1. Chapter 48
Sexuality
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

2. The Whole Person Patients and residents are viewed as whole persons.
They have needs.
Physical
Safety
Love and belonging
Self-esteem
Self-actualization
Sexuality involves the whole person.
Illness, injury, and aging can affect sexuality.
The person’s physical, emotional, social, and spiritual needs are considered.
Review the Body Structure and Function Review: The Reproductive System Box on p. 766 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

3. Sex and Sexuality
Sex is the physical activities involving the reproductive organs.
It is done for pleasure or to have children.
Sexuality is the physical, emotional, social, cultural, and spiritual factors that affect a person’s feelings and attitudes about his or her sex.
Sexuality involves the personality and the body.
It affects how a person behaves, thinks, dresses, and responds to others.
Sexuality is important throughout life.
Attitudes and sex needs change with aging.
Sexuality develops when a baby’s sex is known. By the age of 2, children know their own sex. Three-year-olds know the sex of other children. Children learn male and female roles from adults.
As children grow older, interest increases about the body and how it works.
Sex has more meaning as young adults mature.
Attitudes and sex needs are affected by life events (for example, divorce, death of a partner, injury, illness, and surgery).
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

4. Sexual Relationships
A heterosexual is attracted to members of the other sex.
Sexual behavior is male-female.
A homosexual is attracted to members of the same sex.
Gay refers to homosexuality.
Homosexual men are called gay men.
Lesbian refers to a female homosexual.
Bisexuals are attracted to both sexes.
Many gay persons openly express their sexual preferences and relationships.
Bisexuals often marry and have children. They may seek a same-gender relationship or experience outside of marriage.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

5. Sexual Relationships (cont’d)
Transvestites dress and behave like the other sex for emotional and sexual relief.
Transsexuals believe that they are members of the other sex.
They often feel “trapped” in the wrong body.
Transgender is a broad term used to describe people who express their sexuality or gender in other than the expected way.
The term also describes persons undergoing hormone therapy or surgery for sexual reassignment.
Female to male; male to female
Transvestites are commonly called cross-dressers. Most are men. Often, they marry and are heterosexual.
Most transsexuals have always had these feelings. As children, they usually behave like the other sex. Some have sex-change operations.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

6. Injury, Illness, and Surgery
Injury, illness, and surgery can affect sexual function.
Sexual ability may change.
Most chronic illnesses affect sexual function.
Reproductive system surgeries have physical and mental effects.
Removal of the uterus, ovaries, or a breast affects women.
In men, prostate or testes removal affects erections.
Sometimes, the nervous, circulatory, and reproductive systems are involved.
Heart disease, stroke, diabetes, and chronic obstructive pulmonary disease are examples.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

7. Injury, Illness, and Surgery (cont’d)
Impotence (erectile dysfunction; ED) is the inability of the male to have an erection.
Causes include:
Diabetes
Spinal cord injuries
Prostate problems
Cardiovascular disorders
Drug abuse
Psychological factors
Some drugs treat ED.
Emotional changes are common.
Some drugs for high blood pressure cause ED, so do other drugs.
The person may feel unfit for closeness and love. Time and understanding are helpful, so is a caring partner. Some men need counseling.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

8. Injury, Illness, and Surgery (cont’d)
Changes in sexual function greatly impact the person.
Fear, anger, worry, and depression are seen in the person’s behavior and comments.
The person’s feelings are normal and expected.
The care plan has measures to help the person deal with his or her feelings.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

9. Sexuality and Older Persons
Reproductive organs change with aging.
Frequency of sex may decrease.
Some older people do not have intercourse.
This does not mean loss of sexual needs or desires.
Often, needs are expressed in other ways.
Sexual partners are lost through
Death
Divorce
Relationship break-ups
A partner needing hospital or nursing center care
Love, affection, and intimacy are needed throughout life.
Reasons for decrease in frequency relate to weakness, fatigue, and pain. Reduced mobility, aging, and chronic illness are factors.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

10. Meeting Sexual Needs
The nursing team promotes the meeting of sexual needs.
Follow the person’s care plan.
The measures in Box 48-1 on p. 768 in the Textbook may be part of the person’s care plan.
Review the Focus on Long-Term Care and Home Care: Meeting Sexual Needs Box on p. 768 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

11. The Sexually Aggressive Person
Some persons want the health team to meet their sexual needs.
Often, there are reasons for the person’s behavior.
Understanding this helps you deal with the matter.
Causes of sexually aggressive behaviors include:
Nervous system disorders
Confusion, disorientation, and dementia
Drug side effects
Fever
Poor vision
They flirt or make sexual advances or comments. Some expose themselves, masturbate, or touch the staff. This can anger and embarrass the staff member. These reactions are normal.
The person may confuse someone with his or her partner, or the person cannot control behavior. Changes in the brain and mental function make control difficult. Sexual behavior in these cases is usually innocent.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

12. The Sexually Aggressive Person (cont’d)
Touch is sometimes to gain attention.
Sometimes, masturbation is a sexually aggressive behavior.
Urinary or reproductive system disorders, poor hygiene, and being wet or soiled from urine or feces can cause genital soreness and itching.
Some persons touch and fondle the genitals for sexual pleasure.
Touching genitals could signal a health problem.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

13. The Sexually Aggressive Person (cont’d)
Touch can have a sexual purpose.
You must be professional about the matter.
Ask the person not to touch you.
Tell the person that you will not do what he or she wants.
Tell the person what behaviors make you uncomfortable.
Allow privacy if the person is becoming aroused.
Discuss the matter with the nurse.
Follow the care plan.
When allowing for privacy, provide for safety. Complete a safety check of the room (see the inside front cover of the Textbook). Tell the person when you will return.
The care plan has measures to deal with sexually aggressive behaviors. They are based on the cause of the behavior.
Review the Focus on Communication: The Sexually Aggressive Person Box on p. 769 in the Textbook.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

14. The Sexually Aggressive Person (cont’d)
Protecting the person
The person must be protected from unwanted sexual comments and advances.
This is sexual abuse. Tell the nurse right away.
Sexual abuse is a serious matter.
No one should be allowed to sexually abuse another person. This includes staff members, patients, residents, family members or other visitors, and volunteers.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.

15. Sexually Transmitted Diseases
Some diseases are spread by sexual contact.
See Chapter 44.
Copyright © 2012 by Mosby, an imprint of Elsevier Inc. All rights reserved.