SEXUALITY/

SEXUAL HEALTH

By:- Firoz Qureshi

Dept. Psychiatric Nursing
 INTRODUCTION
Human are sexual beings. Sexuality is a basic human
need and an innate part of the total personality. It
influences our thoughts, actions and interactions, and
is involved in aspects of physical and mental health.

Society's attitude towards sexuality is changing.

clients are more open to seeking assistance in
matters of pertaining to sexuality.
 CONT
Although not all nurses need to be educated as sex
therapists, they can readily integrate information on
sexuality into the care given by focussing on
preventive, therapeutic, and educational
interventions to assist individuals to attain, regain or
maintain sexual wellness.
DEFINITION

Health: It is a relative state in which one is able to

function well physically, mentally, socially and
spiritually in order to express the full range of one's
unique potentialities within the environment in
which one measure is living.
-DUBO
 SEXUAL HEALTH
It is the integration of the somatic, emotional,
intellectual and social aspects of sexual being, in
ways that are positively enriching and enhance
personality, communication and love.

"Sexual health is a state of physical, emotional, mental

and social well-being in relation to sexuality; it is not
merely the absence of disease, dysfunction or
infirmity.

-WHO-1950
 FACTORS INFLUENCING SEXUALITY
Many factors influence a person's sexuality such as
developmental level mentioned below:
a)culture
b) Religious Values
c) Personal
d) Health Status
e) Medication
 STAGES OF SEXUAL DEVELOPMENT
ACCORDING SEGMUND FREUD
a) The Oral stage: During this period, the oral region or the
secondary area of mouth provides the greatest sensual
satisfaction for the infant.
b)The Anal stage: The greatest amount of sensual pleasure for
the toddler is obtained from the anal and urethral areas.
c)The phallic stage: The greatest sensual pleasure is derived
from the genital areas. The oedipal stage occurs in the later
of the phallic period. During this stage, the child "loves"
parent of the opposite sex as the provider of sensual
satisfaction. The parent of the same sex considered them as
rival.
 CONT
c)The phallic stage: The greatest sensual pleasure is
derived from the genital areas. The oedipal stage
occurs in the later of the phallic period. During this
stage, the child "loves" parent of the opposite sex as
the provider of sensual satisfaction. The parent of the
same sex considered them as rival.
 CONT
d)The Latency Stage: At the beginning of the latency
stage, the child has resolved or is resolving the
oedipal conflict. During the latency period children
form close relationship with others of their own age
and sex.
e) The pubescent Stage : During puberty, secondary
sexual characteristics appear in both sexes. The same
psychosexual conflicts that occurred during the
oedipal period are revived. If children resolve the
conflicts, they are free to enter in to heterosexual
relationship as adult.
 COMPONENTS OF SEXUALITY
Components of sexual health includes:
1. Sexual Self concept-This defines as how one values
oneself as a sexual being. It determines the gender
and a kind of people a person is attracted to, and
values about when, where and with whom one
expresses sexuality.

2. Body -image -It is a sense of self, it is constantly

changing. pregnancy ,aging, trauma, disease and
therapies can alter an individual's appearance and
function which can affect body image.
 CONT
3. Gender identity-It is one's self image as a male or female.
Gender role behaviour is the outward expression of a
person's sense of maleness or femaleness as well as
expression of what is perceived as gender appropriate
behaviour.

4. Sexual Orientation -It is defined as one's attraction to

people of same sex, opposite sex or both sexes.
Sexual orientation lies along continuum with a wide range
between the two extremes of exclusively heterosexual
attraction and exclusively homosexual attraction, individual
who are attracted with both sexes are called bisexuals.
 TYPES OF SEX
Vaginal sex
Anal sex
Oral sex
Masturbation
Group sex
Sex toys
SEXUAL RESPONSE CYCLE: KAPLANS
Involve people's emotional, psychological, physical
and spiritual make-up. Commonly occurring phases
of human sexual response follows a similar sequence
in both males and females.
 1.DESIRE PHASE
-The response cycle start in the brain with conscious
sexual desires called the desire phase. Sexual
arousing stimuli, called erotic stimuli including
sight, hearing, smelling touch and imagination
(sexual fantasy) can all invoke sexual arousal.
Sexual desire fluctuates within each person and
varies from person to person. Psychological causes
are more cause of lack of sexual desire, medication,
drugs, hormones imbalances can also block sexual
desires.
2. EXCITEMENT PHASE OR PLATEAU PHASE
Involves two primary physiologic changes as follows: -
Vasoconstriction and -Myotonia
Vasoconstriction
It is increased in the blood flow to various body parts
resulting in erection of the penis and clitoris and swelling of
the labia, testes and breasts.
Stimulates sensory receptors in body parts that in turn
transmit messages to the conscious brain where they are
interpreted as pleasurable sensations.
Myotonia
Increasing tension in muscles, may increase until release by
orgasm or it may simply fade away.
 REASONS FOR SEXUAL ACTIVITY
Other than the need of extending one's family tree, there
are many other reasons why people have sex. According
to a research, the main reasons for sexual activities are:
physical attraction, as a means to an end, To increase
emotional connection and
To alleviate insecurity.
a)SEXUALITY AND AGE
Child and Adult Sexuality-
b) SOCIO-CULTURAL ASPECTS OF SEXUALITY
Human sexuality can also be understood as part of the
social life of humans, governed by implied rules of
behaviour and the status.
 c)PSYCHOLOGICAL ASPECT
Sexuality in humans generates profound emotional and
psychological responses.

