This topic based on advance nursing practice

1. SEXUAL HEALTH AND
SEXUALITY
PRESENTED BY
BRIJESH TYAGI
M.Sc.(N) PREVIOUS
P. G COLLEGE OF NSG
C. H. R. I. GWALIOR

2. INTRODUCTION
 Sexuality is a crucial part of a person’s identity.
 Sex is central to who we are and to our
emotional well-being.
 All people have the potential to positively
experience and pleasurably express their
sexuality .
 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.

3. TERMINOLOGIES
 CLIMACTERIC- Decline in sexual drive. Eg. Menopause in
women
 GENDER ROLE- Behaviour appropriate to the sex of an
individual
 HETEROSEXUAL- Sexual and emotional orientation towards
persons of opposite sex.
 HOMOSEXUAL- Sexual and emotional orientation
towards persons of same sex.
 INFERTILITY- Inability to conceive
 MAYOTONIA- Lack of muscles tone, muscle action has a
prolonged contraction phase and slow relaxation.
 ORGASM- The climax of sexual excitement.
 SEXUAL ORIENTATION- It describes the predominant gender
perforation of a person’s sexual attraction

4. SEXUAL HEALTH
DEFINITION
Sexual health is the integration of
the somatic, emotional,
intellectual and social aspects of
sexually, in ways that are
positively enriching and that
enhance personality,
communication and love.
W.H.O.

5. Conti… defi.
…a state of physical, emotional, mental and social
well-being in relation to sexuality; it is not merely
the absence of disease, dysfunction or infirmity.
Sexual health requires a positive and respectful
approach to sexuality and sexual relationships, as
well as the possibility of having pleasurable and
safe sexual experiences, free of coercion,
discrimination and violence. For sexual health to
be attained and maintained, the sexual rights of all
persons must be respected, protected and fulfilled.
WHO post-2002 working definition

6. Conti… defi..
TheWHO has defined three elements of sexual
health:-
 A capacity to enjoy and control sexual behavior in
accordance with a social and personal ethic
 Freedom from fear, shame guilt, false beliefs, and
other psychological factors inhibiting sexual
response and impairing sexual relationship and
 Freedom from organic disorders , disease, and
deficiencies that interfere with sexual and
reproductive functions.

7. COMPONENTS OF SEXUALHEALTH
 Sexual self concept- 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 from
intimate relationship through out life.
A negative sexual concept may impede formation of
relationship.
 Body image- It is the sense of life, it is constantly
changing , aging, pregnancy, trauma, disease and
therapies can alter an individual’s appearance and
function, which can affect body image.

8. Conti. Compo.
Gender identity- It is one’s self image as a male
and female.
gender role behaviour is the outward expression if
what is perceived as gender appropriate behaviour.
 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
Individual who are attracted to people of both
genders are called bisexual.

9. ALTERATION IN SEXUALHEALTH
 Infertility- Infertility is defined as the inability to
conceive after one year of unprotected intercourse.
A couple who want to conceive and cannot, may
experience a sense of failure and feel that their bodies
are some how defective.
 Sexual abuse- Sexual abuse is a widespread problems
in our society. Abuse crosses all gender, socioeconomic
conditions, age, and ethnic groups.
Sexual abuse has far ranging effects on physical and
psychological functioning.

10. Conti. Altration
Personal and emotional health- Ideally, sex is a
natural, spontaneous act that passes easily through a
number of recognizable physiological changes.
Nurse encounter clients who have problem with one or
more stages of sexual activity.
Eg. Patients taking antidepressants have noted that
their ability to reach orgasm in negatively affected.
 Sexual dysfunction- Sexual dysfunction as defined as
absence of complete sexual functioning.
It is more prevalent in men and women with poor
emotional and physical health.

11. SEX EDUCATION
 Physical aspects-
 Anatomy and physiology of the reproductive organs.
 Physical, emotional , and psychological changes during
puberty.
 Contraception, pregnancy and childbirth.
 Social aspects-
 Sex drive or sexual feelings in childhood and adolescence.
 Emotional development teenag exitement and emotional
stress
 Social relationship (with perents, siblings, peers, of either
sex)
 Sex role
 Gender role

12. SEX EDUCATIONAT SCHOOL
 Teaching should be scientifically correct.
 The group of students should be homogenous in
age and cultural background.
 Groups should over to members other wise two
way communication is difficult.
 Task should be supported by A.V. aids.
 At least one trained teacher.
 Support for administration.
 Support of parents and teachers.
 Avoid culture based sensational and needlessly
controversial topics.

13. SEXUALITY
DEFINITION
Sexuality is the collective characteristics that
the differences between male and female, the
constitution and life of the individual as
related to sex.
OR
The feeling and activities connected with a
person’s sexual desire.
OR
The state of having sex:- the collective characteristics that
mark the differences between the male and female.

