Sexuality

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Sexuality
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Sexuality
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  1. sexuality
    is the degree to which a person exhibits and experiences maleness or femaleness physically, emotionally, and mentally. Sexuality is defined not only by a person’s genitalia and hormones but also by their attitudes and feelings. It can also be defined as learned behaviors in how a person reacts to his or her own sexuality and by how one behaves in relationships with others. Culture profoundly influences learned behaviors about sexuality. Sexuality is an integral part of a person’s identity and is present in one’s demeanor through actions, communications, and physical appearance.
  2. Sexual health
    may be defined as the integration of the somatic, emotional, intellectual, and social aspects of sexual being, in ways that are positively enriching and that enhance personality, communication, and love. Because our sexuality is so basic to our sense of self, nurses need to value sexuality as a critical element of health and well-being in general and must be skilled in identifying and meeting problems related to sexual self-concept, body image, and sexual identity.
  3. Sexual identity
    encompasses a person’s self-identity, biologic sex, gender identity, gender role behavior or orientation, and sexual orientation or preference.
  4. Biologic sex
    is the term used to denote chromosomal sexual development: male (XY) or female (XX), external and internal genitalia, secondary sex characteristics, and hormonal states.
  5. Gender identity
    is the inner sense a person has of being male or female, which maybe the same as or different from his or her biologic gender.
  6. Gender role behavior
    is the behavior a person conveys about being male or female, which, again, may or may not be the same as biologic gender or gender identity.
  7. Sexual orientation
    refers to the preferred gender of the partner of an individual. The origins of sexual orientation are unknown, but there are studies claiming a genetic basis. Certainly, some sexual preferences are culturally determined and may be dictated by opportunity.
  8. Common sexual orientations are as follows:
    • -a heterosexual
    • -a homosexual (gay/lesbian)
    • -a bisexual
    • -a transsexual
    • -a transvestite
  9. heterosexual
    one who experiences sexual fulfillment with a person of the opposite gender.
  10. homosexual
    is one who experiences sexual fulfillment with a person of the same gender.
  11. gay
    Homosexual males often use the term gay
  12. lesbian
    homosexual females use the term lesbian
  13. bisexual
    is a person who finds pleasure with both opposite-sex and same-sex partners. Homosexual or heterosexual people may have bisexual relationships at times.
  14. transsexual
    person of a certain biologic gender who has the feelings of the opposite sex. The person feels trapped within the body of the wrong sex. The reason behind this is unknown, although many factors are believed to be involved. For many transsexuals, the solution is to change their bodies, through surgery and hormone therapy, to match their inner feelings.
  15. transvestite
    an individual who desires to take on the role or wear the clothes of the opposite sex. Most transvestites are heterosexual, and many keep their lifestyle hidden.
  16. mons pubis
    is a pad of fatty tissue that lies over the part of the bony pelvis called the symphysis pubis. In the physically mature female, the mons pubis is covered with coarse pubic hair. It contains many nerve endings that make the mons pubis sensitive to touch and pressure.
  17. labia majora
    consist of two rounded folds of fatty tissue. The outer lips separate downward from the mons pubis and meet again below the vaginal introitus. The labia majora contain a multitude of sebaceous and sweat glands. They respond to touch during sexual activity.
  18. labia minora
    are the smaller lips located within the labia majora. They are thin and sensitive structures and are pink. When stimulated by touch, the labia minora may turn a darker pink or even red owing to the presence of many blood vessels. The labia minora have no hair and are smooth.
  19. clitoris
    is found above the urinary meatus at the joining of the labia minora, called the clitoral hood. The clitoris is a small, button-like structure similar to the penis in its reaction to stimuli. The clitoris contains erectile tissue, blood vessels, and nerves. It is extremely sensitive.
  20. hymen
    The opening of the vagina lies between the urinary meatus and the anus. It may contain a structure called the hymen, which is a thick membrane with no apparent function. At one time, the hymen was thought to represent virginity (not having experienced sexual intercourse), but this is erroneous. Remnants, or “tags,” of the hymen may be noted at the vaginal introitus in both sexually active and inactive women.
  21. ovaries
    The female body normally contains two ovaries, one on each side. The ovaries closely resemble an almond in size and shape. When a girl is born, each of her ovaries contains some 200,000 to 400,000 follicles. This number steadily decreases until puberty, when 100,000 to 200,000 follicles remain, and the number continues to decline over the reproductive years.The ovaries also secrete the hormones estrogen and progesterone.
  22. fallopian tubes
    are slender structures that extend from either side of the uterus and end in a fringed fashion near each ovary. Their function is to transport a mature ovum (female reproductive cell) from an ovary to the uterus. Fertilization of the ovum by a sperm usually occurs in the tube. The fertilized ovum then travels the rest of the way to the uterus, where it implants. An unfertilized ovum travels the same path but does not implant and is eventually expelled from the body during menses. Because the lumen of each tube is so narrow, it can easily be damaged by the effects of infection and surgery.
  23. uterus
    is a pear-shaped organ about 3 inches long located between the urinary bladder and the rectum. Its primary purpose is to house and nurture a pregnancy (the condition of carrying a developing embryo in the uterus).
  24. The uterus comprises three layers:
    • 1. The outermost layer, the perimetrium, consists of elastic tissue.
    • 2. The middle layer, the myometrium, is muscular.
    • 3. The innermost layer, the endometrium, comprises tissue that thickens and sloughs off with menses.
  25. cervix
    is the structure at the lower portion of the uterus that connects the uterus and the vagina. The cervix is usually closed, but during the birth process, it dilates and thins out extensively to permit the birth of a baby. The cervix is a smooth pink structure that possesses few nerve endings. When touched, the sensation resembles that of touching the end of one’s nose.
  26. vagina
    is a tubular, hollow organ that lies between the urethra and the rectum. Its size and shape vary among women. The walls of the vagina are composed of rugae, or ribbed tissue
  27. The vagina serves three purposes:
    • it is (1) a receptacle for the penis during sexual intercourse, (2) a birth canal for the passage of a baby, and (3) an exit for menstrual flow from the uterus. 
    • During sexual activity, the walls of the vagina secrete, or “sweat,” a thin watery material, sometimes in copious amounts. This lubrication is necessary for the comfortable placement and movement of the penis in the vagina.
  28. breasts
    Although the breasts are not considered part of the internal or external genitalia, they are an important aspect of female physical sexuality. The breasts consist of fatty and glandular tissues and the nipples. Their size and shape vary widely among women. The nipples are pale to deep pink. Caressing of the breasts can be pleasurable during sexual activity,and many women can be brought to orgasm by this action alone.
  29. Menstruation
    often referred to as a woman’s “period or menses,” is a cycle during which the body prepares for the presence of a fertilized ovum. Cycles are about 28 days long but may vary from 21 to 40 days.
  30. menarche
    The first menstrual period is experienced at about 12 years of age, but the age of menarche is individual and may occur anywhere between 8 and 17 years of age.
  31. Menopause
    the cessation of a woman’s menstrual activity, occurs between the ages of 45 and 55 years. The woman may experience irregular menses overtime before menstruation ends.
  32. menstrual cycle
    is controlled by a series of reactions that rely on feedback from the ovaries to the pituitary gland. Actually, two cycles occur simultaneously: one in the ovaries and one in the endometrium of the uterus.
  33. follicular phase.
    In the ovaries, in a typical 28-day cycle, the phase from day 4 to 14 is called the follicular phase. During this phase, a number of follicles mature, but only one produces a mature ovum.
  34. proliferation phase
    At the same time, in the uterus, the endometrium is becoming thick and velvety in preparation for receiving a fertilized egg. This phase in the uterus is called the proliferation phase. Ovulation generally occurs on day 14 when the mature ovum ruptures from the follicle and the surface of the ovary and is swept into the fallopian tube. If sperm are present, the ovum is fertilized at this time.
  35. mittelschmerz, or middle pain
    Some women can detect ovulation by the presence of a sharp, cramping pain over the ovulating ovary; this pain is called mittelschmerz, or middle pain, because it occurs in the middle of the cycle.
  36. luteal phase
    From day 15 to day 28, the phase in the ovaries is called the luteal phase. The leftover empty follicle fills up with a yellow pigment and is then called the corpus luteum, or yellow body. The purpose of the corpus luteum is to produce hormones that encourage a fertilized egg to grow. If fertilization does not occur, the corpus luteum begins to disintegrate.
  37. secretory phase
    During the luteal phase in the ovaries, the uterus also undergoes changes. This phase is called the secretory phase. The endometrial lining thickens. However, in the absence of a fertilized egg, the corpus luteum dies and the endometrial lining disintegrates.
  38. menses, or the menstrual flow
    At day 28, menses, or the menstrual flow, begins as a result of the uterus shedding the useless portion of its endometrium. Menses lasts for 3 to 7 days, the average length of flow being 5 days. The menstrual discharge is a bloody fluid that also contains endometrial debris, mucus, and enzymes. It is odorless until exposed to the air, when the woman may notice alight, fleshy, pungent odor. Deodorized pads and tampons do little to minimize odor and can cause chemical irritation to the vulva and vagina. Good hygiene and regular bathing are much more effective during menses to prevent odor. Normal blood loss averages 30 to 80 mL. Pads and tampons should be changed frequently to prevent odor and irritation from wetness. Women using tampons should read and follow the manufacturer’s suggestions to reduce the risk for toxic shock syndrome. Usually, the flow is the heaviest and is bright red on the first day or two of menses, gradually tapering off to light-brown staining. Many women experience some degree of discomfort either premenstrually or during menses. There is no scientific rationale supporting abstinence from sexual activity during menses. Many women enjoy sex during menses owing to the increase in vascularity in the pelvic region, which heightens enjoyment. Men may also enjoy the warm wetness the menstrual flow provides to the vagina. If flow is heavy, a diaphragm can be used to hold it back during sexual activity, or a towel can be used to protect the bedding. Some women who experience abdominal cramping during menses, or dysmenorrhea, find that sexual activity and orgasm relieve their discomfort. For women who want to avoid menstruating altogether, in May 2007 the U.S. FDA approved the first oral contraceptive designed to be taken 365 days a year. Women who use the drug don’t have regular menstrual periods although they can have breakthrough bleeding (spotting or light bleeding). While there are obvious advantages to not having menstrual periods, women should be counseled that there are no long-term safety data on these drugs. Risks are thought to be similar to those of conventional oral contraceptives: an increased incidence of blood clots, heart attacks and stroke, especially in women who smoke. Positive benefits may include lowering the risk for ovarian cancer and endometrial cancer.
  39. Menstrual cycle–related distress, commonly called premenstrual (tension) syndrome (PMS)
    reportedly occurs in 50% to 90% of the female population. PMS is characterized by the appearance of one or more of the following several days before the onset of menstruation: irritability, emotional tension, anxiety, mood changes, headache, breast tenderness,and water retention. Although it is often used to explain unusual behavior (and has been used as a legal defense), its etiology is still uncertain (both physiologic and psychogenic theories have been postulated), as are its effects on women’s roles and relationships. Some literature perpetuates a twofold myth: (1) biology and physiology are destiny (many females do and should experience premenstrual distress) and (2) female biology and physiology result in psychiatric disorder, destruction,and violence. Nurses have a great role to play in researching PMS and ensuring that women and the public correctly understand its effects.
  40. testes
    are about the size of walnuts, feel smooth and are freely movable within the scrotum. Normally, two testes are present. The testes produce sperm and the hormones necessary for the maintenance of male sex characteristics. The primary hormone secreted by the testes is testosterone, which is responsible for a man’s deep voice, beard growth, and body hair.
  41. scrotum
    is the loose, bag-like structure that houses the testes. The scrotum hangs between a man’s upper thighs. The area around the base of the penis and the scrotum is covered with pubic hair. The looseness of the scrotum is intentional to provide expansion and contraction. When exposed to cool temperatures, the scrotum contracts and draws the testes closer to the body for warmth. In warm temperatures, the scrotum becomes loose and allows the testes to hang farther away from the heat of the body. The testes are sensitive organs and can suffer discomfort, sometimes extreme, if handled roughly or jostled. It is important for men and boys to wear a properly fitted athletic supporter, or jockstrap, when engaged in strenuous physical activity. However, the continuous use of such a support can cause the temperature within the scrotum to rise and the delicate sperm to die because of constant exposure to high temperatures. Snug-fitting garments such as tight jeans can have the same effect on a man’s fertility. The scrotum can be a source of sexual pleasure when lightly stroked, fondled, or caressed during sexual activity.
  42. penis
    is a tubular structure located above the scrotum. It functions to eliminate urine from the bladder, to ejaculate semen and impregnate a woman, and as a sex organ for sexual pleasure. It consists of the shaft and the glans (head of the penis). In the uncircumcised male, the glans is covered by loose skin (foreskin) that can be retracted. In the circumcised male, the foreskin has been surgically removed, and the glans is exposed. Penis size and shape vary among individuals. Normally, the penis is soft and flaccid and 2.5 to 4 inches long. The dimensions of the penis in no way dictate the man’s ability to perform effectively during sexual activity. When an erection occurs, the blood vessels in the shaft of the penis become congested, and the penis becomes hard and erect. The size of the penis during an erection may increase to 5.5 to 7 inches in total length. The penis, particularly the glans, is extremely sensitive to stimulation. Stroking and handling of the shaft of the penis are also pleasurable during sexual activity. The stimulation that prompts an erection varies. A full bladder on awakening in the morning can cause an erection. Fantasy, memories of a past sexual encounter, and accidental brushing by an attractive stranger can all lead to an erection. An erection in the male does not always signify desire for sexual activity. Exposure of the male patient by the nurse during a bed bath may cause an erection. An erection is a normal physiologic response and not something the man can voluntarily control. The erection ceases if no further stimulation is added.
  43. Internal genitalia of the male
    Tubules from the testes drain into the epididymis, which in turn drains into the vas deferens and ejaculatory ducts. These ducts then drain directly into the urethra. It is believed that the vas deferens acts as a reservoir for sperm between ejaculations. The seminal vesicles, prostate gland, and Cowper’s glands produce a liquid called seminal plasma. The seminal plasma and the sperm collectively make up the semen. The plasma aids in the transport of sperm and also provides energizing nutrients for the sperm. It contains a form of sugar (fructose), mucus, salts, water, base buffers, and coagulators to aid the sperm in their journey. Semen is a thick, creamy white fluid with the consistency of mucus or egg whites.
  44. male breasts
    contain little real breast tissue, but they still may be stimulated during sexual activity. Although the area of sensitivity is usually limited to the nipple and areola, its stimulation can be as pleasurable an experience for the male as it is for a female.
  45. Ejaculation
    is the expulsion of semen by the rhythmic contractions of the penis. The penis engages in short, jerky movements that produce a spurt of semen with each motion. The period of ejaculation is short, and the penis becomes flaccid after ejaculation. The normal amount of semen per ejaculate is 2 to 6 mL. A fertile man dispels 120 to 160 million sperm per ejaculate. Cowper’s glands produce small droplets of fluid during sexual activity that neutralize the acidity of the male urethra and aid in the transport of sperm. This fluid may contain sperm. Therefore, contraceptive measures, if used, must be taken before this fluid can be introduced into the vagina. Many males, particularly adolescent boys, may experience a phenomenon known as a nocturnal emission, or “wetdream.” These ejaculatory episodes occur during sleep without physical stimulation. They are perfectly normal and do not represent any sort of deviation.
  46. sexual response cycle is not limited to the genital organs but is a total-body response that causes many physiologic changes throughout the body. The cycle has four phases:
    (1) excitement, (2) plateau, (3) orgasm, and (4) resolution; there is a smooth progression from one phase to the next. Although only physiologic responses are discussed here, the emotional and mental involvement of sexual response contributes a great deal to the pleasure and satisfaction of sexual activity.
  47. erogenous zones
    areas that when stimulated cause sexual arousal and desire. The genitals are an obvious source of sexual pleasure for both men and women, but other areas of the body are also considered erogenous zones. The skin is the largest erogenous zone. Other areas include the ears, lips, thighs, and breasts. Some people can reach orgasm simply by stimulation of erogenous zones other than the genitals. The most important body organ for sexual arousal and stimulation is the brain. It allows individuals freedom to enjoy a sexual experience but also may prevent satisfaction by inhibitions, doubts, and guilt.
  48. excitement phase
    is initiated by erotic stimulation and arousal. Some of the physiologic changes common in both men and women include an increase in heart rate and blood pressure and the appearance of a pink to red flush to the skin.This sex flush, which is more evident in women than in men, spreads over the face, neck, back, and upper torso. Congestion of the genitals with increased blood flow begins in the excitement phase and causes even more arousal. The length of the excitement phase varies greatly among individuals and even from one experience to another. Women usually enjoy a more prolonged period of stimulation than do men. During the excitement phase, the woman’s breasts swell and the nipples become erect and hard to the touch. Lubrication of the vagina seeps to the outside of the body along the vulvar creases and makes stimulation of the genitals more pleasurable by decreasing friction. The upper two thirds or so of the vagina enlarge and expand. The clitoris enlarges and emerges slightly from the clitoral hood. The labia also enlarge and separate and turn a deep rosy red with arousal. The first obvious sign of arousal in the man is an erection of the penis caused by increased pelvic congestion of blood. The scrotum noticeably elevates, thickens, and enlarges. The skin of the penis and scrotum turns a deep reddish-purple in response to congestion and arousal. Male nipples may also harden and become erect.
  49. plateau phase
    The intensity of the plateau phase is greater than that of excitement but not enough to begin orgasm. Desire and arousal continue to build and intensify. This phase varies from a few minutes to 15 to 20 minutes. In the female, the clitoris retracts and disappears under the clitoral hood. It is thought that the clitoris performs in this mysterious way as the body’s protection against overstimulation. In the male, secretions from Cowper’s glands may appear at the glans of the penis during the plateau phase.
  50. orgasm
    The term orgasm defines the climax and sexual explosion of the tension that has been building over the preceding phases. Orgasm lasts only seconds, but it is an extremely intense reaction. Characteristics of the orgasm phase are the involuntary spasmodic contractions of the genital organs. The number of contractions felt by the individual depends on the intensity of the orgasm. The orgasm phase in the female begins with a heightened feeling of physical pleasure, followed by overwhelming release and involuntary contractions of the genitals. Loss of muscular control can also be seen in spastic contractions and twitching of the arms and legs. The number of contractions can be as few as 4 or as many as 20. Areas of the body that contract spasmodically are the uterus, anal sphincter, rectum, and urethral sphincter. It is believed that women achieve orgasm in a variety of ways. Although some women can achieve orgasm by penile thrusting in the vagina alone, most women need clitoral stimulation to reach orgasm. During orgasm in the male, involuntary spasmodic contractions occur in the penis, epididymis, vas deferens, and rectum. The male orgasm is most often accompanied by ejaculation of semen from the urinary meatus of the penis. It is not necessary for ejaculation and orgasm to occur simultaneously; rather, it is a coincidence that the two events usually happen at the same time.
  51. resolution phase
    is characterized by a return to normal body functioning present before the excitement phase. Feelings of relaxation, fatigue, and fulfillment are common. Some people have a need to be held, fondled, and caressed. Physical demonstrations of affection may initiate the sexual response cycle once again. The woman is physiologically capable of immediate response to sexual stimulation. Because of this, many women can achieve multiple orgasms.
  52. refractory period
    The man experiences a period during which he is incapable of sexual response, called the refractory period. The length of the refractory period is individual; it might be a few minutes or even days before the man’s body responds readily to continued sexual stimulation.
  53. Forms of sexual stimulation include:
    kissing, hugging, stroking, squeezing, breast stimulation, manual stimulation of the genitals, oral–genital stimulation, and anal stimulation. Sexual stimulation may be physical or psychological. Erotic stimulation through the use of films, magazines, and photographs is common.
  54. Fetishism
    usually practiced by a male, is sexual arousal with the aid of an inanimate object not generally associated with sexual activity. Items such as shoes, leather, rubber, and women’s undergarments might be used.
  55. Masturbation
    is a technique of sexual expression in which an individual practices self-stimulation. It is a way for a person to learn what he or she prefers during stimulation and what feels good. Men masturbate by holding and stroking the shaft of the penis. Women find manual stimulation of the clitoris enjoyable, although variations of technique are numerous. Many myths and misinformation surround masturbation.The reality is that people masturbate regardless of sex, age, or marital status. People might not masturbate because they feel guilty about it or believe self-stimulation is wrong. Masturbation is not “dirty” and will not lead to blindness or insanity.
  56. act of intercourse (coitus or copulation)
    is the insertion of the penis into the partner’s vagina, anus, or mouth. It usually begins by stimulation of the senses in some way, followed by a period of activity known as foreplay. “Petting” is part of foreplay; it can involve simple stroking of the breasts,arms, back, and neck without genital involvement or may lead to mutual masturbation and orgasm.
  57. vaginal intercourse
    The act of placing the penis in the vagina, penile–vaginal intercourse, can be accomplished in various positions. The most common position in Western cultures is the missionary position, in which the woman lies horizontally underneath the man. (This position was named by the Polynesians because it was the preferred position for intercourse used by religious missionaries.) Couples may find other positions to be more stimulating and comfortable. Clitoral stimulation is difficult to achieve in the missionary position. Lying side by side, female on top, and rear entry are some examples of coital positions that enable clitoral stimulation. Sexually inhibited people may believe they need “permission” to engage in alternative sexual positions. When the penis is pushed into the vagina, the man begins rhythmic thrusting movements of his hips to move the penis back and forth along the vaginal walls. The woman might match her partner’s hip movements with movements of her own body. These movements continue until orgasm is attained by one person or both. Simultaneous orgasms, or both people attaining orgasm at the same moment, are difficult to achieve, and a preoccupation with attaining simultaneous orgasms might disrupt the ultimate intimacy and satisfaction possible during coitus. The period after coitus is just as significant as the events leading up to it. Caressing, hugging, and kissing deepen the couple’s intimacy and should be nurtured, not rushed.
  58. anal intercourse
    the act of inserting the penis into the anus and rectum of a partner, is another form of intercourse. Commonly practiced by gay men, it is also used by heterosexual couples. Once the penis (or any object) is placed in the rectum, it should not be introduced into the vagina without thorough cleansing because many microorganisms present in the rectum can cause vaginal infections. Care should be used to avoid injury to the delicate rectal mucosa, and lubrication is essential for comfort. Condoms are now recommended for both types of intercourse to prevent sexually transmitted infections (STIs).
  59. oral-genital stimulation
    Stimulation of the genitals by the mouth and tongue might be used during foreplay or as a way to reach orgasm. These techniques may be used by one partner or both simultaneously (soixante-neuf). More younger people are using oral–genital stimulation as a replacement for vaginal intercourse to reduce the incidence of pregnancy.
  60. cunnilingus
    is stimulation of the female genitals by licking and sucking the clitoris and surrounding structures.
  61. fellatio
    is stimulation of the male genitals by licking and sucking the penis and surrounding structures.
  62. Abstinence
    is not having sex. It is the most effective form of birth control, preventing pregnancy 100% of the time when practiced consistently. Abstinence also prevents the transmission of STIs 100% of the time when practiced appropriately and consistently. Some STIs spread through oral–genital sex, anal sex, or even intimate skin-to-skin contact without actual penetration (genital warts and herpes can be spread this way). Therefore, only avoiding all types of intimate genital contact can prevent these STIs.
  63. complete abstinence
    Avoiding all types of intimate genital contact—including anal and oral sex—is complete abstinence. There are no side effects or health risks related to abstinence.
  64. Alternate forms of sexual expression include:
    voyeurism, sadism, masochism, sadomasochism, and pedophilia.
  65. Voyeurism
    is the achievement of sexual arousal by looking at the body of another. Some voyeurs develop complex means to spy on others that involve violations of privacy.
  66. Sadism
    refers to the practice of gaining sexual pleasure while inflicting abuse on another person.
  67. Masochism
    refers to gaining sexual pleasure from the humiliation of being abused.
  68. Sadomasochism
    is the act of practicing sadism and masochism together. It might involve being tied up, biting, hitting, spanking, whipping, pinching, and other activities.
  69. Pedophilia
    is a term used to describe the practice of adults gaining sexual fulfillment by performing sexual acts with children.
  70. Developmental aspects of sexuality through the life span in infancy: birth to 18 months
    • characteristics:
    • • Needs affection and tactile stimulation
    • • Boys have penile erections, and girls have orgasmic potential
    • • Gradually can differentiate self from others
    • • Obtain pleasure from touching genitals
    • • Dressed according to gender
    • • Toys are gender related

