Sexuality: Psychological, Biological, and Social Aspects

Ch- 46 Sexuality

Introduction to Sexuality

Sexuality is a multifaceted aspect of human life, encompassing biological sex, sexual activity, gender identities and roles, and sexual orientation. Sexual health involves the integration of physical, emotional, intellectual, and social aspects of sexual being in ways that are positively enriching.

• Biologic sex: Sex assigned at birth based on chromosomal development.

• Sexual activity: Includes a range of behaviors from intercourse to masturbation.

• Gender identity and roles: How individuals perceive themselves and express their gender.

• Sexual orientation: The pattern of romantic or sexual attraction to others.

Sexual Identity

Components of Sexual Identity

Sexual identity is a complex construct involving several interrelated components:

• Self-identity: One's personal sense of self as it relates to gender and sexuality.

• Biologic sex: Determined by chromosomes (XX for female, XY for male).

• Gender identity: Internal sense of being male, female, both, neither, or somewhere along the gender spectrum.

• Gender role behavior/expression: Outward presentation of gender through behavior, clothing, voice, etc.

• Sexual orientation: Direction of romantic or sexual attraction (e.g., heterosexual, homosexual, bisexual).

Key Terminology in Gender and Sexuality

Definitions

• Gender identity: One's internal sense of being male, female, both, neither, or another gender.

• Gender expression: The external display of gender through behavior, clothing, haircut, voice, etc.

• Gender diverse: Individuals whose gender identity or expression differs from societal expectations.

• Gender dysphoria: Psychological distress resulting from an incongruence between one's assigned sex at birth and gender identity.

• Cisgender: A person whose gender identity aligns with their sex assigned at birth.

• Transgender: A person whose gender identity differs from their sex assigned at birth.

• Gender binary: The classification of gender into two distinct, opposite forms (male and female).

• Gender fluid: A gender identity or expression that varies with time.

Sexual Orientation

Types of Sexual Orientation

• Heterosexual: Attraction to individuals of the opposite gender.

• Gay or lesbian: Attraction to individuals of the same gender.

• Bisexual: Attraction to both men and women.

• Asexual: Lack of sexual attraction to others.

• Questioning: Exploring or unsure about one's sexual orientation.

Sexual Expression

Forms of Sexual Expression

Sexual expression ranges from adaptive (healthy) to maladaptive (potentially harmful) behaviors.

• Masturbation: Self-stimulation of the genitals for sexual pleasure.

• Sexual intercourse: Vaginal or anal penetration between partners.

• Oral–genital stimulation: Oral contact with the genitals.

• Abstinence: Choosing not to engage in sexual activity.

• Alternative expressions: Includes voyeurism, sadism, masochism, sadomasochism, and pedophilia (the latter being illegal and harmful).

Factors Affecting Sexuality

Influences on Sexuality

• Developmental considerations: Sexuality evolves across the lifespan.

• Culture: Cultural norms shape sexual attitudes and behaviors.

• Religion: Religious beliefs may influence sexual values and practices.

• Ethics: Personal and societal ethics guide sexual behavior.

• Lifestyle: Individual choices and experiences affect sexuality.

Menstruation and Menstrual Cycle

Phases of the Menstrual Cycle

• Follicular phase: One follicle matures and produces an ovum.

• Proliferation phase: Endometrium thickens in preparation for possible implantation.

• Luteal phase: Corpus luteum develops and secretes hormones.

• Secretory phase: Endometrial lining disintegrates if no fertilization occurs.

• Menopause: Permanent cessation of menstruation, marking the end of reproductive capacity.

Causes of Menstrual Cycle Irregularities

• Pregnancy or breast-feeding

• Eating disorders, extreme weight loss, or excessive exercise

• Polycystic ovary syndrome (PCOS)

• Premature ovarian failure

• Pelvic inflammatory disease (PID)

• Uterine fibroids

Sexual Response Cycle

Phases of the Sexual Response Cycle

• Excitement: Initial arousal phase with increased heart rate and blood flow to genitals.

• Plateau: Heightened arousal and sustained sexual tension.

• Orgasm: Climax phase with involuntary spasmodic contractions of genital organs.

• Resolution: Return to baseline physiological state.

Example: During the orgasm phase, both males and females experience intense pleasure and rhythmic muscular contractions.

Sexually Transmitted Infections (STIs)

Common STIs

• HIV

• Bacterial vaginosis (BV)

• Chlamydia

• Cytomegalovirus

• Genital herpes

• Gonorrhea

• Human papillomavirus (HPV)

• Syphilis

• Trichomoniasis

Prevention of STIs

• Delay initiation of sexual activity

• Regular STI screenings

• Learn symptoms of common STIs

• Avoid sex during menstruation

• Avoid anal intercourse

• Avoid douching

Sexual Dysfunction

Male Sexual Dysfunction

• Erectile dysfunction: Inability to achieve or maintain an erection.

