SEXUALITY AND REPRODUCTIVE

Glossary

Desire phase, part of the response cycle, which starts in the brain, with
conscious sexual desires

Dysmenorrhea, painful menstruation

Erectile dysfunction, or impotence, the inability to achieve or maintain an

erection sufficient for sexual satisfaction for oneself or one's partner

Excitement/plateau phase, part of the response cycle, involves

vasocongestion and myotonia

Gender, indicates biological male or female status

Gender identity, a person's sense of being masculine or feminine, as distinct

from being male or female

Hypoactive sexual desire disorder, involves a persistent or recurring absence

of sexual thoughts or disinterest in sexual activity

Menopause, cessation of menstruation

Menstruation, the monthly discharge of blood through the vagina occurring

in nonpregnant women from puberty to menopause

Orgasmic disorder, a difficulty or inability to achieve orgasm in spite of

stimulation and arousal

Orgasmic phase, part of the response cycle, the involuntary climax of sexual
tension, accompanied by physiologic and psychologic release

Rapid ejaculation, when a man is unable to delay ejaculation long enough to

satisfy his partner

Resolution phase, the part of the response cycle period of return to the
unaroused state, which may last 10 to 15 minutes after orgasm, or longer if
there is no orgasm

Retarded ejaculation, the inability to ejaculate into the vagina, or a delayed

ejaculation of semen

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Sex, the term most commonly used to identify biologic male or female status

Sexual arousal disorder, when a woman is unable to attain or maintain

adequate vaginal lubrication and/or has decreased clitoral and labial
sensations

Sexual health, the integration of the somatic, emotional, intellectual, and

social aspects of sexuality, in ways that are positively enriching and that
enhance personality, communication, and love

Sexual orientation, the preference of a person for one sex or the other

Sexual pain disorders, include dyspareunia, vaginismus, and genital pain

Sexual self-concept, how one values oneself as a sexual being

Sexuality, the collective characteristics that mark the differences between

the male and female, the constitution and life of the individual as related to
sex

I. FACTORS AFFECTING SEXUALITY

A. DEVELOPMENTAL CONSIDERATIONS
‹ sexuality is the only distinguishing trait present at conception
‹ gender, or sex, influences behavior throughout life

Stages:
Birth to 12 years
‹ gender related

By 3 years
‹ gender identity
‹ obtain pleasure from touching/fondling genitals
‹ toys are gender related
‹ able to identify own gender

Preschooler
‹ increased awareness of body parts
‹ sexuality has been internalized and preference for sexual partners
determined
‹ enjoys exploring body parts of self and playmates
‹ engages in masturbation

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 School Age
‹ gender role behaviors
‹ tendency toward having same-sex friends
‹ increasing self-awareness

Adolescence
‹ need information regarding changes; information obtained based on
myths
‹ develop opposite-sex relationships
‹ masturbation is common
‹ girls concerned w/reputations and self-image
‹ become “hippy” and w/small waist
‹ boys preoccupied w/competitiveness of sexual activity
‹ increase in testes size and they drop further into place
‹ increased perspirations and vaginal secretions

Young/Middle Adulthood
‹ premarital sex is common
‹ may experiment w/various sexual expressions
‹ develop own value system and respects values of others
‹ women are in “childbearing” mode and searching for a mate;
become menopausal w/an increased sex drive
‹ men begin graying, having decreased ejaculations and sex drive

Older Adulthood
‹ orgasms may become shorter and less intense in both sexes
‹ vaginal secretions decrease and period of resolution in men
lengthens
‹ fear loss of sexual abilities

B. CULTURE
• every culture has its own norms dictating duration of sexual
intercourse, methods of sexual stimulation and sexual positions
• some cultures promote childhood sexual play, polygamy/monogamy,
and puberty rites including male circumcision
• religious beliefs promote beliefs on premarital / extramarital coitus,
homosexuality, and decisions on circumcision (male and female)

