The first 3 years of life are crucial in the development of gender identity (Edelman and Mandle, 2010). The child identifies with the parent of the same sex and develops a complementary relationship with the parent of the opposite sex. Children become aware of differences between the sexes, begin to perceive that they are either male or female, and interpret the behaviors of others as behavior appropriate for a female or a male.

During the school years parents, educators, and peer groups serve as role models and teachers about how men and women act with and relate to one another. School-age children generally have questions regarding the physical and emotional aspects of sex. They need accurate information from home and school about changes in their bodies and emotions during this period and what to expect as they move into puberty (Edelman and Mandle, 2010). Knowledge about normal emotional and physical changes associated with puberty decreases anxiety as these changes begin to happen. Menstruation or nocturnal emission is sometimes frightening for uninformed children, and some view them as evidence of a dreadful disease.

The emotional changes during puberty and adolescence are as dramatic as the physical ones. The adolescent functions within a powerful peer group, with the almost constant anxiety of “Am I normal?” and “Will I be accepted?” (Fig. 34-1). They face many decisions and need accurate information on topics such as body changes, sexual activity, emotional responses within intimate sexual relationships, STIs, contraception, and pregnancy.

In the United States approximately 46% of high school students report that they have had sexual intercourse at least one time and 14% of high school students had had four or more sexual partners (CDC, 2010a). One reason why adolescents are sexually active is because many believe that sexual intercourse helps them achieve goals of intimacy, relationships, and pleasure (Fantasia, 2009). A substantial number of sexually active teenagers do not protect themselves from pregnancy or STIs. The dynamics of sexual risk taking are not fully understood, but studies have found correlations among drug/alcohol use, sexual abuse, and unsafe sex (Elkington, Bauermeister, and Zimmerman, 2010; Fantasia, 2009). Adolescents tend to think that unwanted pregnancy, STIs, and other negative outcomes of sexual behavior are not likely to happen to them. Parents need to understand the importance of providing factual information, sharing their values, and promoting sound decision-making skills. They need to know that, even with the best guidance and information, adolescents make their own decisions and need to be held accountable for them.

Adolescence is often a time when individuals explore their primary sexual orientation (Bowder and Greenberg, 2010). They may identify with a sexual minority group such as lesbian, gay, bisexual, or transgender (LGBT) (Young-Bruehl, 2010). Adolescents often face significant stress related to these choices and benefit from education about sexuality issues (Doty et al., 2010). Support from peers, family, school counselors, clergy, nurses, and other health professionals is important during this time.

Sexuality in older adults is an important aspect of health that is often overlooked by health care providers. Studies show a positive correlation between sexual activity and physical health in older adults (Lindau and Gavrilova, 2010; Lindau et al., 2007). Many studies suggest that older adults retain an interest in sexual function and are sexually active. Other studies conclude that there is a decline of sexual interest and behavior among older adults, especially in women (Box 34-1). Factors that determine sexual activity in older adults include present health status, past and present life satisfaction, and the status of marital or intimate relationships. For example, many older women are widowed or divorced and lack available sexual partners, which accounts for their decline in sexual activity. Nurses working with older adults need to be aware of the sexuality of their patients, assess interest and functioning, and plan accordingly (Wallace, 2008). It is essential to maintain a nonjudgmental attitude and convey that sexual activity is normal in later years. Emphasize that sexual activity is not essential to maintaining quality of life, especially when patients have decided not to remain sexually active.

To be effective in promoting sexual health, nurses need to understand the normal sexual changes that occur as people age. The excitement phase prolongs in both men and women, and it usually takes longer for them to reach orgasm. The refractory time following orgasm is also longer. Both genders experience a reduced availability of sex hormones. Men often have erections that are less firm and shorter acting. Women usually do not have difficulty maintaining sexual function unless they have a medical condition that impairs their sexual activity. Typically the infrequency of sex in older women is related to the age, health, and sexual function of their partner. Women continue to experience changes related to menopause, and those with problems related to urinary incontinence often experience embarrassment during intercourse. Couples who have physically disabling conditions often need information about which positions are more comfortable when having sexual intercourse.

Barrier methods include over-the-counter spermicidal products and condoms. Spermicidal products (e.g., creams, jellies, foams, and sponges) are put into the vagina before intercourse to create a spermicidal barrier between the uterus and ejaculated sperm. A condom is a thin rubber sheath that fits over the penis to prevent entrance of sperm into the vagina. A diaphragm is a barrier method, which must be used with a spermacide with each sexual encounter. Vaginal spermicides and condoms are most effective when instructions are followed carefully; their combined use is more effective in preventing pregnancy than the use of either one alone (Warner and Steiner, 2009).