    • nursing implications and teaching guidelines:
    • • Avoid early weaning to prevent oral deprivation.
    • • Encourage parents to provide ample physical touch, deprivation of which may cause physical and mental underdevelopment.
    • • Self-manipulation of genitals is normal behavior; avoid denoting this as “bad.”
    • • Avoid confusion of sex by consistent use of male or female role reinforcement.
  71. development aspects of sexuality through the life span for a toddler: age 1-3 yr
    • characteristics:
    • • Establishes control over bowels and bladder
    • • Both sexes enjoy fondling genitals
    • • Able to identify own gender
    • • Develops vocabulary related to anatomy

    • nursing implications and teaching guidelines:
    • • Allow toddler to designate his or her readiness to toilet training. Strict measures may lead to compulsive behaviors later.
    • • Punishment of genital fondling may lead to guilt and shame regarding sexual behavior later in life.
    • • Use proper terms for body parts.
  72. developmental aspects of sexuality through the life span for a preschooler: age 4-6 yr
    • characteristics:
    • • By age 6, sexuality has been internalized and preference for sexual partners determined
    • • Methods of play and dress are in accordance with gender
    • • Enjoys exploring body parts of self and playmates
    • • Engages in masturbation

    • nursing implications and teaching guidelines:
    • • Parents may cause anxiety in the child by intolerance of inconsistency of sex-role behavior.
    • • Negative overreaction by parents of child’s masturbating behavior can lead to a belief that the genitals and sex are bad and dirty.
  73. developmental aspects of sexuality through the life span for school-aged: age 6-10 yr
    • characteristics:
    • • There is attachment to the parent of the opposite sex
    • • Tendency toward having same-sex friends
    • • Curiosity about sex and sharing of fears
    • • Increasing self-awareness

    • nursing implications and teaching guidelines:
    • • Same-sex preference for relationships is not related to heterosexual or homosexual tendencies.
    • • Give child the information desired in a clear, factual form. May look to peers for information that may be incorrect.
  74. developmental aspects of sexuality through the life span for preadolescence: age 10-13 yr
    • characteristics:
    • • Puberty begins for most boys and girls with development of secondary sex characteristics
    • • Menarche takes place
    • • May test behavioral limits

    • nursing implications and teaching guidelines:
    • • Information is necessary regarding body changes to alleviate fears. This information should be given to the young person before pubertal changes begin.
    • • Parents need to find a satisfactory middle ground for role setting. Rules that are either too rigid or too lenient can interfere with the development of self-confidence and internal value system.
    • • Treat body image changes with a positive attitude to prevent poor self-image.
  75. developmental aspects of sexuality through the life span for adolescence: age 13-19 yr
    • characteristics:
    • • Begins to develop opposite-sex relationships
    • • Sexual fantasies are common
    • • Masturbation is common
    • • May begin to partake in sexual activity ranging from light to heavy petting to full genital intercourse
    • • Girls concerned with reputations and self-image
    • • Boys preoccupied with competitiveness of sexual activity
    • • Incidence of adolescent pregnancies is increasing

    • nursing implications and teaching guidelines:
    • • Parents share their beliefs and moral value systems with their children.
    • • Teenagers may share their feelings with parents. Not taking them seriously may lead to lack of trust and communication gap.
    • • Teens need information regarding contraceptive measures and the potential for contracting sexually transmitted infections.
  76. developmental aspects of sexuality through the life span for young adulthood: age 20-35 yr
    • characteristics:
    • • Premarital sex is common
    • • Although many young adults choose cohabitation instead of marriage, most marry and begin families before age 30 yr
    • • Knowledge regarding sexual response and activity increases pleasure of relationship
    • • May experiment with various sexual expressions
    • • Develops own value system and respects values of other people
    • • Many couples share financial responsibilities as well as household tasks

    • nursing implications and teaching guidelines:
    • • Encourage communication between partners regarding sexual needs and differences.
    • • Teach use of abstinence and contraceptive measures to prevent unwanted pregnancies.
    • • Counsel against promiscuous behavior to guard against sexually transmitted infections and loss of trust of partner.
    • • Daily communication is necessary to vent stresses and work out difficulties.
  77. developmental aspects of sexuality through the life span for adulthood: age 35-55 yr
    • characteristics: 
    • • Bodily changes as a result of menopause
    • • Couples focus on quality rather than quantity of sexual experiences
    • • Divorce is common
    • • Grown children begin their own lives and sexual experiences
    • • Sexual satisfaction may actually increase because of loss of fear of pregnancy

    • nursing implications and teaching guidelines:
    • • Both men and women need positive reinforcement of what is good about themselves and their relationships.
    • • Teach parents that empty nest syndrome (feelings of loss caused by children leaving) is common. Accentuate positive aspects of this situation.
    • • Encourage couple to use this period as one of renewal for themselves.
  78. developmental aspects of sexuality through the life span for late adulthood and the elderly: age 55 and older
    • characteristics: 
    • • Orgasms may become shorter and less intense in both men and women
    • • Vaginal secretions decrease, and period of resolution in men lengthens
    • • May feel need to conform to stereotypes regarding the aging process and cease sexual activity
    • • Fear of loss of sexual abilities

