This document summarizes a seminar on human sexuality presented by B. Maniratnam. It discusses components of sexual health like sexual self-concept, body image, gender identity, and sexual orientation. It also covers topics like sexual response cycle, theories of Freud and Kaplan on sexual development, sexual dysfunction, sex education, and alterations in sexual health like infertility and sexual abuse.

2. SEMINAR ON
SEXUALITY
PRESENTEDBY
B.MANIRATNAM

3. • Components of Sexual Health: -
• 1.Sexual Self Concept
• 2.Body Image
• 3.Gender identity
• 4.Sexual Orientation

4. • Sexual Self-Concept Defined as how one values oneself
as a sexual being. It determines the gender and kinds of
people a person is attracted to, and the values about
when, where and with whom one expresses sexuality. A
positive sexual self-concept enables people to form
intimate relationship throughout life. A negative sexual
concept may impede formation of relationship.

5. • Body-Image It is the sense of self; it is constantly changing.
Pregnancy, aging, trauma, disease and therapies can alter an
individual's appearance and function. which can affect body
image.
• Gender Identity It is one's self image as a male or female.
Gender role behaviour is the outward expression of a person's
sense of maleness or femaleness as well as expression of what
is perceived as gender- appropriate behaviour.

6.  Transgender: It is a term for people whose gender identity or gender expression
differs from their anatomical sex. It includes:
 Cross-dressers: People who routinely wear dresses associated with the opposite
sex.
 Intersexes: People who have ambiguous genitals at birth (hermaphrodites).
 Preoperative transsexuals: People whose gender identity or expression conflicts
with their anatomy. Many undergo hormonal treatment and may undergo gender
reassignment surgery '
 Postoperative transsexuals: People who had full or partial surgery to change their
gender

7. • Sexual Orientation It is defined as one's attraction to people of
same sex, opposite sex or both sexes. Sexual orientation lies
along a continuum with a wide range between the two
extremes of exclusively heterosexual attraction and exclusively
homosexual attraction.
• Individuals who are attracted to people of both genders are
called bisexuals.

8. • Alterations in Sexual Health: -
• Infertility: Infertility is defined as the inability to conceive after 1 year of
unprotected intercourse. A couple who wants to conceive and cannot, may
experience a sense of failure and feel that their bodies are somehow defective.
Choices for the infertile couple include pursuit of adoption, medical assistance with
fertilization or adopting the probability of remaining childless.
• Sexual abuse: Sexual abuse is a widespread health problem in our society. Abuse
crosses all gender, socioeconomic conditions, age, and ethnic groups. Sexual abuse
has far ranged effects on physical and psychological functioning.

9. • Personal and emotional health: Ideally, sex is a natural, spontaneous act
that passes easily through a number of recognizable physiological
changes. Nurses encounter clients who have problem with one or more
stages of sexual activity. E.g., persons taking antidepressants have noted
that their ability to reach orgasm is negatively affected.
• Sexual dysfunction: Sexual dysfunction is defined as absence of
complete sexual functioning. It is more prevalent in men and women
with poor emotional and physical health.

10. • SEX EDUCATION: -
• Components of sexual health education
Physical aspects:
 Anatomy and physiology of the reproductive organs.
 Physical, emotional and psychological changes during puberty.
 Contraception, pregnancy and childbirth.

11. Social aspects:
 Sex drive or sexual feelings in childhood and adolescence.
 Emotional development - teenage excitement and emotional stress.
 Personal identity (self-esteem).
 Social relationship (with parents, siblings, peers of either sex).
 Sex roles.
 Gender roles.
 STD HIV.

12. • Sex education at school:
Sex education in the school has the best extension than it is provided at home
 Teaching should be scientifically correct.
 It should be a two-way dialogue.
 The group of students should be homogenous in age and cultural background.
 Groups should be over two members. Otherwise, two-way communication is difficult.
 Talks should be supported by AV aids.
 At least one trained teacher.
 Support of administration.
 Support of parents and teachers.
 A talk should be arranged for them to give the contents of the program.
 Avoid culture based sensational and needlessly controversial topics.
 If the teaching is round the year, 45min-lhr session once a week half day or full day workshop periodically four times a year would
serve as alternative.

