SEXUALITY

SEX

the most significant motivator in human life (Freud)

You will not die without sex (although you may want to)

in biological scheme of things, it is reproduction, not individual

survival, that counts

Sex is the most wonderful thing on this earth, as long as God is in

it. When the Devil gets in it, it's the most terrible thing on this earth.

BILLY GRAHAM, Just As I Am

Animals, including us humans,

are supplied with powerful instincts that urge them on to having sex,
sometimes at the cost of their own lives!

As human beings we express ourselves sexually from birth to death.

Aging, chronic and disabling conditions may necessitate certain

adaptations in the way we express our sexuality, but we do not cease to
be sexual beings.

(Parke, 1991)

We are all born with the capacity to function as sexual beings.

Clients do not leave their sexuality behind when they enter the
healthcare system their sexuality comes along as part of the whole
person.

A holistic care approach to client health care needs indicates that all
aspects of being interact.

Sexuality

A multidimensional phenomenon that includes feelings, attitudes, and

actions

It has both biologic and cultural components

It encompasses and gives direction to a persons physical, emotional,

social, and intellectual responses throughout life.

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An integral part of the whole human being, categorized into four

separate aspects:

a. biologic sex

b. sexual orientation

c. gender/sexual identity

d. gender role

Biologic sex

Includes all of the human beings genetically determined anatomy

and physiology, which is also influenced by intrauterine
conditions.

A classification of male or female based on many criteria, among

them anatomic and chromosomal characteristics.

Sexual orientation

is generally classified by the sex, or gender, of a person that an

individual finds sexually attractive.

In simpler terms, it is based on what sex you are attracted to or a

choice.

Sexual orientation

Is which sex you find erotically attractive

if you are attracted to the opposite sex, then your sexual

orientation is heterosexual.

If you are attracted to someone the same sex as yourself, then

that type of sexual orientation is homosexual.

Bisexual is when an individual is attracted to both sexes.

Sexual/Gender identity

pertains to an individual's conception of themselves.

an individual's personal perception of their own sex, not who they

are attracted to.
 example, if a woman declares herself a lesbian, then lesbian is
her sexual identity.

Gender role

the outward manifestations of personality that reflect the gender

identity as to whether male or female

Is also culturally influenced

In western society, women were viewed as kind and nurturing,

with sole responsibility of childrearing and homemaking while
men were viewed as financial providers for the family

We are all born with the capacity to function as sexual beings.

Clients do not leave their sexuality behind when they enter the
healthcare system their sexuality comes along as part of the whole
person.

A holistic care approach to client health care needs indicates that all
aspects of being interact.

Sexual Health

According to the W.H.O., the integration of the somatic, emotional,

intellectual, and social being, in ways that are positively enriching and
that enhances personality, communication, and love.

Sexual Function

Implies the persons capacity to engage in and to experience pleasure

from sexual activity

Human Sexual Response

A total body response that represents an opportunity for the

integration of biologic sexuality with our thoughts, feelings, and
interpersonal relationships.

Richard von Krafft-Ebing

studied sexual "deviations" in the late 1800's.

He popularized the term homosexuality, and fought to decriminalize it.

On the negative side, he was convinced that women who have strong
sexual appetites are quite abnormal.

Henry Havelock Ellis

Looked into the social aspects of sexuality in the late 1800's and
early 1900's.
 He is a hero to both the homosexual community and the feminist
movement.

He insisted that homosexuality was both inborn and irreversible,

a notion some people still don't accept.

He suggested that women have the similar sexual needs and

desires as men!

Alfred Kinsey

a Harvard entomologist, systematically collect data on sexual

practices in the 1930's.

He found that 90% of the men he interviewed had masturbated

85% had engaged in premarital intercourse

60% had engaged in oral sex

It shocked a conservative American public, who had been in heavy

denial about this sort of thing!

Virginia Masters & William Johnson

in the 1960's and 70's, gave us the details about the mechanics of
sex.