C. RELIGION
• some view organized religion as having a generally negative effect on
expression of sexuality
• sexual expression other than male-female coitus are considered
unnatural by some concept of virginity came to be synonymous with
purity, and sex became synonymous with sin
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 • double standards and rigid regulations exists in many religions
• sexual dysfunctions can be related to anguish over negative
connotation of sex dictated by religion
• many have recognized the importance of sold sex education w/in the
realm of church
• new interest in spirituality of marriage, supporting the intimate/sexual
relationship of married couples
• provides guidelines

D. ETHICS
• healthy sexuality depends on freedom from guilt and anxiety
• what one views bizarre, perverted or wrong may be natural and right
to another
• if sexual expression is performed by consenting adults, is not harmful
to them and is practiced in privacy, it is not considered a deviant
behavior
• many accept sexual expression of various forms

E. LIFESTYLE
• both men and women are exposed to stress, and many are under
considerable strain to perform and function in workplace as well as at
home
• stressors may be external (job, financial demands) or internal
(competitive)
• although some couples view sexual activity as a release from stressors
of everyday life, most place sex far from the top of the list of things to
do
• crucial for relationships to set aside priority time - - if not for
lovemaking, then for intimate, quiet contact
• sexual expressions from heterosexual, homosexual, bisexual, and
transsexual

F. HEALTH STATE

1. CHRONIC PAIN – individuals w/persistent pain might not desire any

sexual contact
 desire for human warmth and contact does not cease because of
pain
 altered or modified positions for coitus are sometimes necessary

2. DIABETES – hormonal disease in which inadequate insulin secreted

by pancreas
 almost all hormonal disorders affect sexuality women have more
vaginal infections, lose orgasms abilities and lubrication

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  most prevalent and well known
 erectile dysfunction or impotence is a great concern
 circulation problems
 some men might be candidate for penile prosthesis
 pharmacologic mgmt. may be indicated

3. CARDIOVASCULAR DISEASE – pts might experience much anxiety

over the effect the illness will have on sexuality and sexual functioning

 suggestions to reduce anxiety include trying different positions,

rhythms or forms of intimacy
 meds used to control hypertension frequently causes a chg in
sexual functioning
 may be relieved by modifying dose of med or switching to a
different med
 primary goal after MI is to allow the heart ample time to heal
 ADL, including sexual activity, should be resumed gradually
 stressors, (overexertion, alcohol consumption, emotional
upheavals) should be avoided after an uncomplicated MI, sexual
activity may begin at about 3rd week of recovery, beginning
w/masturbation to partial erection in male
 activity gradually increased until 3 months after, when sexual
intercourse may be resumed
 comfortable position that places least stress on affected partner
may be an option

4. DISEASES OF JOINTS AND MOBILITY – affects young and old

people

 pain, fatigue, stiffness, and loss of ROM are most common

 disease itself does not affect sexual functioning, although
manifestation of it can cause discomfort and anxiety
 motivation and positioning are influenced

5. SURGERY AND BODY IMAGE – performed to remove diseased tissue

and repair body organs usually requires incision

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  most devastating kinds remove cancerous tissue and
surrounding structures
 pts need to adjust to major alteration in their bodies
 after a mastectomy, a woman’s return to sexual functioning
depends on many factors, such as support of her partner, value
placed on breast by the man or woman, and fear of discomfort
during sexual activity
 after an ostomy, pt may grieve over the loss of the natural
means to eliminate waste (urine or feces), accompanied by learning
to live with an obvious artificial device
 many are anxious as to how this apparatus will affect their
sex lives and how
accepting their partner will be
6. SPINAL CORD INJURIES – almost always results in some degree of
permanent disability
 pts face multiple adaptations related to mobility, bowel and bladder
control, sexual functioning, and role expectations
 extent of sexual response depends primarily on level and extent of
injury
 ejaculation and orgasm are most likely to remain with low spinal
injuries
 women are more likely to experience orgasm than men but
complain more about lack of physical sensations
 many find other erogenous zones become more easily stimulated
7. MENTAL ILLNESS – the mind plays a powerful role in sexuality and
any disruption of its functioning will no doubt cause some disturbance
in sexual functioning

 disorder such as mild depression can affect desire and functioning

 some w/mental illness act out in sexual manner, such as touching
themselves or removing clothing at inappropriate times and places