14. DEVELOPMENT OF SEXUALITY
INFANCY(0-1)
Role assignment:
Infants are assigned gender role of male & female.
TODDLER(1-3)
Develop gender identity:
By body exploration and genital fondling.
PRESCHOOLER(3-6)
Become increasingly aware of their own and other’s body
parts focuses love on parents of opposite sex.
SCHOOLAGE(6-12)
Gender role behaviour is seen( eg. Tends to friends of same
gender, increased modesty desire for privacy)

15. Conti. Development.
ADOLESCENCE
Adolescence, the transitional period between childhood and
adulthood, begins with puberty.
Biologically the first visible signs of puberty are the development of
the secondary sexual characteristics.
Menstruation can be a first indication of puberty.
Developmental task
1. Achieving awareness and acceptance of body image.
2. Achieving emotional independence of parents and other adults.
3. Achieving new and more nature relation with age mates of both
sexes.
4. Achieving a feminine or masculine social role.
5. Establishing a life-style that is personally and socially satisfying.
6. Acquiring a set of values and an ethical system as a guide to
socially responsible behaviour.

16. Conti. Development
Early Adolescence
Early adolescence begins approximately between 11 and 13 years and
merges with mid adolescence at 14 or 15 years.
It is characterized by an increase an increase in height and the
appearance of the secondary sexual characteristics.
Mid Adolescence
Mid adolescence begins around 14 or 15 years and merges with late
adolescence at about age 17.
Late Adolescence
The late adolescence phase extends from 17 through 21.
The upper limit of the phase depends on cultural, economic, and
educational factors.
The late adolescence is physically mature.
Most late adolescence have achieved a stable body image, and the
agonizing over this or that real or fancied disability is largely over.

17. Conti. Development
Adolescence sexuality
The adolescent’s heightened sexual awareness brings sexual
concerns to the surface.
These include myths about masturbation and concerns about
possible homosexuality, sexual activity, and the presence,
frequency , and content of sexual fantasies and dreams.
Masturbation
Young adolescents may fear that any variation from normal,
particularly of the genitals, has resulted from masturbation.
The adolescents needs to learn that masturbation is normal,
universal that causes neither physical nor mental harm.
It is a natural part of learning about human sexuality and can be
a useful means of relieving sexual tension.

18. Conti. Development
Masturbation is also a common mode of discharge of
tension for adolescents, particularly when alone,
unhappy, or frustrated.
Adolescents boys often fear discovery of evidence of
ejaculation, and girls often fear changes in their genitals
as result of masturbation
Homosexuality
Homosexual experience to some degree is part of the
psychosexual development of many individuals.
The adolescents who is overly affectionate with same-sex
peers or adults may cause considerable parental concern.
This is a result of society’s unresolved position on the meaning
or acceptance of homosexuality

19. Conti. Development
Sexual activity
Adolescents are surrounded by mixed messages. Parents,
religious groups, teachers, health professionals, and
others tell them to refrain from sexual contact, to control
sexual impulses, and to keep away from temptation.
Many of these same adults are asking adolescents to
refrain from activities they themselves openly practice.
At the same time books, movies, music, and
advertisements are laden with sexually stimulating
messages.

20. Conti. Development
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
Decrease hormone production, menopause occurs in
women between 40-55 years climacteric occurs in meu.
LATE ADULTHOOD
Interest in sexual activity often continues, sexual activity,
may be less frequent

21. 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 part of the phallic period.
During this stage, the child “LOVES” parents of the opposite
sex as the provider of sensual satisfaction.
The parent of same sex is considered to be a rival.

22. Conti. stages
THE LATENCY STAGE
At the beginning of the latency stage the child has
resolved or is resolved the oedipal conflict.
During the latency period children from 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 conflict that occurred during the
oedipal period are revived.
If children resolve the conflicts, they are free to enter into
heterosexual relationship as adults.

23. FACTORS INFLUENCING
SEXUALITY
CULTURE
Sexuality regulated by the individual’s culture. For eg.
Muslims can have more than one wife.
Polygamy or monogamy maybe the norm.
Specific sex practices include circumcision.
RELIGIOUS VALUES
Religion influences sexual expression. It provides guideline
for sexual behaviour and acceptable circumstances for
the behaviour as well as prohibited sexual behaviour and
consequences of breaking sexual rules.

24. Conti. factors
PERSONAL
Although ethics is integral to religion, ethical thought
and ethical approaches to sexuality can be viewed
separately from individual to individual
HEALTH STATUS
Healthy minds, bodies and emotions are necessary for
sexual well-being.
Many health factors can interfere with myocardial
infraction person’s expression of sexuality
Disorders that may alter of sexuality are:-

25. Conti. factors
HEART DISEASE
Heart disease influeces sexual expression concerns about the effect of sexual
activity on heart may cause people to restrict or avoid sexual activity.
PROSTATE CANCER
Because of anatomical changes in the posterior urethra following surgery,
retrograde ejaculation sometime results,
HYSTERECTOMY
If there is injury to the nerves during the surgery, hysterectomy may have an
adverse effect on sexual arousal and orgasm.
DIABETES MELLITUS
Many men with long term diabetes mellitus, develop erectile dysfunction
related to neurologic change associated with the disease process.
women who diabetes may experiences orgasmic dysfunction (loss of ability for
orgasm), loss of vaginal lubrications, and pain full intercourse related to a yeast
(monila) infection of the vagina.
SPINAL CORD INJURY
The level of injury to the spinal cord determines the effect on sexual functioning.