Observed and measured many thousands of volunteers and

prostitutes engaging in intercourse and masturbation.

Among the results of their work is the famous Sexual Response

Cycle"

Excitement Phase

Psychological stimulation (fantasy or presence of a love object)

Physiological stimulation (stroking or kissing)

Characterized by the contraction of the muscles of the pelvis, the

erection of the penis, and the lubrication of the vagina.

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Nipples of both sexes become erect

Womans clitoris becomes hard & turgid.

Labia minora become thicker as a result of venous enlargement.

May last several minutes to several hours

Plateau Phase

some researchers just consider it a part of excitement.

Mans testes increase in size 50% & elevate.

In women, vaginal barrel forms the orgasmic platform, the

outer 3rd of the vagina begins to close about 30%, which seems
to be natures way of making sure that the penis (& its produce)
stays where it is as long as possible.

Clitoris elevates & retracts behind the symphysis pubis.

Breast size in the woman increases 25%.

Continued engorgement of the penis & vagina produces specific color

changes.

Pl
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Voluntary contractions of large muscle groups occur.

In men, distention of the penis.

HR increases to 100-175 bpm and RR to approx. 40 bpm.

Blood pressure rises.

Lasts 30 seconds to several minutes.

Orgasmic Phase

It is really just a matter of repeated reflexive contractions (8-15)

of a variety of muscles.

In men, it includes ejaculation (3-7).

 Women take15 minutes to reach orgasm, which means that men
typically orgasm first unless they pay special attention to their
partners during foreplay.

Sexuality is the key to the problem of the psychoneuroses and of

the neuroses in general. No one who disdains the key will ever be able
to unlock the door. Sigmund Freud

An orgasm a day keeps the doctor away.

Resolution Phase

is simply a matter of getting back to normal.

is also known as a refractory period, which is the length of time it

takes before the person is ready for another round of sex.

In young men, it can be a matter of minutes.

In most men, it is hours, even days.

It has been argued that women do not have a refractory period,

but that is likely a myth.

women can have several orgasms in close succession, called

multiple orgasms

Most women, however, find that continued intercourse after one

orgasm eventually becomes uncomfortable.

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There were two kinds of orgasms women could have - clitoral or

vaginal.
 Clitoral orgasms are achieved by contact with the clitoris.

Vaginal orgasms, achieved by full intercourse, were considered

better, more "mature."

Most sexologists believe that all orgasms are essentially clitoral.

It should be noted that, even though the clitoris is the "epicenter"

of orgasm, pretty much all of the pelvic floor, including the
vagina, is sensitive to stimulation.

Another rich source of myths is penis size.

Various studies have suggested that somewhere between 5 and 6

inches when fully erect is the usual range.

The longest medically verified penis was 13 1/2 inches long.

The smallest human penis on medical record is less than an inch long,
fully erect.

Factors influencing Sexuality

Developmental level

Culture

Religious values

Personal ethics

Health status

Developmental level

Sexuality begins with conception and changes throughout the life span.

Every society develops expectations about acceptable forms of sexual

expressions

Infancy (birth to 18 mos)

Given gender assignment of male or female

Differentiates self from others gradually

Dress and toys are gender oriented

External genitals are sensitive to touch

Male infants have penile erections; females, vaginal lubrication

Self-manipulation of genitals is normal

Toddler (1-3 yrs)

Gender identity continues to develop

Develops control over bladder and bowels

Able to identify own gender

Body exploration and genital fondling is normal

Able to name body parts

Preschooler (4-5 yrs)

Increase awareness of self

Explores own and playmates body parts

Learn correct names for body parts

Learns to control feelings and behavior

Focus love on parents of the opposite sex

Ask questions about where babies come from

School age (6-12 yrs)

Tends to have friends of the same sex

Has increasing awareness of self

Continues self-stimulating behavior

Sexual expression within religious and cultural values of family

Adolescence (12-20 yrs)

