Human Sexuality

Write T if the statement is the truth, or M if a myth.

1. Elderly people do not want or need sexual intimacy. 2. A large penis is of great importance to a womans sexual gratification. 3. Menopause or hysterectomy terminates a womans sex life. 4. Contraception reduces sexual pleasure. 5. Condoms eliminate the risk of sexually transmitted disease.

Cont.
6. Sexual intercourse should be avoided during pregnancy. 7. Women cannot get pregnant while they are lactating. 8. Alcohol is a sexual stimulant. 9. Masturbation causes mental illness. 10.A couple must have simultaneous orgasms to achieve sexual satisfaction.

Cont.
11.There is absolutely safe period in a womans sexual cycle in which coitus cannot cause impregnation. 12.Male impotency is incurable. 13.AIDS is spread by kissing. 14.Contraception eliminates the risk of pregnancy. 15.Sex is not important when you are sick.

ALL these are MYTHS!

Sex
Commonly used term to identify male or female status The anatomic differentiation GENDER Used to describe the sexual behavior

Sexuality
Includes all those aspects of the human being that relate specifically to being boy or girl, male or female. Characteristic of the personality reflected in the totality of the persons feelings, attitudes, beliefs, and behavior related to being male or female. The human desire for love, warmth, sharing, and physical intimacy that is present throughout the life span.

Sexual Health
According to the WHO in 1975:

the somatic, emotional, intellectual, and social aspects of sexual being, in ways that are positively enriching and that enhance personality, communication, and love.

Sexual health is the integration of

Characteristics of Sexual Health

1. SELF-AWARENESS: Knowledge about sexuality and sexual behavior. 2. SELF-ESTEEM: Ability to express ones full sexual potential, excluding all forms of sexual coercion, exploitation, and abuse. 3. HAVE PERSONAL PHILOSOPHY AND ETHICAL CODE: Ability to make autonomous decisions about ones sexual life within the context of personal and social ethics. 4. SELF-ACTUALIZING: Experience of sexual pleasure as a source of physical, psychologic, cognitive, and spiritual well-being.

Cont. of characteristics
5. AUTONOMOUS: Capability to express sexuality through communication, touch, emotional expression, and love. 6. RESPECT OTHERS: Right to make free and responsible reproductive choices. 7. DISPLAY RESILIENCE: Ability to access sexual healthcare for the prevention and treatment of all sexual concerns, problems and disorders.

 Biologic Sex genetically determined anatomy and physiology. Gender Identity a persons psychological identification with a particular sex, as reflected in his or her masculine or feminine behavior traits. May not conform to ones biologic sex. Transgender CROSS DRESSERS INTERSEXED PREOPERATIVE TRANS-SEXUALS POST-OPERATIVE TRANS-SEXUALS

SEXUAL IDENTITY
The preference of a person for one sex or the other.
Heterosexual Bisexual Homosexual Trans-sexual

Gender Role Behavior

The way a person acts as a male or female, including the expression of what is perceived as gender appropriate behavior.

 3. Young Adulthood (18-40 y)

Beginning of intimate relationships with long-term implications Dating, cohabitation, and marriage

 4. Middle Adulthood (40-65 y)

Decreased hormone production, causing climateric or menopause in women. Among males, changes in climasteric is gradual.

 5. Older Adult (65 years and over)

Broader concept of sex: touching, hugging, romantic gestures, comfort, warmth, dressing up, joy, spirituality, and beauty. Interest in sex not lost Males: more time to achieve genital erection, seminal volume decreases, and intensity of contraction decreases. Females: remain capable of multiple orgasms and experience increase in sexual desire after menopause.

 Culture -puberty rites, body beautification, circumcision, and body mutilation.

Religious Values Guidelines that are acceptable and prohibited and consequences of breaking sexual rules. Ex. Extramarital relations, premarital sex as taboo

D. Personal Ethics E. Health Status

1. 2. 3. 4. 5. 6. 7. 8. Heart disease Diabetic mellitus Spinal cord injury Surgical procedures Joint disease Chronic pain STDs Mental disorder

9. Medications
Antidepressants: fail ejaculation Amphetamines: increase sex drive/ delay orgasm Steroids: decrease drive, shrink testicles and cause infertility Antihypertensives: decrease vaginal lubrication and sexual desire Cocaine: decrease sexual desire and function Alcohol: impotence and orgasmic dysfunction Narcotics: ED

Methods of Sexual Behavior

1. Gender-role behavior: outward expression of the persons sense of maleness/femaleness 2. Sexual Stimulation
1. Physical 2. Psychological

3. Sexual Intercourse

Stages of Human Sexual Response

1. Desire phase: starts in the brain through erotic stimuli, may be real or symbolic.

2. Excitement
Female Vagina: lubrication, inner two thirds lengthens, dark purple Labia: minora enlarge, deeply colored; majora flatten Uterus: elevates Breast: increase in size; nipples erect CR: slows early then increase RR: increase BP: increase Skin: flush