13. • SEXUALITY:
• Sexuality is the collective characteristics that mark the differences between male and female, the constitution
and life of the individual as related to sex.
• Development of sexuality
• The development of sexuality begins with conception and continues throughout life span.
• Stages characteristics
• Infancy (0-1): - Role assignment: Infants are assigned gender role of male or female.
• Toddler (1-3): - Develop gender identity: by body exploration and genital fondling.
• Pre-schooler: - Become increasingly aware of their own and other's body parts focuses love on parent of
opposite sex. Psychological aspects of human relations 621.

14. • School age (6- 1 2): - Gender role behaviour is seen (e.g., Tends to friends of same gender, increased modesty,
desire for privacy)
• Adolescence: - Primary and secondary sex characteristics develop. Menarche usually takes place. Develops
relationship with interested partners.
• Young adulthood: - Becomes capable of establishing a lasting relationship with a member of opposite sex, sexual
activity is common. Establishes own lifestyle and values
• Middle adulthood: - Decreased hormone production, menopause occurs in women between 40-55 years
climacteric occurs in men. Individuals establish moral and ethical standards.
• Late adulthood: - Interest in sexual activity. Often continues, sexual activity, maybe less frequent.

15. • FREUDS THEORY CONCERNING DEVELOPMENT OF SEXUALITY
• Stages of Psychosexual Development
 The Oral Stage: During this period, the oral region or the sensory area of mouth
provides the greatest sensual satisfaction for the infant.
 The Anal Stage: The greatest amount of sensual pleasure for the toddler is obtained
from the anal and urethral areas.
 The Phallic Stage: The greatest sensual pleasure is derived from the genital areas.
The oedipal stage occurs in the later pan of the phallic period. During this stage, the
child "loves" parent of the opposite sex as the provider of sensual satisfaction. The
parent of same sex is considered to be a rival.

16.  The Latency Stage: At the beginning of the latency stage the child has
resolved or is resolving the oedipal conflict. During the latency period
children form close relationship with others of their own age and sex.
 The Pubescent Stage: During puberty, secondary sexual characteristics
appear in both sexes. The same psychosexual conflicts that occurred
during the oedipal period are revived. If children resolve the conflicts,
they are free to enter into heterosexual relationships as adults.

17. • Sexual Response Cycle: Kaplan (I979)
• Sexual response involves people's emotional, psychological, physical and
spiritual make-up. It is the role of a nurse to support and facilitate
healthy sexual expression and accurate knowledge of sexual response
cycle is important to this role. Commonly occurring phases of human
sexual response follows a similar sequence in both males and females.

18. 1. Desire Phase: The response cycle starts in the brain with
conscious sexual desires called the desire phase. Sexually
arousing stimuli, called erotic stimuli including sight, hearing,
smell, touch and imagination (sexual fantasy) can all invoke
sexual arousal. Sexual desire fluctuates within each person and
varies from person to person. If people suppress or block out
conscious sexual desires, they may not experience any
physiologic response. Although psychological causes are more
common cause of lack of sexual desire, medication, drugs,
hormone imbalances can also block sexual desires.

19. 2. Excitement phase: Involves two primary physiologic changes.
• Vasocongestion it is increase in the blood flow to various body parts resulting in
erection of the penis and clitoris and swelling of the labia, testes and breasts.
Vasocongestion stimulates sensory receptors in these body parts that in turn
transmit messages to the conscious brain where they are interpreted as pleasurable
sensations. When stimulation is continued, Vasocongestion increases until it either is
released by orgasm or fades away.
• Myotonia Increase of tension in muscles, may increase until release by orgasm or
it may also simply fade away.

20. 3. Orgasmic Phase: In this phase, there is involuntary
climax of sexual tension, accompanied by physiologic and
psychologic release. This phase is considered the
measurable peak of sexual experience. Although the
entire body is involved, the major focus of orgasm is felt
in the pelvic region. Male orgasms usually last for 10-30
sec, while female orgasms last 10-50 sec. Men usually
have an ejaculation and expel semen as part of their
orgasm.

21. 4. Resolution Phase: It is the period of return to the
unaroused state, lasting l0-15 min after orgasm. This
phase in females is quite varied as some women
experience multiple successive orgasms, followed by a
longer period of resolution.

22. • Sexual Dysfunction: The ability to engage in sexual behaviour is
of great importance to most people. It is divided into:
1.Male dysfunction.
2.Female dysfunction Sexual dysfunction.