Primary and secondary sex characteristics develop

Menarche takes place

Develops relationships with the opposite sex

Masturbation is common

May participate in sexual activity

Young Adulthood (20-40 yrs)

Sexual activity before marriage is common

Many prefer cohabitation instead of marriage

Establishes own lifestyle and values

Share financial obligations and task around home

Middle Adulthood (40-65 yrs)

Experience decrease hormone production

Menopause occurs in women

Climacteric occurs gradually in men

Quality rather than the number of sexual experiences becomes

important

Divorce is common

Establish independent moral and ethical standards

Late Adulthood (65 yrs & up)

Interests in sexual activity may continue

Sexual activity becomes less frequent

Womens vaginal secretions diminish, and breasts atrophy

Men produce fewer sperm

Culture

Cultural groups have their own practices and values relating to

sexuality

North Americans have strong negative attitudes about homosexuality

Different groups hold diverse attitudes about husband/wife roles,

childhood sexuality, nudity, and appropriate sexual behavior

Religious Values

Religion provides guidelines for sexual behavior and acceptable

circumstances for the behavior, as well as prohibited sexual behavior
and the consequences of breaking the sexual rules (e.g. Virginity,
homosexuality, abortion).

Personal ethics

Ethical thought and ethical approaches to sexuality is viewed through

developed written or unwritten codes of conduct based on ethical
principles (e.g. Masturbation, oral/anal intercourse, cross-dressing)

Health Status

Healthy minds, bodies, and emotions are necessary for sexual wellness.
Many factors can interfere with persons expression of sexuality (heart
dse, DM, SCI, surgeries, jt dse, chronic pain, STDs, mental d/o,
medications)

Types of Sexual Intercourse

Genital intercourse

Oral-genital intercourse

Anal intercourse

Genital Intercourse

Most common form of with a sexual partner that is heterosexual

Also known as coitus or copulation

Penile-vaginal intercourse

Both physically and emotionally satisfying

Oral genital Intercourse

Has three forms:

Cunnilingus oral stimulation (kissing, licking, or sucking)

of the female genitals

Fellatio oral stimulation of the penis by

licking and sucking

Soixante-neuf (69) simultaneous oral-

genital stimulation by two persons

Anal Intercourse

The penis is inserted into the anus and rectum of the partner

Stimulation applied by hands or by sex aids such as vibrators

Can be source of sexual pleasure, because the anus is richly

innervated

Most common practiced by gay men and some heterosexual

couples

Anilingus oral-anal stimulation

Even today in movies, if a male thinks some other male has come
onto them, and they are not interested, they usually react with horror,
violence or verbal abuse. People copy the behaviors they see in movies,
so they also need to see modeled a polite decline such as Sorry, you
are not my type. I prefer women.

~ Roedy (born: 1948-02-04 age: 64)

Types of Sexual Orientation

Heterosexuality

Homosexuality

Bisexuality

Transexuality

Heterosexuality

Sexual fulfillment with a member of the opposite gender

Interest in the opposite sex and sexual relationships may begin as early
as in the beginning of puberty

Homosexuality

Sexual fulfillment with a member of his or her own sex.

Lesbian - A lesbian is a woman who is romantically and sexually

attracted only to other women.

Gay - refer to the entire homosexual population, both men and women.

Bisexuality

Achieve sexual satisfaction from both homosexual and

heterosexual relationships.

Bisexual an individual attracted, both romantically and sexually,

to people of both genders, they are considered bisexual.

Transexuality

Having feelings as if he or she should be of opposite gender

Transgender a term used to describe people who exhibit a

partial reversal of gender roles or have undergone sexual reassignment
therapies (either surgically or hormonally). These individuals often feel
as if they were born the wrong sex.

Types of Sexual
Expression

Celibacy
 Abstinence from sexual activity

It is the avowed state of certain religious orders

A way of life for many adults and one that is becoming

fashionable among a growing number of young adults

The ability to concentrate on means of giving and receiving love

other than through sexual expression

An erection is like the Theory of Relativity - the more you think about it,
the harder it gets.