Nonprescription methods of contraception based on the physiological changes of the menstrual cycle include the rhythm, basal body temperature, cervical mucus, and fertility-awareness methods. Couples who use these methods need to understand the reproductive cycle of the woman’s body and the subtle signs and signals that her body gives during the cycle. To prevent pregnancy couples abstain from sexual intercourse during designated fertile periods.

An IUD is a plastic device inserted by a health care provider into the uterus through the cervical opening. IUDs contain either copper or progesterone. The primary mechanism by which both types of IUDs prevent pregnancy is to stop the sperm from fertilizing an egg (Grimes, 2009; Murphy, 2011; Ortiz and Croxatto, 2007). The release of progesterone may also increase cervical mucus thickness and alter the lining of the uterus.

The diaphragm is a round, rubber dome that has a flexible spring around the edge. It is used with a contraceptive cream or jelly and is inserted in the vagina so it provides a contraceptive barrier over the cervical opening. The woman needs to be refitted after a significant change in weight (10-lb gain or loss) or pregnancy. The cervical cap functions like the diaphragm; however, it covers only the cervix. It may be left in place longer, and some perceive it as more comfortable than the diaphragm.

Sterilization is the most effective contraception method other than abstinence. Female sterilization, or tubal ligation, involves cutting, tying, or otherwise ligating the fallopian tubes. In male sterilization, or vasectomy, the vas deferens, which carries the sperm away from the testicles, is cut and tied. Both a tubal ligation and a vasectomy are usually considered permanent surgical procedures.

The natural history of HIV is composed of three stages. The primary infection stage lasts for about a month after contracting the virus. During this time the person often experiences flulike symptoms. Then he or she enters the clinical latency phase; at this time there are no symptoms of infection. HIV antibodies appear in the blood about 6 weeks to 3 months after infection. If left untreated, people who are infected with HIV live about 10 years. The last stage, acquired immunodeficiency syndrome (AIDS), happens when the person begins to show symptoms of the disease. AIDS is a serious, debilitating, and eventually fatal disease. Highly active antiretroviral therapy (HAART) greatly increases the survival time of persons who live with HIV/AIDS (Marrazzo et al., 2009).

HPV is the most common STI in the United States, with approximately 6 million new infections every year (CDC, 2010b). Most HPV infections are asymptomatic and self-limiting. However, certain types of HPV can cause cervical cancer in women and anogenital cancers and genital warts in both men and women (CDC, 2010b; Palefsky, 2010). HPV is spread through direct contact with warts, semen, and other body fluids from others who have the disease. The textured warts often have a cauliflower appearance and are most common on the penis and scrotum in men and the vagina and cervix in women. An HPV vaccine that protects both men and woman against the types of HPV that most commonly cause health concerns is available (CDC, 2010b).

An infection of the bacteria Chlamydia trachomatis causes chlamydia. It is the most commonly reported bacterial STI in the United States, affecting about 2.8 million Americans each year (CDC, 2009). Chlamydia infects the genitourinary tract and rectum in adults, and it causes conjunctivitis and pneumonia in newborn babies. Transmission occurs when the person comes in contact with fluids from infected sites (e.g., cervix or urethra). It is a major health issue because, if it is not treated, it causes PID, ectopic pregnancy, infertility, and neonatal complications. The risk of infection is higher in people who are less than 25 years old and who do not consistently use barrier contraceptives. It is also common in people who have multiple sex partners and who are infected with other STIs (Marrazzo et al., 2009). Most chlamydia infections go undiagnosed and untreated because 75% of women and 50% of men experience no symptoms (Grimshaw-Mulcahy, 2008). Symptoms that women often experience include dysuria, urinary frequency, and purulent vaginal discharge. In men it usually infects the urethra and causes nongonococcal urethritis (NGU). Dysuria and urethral discharge are common symptoms of NGU (Marrazzo et al., 2009).

Sexual interest and activity of women and their partners vary during pregnancy and menstruation. Some cultures encourage sexual intercourse or male-female contact during menstruation and pregnancy, but other cultures strictly forbid it. For example, in the Hindu culture a woman avoids worship, cooking, and other members of the family during menstruation. Research has found no physiological contraindication to intercourse during menstruation or during most pregnancies. Female sexual interest tends to fluctuate during pregnancy, with increased interest during the second trimester and often decreased interest during the first and third trimesters. There is often a decrease in libido during the first trimester because of nausea, fatigue, and breast tenderness. During the second trimester blood flow to the pelvic area increases to supply the placenta, resulting in increased sexual enjoyment and libido. During the third trimester the increased abdominal size often makes finding a comfortable position difficult (Lowdermilk et al., 2010).

