Sexuality



Sexuality


Objectives



• Identify personal attitudes, beliefs, and biases related to sexuality.


• Discuss the nurse’s role in maintaining or enhancing a patient’s sexual health.


• Describe key concepts of sexual development across the life span.


• Identify causes of sexual dysfunction.


• Assess a patient’s sexuality.


• Formulate appropriate nursing diagnoses for patients with alterations in sexuality.


• Identify patient risk factors in the area of sexual health.


• Identify and describe nursing interventions to promote sexual health.


• Evaluate patient outcomes related to sexual health needs.


• Identify other health care providers and community resources available to help patients resolve sexual concerns that are outside the nurse’s level of expertise.


• Use critical thinking skills when helping patients meet their sexual needs.


Key Terms


Bisexual, p. 675


Climacteric, p. 685


Condom, p. 676


Contraception, p. 674


Diaphragm, p. 676


Dyspareunia, p. 675


Gay, p. 675


Gender identity, p. 674


Gender roles, p. 674


Hypoactive sexual desire disorder, p. 679


Infertility, p. 677


Lesbian, p. 675


Perimenopausal, p. 675


Sexual dysfunction, p. 679


Sexual health, p. 674


Sexual orientation, p. 674


Sexuality, p. 674


Sexually transmitted infection (STI), p. 674


Sterilization, p. 676


Transgender, p. 675


Tubal ligation, p. 677


Vasectomy, p. 677


image


http://evolve.elsevier.com/Potter/fundamentals/



Sexuality is part of a person’s personality and is important for overall health. Even though discussion of sexual topics has increased over the years, many adults lack knowledge regarding sexuality. Although patients may be hesitant to bring up their concerns, they often share their feelings when the nurse addresses sexuality in a relaxed, matter-of-fact manner. To feel comfortable addressing sexuality, nurses need therapeutic communication skills and to be knowledgeable about sexual functioning, issues, and assessment. Many values and issues surround sexuality. Religious teachings, cultural influences on gender roles, beliefs about sexual orientation, and social and environmental climates influence the values systems for both patients and health care providers.


Sexuality has many definitions. Expression of an individual’s sexuality is influenced by interaction among biological, sociological, psychological, spiritual, economic, political, religious, and cultural factors (Gorman and Sultan, 2008; World Health Organization [WHO], 2010). In addition, values, attitudes, behaviors, relationships with others, and the need to establish emotional closeness with others influence sexuality.


Sexuality differs from sexual health. According to WHO (2010), sexual health is “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.” People who are sexually healthy have a positive and respectful approach to sexuality and sexual relationships. They also have a potential for having pleasurable and safe sexual experiences that are free from coercion, discrimination, and violence.


Scientific Knowledge Base


Nurses help patients achieve sexual health by having a sound scientific knowledge base regarding sexuality. A basic understanding of sexual development, sexual orientation, contraception, abortion, and sexually transmitted infections (STIs) is necessary.


Sexual Development


Sexuality changes as a person grows and develops. Each stage of development brings changes in sexual functioning and the role of sexuality in relationships.


Infancy and Early Childhood


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.


School-Age Years


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.


Puberty/Adolescence


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.



Building Competency in Patient-Centered Care


A 15-year-old girl tells the nurse at a family planning clinic that she is sexually active but does not use birth control. She states that her boyfriend won’t use condoms and she is concerned about pregnancy. In addition, she lives at home with her parents, and she doesn’t want them to know that she is using contraception. What assessment and teaching strategies would you use to address these patient concerns?


Answers to questions can be found on the Evolve website.


Young Adulthood


Although young adults have matured physically, they continue to explore and mature emotionally in relationships. Intimacy and sexuality are issues for all young adults whether they are in a sexual relationship, choose to abstain from sex, remain single by choice, are homosexual, or are widowed. People are sexually healthy in numerous ways. Sexual activity is often defined as a basic need, and healthy sexual desire is channeled into forms of intimacy throughout a lifetime.


As sexually active adults develop intimate relationships, they learn techniques of stimulation that are satisfying to both themselves and their sexual partners. Some adults need permission or affirmation that alternative ways of sexual expression other than penile-vaginal intercourse are normal. Other individuals require significant education or therapy to achieve mutually satisfying sexual relationships.


Middle Adulthood


Changes in physical appearance in middle adulthood sometimes lead to concerns about sexual attractiveness. In addition, actual physical changes related to aging affect sexual functioning. Decreasing levels of estrogen in perimenopausal woman lead to diminished vaginal lubrication and decreased vaginal elasticity. Both of these changes often lead to dyspareunia, or the occurrence of pain during intercourse. Decreasing levels of estrogen may also result in a decreased desire for sexual activity. As men age, they are likely to experience changes such as an increase in the postejaculatory refractory period and delayed ejaculation. Anticipatory guidance regarding these normal changes, using vaginal lubrication, and creating time for caressing and tenderness ease concerns regarding sexual functioning. Some aging adults also need to adjust to the impact of chronic illness, medications, aches, pains, and other health concerns about sexuality.