~Author Unknown

Masturbation

Self-stimulation for erotic pleasure

Mutually enjoyable activity for sexual partners

Offers sexual release, which may be interpreted by the person as

overall tension or anxiety relief

A test whether everything in their body is still functional

Masturbation: the primary sexual activity of mankind. In the

nineteenth century it was a disease; in the twentieth, it's a cure.

~Thomas Szasz

Pornography tells lies about women. But pornography tells the

truth about men.

~John Stoltenberg

Erotic stimulation

Use of visual materials such as photographs or magazines for sexual

arousal

Is thought to be a male phenomenon

Virginity can be lost by a thought.

~St. Jerome

Fetishism

Sexual arousal resulting from use of certain objects or situations

The object of stimulation does not just enhance the experience;

rather, it becomes a focus of arousal
 A person may come to require the object or situation for
stimulation

Transvestism

Dresses to take on the role of the opposite sex

Can be heterosexual, homosexual, or bisexual

Voyeurism

Obtaining sexual arousal by looking at another persons body

French word for "watcher, a matter of secretly observing others

undressing or engaging in sexual acts.

these people (usually men) "peeping Toms."

Passes with more active sexual expression

Reflects great insecurity or inability to feel confident enough to

relate to others on more personal levels

Sadomasochism

Involves inflicting pain (sadism) or receiving pain (masochism) to

achieve sexual satisfaction

A practice considered to be within the limits of normal sexual

expression

gain sexual satisfaction by actually being beaten, cut, pierced, or

whipped, or doing so to another person, especially someone who
is unwilling.

Exhibitionism

Revealing ones genitals in public

The usual term for these people is "flasher."

It is mostly men, but there are a considerable number of women

as well.

Pedophilia

sexual encounters with children

an activity engaged in by men, and most of these people seem to

lack adult sexual experience and to have strong feelings of
inferiority and inadequacy

preying on children apparently makes them feel powerful.

 found more often among heterosexuals than homosexuals.

It doesn't matter what you do in the bedroom as long as you don't

do it in the street and frighten the horses.

~Mrs. Patrick Campbell

Bestiality

having sexual relations with animals.

It isn't quite as rare as one might think: Kinsey found that 17% of farm
boys admitted to sex with animals.

More recent research suggests that it is found primarily in young boys

who are mentally deficient.

Because of our Christian heritage, our taboos about sex and

talking about sex are overly strong, particularly about variations that
are unpopular, dangerous or illegal. The net result is, for example, a
young sadist enters puberty, but fears telling anyone. He fans his
fantasies with violent video games.

He secretly tortures and kills animals. Then he joins the military,

is shipped to some foreign land where he can butcher and torture
innocent people to his hearts content, is given a medal for it, comes
home and becomes a mental basket case. It would have been better if
he felt free to get help containing and redirecting his desires.

~ Roedy (born: 1948-02-04 age: 64)

Inappropriate Sexual Behavior

Exposing themselves

Asking the nurse to provide intimate physical care

Touching and grabbing the nurse; trying to pull the nurse into bed

Making blatant sexual statement to the nurse

Offering the nurse sex

Whistling; making comments about nurses attractiveness or

desirability

Making sexual comment to another client

Possible Reasons for Inappropriate Sexual Behavior

Fear or anxiety over future ability to function sexually

 Unmet need for intimacy and sexual closeness

Misinterpretation of the nurses behavior as sexual or provocative

Need for reassurance that they are still sexual beings and
sexually attractive

Possible Reasons for Inappropriate Sexual Behavior

Need for attention, control, or power

Confusion due to neurological impairment or trauma

Belief that flirtatious behavior is expected due to influence of media

portrayal of nurses as sexy, available, and experienced

Nursing Strategies for Inappropriate Sexual Behavior

Communicate that the behavior is not acceptable

I really dont like the things you are saying.