    • nursing implications and teaching guidelines:
    • • Sexual activity need not be hindered by age.
    • • Teach couples that adaptation to bodily changes is possible with use of comfortable positions for intercourse and increased time for stimulation.
    • • Teach alternatives to coitus, such as caressing, hugging, and stroking, when coitus is impossible because of illness or disability.
    • • Couples who have been consistently sexually active throughout their lives may continue their intimate relationship for as long as they desire.
  79. Sexually transmitted infections (STIs) or diseases (STDs), once called venereal diseases
    are infections that are spread primarily through sexual contact. They are among the most common infectious diseases in the United States today. More than 20 STIs have been identified, and they affect more than 13 million men and women in this country each year. A Centers for Disease Control and Prevention study estimates that one in four (26%) young women between the ages of 14 and 19—or 3.2 million teenage girls—is infected with at least one of the most common sexually transmitted diseases: human papillomavirus (HPV), chlamydia, herpes simplex virus, and trichomoniasis. The study also finds that African American teenage girls are the most severely affected. Nearly half of the young African American women (48%) were infected with an STI, compared to 20% of young white or Mexican American women. The annual comprehensive cost of STIs in the United States is estimated to be well in excess of $10 billion. According to the National Institute of Allergy and Infectious Diseases (NIAID), understanding the basic facts about STIs—the ways in which they are spread, their common symptoms, and how they can be treated—is the first step toward prevention. Having an STI might affect one’s self-concept and keep an individual from becoming intimate for fear of spreading the infection. Some STIs, such as HIV that progresses to acquired immunodeficiency syndrome (AIDS), are deadly because there is no cure.
  80. NIAID recommends understanding at least five key points about all STIs in this country today:
    • 1. STIs affect men and women of all backgrounds and economic levels. They are most prevalent among teenagers and young adults. Nearly two-thirds of all STIs occur in people younger than 25 years of age.
    • 2. The incidence of STIs is rising, in part because in the last few decades, young people have become sexually active earlier yet are marrying later. In addition, divorce is more common. The net result is that sexually active people today are more likely to have multiple sex partners during their lives and are potentially at risk for developing STIs.
    • 3. Most of the time, STIs cause no symptoms, particularly in women. When and if symptoms develop, they may be confused with those of other diseases not transmitted through sexual contact. Even when an STI causes no symptoms, a person who is infected may be able to pass the disease on to a sex partner. That is why many doctors recommend periodic testing or screening for people who have more than one sex partner.
    • 4. Health problems caused by STIs tend to be more severe and more frequent for women than for men, in part because the frequency of asymptomatic infection means that many women do not seek care until serious problems have developed.
    • • Some STIs can spread into the uterus (womb) and fallopian tubes to cause pelvic inflammatory disease (PID), which in turn is a major cause of both infertility and ectopic (tubal) pregnancy. The latter can be fatal.
    • • STIs in women also may be associated with cervical cancer. One STI, human papillomavirus infection (HPV), causes genital warts and cervical and other genital cancers.
    • • STIs can be passed from a mother to her baby before, during, or immediately after birth; some of these infections of the newborn can be cured easily, but others may cause a baby to be permanently disabled or even die.
    • 5. When diagnosed and treated early, many STIs can be treated effectively. Some infections have become resistant to the drugs used to treat them and now require newer types of antibiotics. Experts believe that having STIs other than HIV increases one’s risk for becoming infected with the HIV virus.
  81. Acquired immunodeficiency syndrome (AIDS)
    • • Human immunodeficiency virus (HIV)
    • • Positive ELISA and Western Blot tests
    • • Incidence high in IV drug users and homosexual and bisexual men; increased heterosexual transmission
    • • Fatigue, diarrhea, weight loss, enlarged lymph nodes, fever, anorexia, and night sweats
  82. Cervical intraepithelial neoplasia (CIN)
    Cervical cancer
    • • Abnormal Pap smears
    • • Women with multiple sex partners, women who began sexual activity before age 18, and women whose partners have multiple female partners
    • • Asymptomatic
    • • Possible vaginal bleeding or spotting
  83. Chlamydia trachomatis
    Nongonococcal urethritis (NGU)
    Chlamydia
    • • The most prevalent STI to date
    • • Intracellular bacteria
    • • Vaginal discharge, burning on urination, urinary frequency, dysuria, and urethral soreness
    • • Many women do not have symptoms.
  84. Cytomegalovirus (CMV)
    • • A virus in the same family as herpes and Epstein-Barr
    • • May be asymptomatic or may be confused with another disease such as pneumonia, mononucleosis, or hepatitis
    • • Not exclusively sexually transmitted
  85. Nonspecific vaginitis
    Gardnerella vaginalis
    • • Mixed anaerobic bacteria
    • • Foul-smelling, thin, grayish white vaginal discharge
    • • Male partners do not have symptoms.
  86. Neisseria gonorrhoeae
    “The clap” or “the drip”
    Gonorrhea
    • • Gram-negative bacteria
    • • Both men and women may not have symptoms.
    • • Symptoms in men: purulent penile discharge, dysuria, frequency of urination
    • • Symptoms in women: dysuria, abnormal menses, vaginal discharge, pelvic inflammatory disease
    • • Symptoms of pharyngitis (sore throat) if oral sex was practiced
    • • May be accompanied by chlamydial infection
    • • Detected by gonorrhea culture of cervix or penile discharge from men
    • • Newborns exposed at birth are at risk for blindness and pneumonia.
    • • Untreated gonorrhea can result in infertility, skin rash with lesions, and acute arthritis.
  87. Herpes simplex virus type 1 and 2
    “Cold sores”
    Herpes
    • • A DNA virus
    • • Lesions develop mostly in oral and genital areas.
    • • Appear as single or multiple painful vesicles, which rupture and form ulcer-like lesions; these form scabs as they heal.
    • • First infections last about 10 to 14 days, whereas subsequent infections are shorter in duration.
    • • Recurrences are usually preceded by prodromal symptoms of tingling and fullness.
  88. Human papillomavirus (HPV)
    Condylomata acuminate
    Genital warts
    Venereal warts
    • • A DNA virus; vaccine now available.
    • • Pale, soft, papillary lesions found around the internal and external genitalia and perianal and rectal areas of the body; vary in size
    • • Profuse watery vaginal discharge, dyspareunia, intense pruritus (itching), and vulvar irritation
    • • Women with HPV are at risk for cervical cancer.
    • • Male partner may or may not have lesions.
  89. Treponema pallidum
    Syphilis
    • • A spirochete detected through serologic blood test (VDRL, RPR, STS)
    • • Three stages to disease if left untreated
    • Primary: Single painless genital lesion 10 days to 3 months after exposure
    • Secondary: Generalized skin rash, enlarged lymph nodes, fever that may appear 2 to 4 weeks after appearance of primary lesion; may last for several years
    • Latent: Usually 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 may occur.
  90. Trichomoniasis
    “Trich”
    Trichomonas vaginalis
    • • Protozoan with flagella
    • • Identified on wet-mount microscopic examination of vaginal discharge
    • • May be identified on Pap smear
    • • Usually asymptomatic in male patients
    • • 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 examination.
  91. Sexual dysfunction
    is a problem that prevents an individual or couple from engaging in or enjoying sexual intercourse and orgasm. Dysfunctions might occur as a result of physiologic malfunctions, conflicts with cultural norms, interpersonal problems, or any combination of these. Anxieties and fears concerning the sexual act are almost always present. Patients with severe sexual dysfunctions require intensive professional therapy from a qualified sex therapist.
  92. Erectile dysfunction, also called impotence
    is the inability of a man to attain or maintain an erection to such an extent that he cannot have satisfactory intercourse. Common causes of impotence (which may be physiologic or psychological) include various illnesses, treatments for these illnesses, and personal anxieties. New medications have revolutionized treatment for erectile dysfunction.
  93. Premature ejaculation
    is a condition in which a man consistently reaches ejaculation or orgasm before or soon after entering the vagina. The result is that his partner usually does not have time to reach sexual satisfaction. Causes of the problem are rarely physical.
  94. Retarded ejaculation, also called ejaculatory incompetence (or delayed intravaginal ejaculation)
    refers to a man’s inability to ejaculate into the vagina, or delayed intravaginal ejaculation. The causes of this problem are similar to those of impotence. When it occurs after the man has experienced normal ejaculations, the cause is most probably due to interpersonal problems.
  95. Inhibited sexual desire
    Inhibited sexual desire consists of an inhibition in sexual arousal so that congestion and vaginal lubrication are absent or minimal. Causative factors may be anxiety, negative emotions, fear, interpersonal problems, or physical factors. Orgasmic dysfunction is defined as the inability of a woman to reach orgasm. The causes are similar to those of inhibited sexual desire.
  96. Dyspareunia
    is painful intercourse. Although it is most often described by women, some men may also suffer from this disorder. The cause is usually physical, although psychological problems such as fear and anxiety can cause pain.
  97. Vaginismus
    is a rare condition in which the vaginal opening closes tightly and prevents penile penetration. Vaginismus is due to involuntary spastic contractions of the muscles at and around the vaginal opening and the levator ani muscles. The cause of vaginismus may be physical, psychological, or both.
  98. Vulvodynia
    a chronic vulvar discomfort or pain characterized by burning, stinging, irritation, or rawness of the female genitalia that interferes with sexual activity, is particularly problematic because little is known about its cause or treatment.
  99. Diabetes mellitus
    is a hormonal disease in which an inadequate amount of insulin is secreted by the pancreas. Although almost all hormonal disorders affect sexuality in some way, diabetes is the most prevalent and well known. Erectile dysfunction, or impotence, is a great concern among diabetic men. Treatment to date depends largely on the degree of erectile ability lost. Some men might be candidates for a penile prosthesis, which was developed in 1973. The prosthesis is surgically implanted below the base of the penis, and inflation of the device produces an erection when sexual activity is desired. Pharmacologic management (e.g., Viagra, Levitra,or Cialis) might also be indicated. It is not uncommon for diabetic women to experience loss of capacity for orgasm (orgasmic dysfunction). Difficulty experiencing arousal and loss of vaginal lubrication have also been reported. Frequent Monilia infections of the vagina are also common and can cause discomfort during coitus.
  100. Cardiovascular disease
    is prevalent in North America, and the sexual response cycle can greatly increase the demands on the heart and other structures. A person with a cardiovascular disease might experience much anxiety over the effect the illness will have on sexuality and sexual functioning.
  101. HTN
    The most significant difficulty a hypertensive person faces regarding sexuality is that the medication used to control the disease frequently causes a change in sexual functioning. These sexual dysfunctions may be relieved by modifying the dose of the medication or switching to a different medication.
  102. MI (heart attack)
    The primary goal after a myocardial infarction (MI) is to allow the heart ample time to heal. Activities of daily living, including sexual activity, should be resumed gradually, and stressors such as overexertion, alcohol consumption, and emotional upheavals should be avoided. In an uncomplicated MI, sexual activity may begin at about the third week of recovery, beginning with masturbation to partial erection in the male. Generally, this activity is gradually increased until 3 months after the MI, when sexual intercourse may be resumed. A comfortable position that places the least stress on the affected partner should be used.
  103. dz of the joints and mobility
    Joint diseases and disorders affect young and old people. Pain, fatigue, stiffness, and loss of range of motion can accompany any of the dozens of known diseases of the joints. The disease itself does not affect sexual functioning, although the manifestation of it can cause discomfort and anxiety.
  104. surgery and body image
    Surgery is performed to remove diseased tissue and repair body organs, and it usually requires an incision with resulting scars. The most devastating kinds of surgery are those used to remove cancerous tissue and surrounding structures. Patients are almost always distressed about a diagnosis of cancer and possible death. After surgery, patients need to adjust to major alterations in their bodies. Changes in body image also affect a person’s self-perception as a sexual being.
  105. Mastectomy
    is a surgical procedure to remove a breast and surrounding tissue. After such a surgery, a woman’s return to sexual functioning depends on many factors, such as support of her partner, the value placed on the breast by the man or woman, and fear of discomfort during sexual activity.
  106. An ostomy
    is a surgical opening placed on the outside of the body to allow for the passage of secretions and elimination into a closed drainage bag. Grieving over the loss of the natural means to eliminate waste, such as urine or feces, accompanies learning to live with an obvious artificial device. Many people are anxious as to how this apparatus will affect their sex lives and how accepting their partners will be of it.
  107. spinal cord injuries
    Thousands of people are victims of spinal cord injuries each year as a result of various types of accidents. This type of injury almost always results in some degree of permanent disability. Such people face multiple adaptations in their lifestyles, including those related to mobility, bowel and bladder control, sexual functioning, and role expectations. The extent of sexual response that remains after a spinal cord injury depends primarily on the level and extent of the injury. Ejaculation and orgasm are most likely to remain with low spinal injuries. Women are more likely to experience orgasm than men, but they complain more about the lack of physical sensations during the excitement phase than do men. Many people find that other erogenous zones become more easily stimulated after the injury.