Later in the adult years some individuals have to adjust to the social and emotional changes associated with children moving away from home. This results in either a time of renewed intimacy between partners or a time when formerly intimate partners realize that they no longer care for one another or have common interests. In either case, when children leave home, intimate relationships usually change.


Older Adulthood


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.


Sexual Orientation


Sexual orientation describes the predominant pattern of a person’s sexual attraction over time. Many stereotypical myths remain about people who are LGBT. Current evidence indicates that they experience decreased access to health care and do not readily seek preventive care (Brown, 2009; Williamson, 2010). Nonjudgmental nurses who have a solid knowledge base help to discourage these myths and provide nursing care that includes attention to the person’s sexual orientation.


Contraception


Numerous contraceptive options are available to sexually active couples today. They provide varying levels of protection against unwanted pregnancies. Some methods do not require a prescription, whereas others require a prescription or some other type of intervention from a health care provider. Methods that are effective for contraception do not always reduce the risk of STIs. For example, the pill and intrauterine device (IUD) are effective as birth control but not for protection from STIs. Effectiveness varies with each contraceptive method and the consistency of use. Unplanned pregnancies occur because contraceptives are not used, are used inconsistently, or are used improperly (Gabelnick et al., 2009).


Nonprescription Contraceptive Methods


Nonprescription methods for contraception include abstinence, barrier methods, and timing of intercourse with regard to the woman’s ovulation cycle. Although abstinence from sexual intercourse is 100% effective, it is often difficult for both men and women to use consistently. Any act of unprotected intercourse potentially results in pregnancy and exposure to STIs.


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.


Methods That Require a Health Care Provider’s Intervention


Contraceptive methods that require the intervention of a health care provider include hormonal contraception, IUDs, the diaphragm, the cervical cap, and sterilization. Hormonal contraception is available in several forms: oral contraceptive pills, vaginal contraceptive rings, hormonal injections, subdermal implant, transdermal skin patches, and IUDs. Hormonal contraception alters the hormonal environment to prevent ovulation, thicken cervical mucus, and thin the lining of the uterus.


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.


Sexually Transmitted Infections


The incidence of STIs continues to increase. About 19 million people in the United States are diagnosed with an STI each year; almost half of them are 15 to 24 years of age (CDC, 2009). The prevalence of STIs is a major health concern for several reasons. Black and Hispanic populations are diagnosed with STIs more frequently than whites, and women have more complications associated with STIs than men. In addition, social factors such as poverty, low literacy, discrimination, use of illegal drugs (e.g., crack cocaine, methamphetamine), incarceration, sexual abuse, and racial segregation contribute to racial disparities in the STI rates (Hogben and Leichliter, 2008). Treatment of STIs in America costs about $16 million annually (CDC, 2009). Commonly diagnosed STIs include syphilis, gonorrhea, chlamydia, trichomoniasis, and infection with the human papillomavirus (HPV) and herpes simplex virus (HSV) type II (genital warts and genital herpes, respectively).


As the name implies, STIs are transmitted from infected individuals to partners during intimate sexual contact. The site of transmission is usually genital, but sometimes it is oral-genital or anal-genital. People most likely to be infected share one key characteristic: unprotected sex with multiple partners. Gonorrhea, chlamydia, syphilis, and pelvic inflammatory disease (PID) are caused by bacteria and are usually curable with antibiotics. Patients need to take antibiotics for the full course of treatment. However, an emerging concern is that some of these bacterial infections (e.g., gonorrhea and syphilis) are now developing antibiotic-resistant strains. Infections such as genital herpes, HPV, and human immunodeficiency virus (HIV) are caused by viruses and cannot be cured.


A major problem in dealing with STIs is finding and treating the people who have them. Some people do not know that they are infected because symptoms are sometimes absent or go unnoticed (CDC, 2009). Common symptoms of an STI include discharge from the vagina, penis, or anus; pain during sex or when urinating; blisters or sores in the genital area; and fever (Marrazzo et al., 2009). Because sexual behavior often includes the whole body rather than just the genitalia, many parts of the body are potential sites for an STI. The ears, mouth, throat, tongue, nose, and eyelids are sometimes used for sexual pleasure. The perineum, anus, and rectum are also frequently included in sexual activity. Furthermore, any contact with another person’s body fluids around the head or an open lesion on the skin, anus, or genitalia can transmit an STI.


Sometimes people do not seek treatment because they are embarrassed to discuss sexual symptoms or concerns. They are also often hesitant to talk about their sexual behavior if they believe that it is not “normal.” Any sexual behavior that embarrasses the patient often hinders the detection of an STI. Develop communication skills and a nonjudgmental attitude to provide effective care for those diagnosed with one. Detect valuable clues about an STI by establishing trust, talking with patients, and asking questions in a caring manner. Assess attitudes toward sexuality and adjust the intervention to make it acceptable to the patient’s sexual value system.