I see you are not dressed. I will be back in 10 minutes and will
help you with breakfast when you get your clothes on.

Nursing Strategies for Inappropriate Sexual Behavior

Tell the client how the behavior makes you feel

When you act like that toward me, I dont even want to come into your
room. It embarrasses me and makes it hard for me to give you the kind
of nursing care you need.

Nursing Strategies for Inappropriate Sexual Behavior

Identify the behavior you expect

Please call me by my name, not honey.

I expect you to keep yourself covered when I am in the room. If you

are feeling hot or something is uncomfortable, let me know, and I will
try to make you more comfortable.

Nursing Strategies for Inappropriate Sexual Behavior

Set firm limits

Take the clients hand and move it away, use direct eye contact, and
say,

Dont do that!

Nursing Strategies for Inappropriate Sexual Behavior

 Try to refocus clients from inappropriate behavior to their real
concerns and fears; offer to discuss sexuality concerns

All morning you have been making very personal sexual comments
about yourself. Sometimes people talk like that when they are
concerned about the sexual part of their life and how their illness will
affect them. Are there things that you have questions about or would
you like to talk about?

Nursing Strategies for Inappropriate Sexual Behavior

Report the incident to your nursing instructor, charge nurse, or nursing

clinical specialist. Discuss the incident, your feelings, and possible
interventions

Nursing Strategies for Inappropriate Sexual Behavior

Assign a nurse who will confront the behavior and relate to the client in
a consistent manner.

Clarify the consequences of continued inappropriate behavior

(avoidance, withdrawal of services, no chance to help resolve
underlying concerns of the client).

The behavior of a human being in sexual matters is often a prototype

for the whole of his other modes of reaction in life.

SIGMUND FREUD

Sexuality and the Psychology of Love

The PLISSIT model of intervention

Was developed by Annon (1974) for helping clients with sexual

problems

Represents the four progressive levels by the acronym PLISSIT:

P Permission giving

LI Limited information

SS Specific suggestions

IT Intensive therapy

Permission giving

Clients may feel that they need permission to be sexual beings, to asks
questions, to show affection, and express themselves sexually
Means that the nurse by attitude or word lets the client know that
sexual thoughts, fantasies, and behaviors between informed consenting
adults are allowed

It begins when the nurse acknowledges the clients verbal and

nonverbal sexual concerns

Can alleviate many sexual concerns

Limited Information

Clients need accurate but concise information

The nurse might explain what is normal; how some medical

conditions, treatments, injuries, or surgeries may affect sexuality
and functioning; or how aging may affect sexuality and
functioning

Requires basic and specific knowledge on sexuality and

functioning and how health problems can effect sexual
functioning

Specific Suggestions

Requires specialized knowledge and skill about how sexuality and

functioning may be affected by a disease process or therapy and
what interventions might be effective

Offers suggestions to help client adapt sexual activity to promote

optimal functioning

Intensive Therapy

Provided by a clinical nurse-specialist or sex therapist

Used when the first three levels of counseling are ineffective

Involve such issues as sexual motivation, marriage, or self-concept.

Nursing Interventions on Sex & Sexuality

Create a nonjudgmental, accepting atmosphere

Explain human anatomy and physiology of male and female body

and human production

Support parents role as primary sexuality educators for their

children

Educate parents on sexual growth and development

Use appropriate questions for clients self-reflection

Nursing Interventions on Sex & Sexuality

Explore the meaning of sexual roles

Discuss sexual behavior and appropriate ways to express ones

feelings and needs

Inform children and adolescents of the benefits of postponing

sexual activity and on the negative consequences of early
childbearing

Teach about STIs, including HIV infection and AIDS

Nursing Interventions on Sex & Sexuality

Teach about safer sex practices

Educate children and adolescents about effective contraception,

including assisting adolescents in choosing a method as appropriate

Facilitate role-playing to aid in resisting peer and social pressures of

sexual activity

Enhance self-esteem through peer role-modeling and role-playing

THE END