SEXUALITY CONCEPT IN NURSING By Purwaningsih

Organs have dual functions: Produce reproductive cells Produce hormones responsible for sex characteristics Females - estrogen and progesterone Males - testosterone REPRODUCTIVE SYSTEM

SEXUALITY Expressed by individuals of all ages A way to show feminine or masculine qualities: Clothing styles and colors Hairstyles Hobbies and interests Sexual habits (continue into old age) Gestures 2.03 Nursing Fundamentals 7243

Caressing, touching, holding hands Masturbation SEXUALITY May be expressed by: Sexual intercourse Caressing, touching, holding hands Masturbation Is a right of all residents to experience 2.03 Nursing Fundamentals 7243

N24: Sexuality, STIs, Contraception 4/13/2017 Factors affecting sexuality Culture Religion Ethics Lifestyle Health state Age Stereotypes Fathers more than mothers Ie. What was attitude toward sex & sexuality prior to surgery. ethics: the discipline dealing with what is good and bad and with moral duty and obligation. 2. a : a set of moral principles : a theory or ... Cabrillo College ADN / C.Madsen RN, MSN

External genitals of the female

Female Reproductive System Copyright © The McGraw-Hill Companies, Inc. Permission required for reproduction or display. Female Reproductive System oviduct oviduct ovary uterus fimbriae ovary uterus urinary bladder cervix vagina pubic symphysis rectum urethra vagina anus

Function of Female Reproductive System Ovulation – ova begins to mature & enlarge until discharged Migrates toward & enters oviduct where possible fertilization may take place Mentrual Cycle – involves production of estrogen & progesterone Menopausal period – end of woman’s reproductive capacity. Early menopause – surgical removal of ovaries, chemotherapy, radiations, unknown etiology

Sexual Health Negative definitions Avoidance of unintended pregnancy Avoidance of sexually transmitted infections Absence of sexual dysfunctions Positive definitions (the above plus) Equitable relationships Sexual fulfilment Sexual rights (and responsibilities)

Sexual Rights – WHO, 2002 Sexual rights include the right of all persons, free of coercion, discrimination and violence, to the highest attainable standard of sexual health, including access to sexual and reproductive health care services seek, receive and impart information related to sexuality sexuality education respect for bodily integrity choose their partner decide to be sexually active or not consensual sexual relations consensual marriage decide whether or not, and when, to have children pursue a satisfying, safe and pleasurable sexual life

Infantile sexuality Freud Montague Parental reinforcement orality Touch Parental reinforcement Trust

Toddlers… Body image Primary identification Exploration of body Self concept Autonomy vs. shame and doubt Primary identification Traditionally imitation from observation of same sex parent Exploration of body Masturbation ‘anality’

Preschoolers… Initiative vs. guilt Conscience, superego Self concept ~ emerging overt sexuality Parental and peer (re)enforcements Masturbatory substitutes Rocking, riding

Schoolagers… Sexuality ‘sublimated’ into industry Doesn’t mean ‘asexual’ Cognition Social interaction skills More self concept and body image Inter-relationship depends on environment Chum-ship Some mid- and late schoolagers are sexually active Development of secondary sexual maturation

Answering questions about sex… Open acceptance Answer what is asked Know the facts! Be honest Don’t skip information because initial response is ‘Oh, I know that…’ Also, don’t include too much information in one sitting

Adolescence Establishing sexual identity or self concept Involves understanding roles, values, duties and responsibilities as well as physical responses Sexual orientation is a continuum A personal evaluation of one’s sexual feelings and actions Accommodating adult erotic feelings Experimental sexual behaviors Dealing with behavior choices

Biology vs. Psychology Physical sexual response cycles in men and women only understood since the 1970’s Masters and Johnson excitement, plateau, orgasm, resolution Most people closely tie physiology with emotions Sex for sex’s sake vs. sex for love’s sake Sex for procreation vs. recreation Abstinence is not a dirty word

Young adults Developmental level and chronology often not synchronous Making love and having sex aren’t the same There aren’t any ‘abnormals’ in sexual relationships if the behavior is acceptable to both parties Overtly or covertly, everybody cares about and is interested in sex, whether or not they act on it

Adulthood Developmental stages of partners impacts quality of relationship Stresses of everyday life can negatively impact sexual expression ‘Being all things to all people’ What to do with the kids… Fatigue and poor communication greatest impediments to positive sexual behavior Creativity and time management Loss of partner from divorce or death

Aging and sexuality Age should not be a barrier to sexual expression Social circumstances might be – but can be changed Attitudes and expectations may be problematic Those who are aging Relatives and friends

Sexuality and Aging Human drive Other bodily changes Opportunity Diminishes with aging Other bodily changes Mechanically less responsive Opportunity Partner passes away or is ill Cultural bias Images of beauty, sexuality