  108. chronic pain
    Many chronic illnesses are accompanied by constant pain, and an individual with persistent pain might not desire any sexual contact. However, the desire for human warmth and contact does not cease because of pain. Altered or modified positions for coitus are sometimes necessary, and discussing these with patients can be an important part of implementing in the Nursing Process.
  109. mental illness
    Various psychological and physical disorders can cause 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. Even a disorder such as mild depression can affect desire and sexual functioning. Sometimes, it is difficult for the partner of a patient who has developed a mental illness to continue the sexual relationship. People afflicted with Alzheimer’s disease can lose the memory of any contact with a partner or spouse. At times, patients with mental illness act out in a sexual manner, such as touching themselves or removing their clothing at inappropriate times and places.
  110. medications
    Some medications have side effects that may affect sexual functioning. These include amyl nitrates, anticonvulsants, antidepressants, antihistamines, antihypertensives, antipsychotics, antispasmodics, barbiturates, and narcotics. Recreational drugs including cocaine, ethyl alcohol, and marijuana are used by some to heighten the sexual experience. These drugs can have serious and even deadly side effects.
  111. Nursing goals to enhance interactions with patients and to promote individual sexual health are as follows: The nurse will be able to:
    • • Feel comfortable as a sexual being.
    • • Develop self-awareness regarding sexual topics.
    • • Develop communication skills that promote discussion of sexual concerns with patients.
    • • Identify patients with problems related to sexuality and intervene competently and comfortably to meet these needs.
    • • Practice responsible sexual expression.
  112. As a rule, three general categories of patients should have a sexual history recorded by the nurse:
    • • Any inpatient or outpatient receiving care for pregnancy, STI, infertility, or contraception
    • • Any patient experiencing sexual dysfunction
    • • Any patient whose illness will affect sexual functioning and behavior in any way
  113. Four general levels of sexual history are:
    • Level 1: Sexual history as part of a comprehensive health history—obtained by a nurse
    • Level 2: Sexual history—obtained by a nurse with education and training in sexuality
    • Level 3: Sexual problem history—obtained by a sex therapist
    • Level 4: Psychiatric/psychosocial history—obtained by a psychiatric nurse clinician
    • Each level acquires more specific information from the patient regarding sexual health and also requires the interviewer to have more sophisticated preparation and skills. The professional nurse usually performs a sexual history on level 1.
  114. Nursing diagnoses written to address problems of sexuality belong to one of two categories:
    • • Ineffective Sexuality Patterns: The state in which an individual experiences or is at risk for a change in sexual health, which results in concern regarding own sexuality. Sexual health is the integration of somatic, emotional, intellectual, and social aspects of sexual being in ways that are enriching and that enhance personality, communication, and love.
    • • Sexual Dysfunction: The state in which an individual experiences or is at risk for change in sexual function that is viewed as unsatisfying, unrewarding, or inadequate.
    • Related diagnoses include Rape-Trauma Syndrome, Impaired (or Risk for Impaired) Parenting, and Readiness for Enhanced Parenting.
  115. Sexual dysfunction may be specified as erectile failure (impotence), premature ejaculation, retarded ejaculation, inhibited sexual desire, orgasmic dysfunction, vaginismus, or dyspareunia. Common etiologies for sexual dysfunction include effects of medication (specify), effects of alcohol consumption, effects of disease process (specify), history of abuse (specify rape, incest), feelings of depression, guilt, anxiety, fear of rejection, miscommunication with partner, fear of pain, effects of birth control method (specify), lack of knowledge, or effects of surgical procedure (specify).
  116. The nursing diagnosis Ineffective Sexuality Patterns can be further specified by loss of desire (to abstinence), increased desire (to promiscuity), or change in sexual expression. Common etiologies for Ineffective Sexuality Patterns include stress (lifestyle, job, family, finances, marital conflict), isolation from partner, effects of pregnancy (specify), feelings of depression, loss of privacy, loss of communication with partner, relationship change (new partner), effects of disease process (sexual position, frequency, mode of expression), change in body image, change in self concept, or loss of partner.
  117. Changes in sexuality can affect other areas of human functioning. In the following nursing diagnoses, problems of sexuality are the etiology of another problem:
    • • Impaired Adjustment related to loss of sexual partner, loss of sexual body part
    • • Anxiety related to fear of pregnancy, loss of sexual functioning or desire, effects of disease process on sexual functioning
    • • Pain related to sexual position, penile penetration, effects of genital surgery, lack of vaginal lubrication
    • • Ineffective Coping related to effects of body image on sexual expression, change in sexual partner
    • • Fear related to pain during sexual intercourse, history of sexual abuse
    • • Anticipatory Grieving related to loss of sexual functioning, effects of surgical excision of genital body part
    • • Delayed Growth and Development related to sexual exploitation or abuse, sexual guilt, effects of hormonal imbalance, lack of information about sexuality
    • • Deficient Knowledge (specify: contraceptive methods, spread of STIs, sexual response, genital anatomy, modes of sexual expression, self-examination, effects of disease or medications) related to misinformation, sexual myths, lack of interest in learning, cognitive limitation
    • • Disturbed Body Image (specify: surgical excision of genital body part, loss of or gain in body weight) related to fear of rejection
    • • Impaired Social Interaction related to effects of marital separation or divorce
    • • Social Isolation related to fear of contracting STI, fear of sexual encounter
  118. Specific patient outcomes to promote sexual health follow. The patient will:
    • • Define individual sexuality.
    • • Establish open patterns of communication with significant others.
    • • Develop self-awareness and body awareness.
    • • Describe responsible sexual health self-care practices, identifying appropriate resources.
    • • Practice responsible sexual expression (e.g., by 5/1/12, the patient will use rubber condoms during all sexual encounters).
    • Specific patient outcomes will depend on the nature of the patient’s problem or concern. Expected outcomes should be patient-oriented—that is, something the patient desires to door has the ability to accomplish. For example, it is not enough to advise a method of birth control; rather, the nurse needs to know which method the patient is motivated and able to use.
  119. myth: Each person is born with a certain amount of sexual drive, which if overdrawn in youth leaves little reserve for later years.
    Actually, the correlation between sexual activity and length of time it persists throughout life is just the opposite. The more consistently sexually active a person is, the longer the activity continues into the later years of life.
  120. myth: The need for expressing one’s sexuality becomes less important in the latter half of one’s life.
    Physiologically, sexual desire and ability do not decrease markedly after middle age. The expression of one’s sexuality, as an integral part of development, follows the overall pattern of health and physical performance.
  121. myth: Sexual abstinence is necessary in training for sports.
    Physiologically, the achievement of orgasm is rarely more demanding than most activities encountered in daily life. The desire for sleep that often follows is most commonly due to factors other than physical exhaustion from sexual activities. There is no scientific evidence that sex “weakens” a person.
  122. myth: Excessive sexual activity can lead to mental illness.
    The biologic significance of human sexuality has no greater effect on total development than any other necessary biologic function. There is no scientific basis for believing that one will develop a mental or physical illness with excessive or no sexual activity.
  123. myth: Wet dreams are indicators of sexual disorders.
    Erotic dreams that culminate in orgasms are normal common physiologic phenomena in at least 85% of men. They can occur at any age after puberty. Some women also report in clinical studies that their sexual dreams culminate in orgasm. In women, this phenomenon is believed to increase with advancing age.
  124. myth: Because of the anatomic nature of the sex organs, women are passive and men are aggressive.
    Physiologic studies disprove this myth by showing the woman to be far from passive. Maximum gratification requires each partner to be both passive and aggressive in participating mutually and cooperatively.
  125. myth: It is unnatural for a woman to have as strong a desire for sex as a man—women should not enjoy sex as much as men.
    These myths have been reinforced by a society that has traditionally taught women that they are to suppress sexual desires to gain love, security, and society’s respect, based on the assumption that it is the basic nature of women to be submissive, dependent, and subordinate. Physiologic studies indicate that, in some respects, the woman’s sex drive is not only as strong but may be even stronger than that of the man.
  126. myth: Women who have multiple orgasms or who readily come to climax are nymphomaniacs or promiscuous.
    Physiologic studies at this time suggest that we do not know women’s sexual potential; these studies indicate that there is a wide range of intensity and duration of orgasmic experience, and the potential for multiple or frequent orgasms within a brief period is not at all uncommon. Therefore, women normally may have greater orgasmic capacity than men with regard to duration and frequency of orgasm.
  127. myth: There is a difference between vaginal orgasm and clitoral orgasm.
    Physiologic misunderstanding has produced the myth of separate clitoral and vaginal orgasms rather than their interrelations. Female orgasm is normally initiated by clitoral stimulation, but because it is a total-body response, there are marked variations in intensity and timing. There is no reason to believe that the female response to the sex act is due to a vaginal rather than a clitoral orgasm.
  128. myth: A mature sexual relationship requires the man and woman to achieve simultaneous orgasm.
    Although simultaneous orgasm may be desirable, it is unrealistic. Often, it is possible only under the most ideal circumstances and is not a determinant of sexual achievement or of satisfaction (except to someone who accepts this as dogma).
  129. myth: It is dangerous to have intercourse during menstruation.
    Because the source of the menstrual flow is from the uterus rather than the vagina, there is no basis for concern about tissue damage to the vagina. Actually, the desire for sex increases during the menses as a result of increased pelvic vasocongestion. There is no physiologic basis for abstinence during the menses.
  130. myth: The larger penis has greater possibilities for producing orgasm in the woman.
    Physiologically, there is practically no relation between the size of a man’s penis and his ability to satisfy a woman sexually. Furthermore, there is little correlation between penile size and body size and their relation to sexual potency.
  131. myth: The face-to-face coital position is the proper, moral, and healthy one.
    Recent knowledge of human sexual practices dispels this myth with the recognition that there is no normal or single most acceptable sexual position. Whatever position offers the most pleasure and is acceptable to both partners is correct for them. Any variation is normal, healthy, and proper if it satisfies both partners.
  132. myth: The ability to achieve orgasm is an indicator of a person’s sexual responsiveness.
    Achievement of a satisfactory sexual response is the result of numerous physical, psychological, and cultural influences. Too often, the physical fact of orgasm (or lack of orgasm) is taken to be symbolic of sexual responsiveness and seen out of context of the entire relationship between man and woman. 
  133. A good exercise for women in developing body awareness is the use of Kegel exercises. These exercises promote good vaginal tone by localizing and strengthening the pubococcygeal muscle. A woman can locate this muscle by stopping a stream of urine midway through urination. Contracting this muscle can be repeated at any time of the day in any circumstance because its performance is undetectable. Some women who practice Kegel exercises have found that their sexual satisfaction is improved.
  134. Rape
    is motivated by the need to dominate and humiliate the victim.
  135. Contraception
    is a process or technique for preventing pregnancy by means of a medication, device, or method that blocks or alters one or more of the processes of reproduction in such a way that sexual union can occur without impregnation. The prevention of unwanted pregnancy must be a conscious decision. Anyone considering the possibility of a sexual encounter who is unprepared for pregnancy should refrain from intercourse or obtain a contraceptive method from a healthcare provider or from the pharmacy; it is too late to think about contraception during sexual intercourse. To practice responsible sexuality, the contraceptive method must be used consistently and according to instructions.
  136. prevention of STIs
    The various STIs are widespread. The only sure way to avoid an STI is to remain a virgin until marriage, to marry a person who is a virgin, and thereafter, never to have sex with anyone else. When this is impractical, there are other practices that can decrease a patient’s risk for STIs.
  137. The best way to prevent STIs is to avoid sexual contact with others. If you decide to be sexually active, there are things that you can do to reduce your risk of developing an STI:
    • • Have a mutually monogamous sexual relationship with an uninfected partner.
    • • Correctly and consistently use a male condom.
    • • Use clean needles if injecting intravenous drugs.
    • • Prevent and control other STIs to decrease susceptibility to HIV infection and to reduce your infectiousness if you are HIV infected.
    • • Delay having sexual relations as long as possible. The younger people are when having sex for the first time, the more susceptible they become to developing an STI. The risk of acquiring an STI also increases with the number of partners over a lifetime.