Male Penis: erect, increases Scrotom/testes: tenses, congested and thick testes rise higher in scrotom, increase size by 50% Breast: nipples erect and swell RR: increase CR: slow initially then quickens

3. Plateau
Female Vagina: opening decreases in size by 0ne third Labia: skin become pink to bright red in nulliparous, red to deep wine in multiparous Clitoris: retracts Skin: flushes Male Skin: flushed Muscular tension over face, neck, abdomen, and limbs Penis: enlarges Testes: increase by 50 to 100%, elevation fully accomplished BP: increases

4. Orgasmic
Female Vagina: contraction begins in outer one third; at 0.8-sec intervals and recur from 3 to 15 times; time becomes longer and strength of contraction decreases Uterus: contracts as in labor Rectal contractions Muscular spasms; loss of voluntary control CR: twice normal BP: increases by one third RR: three times normal
Males

Higher RR, CR and BP than women Testes, prostate, and seminal vesicles contract Ejaculates sperm and seminal fluid Penis: contracts to emit ejaculatory products Rectal contraction

 Female Breasts: erection decreases Skin: perspires Vagina: within 5-10sec, clitoris returns to normal position; congestion disappears Labia: return to unstimulated size VS returen to prestimulation condition Urinary: with urge to urinate esp among nulliparous

5. Resolution

Male Penis: erection lost Testes: descend rapidly Scrotum: reverts to uncongested state Skin: flushes, perspiration confined to palms and soles of feet but sometimes widespread Nipple: erection lost Muscle tension lost in 5min. period VS normalizes

 Sexual fantasy/ solo sex Masturbation Cunnilingus Fellatio Sixty-nine Anal stimulation Genital/anal intercourse

Love Play

Alterations in Sexual Function

Male Dysfunctions 1. Erectile dysfunction/impotence: inability to achieve or maintain an erection sufficient for sexual satisfaction for oneself or partner. 2. Rapid ejaculation: man is unable to delay ejaculation long enough to satisfy his partner. 3. Retarded ejaculation: inability to ejaculate into the vagina or delayed ejaculation. Male difficulty to reach orgasm.

Alterations in Sexual Function

Female Dysfunctions: 1. Hypoactive sexual desire: a persistent or recurring absence of sexual thoughts or disinterest in sexual activity. 2. Sexual arousal disorder: woman is unable to attain or maintain adequate vaginal lubrication/decreased clitoral or labial sensation. 3. Orgasmic disorder: difficulty/inability to achieve orgasm inspite of stimulation and arousal.

4. Sexual Pain Disorders

Dyspareunia: during intercourse due to inadequate lubrication, infection or hormonal imbalance. Vaginismus: involuntary spasm of lower third of vagina which makes insertion of penis painful or impossible. Genital pain: pain with any type of sexual stimulation other than sexual intercourse

6 Basic Skills of Nurses on Sexuality

1. Self-knowledge and comfort with their own sexuality. 2. Acceptance of sexuality of the client. 3. Knowledge of growth and development throughout the life cycle. 4. Knowledge on basic sexuality, health risks and problems, and treatment regimen. 5. Therapeutic communication skills.
HIV positive: listen and react approach

6. Recognize need of the client and family members to have topic of sexuality introduced in written/printed and verbal discussion.

Assignment
1. List four (4) measures to stop sexual harrassment. 2. List the four (4) steps in the model for counselling clients with sexual problems (PLISSIT). 3. List four (4) responsibilities of the nurse during the examination of a womans reproductive system.

Case Study
Brandon Dimapakale, a 6-foot tall, well muscled healthy, 19 y/o college freshman in a school of nursing, confides to his nursing supervisor that everything is great about college life with one exception. All of a sudden, I find myself questioning the values I learned at home about sex and marriage. My mom was really insistent that each of her sons should respect women and that intercourse was something you saved until you were ready to get married. If she told us once she told us a hundred times that wed

Save ourselves, the girls in our lives, and her and dad a lot of heartache if we could just learn to control ourselves sexually. Problem is that no one here seems to subscribe to this philosophy. I feel like Im abnormal in some way to even think like this. Theres a lot of sexual activity in the dorms and no one even thinks Im serious if you talk about virginity positively. What do you think? Did mom sell me a bill of goods? Is it true that if you take the proper precautions, no one gets hurt and everyone has a good time?

Mark reports that he is a virgin and that he does really miss his close family back home. I do get lonely at times, and would love to just cuddle with someone or even give and get a big hug but no one seems to understand this. Now identify Marks strengths and your personal strengths as a nurse. Make a one-problem-NCP out of this.