Sexuality is a significant part of each person’s being, yet sexual assessment and interventions are not always included in health care (Lindau et al., 2007; Stilos et al., 2008). The area of sexuality is often emotionally charged for nurses and patients. Sometimes nurses avoid discussing sexual issues with patients because they lack information or have different values than their patients. Nurses who have difficulty discussing topics related to sexuality need to explore their discomfort and develop a plan to address it. If you are uncomfortable with topics related to sexuality, the patient is unlikely to share sexual concerns with you.

Decisions patients make regarding contraception have far-reaching effects on their lives. Pregnancy, whether planned or unplanned, significantly affects the life of the mother and father and often their support network. Effects are physical, interpersonal, social, financial, and societal. The choice to use contraception is multifaceted and not completely understood. Factors that affect the effectiveness of contraception include the method of contraception, the couple’s understanding of the contraceptive method, the consistency of use, and compliance with the requirements of the chosen method. Choice of contraception method varies in relation to the age, marital status, income, education, and previous pregnancies of the woman (Mosher and Jones, 2010).

Half of all pregnancies in the United States are unplanned; the majority of unplanned pregnancies occur in teenagers, women over 40 years of age, and low-income nonwhite women (Paul and Stewart, 2009). Almost half of unintended pregnancies end in abortion (Mosher and Jones, 2010). Abortions have been performed since ancient times. The safety and availability of abortions in the United States improved after the 1973 Supreme Court decision Roe v Wade, which established the right of every woman to have an abortion. Abortions are safer and less costly when performed in the early weeks of pregnancy.

Abortion is a hotly debated issue. Women and their partners who face an unwanted pregnancy may consider it. If caring for a patient contemplating abortion, provide an environment in which the patient is able to discuss the issue openly, allowing exploration of various options with an unwanted pregnancy. Discuss religious, social, and personal issues in a nonjudgmental manner with patients. Reasons for choosing an abortion vary and include terminating an unwanted pregnancy or aborting a fetus known to have birth defects. When a woman chooses abortion as a way of dealing with an unwanted pregnancy, the woman and often her partner experience a sense of loss, grief, and/or guilt.

Be aware of personal values related to abortion. Nurses are entitled to their personal views and should not be forced to participate in counseling or procedures contrary to beliefs and values. It is essential to choose specialties or places of employment where personal values are not compromised and the care of a patient in need of health care is not jeopardized.

Sexual abuse is a widespread health problem. Abuse crosses all gender, socioeconomic, age, and ethnic groups. Most often it is at the hands of a former intimate partner or family member. Sexual abuse has far-ranging effects on physical and psychological functioning (Edelman and Mandle, 2010). Sometimes sexual abuse begins, continues, or even intensifies during pregnancy. Cues that raise a question of possible sexual abuse include extreme jealousy and refusal to leave a woman’s presence. The overall appearance is sometimes that of a very concerned and caring husband or boyfriend, when the underlying reason for this behavior is very different.

When you recognize abuse, mobilize support for the victim and the family. All family members usually require therapy to promote healthy interactions and relationships. Rape victims often need to work through the crisis before feeling comfortable with intimate expressions of affection. The partner needs to know how to help and support the victim. Children who have been sexually molested need to understand that they are not at fault for the incident. The parents need to understand that their response is critical to how the child reacts and adapts. Nurses are in an ideal position to assess occurrences of sexual violence, help patients confront these stressors, and educate individuals regarding community services. Nurses must also report suspected abuse to the proper authorities.

Sexual dysfunction, the absence of complete sexual functioning, is common. The incidence of sexual dysfunction in the general population is estimated to be as high as 40% in men and 45% in women (Gorman and Sultan, 2008; Murtagh, 2010; Shifren et al., 2008). It is more prevalent in men and women with poor emotional and physical health (Box 34-3). Sometimes the exact cause cannot be determined.

Box 34-3

Illnesses and Medications that Affect Sexual Functioning of Men and Women

Illnesses • Diabetes mellitus • Cancer (e.g., prostate, breast, colon, ovarian, testicular, rectal) • Neuropathy • Spina bifida • Spinal cord injury • Unstable angina • Uncontrolled hypertension • Chronic obstructive pulmonary disease • Human immunodeficiency virus (HIV) infection Only gold members can continue reading. Log In or Register to continue Share this: Click to share on Twitter (Opens in new window) Click to share on Facebook (Opens in new window) Related Related posts: Legal Implications in Nursing Practice Young and Middle Adults Nursing Diagnosis Stress and Coping Stay updated, free articles. Join our Telegram channel Join Tags: Fundamentals of Nursing Nov 17, 2016 | Posted by admin in NURSING | Comments Off on Sexuality Full access? Get Clinical Tree Get Clinical Tree app for offline access Get Clinical Tree app for offline access