because of your illness?

50. Copyright 2008 by Pearson Education, Inc.
Client Sexual Assessment
• What are your partner’s concerns about
your future sexual functioning?
• Do you have any other sexual questions or
concerns that I have not addressed?

51. Copyright 2008 by Pearson Education, Inc.
NANDA Nursing Diagnoses
• Diagnoses relating specifically to sexuality:
– Ineffective Sexuality Pattern
– Sexual Dysfunction

52. Copyright 2008 by Pearson Education, Inc.
NANDA Nursing Diagnoses
• Sexual problems as etiology of other
diagnoses:
– Deficient Knowledge
– Pain
– Anxiety
– Fear
– Disturbed Body Image

53. Copyright 2008 by Pearson Education, Inc.
Nursing Interventions
• Education
• Provide privacy during intimate body care
• Involve the client’s partner in physical care
• Give attention to the client’s appearance
and dress
• Give clients privacy to meet their sexual
needs alone or with a partner within
physically safe limits

54. Copyright 2008 by Pearson Education, Inc.
Health Promotion Teaching
• Sex Education
• Teaching Self Examinations
– Self-breast examination (BSE)
– Testicular self-examination (TSE)
• Responsible Sexual Behavior
– Prevention of sexually transmitted disease
– Prevention of unwanted pregnancies
– Avoidance of sexual harassment and abuse

55. Copyright 2008 by Pearson Education, Inc.
Health Promotion Teaching

56. Copyright 2008 by Pearson Education, Inc.
Health Promotion Teaching

57. Copyright 2008 by Pearson Education, Inc.
Health Promotion Teaching

58. Copyright 2008 by Pearson Education, Inc.
Post Test
• Use your clickers to complete the following
post test.

59. Copyright 2008 by Pearson Education, Inc.
Question 1
Clients are least likely to introduce the topic of sex with
health care providers for which of the following
reasons?
1. They assume that health care providers know little
about sexual functioning.
2. Most clients have few, if any, questions or problems.
3. Female clients prefer to discuss problems with female
health care providers.
4. They are too embarrassed to introduce the topic of
sex.

60. Copyright 2008 by Pearson Education, Inc.
Rationales 1
1. Most people assume that providers have a
great deal of information.
2. Many clients have questions and concerns.
3. While talking with someone of the same
gender may make it easier for some women, it
is not a requirement for assessment and
intervention.
4. Correct. Clients still may feel a great deal of
shame and discomfort regarding sexuality.

61. Copyright 2008 by Pearson Education, Inc.
Question 2
A nurse receives information that a client is a
transsexual. Appropriate care is based on this
knowledge. Which of the following is most
representative of this client?
1. Gonadal gender, internal organs, and external genitals
are contradictory.
2. Sexual anatomy is not consistent with gender identity.
3. Sexual attraction is to individuals of both genders.
4. Gender identity is altered by acute psychosis.

62. Copyright 2008 by Pearson Education, Inc.
Rationales 2
1. Option 1 is the definition of intersex.
2. Correct. Transsexuals’ anatomical
gender is not the same gender as they
feel themselves to be.
3. Option 3 is the definition of bisexuality.
4. Transsexuality is a lifelong belief and not
altered by an acute condition.

63. Copyright 2008 by Pearson Education, Inc.
Question 3
A male client is beginning an antidepressant medication. Which of
the following should be included in the teaching?
1. “Your partner will be pleased because your sexual functioning is
going to improve.”
2. “You may find that your desire for sex will decrease while on this
medication.”
3. “Retrograde ejaculation is a common problem when taking
antidepressants.”
4. “Your skin will probably become supersensitive to touch, so you
may need to change your activity during sex.”

64. Copyright 2008 by Pearson Education, Inc.
Rationales 3
1. If the depression lifts, there may be an
improvement but the focus in option 1 is on the
partner rather than where it should be—on the
client.
2. Correct. Orgasmic response and sex drive
are often inhibited by antidepressants.
3. Retrograde ejaculation is associated with
removal of the prostate.
4. Skin hypersensitivity is not a side effect of
antidepressant medications.

65. Copyright 2008 by Pearson Education, Inc.
Question 4
A client who had a hysterectomy 3 days ago, says to
the nurse, “I no longer feel like a real woman.” What is
the best response?
1. “Don’t worry about that. The feeling will probably go
away.”
2. “You should talk to your doctor about how you feel.”
3. “I don’t blame you. I would feel like half a woman also.”
4. “I hear your concern. Tell me more about your
feelings.”

66. Copyright 2008 by Pearson Education, Inc.
Rationales 4
1. Option 1 is an unprofessional response and
false reassurance. The ANA Code of Ethics
indicates that clients are entitled to a timely
and appropriate response to their needs.
2. Option 2 suggests postponing the discussion
and that the physician is the better person to
deal with her concerns, which is untrue.
3. Option 3 represents feeding into her negative
self-concept and inappropriate self-disclosure.
4. Correct. More information is needed before
intervening. Also, the client needs the
opportunity to express her feelings.

67. Copyright 2008 by Pearson Education, Inc.
Question 5
A 75-year-old male client reports decreased frequency
of sexual intercourse although he does not express
dissatisfaction or difficulty. He seems a little
embarrassed by the discussion but is engaged and
asks some questions. An appropriate nursing
diagnosis would be which of the following?
1. Sexual Dysfunction
2. Disturbed Body Image
3. Sedentary Lifestyle
4. Readiness for Enhanced Knowledge

68. Copyright 2008 by Pearson Education, Inc.
Rationales 5
1. It does not suggest pathology.
2. It does not suggest disturbed body image.
3. It would be incorrect to assume his lifestyle is
sedentary merely because the frequency of his
sexual activity has decreased.
4. Correct. A change in sexual frequency is not
abnormal but may suggest an opportunity for
enhanced knowledge if he desires. Further
assessment of the reason for the decrease in
sexual activity is indicated.

69. Copyright 2008 by Pearson Education, Inc.
Resources
• Audio glossary
• Society for Human Sexuality
Provides information on all forms of human sexuality
• Electronic Journal of Human Sexuality
An educational site and journal published by the Institute
for Advanced Study of Human Sexuality
• American Association of Sex Educators, Counselors,
and Therapists
Interdisciplinary professional organization that promotes
understanding of human sexuality and healthy sexual
behavior

70. Copyright 2008 by Pearson Education, Inc.
Resources
• Sex Information and Education Council of Canada
An educational organization to enhance public and
professional education concerning human sexuality
• Sexuality Information and Education Council of the
United States
A national organization that affirms sexuality as a natural
and healthy part of living. Lots of information on this site.
• Sexuality and U
A Canadian Web site that promotes reliable sexuality
education. Has sites for teens, adults, parents, teachers,
and health professionals.

71. Copyright 2008 by Pearson Education, Inc.
Resources
• Merck Manual of Diagnosis and Therapy--Gynecological
and Obstetrics
A wealth of information about all types of women's health
issues and diseases
• Merck Manual of Diagnosis and Therapy--Erectile
Dysfunction
Overview of male erectile dysfunction