23. 1. Male dysfunction
 Erectile dysfunction: Persistent or recurrent inability to achieve or maintain
sufficient erection until completion of sexual activity. It can be caused by
physiologic or psychological factors.
 Rapid Ejaculation: Persistent or recurrent ejaculation with minimal sexual
stimulation or before the person wishes it. It is the inability to delay ejaculation.
 Retarded Ejaculation: Persistent or recurrent delay in ejaculation or absence of
orgasm following a normal sexual excitement phase during sexual activity

24. 2. Female Dysfunction
 Hypoactive Sexual Dysfunction: It involves absence of sexual thoughts or disinterest in
sexual activity. E.g., pregnancy can affect sexual desire if it is associated with physical
discomfort, fear of injury to the foetus. Postpartum hormonal changes, fatigue and anxiety
of new parenthood may contribute to decreased sexual desire (e.g., nursing mothers
produce unusually high levels of prolactin which severely reduces sex drive).
 Sexual Arousal Disorder: Failure to attain or maintain vaginal lubrication or experience
subjective sense of sexual excitement and pleasure during sexual activity.
 Orgasm Disorder: Difficulty or inability to achieve orgasm in spite of stimulation and
arousal.
 Sexual Pain Disorder: Dyspareunia describes the pain experienced by a woman during
intercourse.

25. Nursing Management
• l. Assessing: Information about a client's sexual health status should always be an integral part of a
nursing assessment. It includes:
• A) Nursing History: It should include sexual concerns to help plan a comprehensive
treatment approach. A nurse should not make assumptions about the client before
taking accurate history. Imposing values on others is detrimental to the nurse-client
relationship.
• B) Physical Examination: The nursing history data which indicates the need for a
physical examination includes suspicion of infertility, pregnancy or a sexually
transmitted disease.

26. II. Planning: The overall goals to meet client's sexual needs include the following:
Maintain, restore or improve sexual health
 Increase knowledge of sexuality and sexual health
 Prevent the occurrence or spread of STDs
 Prevent unwanted pregnancy Increase satisfaction with level of sexual functioning
 Improve sexual self-concept.

27. III. Implementing: The interventions the nurse selects are based on the data obtained
from the client and the identified nursing diagnoses. The interventions are directed at
preventing problems and providing information about the changes and ways to adapt
those changes.
• Providing sexual health teaching: It is an important component of nursing
implementation. Many sexual problems exist because of sexual ignorance; many
others can be prevented with effective sexual teaching. Important areas of teaching
are:
 Sex education
 Responsible sexual behaviour

28. • Sex education: Nurse can assist client to understand the anatomy and how the body
functions. The importance of open communication between partners should be encouraged.
Women may also benefit from learning Kegel exercises which involves contraction and
relaxation of pubococcygeal muscle. The nurse should discuss the effects of treatment to the
client experiencing illness or surgery which alters sexual function.
• Responsible sexual behaviour: It involves the prevention of sexually transmitted diseases
and prevention of unwanted pregnancy and avoidance of sexual harassment. Clients need
education about sexually transmitted diseases, preventive measures and early treatment.
The nurse must teach the various contraceptive methods, advantages, disadvantages,
contraindications, effectiveness, safety and cost.

29. • Counselling for altered sexual function: Nurse can help clients with
altered sexual function using Plissit model, developed by Annon (1
974) which involves four progressive levels represented as:
 P- permission giving
 Li-limited information
 Ss-specific suggestions
 It-intensive therapy

30. • Permission giving: Giving information begins when the nurse
acknowledges the client's spoken and unspoken sexual concerns and
conveys the attitude that sexual concerns and needs are important to
health and recovery.
• Limited information: The nurse must explain accurate but concise
information about medical conditions, treatments, or surgeries may
affect sexuality and sexual functioning.

31. • Specific suggestions: At this level, the nurse requires
specialized knowledge about how sexuality and functioning
may be affected by a disease process or what interventions
may be effective.
• Intensive therapy: It is provided by a clinical nurse specialist or
sex therapist, and is used when the first three levels of
counselling are ineffective

32. •IV. Evaluating: The goals established during the
planning phase are evaluated according to specific
desired outcomes also established during that
phase. If outcomes have not been achieved, the
nurse should explore the reasons.