Some theorists identify sexuality as the central source of

human personality.

d) RELIGIOUS SEXUAL MORALITY

o Most world religions have sought to address the moral issues
that arise from people's sexuality in society and in human
interactions.
o Each major religion has developed moral codes covering
issues of sexuality, morality, ethics etc., which have sought
to guide people's sexual activities and practices.
 CONT
Each major religion has developed moral codes
covering issues of sexuality, morality, ethics etc.,
which have sought to guide people's sexual
activities and practices.
e)SEXUAL ATTRACTION
Each person determines the qualities that they find
attractive.
The qualities may depend on the physical quality,
including both looks and movements of a person but
can also be influenced by voice or smell as well as
by individual preferences resulting from a variety of
genetic, psychological and cultural factors.
f)CREATING A RELATIONSHIP
This involves interactive processes whereby
people find and attract potential partners, and
maintain a relationship, which involve attracting
one or more partners, and maintaining sexual
interest, can include: Flirting.
SEXUAL DYSFUNCTION AND SEXUAL
PROBLEM
The World Health Organizations International
Classifications of Diseases defines sexual problems as
the various ways in which an individual is unable to
participate in a sexual relationship as he or she would
wish. There are four major categories of sexual
problems: Desire disorders, arousal disorders, orgasmic
disorders, and sexual pain disorders.
 CONT
1.Hypoactive sexual desire
a. Low sexual drive
b. Occurs at the excitement phase
2.Sexual aversion
-Anticipation of any kind of sexual interactions
causing great anxiety
3.Sexual arousal disorder
a. In men, erectile dysfunction
b. In women, the difficulty of becoming aroused
 CONT
4.Orgasmic disorders
a. In men, premature ejaculation and ejaculatory
incompetence
b. In women, the inability to have an orgasm
5)Hyper-sexuality (sexual addiction)
6)Sexual pain disordersa). In men, four different
disorders:
a) In men four different disorders;
I. Dyspareunia (pain during intercourse due to a
physical problem)
 CONT
II. Post-ejaculatory syndrome (pain in the genitals
during or after orgasm)
III. Priapism (prolonged erection)
IV. Coital cephalalgia (migraine headaches during and
after orgasm)
b). In women, three different disorders:
I. Dyspareunia (recurrent genital pain during
intercourse)
II. Vaginismus (vagina involuntarily closes)
III. Noncoital sexual pain disorder (genital pain due to
arousal)
 SEXUALLY TRANSMITTED INFECTIONS
Sexually transmitted infections (STIs) are bacterial, viral
or parasitic infections that are spread mainly by sexual
activity.
a)Chlamydia-It is a sexually transmitted infection caused
by the bacterium Chlamydia trachomatis.
In women, symptoms may include abnormal vaginal
discharge, burning during urination, and bleeding in
between period.
Symptoms in men include pain when urinating, and
abnormal discharge from their penis. If left untreated in
both men and women, Chlamydia can infect the urinary
tract and potentially lead to PID.
Chlamydia can be cured with antibiotics.
 Herpes Simplex Virus
The two most common forms of herpes are caused by infection with
herpes simplex virus (HSV). HSV-1 is acquired orally and causes cold
sores.

HSV-2 is acquired during sexual contact and affects the genitals. Some
people are asymptomatic or have very mild symptoms.
Those that do experience symptoms usually notice them 2 to 20 days
after exposure which last 2 to 4 weeks. Symptoms can include small
fluid-filled blisters, headaches, backaches, itching or tingling
sensations in the genital or anal area, pain during urination, Flu like
symptoms, swollen glands, or fever.