8. SEXUALLY TRANSMITTED DISEASE – describe infections that are

almost always transmitted through direct sexual contact

 fear of getting (or transmitting) STD may impair sexual

functioning for some, but others engage in risky sexual behaviors
w/out giving sufficient thought to their health
 hard to control because partner(s) also need treatment which is
difficult if partner is promiscuous or a one-time contact
 condoms are not foolproof in preventing STDs

Types:
Chlamydia – most prevalent to date

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 o intracellular bacteria w/vaginal discharge, burning on
urination, urinary frequency, dysuria, and urethral soreness
o many women do not have symptoms

Gonorrhea – “clap” or “drip”

o men have purulent penile discharge, dysuria, frequency of
urination
o women have dysuria, abnormal menses, vaginal discharge,
pelvic inflammatory disease
o pharyngitis if oral sex practiced
o untreated can result in infertility, skin rash w/lesions, and
acute arthritis

Syphilis – primarily has single painless genital lesions 10 days to 3

months after exposure
o secondarily has generalized skin rash, enlarged lymph nodes,
fever that may appear 2 – 4 weeks after appearance of
lesions and may last several years
o latently usually has no clinical symptoms present for as long
as 20 years; may continue to involve and damage neurologic
and cardiovascular organs; dementia; confusion; paralysis
and paresis

HIV (AIDS) – incidence high in IV drug users and homosexual and

bisexual men
o fatigue, diarrhea, wt loss, enlarged lymph nodes, fever,
anorexia, and night sweats

Human Papilloma Virus (Warts) – pale, soft, papillary lesions found

around internal and external genitalia and perianal and rectal areas,
varying in size
o profuse watery vaginal discharge, dyspareunia, intense
pruritus and vulvar irritation
o males may or may not have lesions Trichomoniasis (Yeast
Infections) – foul-smelling vaginal discharge, thin, foamy, and
green in color, causes itching of vulva and vagina, burning on
urination and dyspareunia; “strawberry” cervix may be seen
on speculum exam

G. MEDICATIONS
• some meds have side effects that affect sexual functioning

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 • some people use illegal drugs because of their reputed ability to
heighten sexual experience, but can have serious and even deadly side
effects

II. APPLICATION OF NURSING PROCESS

A. ASSESSMENT

1. SEXUAL HISTORY – information should include pt’s reproductive and

sexual health
 client who should have sexual history recorded include 1) any
input or output receiving care for pregnancy, STD, infertility or
contraception, 2) any client experiencing sexual dysfunction, and
3) any pt whose illness will affect sexual
functioning and behavior
 begin with nonthreatening questions and progress to more
sensitive concerns
 begin with open-ended questions and progress to more specific
 use language used by the client
 assume all people do all things
 excellent opportunity for nurse to teach by helping pts confront
fears
 nurse’s attitude will greatly affect pt’s response to interview
 privacy is essential
 doors should be closed and no interruptions allowed
 nurse sits close to pt and speaks in quiet, relaxed, objective tone
of voice
 eye contact and open body posture should be used
 narrative form of recording is generally used because it allows
interviewer to document data in many of pt’s own words

2. SEXUAL DYSFUNCTION
Men– erectile failure (impotence)
 history of diabetes, spinal cord trauma, cardiovascular disease,
surgical procedure, alcoholism
 use of antihypertensions, antidepressants, or illicit drugs
 mental depression that may be present premature ejaculation =
client defines dysfunction and ability to control
 causative relationship factors like anxiety, guilt, lack of time,
new partner retarded ejaculation = history of neurologic
disorders, Parkinson’s disease, certain meds

Women – inhibited sexual desire

 use of oral contraceptives or

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  hormonal therapy, alcohol or certain medications
history of sexual abuse, rape or incest, depression, or other
sexual dysfunctions orgasmic dysfunction = communication
pattern between client and partner
 usual sexual pattern and behavior
 dyspareunia = history of diabetes, hormonal imbalance, vaginal
infection, endometriosis, urethritis, cervisitis or rectal lesions
 use of antihistamines, alcohol, tranquilizers, or illicit drugs
 ability for vaginal lubrication during sex
 use of coital positions
 use of cosmetic or chemical irritants to genitals
 vaginismus = pattern of sexual activity (how often, level of
arousal, orgasm)
 presence of other sexual dysfunctions
 history of sexual abuse, trauma or rape
 feelings regarding partner
 causative factors (fear of pregnancy, anxiety, guilt)