Sexuality and Dementia Partners must adapt to change Degree of intimacy May be less interested Patience May be clumsy, poorly coordinated See as appropriate Be supportive of their desire for intimacy May alter what regarded as intimacy Normal sexual activity may be unrealistic May be uncomfortable, frustrating Persons views, attitudes on sexuality may change

Sexuality in the Nursing Home Most still want to be sexually active Over 60% of elderly residents endorsed a desire for intimacy 52% of men 60-69 report intercourse in the previous 4 weeks Barriers to intimacy exist Lack of privacy Staff, family attitudes Informed consent issues Lack of a partner

Hypersexuality Definition Exposure Obscene sexual language Inappropriate masturbation Propositioning of others Touching breasts and genitalia

Infections can be transferred through the exchange of bodily fluids like: Blood Semen Vaginal secretions Saliva Breast milk

Nursing Role in Women’s Health Health promotion Illness prevention Provide support & counseling Encourage women in their health goals and behaviors personal hygiene, detecting & preventing diseases (STDs), diet & exercises, sexuality issues- menopause, contraception, preconception, pre-/postnatal care, stress management & well-being, healthy lifestyles, & avoiding risky behaviors

Nursing Role in Women’s Health Nurses need to model that lifestyle for patients Recommend & promote regular examinations Non-judgmental, understanding & sensitive Screen for/and recognize s/sx. abuse Recognize cultural differences & beliefs Respect sexual orientation

Nursing Dx r/t sexuality N24: Sexuality, STIs, Contraception 4/13/2017 Nursing Dx r/t sexuality Sexual dysfunction Sexuality patterns, ineffective Body image, disturbed Sexual dysfunction: “The state in which a person experiences a change in sexual function that is viewed as unsatisfying, unrewarding, inadequate” (NANDA) Subjective – depends on person’s perspective. Could be actual or perceived limitations. Sexuality patterns, ineffective: “Expressions of concern regarding own sexuality” (NANDA) Body image, disturbed: “confusion in mental picture of one’s physical self” (Ackley) r/t physical, psychological, cognitive/perceptual , cultural, spiritual changes; illness; Cabrillo College ADN / C.Madsen RN, MSN

Guidelines For The Nurse Aide In Dealing With Resident Sexuality Assist to maintain sexual identity by dressing residents in clothing appropriate for men or women Assist with personal hygiene 2.03 Nursing Fundamentals 7243

Assist to prepare for special activities by “dressing up” Nursing Fundamentals 7243 Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued) Assist to prepare for special activities by “dressing up” selecting attractive clothing fixing hair in a special way applying cosmetics wearing a special perfume or aftershave 2.03 Nursing Fundamentals 7243 2.03 Understand basic human needs and nurse aide guidelines in meeting those needs.

Help to develop a positive self-image Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued) Help to develop a positive self-image Show acceptance and understanding for resident’s expression of love or sexuality provide privacy always knock prior to entering a room at any time assure privacy when requested 2.03 Nursing Fundamentals 7243

Never expose the resident Accept the resident’s sexual relationships Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued) Never expose the resident Accept the resident’s sexual relationships 2.03 Nursing Fundamentals 7243

Provide protection for the non-consenting resident Guidelines For The Nurse Aide In Dealing With Resident Sexuality (continued) Provide protection for the non-consenting resident Be firm but gentle in your rejection of a resident’s sexual advances 2.03 Nursing Fundamentals 7243

Possible Effects Of Injury Or Illness On Sexuality Disfiguring surgery may cause a person to feel: unattractive and ugly to others mutilated and deformed unworthy of love or affection 2.03 Nursing Fundamentals 7243

Possible Effects Of Injury Or Illness On Sexuality (continued) Chronic illness and certain medications can affect sexual functioning 2.03 Nursing Fundamentals 7243

Possible Effects Of Injury Or Illness On Sexuality (continued) Disorders that cause impotence diabetes mellitus spinal cord injuries multiple sclerosis alcoholism 2.03 Nursing Fundamentals 7243

Possible Effects Of Injury Or Illness On Sexuality (continued) Surgery can have both physical and/or psychological effects removal of prostate or testes amputation of a limb removal of uterus removal of ovaries removal of a breast colostomy ileostomy 2.03 Nursing Fundamentals 7243

Possible Effects Of Injury Or Illness On Sexuality (continued) Disorders affecting the ability to have sex: stroke nervous system disorders heart disease 2.03 Nursing Fundamentals 7243

Possible Effects Of Injury Or Illness On Sexuality (continued) Disorders affecting the ability to have sex: chronic obstructive pulmonary disease circulatory disorders arthritis or conditions affecting mobility/ flexibility 2.03 Nursing Fundamentals 7243

Sexuality and the Nursing Home, Thomas Magnuson, M.D. Assistant Professor Division of Geriatric Psychiatry UNMC Peter Aggleton University of Sussex