    • Anyone who is sexually active should:
    • • Have regular checkups for STIs even in the absence of symptoms, and especially if having sex with a new partner. These tests can be done during a routine visit to the doctor’s office.
    • • Learn the common symptoms of STIs. Seek medical help immediately if any suspicious symptoms develop, even if they are mild.
    • • Avoid having sex during menstruation. HIV-infected women are probably more infectious, and HIV-uninfected women are probably more susceptible to becoming infected during that time.
    • • Avoid anal intercourse, but if practiced, use a male condom.
    • • Avoid douching because it removes some of the normal protective bacteria in the vagina and increases the risk of getting some STIs.
  138. Anyone diagnosed as having an STI should:
    • • Be treated to reduce the risk of transmitting an STI to a sex partner or from mother to baby.
    • • Discuss with a doctor the possible risk of transmission in breast milk and whether commercial formula should be substituted.
    • • Notify all recent sex partners and urge them to get a checkup.
    • • Follow the doctor’s orders and complete the full course of medication prescribed. A follow-up test to ensure that the infection has been cured is often an important step in treatment.
    • • Avoid all sexual activity while being treated for an STI.
  139. Sometimes people are too embarrassed or frightened to ask for help or information. Most STIs are readily treated, and the earlier a person seeks treatment and warns sex partners about the disease, the less likely the disease will do irreparable physical damage, be spread to others, or in the case of a woman, be passed on to a newborn baby.
  140. safe sex activities NIC and NOC
    • Nursing Interventions:
    • • Discuss patient’s attitudes about various birth control methods.
    • • Instruct patient on the use of effective birth control methods, as appropriate.
    • • Encourage patient to be selective when choosing sexual partners, as appropriate.
    • • Stress the importance of knowing the partner’s sexual history, as appropriate.
    • • Instruct patient on low-risk sexual practices, such as those that avoid bodily penetration or the exchange of bodily fluids, as appropriate.
    • • Instruct patient on the importance of good hygiene, lubrication, and voiding after intercourse, to decrease susceptibility to infections.