• Premature ejaculation: Ejaculation occurs sooner than desired.

• Delayed ejaculation: Difficulty or inability to ejaculate.

Female Sexual Dysfunction

• Inhibited sexual desire: Reduced interest in sexual activity.

• Dyspareunia: Painful intercourse.

• Vaginismus: Involuntary contraction of vaginal muscles.

• Vulvodynia: Chronic vulvar pain without identifiable cause.

Effects of Illness, Injury, and Medications on Sexuality

• Chronic illnesses (e.g., diabetes, cardiovascular disease)

• Diseases affecting mobility or causing chronic pain

• Surgical procedures and changes in body image

• Spinal cord injuries

• Mental illness

• Medications (e.g., antihypertensives, antidepressants)

Sexual Harassment

Forms of Sexual Harassment

• Quid pro quo: Something is withheld in exchange for sexual favors.

• Environmental (hostile environment): Unwelcome sexually oriented or gender-based behaviors that create a hostile work environment.

Examples of Hostile Work Environment

• Sexual bantering or joking

• Offensive pictures or language

• Sexual innuendoes or behaviors

• Unwanted attention

Responding to Sexual Advances or Harassment

• Be self-aware and set clear boundaries

• Confront and provide feedback to the individual

• Document incidents and report to supervisors

• File grievances or seek legal advice if necessary

Nursing Assessment and Interventions in Sexuality

Nursing History

• Reproductive history

• History of STIs or sexual dysfunction

• Sexual self-care behaviors

• Sexual self-concept and functioning

The BETTER Model for Addressing Sexuality

• BRING up the topic of sexuality

• EXPLAIN concern for all aspects of patients’ lives

• TELL patients that sexual dysfunction can occur and will be addressed

• TIMING is important—address sexuality at each visit

• EDUCATE about treatment side effects

• RECORD assessments and interventions in medical records

Physical Assessment

• Annual gynecologic exam with Pap smear

• Assessment for suspected STI, pregnancy, or infertility

• Evaluation of unusual genital symptoms

• Requests for birth control or changes in urinary function

Patient Outcomes and Implementation

Desired Outcomes

• Define individual sexuality

• Establish open communication with significant others

• Develop self- and body-awareness

• Describe and practice responsible sexual health self-care

• Engage in responsible sexual expression

Implementation Strategies

• Build a trusting nurse-patient relationship

• Educate about sexuality and sexual health

• Promote responsible sexual expression and contraception

• Support coping with special sexual needs

• Advocate for the needs of LGBTQ+ individuals

• Counsel regarding sexuality, abortion, abuse, or rape

Contraception

Methods of Contraception

• Behavioral methods

• Barrier methods

• Hormonal methods

• Intrauterine devices (IUDs)

• Emergency contraception

• Sterilization

Barrier Methods of Contraception

Method	Description
Condom	Thin sheath placed over the penis or inside the vagina to prevent sperm from entering the uterus.
Diaphragm	Dome-shaped rubber device placed in the vagina before intercourse to cover the cervix.
Cervical cap	Small cup that fits over the cervix to block sperm entry.
Spermicides	Chemical agents that destroy sperm, used alone or with other barrier methods.
Vaginal sponge	Soft, disposable device containing spermicide, placed in the vagina before intercourse.

Example: The diaphragm is a barrier method of contraception in which a dome-shaped rubber device is placed in the vagina before sexual activity to prevent semen from coming into contact with the cervix.

Sample Questions and Answers

Question 1

What is the term for a person of a certain biologic gender who lives full-time as a member of a gender that differs from the sex and gender assigned at birth?

• Answer: Transsexual

• Rationale: The term transsexual describes those who feel that the sex assigned at birth does not describe them and who live as a member of another gender.

Question 2

In which phase of the sexual response cycle do involuntary spasmodic contractions of the genital organs occur?

• Answer: Orgasm

• Rationale: The orgasm phase is characterized by intense pleasure and involuntary contractions of the genital organs.

Question 3

The diaphragm is a barrier method of contraception in which a dome-shaped rubber device is placed in the vagina before sexual activity to prevent semen from coming into contact with the cervix. True or False?

• Answer: True

• Rationale: The diaphragm is a barrier method that prevents sperm from reaching the cervix.

Additional info: This summary integrates psychological, biological, and social aspects of sexuality, as well as practical considerations for health professionals, in line with developmental and social psychology topics.