3. NURSING EXAMINATION – explain progressive steps of exam and

what client may feel during examination
 responsibilities include providing information about exam,
teaching, providing support during exam, assisting examiner, if
appropriate, with any procedures or lab studies
 keeping pt comfortable and respecting his/her privacy and
modesty should be primary
 some females are uncomfortable w/male examiners and vice
versa for religious, cultural, or other reasons

B. ANALYSIS / DIAGNOSIS

1. INEFFECTIVE SEXUALITY PATTERNS

• state in which an individual experiences or is at risk for chg insexual
health
o sexual health is integration of somatic, emotional, intellectual,
and social aspects of sexual being in ways that are enriching
and that enhance personality, communication, and love
o determine whether situation can be corrected by independent
nursing interventions
o some clients require expertise of other specialties
o common etiologies are effects of meds, effects of alcohol
consumption, effects of disease process, history of abuse,
feelings of depression, guilt, anxiety, fear of rejection,
miscommunication, fear of pain, effects of birth control
methods, lack of knowledge, or effects of surgical procedure
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 o further specified by loss of desire, increased desire, or change
in sexual expression
o common etiologies include stress (lifestyle, job, family,
finances, marital conflict), isolation, effects of pregnancy,
feelings of depression, loss of privacy, loss of communication,
relationship chg, effects of disease process, change in body
image, change in self-concept, or loss of partner

2. SEXUAL DYSFUNCTION
• state in which individual experiences or is at risk for change in
sexual function that is viewed as unrewarding or inadequate
o etiology of other problems such as loss of sexual partner, fear
of pregnancy, loss of sexual functioning or desire, effects of
disease process, sexual position pain, ineffective coping with
body image, history of sexual abuse, loss of functioning due
to surgical excision of genital body part, sexual guilt, effects
of hormonal imbalance, lack of information, fear of rejection,
marital separation or divorce, and fear of contracting STD

C. PLANNING
• define individual sexuality
• establish open patterns of communication w/significant others
• develop self-awareness and body awareness
• describe responsible sexual health self-care practices
• practice responsible sexual expression
• specific outcomes depend on nature of pt’s problem or concern, should
be client-oriented

D. IMPLEMENTING

1. ESTABLISHING TRUSTING RELATIONSHIP

• impossible to address client’s sexuality if trust has not been
developed
o project an objective, nonthreatening, and nonjudgmental
attitude
o stress information pt gives will be kept confidential
o important to establish respect and empathy before discussing
sexual issues
o consider all of pt’s circumstances and life experiences

2. TEACHING ABOUT SEXUALITY AND SEXUAL HEALTH

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 • major goals are a change in knowledge, in client’s attitude, or in
behavior
o offer information, dispel fears, and provide positive
reinforcement
o assist in modifying behaviors or learning new skills to increase
quality of sexual health and functioning

3. CORRECTING SEXUAL MYTHS AND PROMOTING BODY

AWARENESS
• Many believe things about sex that have been heard from family or
friends or as part of their culture that are not true or not based on
scientific data
o refute sexual myths and teach factual information during
assessment
o promote self-confidence and good self-concept
o getting to know one’s physical body is important to healthy
sexual development
o need to be aware of appearance of genitalia
o assist in improving body awareness
o knowing what looks normal can be of great importance so
that abnormalities can be reported
o Kegel exercises promote good vaginal tome by localizing and
strengthening pubococcygeal muscle

E. CONTRACEPTIVE METHODS

1. BEHAVIORAL
• Abstinence
‹ can be a positive way of dealing with sexuality when it
represents a well-thought out decision regarding one’s mind,
body, spirit, sexual health
‹ continuous abstinence involves not having any sex with a
partner at all periodic abstinence and fertility awareness
methods are two methods of contraception that involve charting
a woman’s fertility pattern used to prevent pregnancy
temperature method = woman takes temp every morning before
getting out of bed; temperature will rise between 0.4 – 0.8° F on
day of ovulation and remain until next period