    • Nursing Outcomes:
    • • Affirms self as a sexual being
    • • Exhibits clear sense of sexual orientation
    • • Uses healthy coping behaviors to resolve sexual identity issues
    • • Reports healthy sexual functioning
    • • Performs sexually if environment conducive
    • • Performs sexually without coercion of partner
    • • Describes risks associated with sexual activity
  141. Sex education
    Sex education is critical to healthy sexual development and safe sexual behaviors. Information received from peers and friends is almost always inadequate and may be erroneous. Parents should be taught to answer children’s questions immediately and accurately.
  142. There are two types of abstinence:
    continuous and periodic.
  143. Continuous abstinence
    involves not having any sex with a partner at all. It is 100% effective in preventing pregnancy and STIs. However, individuals may find it difficult to abstain for long periods of time. Ending abstinence without being prepared to protect against an unplanned pregnancy or infection might cause additional problems.
  144. Periodic abstinence and fertility awareness methods
    are two methods of contraception that involve charting a woman’s fertility pattern. Periodic abstinence is a method used by some sexually active women to prevent pregnancy. They become familiar with their fertility patterns and abstain from vaginal intercourse on the days they think they could become pregnant. Women who monitor their fertility to prevent pregnancy either abstain from vaginal intercourse for at least one third of each menstrual cycle or use barrier methods during the fertile or “unsafe” period.
  145. Three basic charting methods can be used to predict ovulation in order to plan or prevent pregnancy:
    • • Temperature method: The woman takes her temperature every morning before getting out of bed. Her temperature will rise between 0.4F and 0.8F on the day of ovulation and will remain at that level until her next period.
    • • Cervical mucus method: The woman observes the changes in her cervical mucus throughout the first part of the menstrual cycle, until after ovulation. Cervical mucus is normally cloudy, but a few days before ovulation it becomes clear and slippery and can be stretched between the fingers. This indicates the most fertile phase of the cycle. The couple must abstain from vaginal intercourse or use a barrier method during this period to avoid pregnancy.
    • • Calendar method: The woman charts her menstrual cycle on a calendar. The couple must refrain from intercourse or use a barrier method during “unsafe” days.