Human Immunodeficiency Virus Infection


HIV infection is sometimes spread through sexual contact. Although HIV is present in most body fluids, it is a bloodborne pathogen. Transmission occurs when there is an exchange of body fluid. Primary routes of transmission include contaminated intravenous (IV) needles, anal intercourse, vaginal intercourse, oral-genital sex, and transfusion of blood and blood products. Populations that are at risk for HIV include people who use illicit IV drugs and share needles, individuals with hemophilia, and people who have unprotected sexual contact.


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).


Human Papillomavirus Infection


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).


Chlamydia


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).


Nursing Knowledge Base


Factors Influencing Sexuality


Use critical thinking skills and basic nursing knowledge when addressing patients’ sexual health needs. Draw from the following areas of nursing knowledge: sociocultural dimensions of sexuality, decisional issues, and alterations in sexual health.


Sociocultural Dimensions of Sexuality


Cultural rules and norms regarding acceptable behavior within the culture influence sexuality. People assign different meanings to sexuality based on their culture, gender, education, socioeconomic status, and religion (Giger and Davidhizar, 2008; Stilos et al., 2008). Society plays a powerful role in shaping sexual values and attitudes and supporting specific expression of sexuality in its members.


Each cultural and social group has its own set of rules and norms that guide sexual behavior, sexual health, and the willingness to discuss this private part of life. For example, cultural norms influence how people find partners, whom they choose as partners, how they relate to one another, how often they have sex, and what they do when they have sex. Personal beliefs enable certain practices and prohibit others (Box 34-2).



image Box 34-2


Cultural Aspects of Care


Latinos and HIV/AIDS Risk Factors


Latinos are less likely to use condoms, less likely to seek human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) testing and have a higher incidence of HIV/AIDS than other ethnic groups in the United States. Latinos with HIV are diagnosed later in the disease process and often in the acute care setting with symptoms and complications associated with AIDS. Sociocultural factors such as gender roles, lack of knowledge, language, younger age at onset of sexual activity, and limited communication between parents and children about use of contraceptives contribute to this discrepancy (Wohl et al., 2009). Traditional Latino culture supports beliefs in abstinence until marriage, and many believe that teaching children about sex promotes sexual activity. Parents are not comfortable teaching their children, especially their daughters, about sex (Lescano et al., 2009).


Implications for Practice



• Direct interventions toward the family versus the individual since collectivism and family are fundamental to Latino culture.


• Whenever possible, first establish a strong therapeutic relationship with the patient and family before discussing sexual health.


• Design culturally sensitive and specific nursing interventions for Latino patients and families.


• Provide written and verbal information (in English and Spanish) about sex education, assertive communication, power in relationships, and negotiation skills.


• Encourage community resources such as churches and schools to improve sex education in Latino families and communities.


• Promote community and multimedia education campaigns in Spanish and English languages.


• Increase HIV testing offered at community and public clinics and consider combining HIV testing with other laboratories to promote acceptance by Latinos.


Impact of Pregnancy and Menstruation on Sexuality


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).


Discussing Sexual Issues


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.


Decisional Issues


Individuals make many decisions about their sexuality. Some nurses help patients make decisions about contraception and abortion.


Contraception


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).


Abortion


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.


Prevention of Sexually Transmitted Infections


Abstinence is the only practice that is considered to be 100% effective in preventing transmission of STIs. Responsible sexual behavior includes knowing one’s sexual partner, being able to openly discuss sexual and drug-use history with the partner, not allowing drugs or alcohol to influence decision making, and using protective devices.


Alterations in Sexual Health


Infertility


Infertility is the inability to conceive after 1 year of unprotected intercourse. A couple who wants to conceive and cannot has special needs. Some experience a sense of failure and feel that their bodies are defective. Sometimes the desire to become pregnant grows until it permeates most waking moments. Some individuals become preoccupied with creating just the right circumstances for conception. With advances in reproductive technology, infertile couples face many choices that involve religious and ethical values and financial limitations.


Choices for the infertile couple include pursuit of adoption, medical assistance with fertilization, or adapting to the probability of remaining childless. Organizations such as RESOLVE: The National Organization of Infertility, a national support group for couples with infertility, or international adoption groups provide couples with support and offer referral sources.


Sexual Abuse


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.


Personal and Emotional Conflicts


Ideally sex is a natural, spontaneous act that passes easily through a number of recognizable physiological stages and ends in one or more orgasms. In reality this sequence of events is more the exception than the rule. Nurses meet patients who have problems with one or more of the stages of sexual activity, including the feeling of wanting sex, the physiological processes and emotions of having sex, and the feelings experienced after sex. For example, some women and men who are taking antidepressants report that their ability to reach orgasm is negatively affected.


Sexual Dysfunction


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


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Nov 17, 2016 | Posted by in NURSING | Comments Off on Sexuality

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