Herpes is spread through skin contact with a person infected with the
virus. There is no cure for the disease but there are antiviral medications that
treat its symptoms and lower the risk of transmission (Valtrex).
 CONT
fever.
Herpes is spread through skin contact with a person
infected with the virus. There is no cure for the
disease but there are antiviral medications that treat
its symptoms and lower the risk of transmission
(Valtrex).
Human papilloma virus (HPV)
The human papilloma virus is the most common STI
in the United States.
There are more than 40 different strands of HPV and
many do not cause any health problems. In 90% of
cases the bodys immune system clears the infection
naturally within 2 years.
 CONT
Some cases may not be cleared and can lead to
genital warts (bumps around the genitals that can be
small or large, raised or flat, or shaped like
cauliflower) or cervical cancer and other HPV
related cancers.
Symptoms might not show up until advanced stages.
It is important for women to get regular pap smears
in order to check for and treat cancers.
There are also two vaccines available for women
(Cervarix and Gardasil) that protect against the types
of HPV that cause cervical cancer.
Gonorrhoea
It is caused by bacterium that lives on moist mucous
membranes in the urethra, vagina, rectum, mouth,
throat, and eyes.
The infection can spread through contact with the penis,
vagina, mouth or anus.
Symptoms of Gonorrhoea usually appear 2 to 5 days after
contact with an infected partner however, Symptoms in
men include burning and pain while urinating, increased
urinary frequency, discharge from the penis, red or
swollen urethra, swollen or tender testicles, or sore
throat.
Symptoms in women may include vaginal discharge,
burning or itching while urinating, painful sexual-
 CONT..
intercourse, severe pain in lower abdomen. Some
antibiotic are resistant to Gonorrhoea but most
cases can be cured with antibiotic.
Syphilis
Is an STD caused by a bacterium. If acquired,
syphilis needs to be treated adequately, otherwise it
can cause long-term complications and death.
Clinical manifestations of syphilis include the
ulceration of the uro-genital tract, mouth or rectum;
if left untreated the symptoms worsen.
HIV/AIDS
The human immunodeficiency virus (HIV) damages
the bodys immune system which interferes with
fighting off disease-causing agents. The virus kills
CD4 cells, which are white blood cells that help fight
off various infections. HIV is carried in body fluids,
and is spread by sexual activity. It can also be spread
by contact with infected blood, breast feeding,
childbirth, and from mother to child during
pregnancy.
 BIRTH CONTROL
1. Relatively ineffective
a) Withdrawal (coitus interruptus), b) Douching
c) Lactational amenorrhea (breast-feeding)
2.Fertility awareness methods
a) Basal body temperature method: This method
involves recording a womans body temperature
throughout her menstrual cycle.
b) Billings method: The billings method is a form of
natural birth control that teaches a woman to
recognize when she is fertile by examining her
cervical mucus.
 CON
Sympto-thermal method: Combination of the
basal body temperature method and the billings
method to prevent pregnancy.
 3. Spermicides
A spermicide is a chemical product that comes in
the form of a foam, jelly, or cream. In order to
increase the effectiveness of them, spermicides
should be used with other barrier forms of birth
control (condoms, diaphragms, cervical cap, etc.).

a. Barrier methods: Preventing Sperm from Meeting

Egg, include the following methods:
1. Male condoms,
2. 2.Female condoms
3. 3.Diaphragm,
4. Cervical cap
CONT
b. Intrauterine devices (IUD)
An IUD is a small t-shaped piece of plastic or
metal that is placed in the uterus to prevent
fertilization. There are 2 types: one is covered
with copper, and the other releases the hormone
progesterone.
 c. Hormonal methods
1.Oral contraception: Medications taken by women to prevent
pregnancy.
These pills may contain a combination of the hormones estrogen,
progestin, or progestin alone.
For 21 days followed by a 7 day break when a woman
menstruates.
The pill is highly effective if taken every day at the same time.
2. Injectable contraception: A hormonal method for those who
cannot remember to take the pill every day at the same time. E. g
Depo-Provera.
 LEGAL ISSUES
There are many laws and social customs which prohibit, or
have an impact on sexual activities. These laws and customs
vary from country to country, and have varied over time.
They cover, for example, a prohibition to non-consensual
sex, to sex outside of marriage, to sexual activity in public,
besides many others.
Most societies consider it a serious crime to force someone
to engage in sexual acts or to engage in sexual activity with
someone who does not consent. This is called SEXUAL
ASSAULT, and if sexual penetration occurs it is called
RAPE, the most serious kind of sexual assault. Laws
regulating the minimum age at which a person can consent
to have sex (age of consent) are frequently the subject of
debate.
 NURSE ROLE IN SEXUAL EDUCATION
-Nurse must be educated regarding sexuality and sexual health
throughout her life span.
-Nurse must examine her/his own beliefs and feelings concerning
sexuality, sexual function, and is considered sexually
normal or abnormal.
-The nurse should assure the client's confidentiality of all data on
sexuality and obtain permission from client before making a
referral for any sexual problem.
-permission: The nurse must convey to the client and significant
others a willingness to discuss sexual thoughts and feelings.
-Provide information to clients and significant others on the effects
of certain situations on sexuality and sexual function. E g:
pregnancy, cancer and its treatments e.g: medications.
 CONT

-Provide specific instructions that can facilitate positive sexual

functioning.
-Provide adequate permission to a client to discuss sexual concerns
if it is important to part of client's nursing care. The nurse should
give permission by:
> Including sexuality in the initial health history and addressing
questions on sexuality in a manner similar to questions on bowel
and bladder function.
>Offering to discuss sexual concerns at appropriate times during
the client's hospitalization/visit.
-The nurse should refer people who needs more help to an
appropriate health care professional (eg: sex therapy, surgery).