Sexuality Foundations 105/320 Collings 2012

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Definitions  1. Sexuality: a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction.  2. Sexual health: a state of physical, emotional, mental, and social well-being related to sexuality.  3. Sexual dysfunction: impairment in normal sexual functioning. Arena, J. & Wallace, M.(2008) SEXUALITY ISSUES IN AGING. Nursing Standard of Practice Protocol: Sexuality in Older Adults. Evidence- Based Geriatric Nursing Protocols for Best Practice (3 rd ed), New York: Springer Publishing Company, Inc.

Basic Concepts  People develop sexual identity, gender identity early  People remain sexual throughout life  Healthy sexuality involves warmth, tenderness, and love, not just genital contact  ASK about questions, concerns re sexuality Just because you don’t want to think about it, it doesn’t make it less real!

Issues  Barriers [Especially in institutional settings]  lack of privacy, rules, transportation  HCP lack knowledge/comfort about discussing subject  Medical conditions  Medications  Antidepressants, Antihypertensives  Normal aging changes  decrease ability, enjoyment

Health Concerns medical conditions associated with poor sexual health and functioning and/or that make sexuality difficult  cardiac disease  stroke and aphasia  Parkinson's disease  Diabetes  BPH  dental problems  SCI  Any pain, fatigue, or mobility – causing condition

Assessment  Assess medical history for conditions that impact sexuality, sexual health, ROS, physical  physiological changes  Medications  Assess status of sexual health; problems/concerns:  Ask open-ended questions such as "Can you tell me how you express your sexuality", "What concerns you about your sexuality?" and "How has your sexuality changed as you have aged?"

Interventions  Communication and Education  Common effects of disease, age, meds  Safe sex practices  Communication with/among family, if needed  Effectively manage chronic illnesses  Improve glucose monitoring and control among diabetics  Ensure appropriate treatment of depression and screening for depression  Suggest substitute medications that may result in sexual dysfunction  Frequently reassess patients for changes in sexual health

Facility Policies  Include sexual health questions on intake and reassessment measures  Provide education on the ongoing sexual needs of patients and appropriate interventions to manage these needs with dignity and respect  Provide needed privacy for individuals to maintain intimacy and sexual health (e.g., in long-term care)

Consent  Participation in sexual relationships may be considered abusive if an older adult is not capable of making decisions  Accurately assess and document older adults' ability to make informed decisions

Enhancing Sexual Health  Compensate for normal changes of aging  Females:  Use of artificial water-based lubricants  Treatment of FSAD with sildenafil citrate (Viagra).  Use of centrally acting serotonin agonists and vasodilating creams. - Males:  Recognizing the possibility for more time and direct stimulation for arousal due to aging changes  Use of sildenafil citrate (Viagra) for erectile dysfunction  Environmental Adaptations  Ensure privacy and safety among long-term-care and community-dwelling residents.

Goals/Outcomes  Pt. will:  Report high quality of life as measured by a standardized quality of life assessment  Report being provided with privacy, dignity, and respect surrounding their sexuality  Report pursuing sexual health free of pathological and problematic sexual behaviors  Verbalize understanding of education regarding sexual health

Sexuality Assessment – older adults  ?vid_id= #player_container ?vid_id= #player_container

SCI and sexuality  Women:  Sixty-nine percent of surveyed [post-SCI]women were satisfied with their post injury sexual experiences, although self confidence, spasticity, and lack of spontaneity were issues Paraplegia (1992) 30, 192–199; doi: /sc  Men:  Normally, men have two types of erections.  Psychogenic erections result from prurient sights or thoughts and depend on the level and extent of paralysis. Men with complete paralysis usually do not have psychogenic erections.  A reflex erection occurs involuntarily by direct contact with the penis or other erogenous zones (ears, nipples, neck). Most paralyzed men are able to have a reflex erection unless nerves in the sacral spinal cord (S2-S4) are damaged.

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