1. Sexuality Foundations 105/320 Collings 2012

2. Video  http://www.youtube.com/watch?v=sw6U etyUuD0 http://www.youtube.com/watch?v=sw6U etyUuD0

4. 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.

5. 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!

6. 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

7. 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

8. 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?"

9. 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

10. 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)

11. 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

12. 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. 18 18  Environmental Adaptations  Ensure privacy and safety among long-term-care and community-dwelling residents.

13. 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

14. Sexuality Assessment – older adults  http://consultgerirn.org/resources/media/ ?vid_id=4852486#player_container http://consultgerirn.org/resources/media/ ?vid_id=4852486#player_container

15. 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:10.1038/sc.1992.54  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. http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.4453431/k.A0C5/Sexuality_for_Men.htm http://www.christopherreeve.org/site/c.mtKZKgMWKwG/b.4453431/k.A0C5/Sexuality_for_Men.htm

17. Questions? Comments? Thoughts?