    The best approach to monitoring fertility is to use all three methods; the combination of these methods is called the symptothermal method. Of 100 couples who use any of these methods for 1 year, 20 women will become pregnant with typical use. The failure rate is higher in single women. Using the methods carefully and consistently and avoiding unprotected vaginal intercourse during the fertile phase can give better results.
  146. Coitus interruptus (withdrawal)
    one of the oldest and most widely used contraceptive methods, is the withdrawal of the penis from the vagina before ejaculation. Pregnancy cannot occur if sperm is kept out of the vagina. Of every 100 women whose partners use withdrawal as a method of contraception, 27 will become pregnant during the first year of typical use. However, pre-ejaculate can contain enough sperm to cause a pregnancy. Pregnancy is also possible if pre-ejaculate or semen is spilled onto the vulva.
  147. Barrier methods include
    the condom, diaphragm, cervical cap, and vaginal sponge used in combination with a spermicidal agent.
  148. Diaphragm
    has been used in various forms since ancient times. It is a dome-shaped device made of latex rubber that mechanically prevents semen from coming into contact with the cervix. It is also used to hold a spermicidal jelly in place against the cervix. The diaphragm is placed in the vagina before sexual activity. It fits between the pelvic notch at the front of the vagina to behind the cervix at the back. It should not be detected by either the woman or her partner when correctly situated in the vagina. A diaphragm must be individually fitted during a pelvic examination. The woman needs to be familiar with her body and able to handle her genitals for diaphragm placement and removal. The diaphragm must be worn during each episode of sexual activity and consistently used with a spermicidal agent. Twenty of 100 women who use the diaphragm will become pregnant during the first year of typical use; 6 will become pregnant with perfect use.
  149. condom
    The traditional condom, or “rubber,” is used by men, although it is appropriate for a woman to have a condom available for her partner’s use. The condom is rolled over the erect penis and collects the semen after ejaculation occurs. If the condom does not have a nipple receptacle end, a small space should be left at the end of the condom to collect sperm (this prevents breakage). Condoms are available over the counter and have had a surge of popularity with the recent increase in the incidence of HIV/AIDS and other STIs. A female condom is also available. The female condom is a ringed pouch that unrolls in the vagina. Advantages include the fact that the male does not need to have an erection for the pouch to be used, and it offers significant protection from STIs. Of 100 women whose partners use condoms, about 14 will become pregnant during the first year of typical use; 2 women will become pregnant with perfect use. The latex condom protects against STIs, including HIV. The latex condom offers better protection against STIs than any other birth control method because it blocks the exchange of body fluids that maybe infected.
  150. cervical cap
    is a thimble-shaped rubber device that is placed over the cervix and may be left there for up to 3 days at a time. Its mechanism of action is similar to that of the diaphragm. Not all women can wear a cervical cap because of individual anatomic differences. There is some evidence to suggest that the cervical cap can cause cervical inflammation and increase the risk for pelvic infection.
  151. spermicides
    are used with barrier methods but can also be used alone. Spermicides come in creams, jellies, foams, and suppositories. Although readily available, spermicides are not as effective alone as when combined with another method, such as a diaphragm or a condom.
  152. vaginal sponge
    is a barrier method that contains a spermicide. The sponge acts not only as a barrier between the semen and the cervix but also as a reservoir to hold semen. The vaginal sponge carries some risk of toxic shock syndrome (TSS) and is contraindicated for use in women who have a past history of TSS. Women who use the vaginal sponge must follow package directions carefully and remove the sponge within 24 hours. The vaginal sponge is about as effective as the diaphragm.
  153. Hormonal methods
    are based on the feedback mechanism of hormones of the menstrual cycle. Synthetic estrogens and progestin chemical compounds are used in the form of a pill, shot, or implant to prevent ovulation.
  154. oral contraceptive (“the pill”)
    is the most common contraceptive method and the most popular method for women in their 20s. Most of the harmful side effects and dangers associated with taking the pill are related to the estrogen component. However, most pills currently available contain a small dose of estrogen. The pill has many beneficial noncontraceptive effects. It has been shown to protect women against the development of breast, ovarian, and endometrial cancer. Taken consistently and as prescribed, the pill is almost 100% effective in guarding against pregnancy. However, the cost might be prohibitive to some women. The woman must also be motivated to take a pill every day at the same time. A health history and physical examination by a healthcare provider are necessary to obtain a prescription for oral contraceptives. Some women should not take the pill if they have certain physiologic disorders or diseases. Smoking increases the risks associated with oral contraceptives. Remind women who are taking the pill to take measures to protect themselves from STIs.
  155. Norplant System
    is a reversible, 5-year, low-dose progestin-only contraceptive. The system consists of six matchstick-size capsules (made of Silastic tubing) that are placed just under the skin of the woman’s upper arm. The average annual pregnancy rate over 5 years is less than 1%. The most common side effect is a change in the menstrual bleeding pattern, including prolonged menstrual bleeding, spotting between menstrual periods, or no bleeding at all.
  156. Implanon system
    a single etonogestrel-containing rod is implanted in the woman through the use of a disposable insertion kit. Removal requires a small incision and takes about 3 minutes. The single-rod system contains 68 mg of etonogestrel in an ethylene vinyl acetate (EVA) copolymer core surrounded by an EVA membrane. The rod releases 67 mcg of etonogestrel daily. This method of contraceptive approaches 100% efficacy. The most common reason for discontinuation is weight gain.
  157. Depo-Provera
    is the brand name of a progestin-only hormonal birth control system. It uses a hormone similar to progesterone, one of the hormones made by a woman’s ovaries that regulates the menstrual cycle. It is called depot medroxyprogesterone acetate (DMPA). An injection of DMPA in the buttock or arm can prevent pregnancy for 12 weeks and is 99.7% effective. Protection is immediate if the injection is given on the first day of the woman’s period. Irregular bleeding is the most common side effect for women using DMPA. Of every 1,000 women who use Depo-Provera, only 3 will become pregnant during the first year of use.
  158. transdermal contraceptivepatch (Evra)
    supplies continuous daily circulating levels of ethinyl estradiol (20 mcg) and norelgestromin (150mcg). The patch is applied weekly on the same day of each week for 3 weeks, followed by a patch-free week. It may be applied to any of four sites: lower abdomen, upper outer arm, buttock, or upper torso (excluding the breast). Women who use the contraceptive patch demonstrate more effective use compared with those using oral contraceptive pills. The patch has been found to have an overall annual probability of pregnancy (method failure plus user failure) of 0.8%. This contraceptive method has the same contraindications as oral contraceptives. The most common side effects include breast symptoms, headache, application site reactions, nausea, upper respiratory tract infection, and dysmenorrhea.
  159. vaginal ring (nuvaring)
    is a soft, flexible, transparent ring made of ethylene vinyl acetate copolymer. It releases approximately 120 mcg of etonogestrel and 15 mcg of ethyl estradiol daily. Each ring is inserted into the vagina and used for one cycle, which consists of 3 weeks of continuous use followed by a ring-free week. Women can insert and remove the ring themselves. It does not need to be fitted, nor does it require particular placement within the vagina. The ring works by inhibiting ovulation in much the same way oral contraceptives do. Used appropriately, the vaginal ring is 99.3% effective in protecting against pregnancy. Benefits of the vaginal ring include ease of use, self-insertion, high degree of effectiveness, and low incidence of negative or adverse effects. The most common side effects include headache, vaginal discharge, vaginitis, vaginal discomfort, foreign body sensation, coital problems, and ring expulsion.
  160. intrauterine device (IUD)
    is an object that is placed by a physician or nurse practitioner within the uterus to prevent implantation of a fertilized ovum. IUDs are small devices made of flexible plastic that provide reversible birth control. IUDs usually prevent fertilization of the egg, but the precise mechanism by which it works is unknown. IUDs seem to affect the way the sperm or egg moves. It may be that substances released by the IUD immobilize sperm. Another possibility is that the IUD prompts the egg to move through the fallopian tube too fast to be fertilized. IUDs that contain copper are more effective for two reasons. The copper affects the behavior of enzymes in the lining of the uterus to prevent implantation and also causes the production of increased amounts of prostaglandin. Only 8 of 1,000 women using copper IUDs will become pregnant with perfect use. Combination hormonal and IUD contraceptive methods include a T-shaped device with a steroid reservoir around the vertical stem (Mirena). It releases 20 mcg of levonorgestrel daily and provides contraception for up to 5 years. Fertilization is prevented because the device causes changes in cervical mucus and endometrial morphology, inhibition of sperm migration, alteration of sperm–egg binding and ovarian function as well as a foreign body reaction by the uterus. Failure of implantation may occur in some women. Estradiol levels are managed within the usual range of women who are not using contraceptives. Normal function of the ovaries and fertility are restored as quickly after discontinuation as with any IUD. Efficacy approaches 100%. An additional benefit of this contraceptive method is that it controls menorrhagia in pre- and perimenopausal women. Adverse side effects peak at 3 months of use and reduce in frequency after that. The most common side effects include bleeding, depression, headache, acne, and weight changes. Both types of IUDs have a filament string that serves two purposes. It allows for easier removal by a clinician, and it allows the woman or her clinician to check if the IUD is still in the correct position.
  161. emergency contraception, often called the "morning after" pill
    is designed to reduce the risk of pregnancy after unprotected intercourse
  162. Emergency contraception is provided in two ways:
    • 1. Increased doses of specific oral contraceptive pills. Emergency contraceptive pills can reduce the risk of pregnancy when taken up to 120 hours after unprotected intercourse (ideally within 72 hours).
    • 2. Insertion of a copper IUD within 5 to 7 days after unprotected intercourse.
  163. Sterilization methods
    should be regarded as permanent and irreversible in both men and women. Although sterilization can sometimes be surgically reversed, the results are not always satisfactory. Sexual desire and ability are unaffected by sterilization. Sterilization in women is accomplished by surgically severing the fallopian tubes. This procedure, known as tubal ligation, prevents the ovum from traveling down the tube. Tubal ligation is usually performed on an outpatient basis, sometimes under local anesthesia. Postoperative care and recovery time are required after a tubal ligation. Sterilization in men is accomplished by surgically severing the vas deferens, which prevents sperm from entering the semen. The vasectomy is usually performed in a physician’s office under local anesthesia. The man and his partner must use an alternative form of contraception until he has produced two semen analyses with zero sperm. It usually takes about 4 to 6 weeks for all stored sperm to be eliminated from the man’s ductal system.
  164. Furture trends with Unisex Reversible Contraceptives
    The concept of unisex reversible contraception is being explored. This method involves a group of drugs called gonadotropin-releasing hormone (GnRH) agonists and can be used to prevent the release of follicle-stimulating hormone (FSH) and luteinizing hormone (LH) from the pituitary gland. The release of FSH and LH triggers ovulation and spermatogenesis. Blocking the release of these hormones will temporarily suppress fertility for women or men. In addition, various contraceptive injections, implants, and vaccines for men are being researched.
  165. Future trends with Male Contraceptives
    Methods of contraception for men continue to be explored. The challenge of developing a reversible method of contraception for men is complicated because men are always producing sperm. Because of this continuous fertility, the opportunities for reversible intervention that are permitted by women’s fertility cycles are not available in men. Effective contraceptive methods for men that do not permanently impair fertility have proven elusive, but research continues. Most research has focused on a hormonal approach to decrease spermatogenesis. The major problem is that interference with steroidogenesis might also interfere with the other actions of testosterone such as sexual function, bone and muscle growth, kidney function, and protein anabolism.
  166. future trends with Female Contraceptives
    Most of the contraceptive products that will soon be available for women are refinements of products already available. New barrier methods for women will include enhanced cervical caps and vaginal sponges with microbicides to protect against STIs. New contraceptive pills, patches, and rings for women will use varied combination of hormones. Injectable progestin products might one day protect against pregnancy for up to 90 days. Oral and/or injectable vaccines may one day immunize women against pregnancy. These vaccines might produce antibodies to attack egg or sperm, or the immune system might create antibodies to a crucial type of protein molecule found on the head of sperm. Contraceptive implants designed to remain effective for 2 or 3 years, as well as biodegradable implants with efficacy of up to 18 months, are under development. Computerized fertility monitors that predict ovulation will offer couples who use fertility awareness methods of contraception a much more sophisticated and accurate charting method. Methods for permanent sterilization will expand to include chemical scarring techniques and insertion of fallopian tube chemical plugs and cryosurgery. Temporary sterilization may be effected by the use of silicone plugs.
  167. HEALTH ISSUES FOR THE GAY, LESBIAN, BISEXUAL, AND TRANSGENDER POPULATION
    • Sexual Behavior
    • • Hepatitis A and B
    • • Enteritis
    • • Human papillomavirus
    • • Bacterial vaginosis
    • • Anal cancer
    • • Other STIs

    • Cultural Factors
    • • Body culture: eating disorders
    • • Socialization through bars: drug, alcohol, and tobacco use
    • • Nulliparity: breast cancer
    • • Parenting: insemination questions, mental health concerns
    • • Gender polarity in dominant culture: conflicts for transgender and intersex persons

    • Disclosure of Sexual Orientation or Gender Identity
    • • Psychological adjustment
    • • Depression
    • • Anxiety
    • • Suicide
    • • Conflicts with family of origin
    • • Lack of social support
    • • Physical/economic dislocation