• Cervical mucus method

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 ‹ mucus is normally cloudy, but a few days before ovulation
becomes clear and slippery and can be stretched between the
fingers indicating most fertile phase of cycle

• Calendar method
‹ chart menstrual cycle on calendar refraining from intercourse or
using barrier method during “unsafe” days

• Coitus interruptus (withdrawal)

‹ oldest and most widely used contraceptive method of withdrawal
of penis from vagina before ejaculation
‹ re-ejaculation can contain enough sperm to cause pregnancy.
‹ pregnancy is also possible if pre-ejaculation or semen is spilled
onto vulva

2. BARRIER METHODS
• Diaphragm
‹ dome-shaped device made of latex rubber that mechanically
prevents semen from coming into contact w/cervix
‹ fits between pelvic notch at front of vagina to behind cervix at
back
‹ must be individually fitted during pelvic exam

• Condom
‹ rolled over erect penis and collects semen after ejaculation
‹ if it does not have nipple receptacle end, sm space should be left
at end to collect sperm
‹ female condom also available
‹ ringed pouch that unrolls in vagina
‹ advantages include fact that male does not need to have an
erection for pouch to be used and offers significant protection
from STDs
‹ better protection against STDs than any other birth control
method because it blocks exchange of body fluids that may be
infected

• Cervical cap
‹ thimble-shaped rubber device that is placed over cervix and may
be left there for up to 3 days at a time
‹ similar to diaphragm
‹ can cause cervical inflammation and increase risk for pelvic
infection

• Spermicides

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 ‹ used with barrier methods but can be used alone
‹ comes in creams, jellies, foams, and suppositories
‹ not as effective alone as when combined w/another method

3. HORMONAL
• Oral contraceptives
‹ “the pill” is most common contraceptive method
‹ almost 100% effective in guarding against pregnancy
‹ cost might be prohibitive to some women
‹ woman must be motivated to take pill every day
‹ health history and physical exam are necessary to obtain
prescription
‹ smoking increases risks associated w/oral contraceptives

• Norplant system
‹ reversible, 5-yr, low-dose progestin-only contraceptive
‹ consists of 6 matchstick-size capsules placed just under the skin
of upper arm
‹ most common side effect is change in menstrual bleeding
pattern, including prolonged menstrual bleeding, spotting
between menstrual periods, or no bleeding at all transdermal
contraceptive patch – supplies continuous daily circulating levels
of ethinyl estradiol and norelgestromin
‹ applied weekly on same day of ea wk for 3 wks, followed by a
patch-free week
‹ four sites of application include lower abdomen, upper outer
arm, buttock, or upper torso
‹ demonstrates more effective use compared w/use of oral
contraceptives
‹ most common side effects include breast symptoms, headache,
application site reactions, nausea, upper respiratory tract
infection and dysmenorrheal intrauterine devices – (IUD)object
that is placed by physician or nurse practitioner w/in uterus to
prevent implantation of fertilized ovum
‹ made of flexible plastic that provides reversible birth control
‹ mechanism by which it works is unknown which seem to affect
the way the sperm or egg moves

4. EMERGENCY CONTRACEPTION
• “Morning after” pill
‹ is designed to reduce risk of pregnancy after unprotected
intercourse
‹ provided as increased doses of specific oral contraceptive pills
ideally within 72 hrs or insertion of copper IUD w/in 5 – 7 days

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5. STERILIZATION
• Tubal ligation
‹ regarded as permanent and irreversible (procedure for females)
‹ surgically severing of fallopian tubes which prevents ovum from
traveling down tube
‹ usually performed on output basis under local anesthesia

• Vasectomy
‹ regarded as permanent and irreversible (procedure for males)
‹ surgically severing vas deferens which prevents sperm from
entering semen
‹ must alternative form of contraception until 2 semen analyses
with 0 sperm are produced (usually takes 4 – 6 wks)

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