26. Conti. factors
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
baby.
Eg, Amputation of leg
Mastectomy, hysterectomy
JOINT DISEASE
Joint disease may indirectly affect sexual functioning
because of pain, stiffness, loss of joint motion, and
fatigue.
Such symptoms influences sexual motivation as well
as sexual positioning and metods.

27. Conti. factors
CHRONIC DISEASE
Chronic pain accompanying chronic disease often
decrease sexual motivation.
SEXUALLY TRANSMITTED DISEASE (STD)
The presence of an STD in one partner induce fear of
transmission in the other, often resulting in abstinence of
sexual contact in some situation, presence of a sexuality
transmitted disease is unknown and transmission occurs.
MENTAL DISORDER
Because mind and thought process are involved in
sexual functioning, any impairment of the brain may effect
sexual impression.
Eg. In depression, it is relatively common to see decreased in
sex.

28. Conti. factors
MEDICATION
Alcohol:-Moderate amount increased sexual
functioning Chronic use decreased sexual desire.
Antianxiety agents:- decreased sexual desire.
Anticonvulsants:- decreased sexual desire.
Antidepressant:- decreased sexual desire.
Antihistamines:- decreased sexual desire.
Anti-hypertensive:- decreased sexual desire.
Anti-psychotic:- decreased sexual desire.
Barbiturates:- in low dose increase sexual pleasure.
In high dose decrease sexual desire.

29. Conti. factors
Cacaine:- In low dose increase sexual pleasure.
In high dose decrease sexual desire.
Marijuana:- In low dose increase sexual pleasure.
In high dose decrease sexual desire.
But prolonged use reduces testosterone
level and reduces sperm production.
Narcotics:- Inhibited sexual desire, and response
erectile and ejaculatory dysfunction.

30. SEXUAL RESPONSE CUCLE
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 his role.
Commonly occurring phase of human sexual
response follows sequence in both male and
female.

31. Conti. Cycle
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 & imagination(sexual fantasy) can all involve sexual arousal, sexual desire
fluctuates within each person and varies from person to person.
EXSITEMENT OR PLATEAU PHASE
Vasocongestion
It is increase in the blood flow to various body parts resulting in erection of
the penis and clitoris and swelling of the lebia, testes and breasts, vasocongestion
stimulates sensory receptors in these body parts that in turn transmit message 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.

32. Conti. Cycle
Myotonia
Increase of tension in muscles, may increase until release by
orgasm or it may also simply fade away.
ORGASMIC PHASE
In this phase, there is involuntary climax of sexual tension,
accompanied by physiological and psychologic release.
This phase is considered the measurable peak of sexual
experience, although in the pelvic region, male orgasm usually
last for 10-30sec., while female orgasms last 10- 50sec.
Men usually have an ejaculation and expel semen as part of
their orgasm.

33. Conti. Cycle
RESOLUTION PHASE
It is the period of oeturn to the unarousal state, lasting 10-15
min. after orgasm.
This phase in female is quite varied as some women
experience multiple successive orgasms, followed by a longer
period of resolution.

34. SEXUAL DYSFUNCTION
MALE DYSFUNCTION
Erectile dysfunction
Persistent or recurrent inability to achieve or maintain sufficient
erection until completion of sexual activity.
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 inn ejaculation or absence of orgasm
following a normal sexual excitement phase during sexual activity

35. Conti. Dysfunction
FEMALE DYSFUNCTION
Hypoactive sexual dysfunction
It involves absence of sexual thoughts or disinterest in sexual
activity.
Sexual arousal disorder
Failure to attain or maintain vaginal lubrication or experience
subjective sense of sexual excitement and pleasure during sexual
activity
Orgasmic disorder
Difficulty or inability to achieve orgasm inspite of stimulation and
arousal.
Sexual pain disorder
Dyspareunia
Describes the pain experienced by a women during
intercourse

36. NURSING MANAGEMENT
1. Assessing
Nursing history:-
It should include sexual concerns to help plan a
comprehensive treatment approach. A nurse should not
make assumptions about client before taking accurate
history.
physical history:-
The nursing history data which indicates the need for
a physical examination includes are:-
suscipicion of infertility, pregnancy, or sexual
transmitted disease

37. Conti. Nsg. Mangt.
2. Planning
 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.
3. implementing
(A)Providing sexual health teaching
Sex education
Responsible for sexual behaviour

38. Conti. Nsg. Mangt.
(B) Counseling for altered sexual function
I. Permission giving
II. Limited information
III. Specific suggestions
IV. Intensive therapy
4. Evaluation
The goals established during the planning phase are
evaluated according to specific desired outcomes also
established during that phase. It outcomes have not been
achieved, the nurse should explore the reasons.