    • Prejudice and Discrimination
    • • Provider bias and lack of sensitivity
    • • Harassment and discrimination in medical encounters, employment, housing, child custody
    • • Limited access to care or insurance coverage
    • • “Pathologizing” of gender variant behavior
    • • Violence against LGBT population

    • Concealed Sexual Identity
    • • Reluctance to seek preventive care
    • • Delayed medical treatment
    • • Incomplete medical history (e.g., concealed risk, sexually related complications, social factors)
  168. Other issues that affect healthcare delivery to the LGBT population include the following:
    • • Public health infrastructure: Efforts to research and address the healthcare needs of LGBT persons are hindered by an inadequate infrastructure to support and fund population-specific initiatives.
    • • Access to quality health services: Financial, structural, personal, and cultural barriers limit access to screening and prevention services and cause delays in receiving care for acute conditions in the LGBT population.
    • • Health communication: Negative provider attitudes, lack of provider education regarding unique aspects of lesbian and gay health, and exclusion of same-sex partners in care planning seriously hamper therapeutic communication between members of the LGBT population and those who provide care.
    • • Educational and community-based programs: Some government agencies, professional organizations, and healthcare organizations address health issues of the LGBT population, but this population still relies heavily on self-created community-based programs to address their special healthcare requirements.
  169. ADVOCATING FOR PATIENTS’ SEXUAL NEEDS
    • • All patients should be accepted as sexual beings with the right to be treated with dignity and with sensitivity to their feelings.
    • • All patients have the right to some degree of privacy.
    • • Anticipate the patient’s desire for privacy by the simple act of drawing a curtain or closing a door.
    • • Patients should be given the option of wearing their own sleepwear to promote sexual identity.
    • • Potentially shaming situations for the patient should be anticipated.
    • • Give information regarding what the procedure is and why it needs to be done, and acknowledge that the patient’s embarrassment is normal and understandable.
    • • Healthcare providers should not simply take for granted that patients do not mind intrusive or embarrassing procedures performed on their bodies and private parts.
    • • Patients have a right to question the physician regarding sexual needs or future sexual functioning.
    • • Anticipate these questions for the patient.
    • • Ask patients if they have any concerns regarding sexuality that can be answered by the nurse.
    • • Nurses can interface with the physician to obtain information required by the patient.
    • • The atmosphere in healthcare settings needs to allow for sexual expression between patients and their partners.
    • • Confidentiality is a right of every patient.
    • • Do not promise confidentiality if that promise cannot be kept.
    • • Allow no one access to the patient’s personal records who is not directly involved in the patient’s care.
    • • Allow no information regarding patients to escape into idle conversation.
    • • All patients should be referred to formally as Mr., Mrs., Miss, or Ms., according to the patient’s preference.
    • • Visitors, including a visiting spouse, should be referred to as people with genders, rather than as “the visitor.”
    • • Patients should be allowed to keep some personal possessions, if it is practical to do so.
  170. abortion counseling
    Abortion remains an issue that deeply divides people. Many believe it is a woman’s right to choose whether to continue a pregnancy and then to take safe and legal action if a decision is made to terminate. Others believe that from fertilization onward, a human being exists who commands the full respect and protection we afford adult humans, and thus abortion is always wrong. Some would allow abortion only if it is indicated for a woman’s health or in cases of rape. It is important to know what you believe, why you believe this, and how your beliefs are likely to influence your ability to counsel women and couples.
  171. counseling in cases of abusive relationships and/or rape
    • It is not uncommon for nurses to encounter children, adolescents, women, and sometimes men who experience sexual abuse and rape in their relationships or families. The Rape, Incest and Abuse National Network (RAINN) reports that:
    • • 1 out of every 6 American women have been the victims of an attempted or completed rape in their lifetime (14.8% completed rape; 2.8% attempted rape).
    • • 17.7 million American women have been victims of attempted or completed rape.
    • • 9 of every 10 rape victims were female in 2003.
    • • While about 80% of all victims are white, minorities are somewhat more likely to be attacked.
    • • About 3% of American men—or 1 in 33—have experienced an attempted or completed rape in their lifetime.
    • • 15% of sexual assault and rape victims are under age 12.
    • Victims of sexual assault are 3 times more likely to suffer from depression, 6 times more likely to suffer from posttraumatic stress disorder, 13 times more likely to abuse alcohol, 26 times more likely to abuse drugs, and 4 times more likely to contemplate suicide. Clearly, nurses need to be alert to evidence of sexual abuse while taking the history and conducting physical examinations. Abuse crosses all socioeconomic and ethnic groups. Become familiar with your legal and clinical responsibilities when a victim is identified. The first priority is getting the victim into a safe environment and mobilizing support for the victim and family. Multiple parties may need therapy. Be familiar with local resources and make appropriate referrals.
  172. Harassment
    is any annoying or distressing comment or conduct that is known or should be known to be unwelcome.
  173. Sexual harassment
    is unwelcome behavior that is sexual or gender-based in nature. This type of harassment usually occurs in the context of an asymmetrical relationship where one person has more formal power than the other (e.g., a faculty member over a student) or more informal power (e.g., one peer over another). Sexual harassment can be directed toward individuals of any age, either gender, and any sexual orientation. There are two forms of sexual harassment: “quid pro quo” and environmental harassment (also called a “hostile” environment).
  174. Quid pro quo harassment
    “Quid pro quo” means something given or withheld in exchange for something else. Quid pro quo harassment occurs when an individual’s employment or well-being is dependent on agreeing to unsolicited and unwelcome sexual demands. This type of harassment is typically initiated by a person in a position of authority who offers either direct or indirect reward or punishment based on the granting of sexual favors. Quid pro quo harassment is a clear abuse of power and is legally, morally, and ethically wrong.
  175. Hostile environment harassment
    occurs when behaviors of a sexual or gender-based nature create a hostile, intimidating environment and when this type of environment hurts an individual’s work performance, classroom performance, or general sense of well-being. In the workplace, for example, the negative behaviors in hostile environment harassment are not directly linked to job-related consequences; instead, the employee’s willingness to suffer the experience of the demeaning environment becomes a condition of employment. This type of harassment is not necessarily caused by a person with formal power. Hostile environment is sometimes difficult to define, as it is not always easy to determine when offensive speech or behavior actually turns to true harassment.
  176. Coworkers and peers can create a hostile environment for a member of the group through the following:
    • • Unwelcome sexually oriented and gender-based behaviors
    • • Sexual bantering
    • • Sexual jokes
    • • Offensive pictures and language
    • • Sexual innuendoes
    • • Sexual behavior
  177. Inappropriate sexual behavior by a patient may cause the nurse to respond with either passive avoidance or aggressive retaliation. An assertive response is recommended that supports the nurse in maintaining his or her self-respect and encourages the patient to accept responsibility for his or her behavior:
    • 1. Be self-aware: Do not deny feelings about being harassed.
    • 2. Confront: Provide feedback to the patient in a nonthreatening way and clearly state what behavior is or is not acceptable.
    • 3. Set limits: Define clear and reasonable consequences that will be enforced if the behavior continues.
    • 4. Enforce the stated limits: Maintain boundaries.
    • 5. Report: Document the incident and submit to supervisor.
  178. Colleagues may also be the source of harassment. The objective of employers should be to create a positive work environment that is characterized by mutually respectful behavior. Many have taken steps to eliminate hostile work environments by educating employees, developing policies against workplace harassment, and outlining guidelines for responding to sexual harassment:
    • 1. If harassed by a coworker, confront the behavior immediately. An assertive statement is sometimes sufficient to stop the behavior.
    • 2. If the harassment continues, document the date and time and describe the behavior.
    • 3. Consult your supervisor.
    • 4. If the harassment still does not stop, file a grievance with administration.
    • 5. Seek legal advice if all previous efforts to stop the behavior have been unsuccessful.
  179. The nurse points out that the human body has many erogenous zones, the largest being which of the following?
    the skin
  180. Cowper's glands
    present in the reproductive system of human males, produce fluids that lubricate the urethra for spermatozoa to pass through
  181. A nursing instructor is teaching a class of nursing students about female reproductive structure and funcation. As part of the class, the instructor discusses menstruation. The instructor determines that the teaching was successful when the students identify which of the following as true about the hormonal interplay related to menstruation?
    The follicle-stimulating hormone stimulates the ovary to produce estrogen and progesterone. The pituitary gland secretes luteinizing hormone. The ovaries secrete the hormone progesterone. Gonadotropin-releasing hormone stimulates the pituitary gland.
  182. Which of the following statements should be incorporated into the teaching plan developed to present instruction about the female menstrual cycle to nursing students?
    Menses ensues when the levels of estrogen and progesterone fall. Menstruation depends on the interplay of various hormones. The hypothalamus secretes gonadotropin-releasing hormone, which stimulates the pituitary gland to secrete follicle-stimulating hormone and luteinizing hormone. These hormones stimulate the ovaries to produce estrogen and progesterone, which are necessary for stimulation of the target organs (vagina, breast, uterus) in preparing for pregnancy.
  183. During the menstrual cycle, when does ovulation typically take place?
    on day 14,  when the mature ovum ruptures from the follicle and the surface of the ovary and is swept into the fallopian tube. From day 15 to day 28, the phase in the ovaries is called the luteal phase. 
  184. Perimenopause
    is the period extending from the first signs of menopause, usually hot flashes, vaginal dryness, and irregular menses
  185. Postmenopause
    is the period beginning from about 1 year after menses cease and beyond. 
  186. A woman complains of pain with intercourse. What client medications should the nurse check for that contribute to dyspareunia?
    Medications that cause dyspareunia include antihistamines, certain tranquilizers, marijuana, and alcohol
  187. Gender identity
    is the inner sense a person has of being male or female.
  188. Gender role behavior
    is the behavior a person conveys about being male or female.
  189. During assessment of a female client, the client tells the nurse that she uses oral contraceptives. Based on the nurse's knowledge about the action of these drugs, which phase of the menstrual cycle would most likely be affected?
    Ovulatory phase. Oral contraceptives suppress ovulation or the rupture of the oocyte from the ovary which occurs during the ovulatory phase. During the proliferative phase, there is proliferation of the endometrium, or uterine lining. During the follicular phase, the ovarian follicles mature, with usually only one follicle reaching full maturity. During the luteal phase, the uterus prepares itself for possible implantation and maintenance of a fertilized ovum.

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