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Describe sexual development and concerns across the life span.
Concepts for Lecture
1. Birth to 18 months: From birth, infants are assigned the gender of
male or female. The infant differentiates self from others gradually.
2. Toddler (1–3 years): Continues to develop gender identity; able to
identify own gender.
3. Preschooler (4–5 years): Becomes increasingly aware of self.
4. School age (6–12 years): Has strong identification with parent of
same gender; tends to have friends of same gender; has increasing
5. Adolescence (12–18 years): Primary and secondary sexual character-
istics develop; menarche usually takes place; develops relationships
6. Young adulthood (18–49 years): Sexual activity is common; estab-
7. Middle adulthood (40–65 years): Men and women experience
decreased hormone production; menopause occurs in women,
8.
Late adulthood (65 years and older): Interest in sexual activity often
continues; sexual activity may be less frequent; women’s vaginal secre-
tions diminish and breasts atrophy; men produce fewer sperm and need
C
HAPTER
40
SEXUALITY
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•
Divide the students into groups. Assign each
group an age group. Ask each to further
develop the nursing interventions and teaching
guidelines for the assigned age group based on
Table 40–1 in the textbook.
the characteristics, nursing interventions, and
teaching guidelines for the age groups of their
assigned clients.
292 CHAPTER 40 / Sexuality
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2
Define sexual health.
Concepts for Lecture
1. The World Health Organization (WHO) defined sexual health in
1975 as the integration of the somatic, emotional, intellectual, and
2.
Characteristics of sexual health include knowledge about sexuality and
sexual behavior; ability to express one’s full sexual potential, excluding
all forms of sexual coercion, exploitation, and abuse; ability to make au-
L
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3
Discuss the varieties of sexuality.
Concepts for Lecture
2. Sexual orientation is one’s attraction to individuals of the same sex,
3. Western culture is deeply committed to the idea that there are only
two sexes. Biologically speaking, there are many gradations of
gender identity running from female to male; this is known as
4. Sexual fantasies and single–partner sex are the most common sexual
outlets for women and men, single and coupled individuals, and het-
erosexual, gay/lesbian, and bisexual individuals. Masturbation is the
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UGGESTIONS FOR
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Discuss the components of the WHO defini-
tion of sexual health.
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• Discuss strategies to deal with clients who have a
different sexual orientation than the student.
•
Invite representatives from local organizations
for gay or lesbian rights to discuss their
expectations of health care providers.
issues and implications for nursing.
CHAPTER 40 / Sexuality 293
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4
Give examples of how the family, culture, religion, and personal expectations
and ethics influence one’s sexuality.
Concepts for Lecture
1. Gender identity, body image, sexual self–concepts, and capacity for
intimacy are developed within the family. Children observe and
model parents. Family messages about sex range from “sex is so
shameful it shouldn’t be talked about” to “sex is a joyful part of
adult relationships.”
Sexuality is regulated by the individual’s culture. Culture influ-
ences the sexual nature of dress, rules about marriage, expectations
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5
Describe physiological changes during the sexual response cycle.
Concepts for Lecture
1. Commonly occurring phases of the human sexual response follow a
2. Desire phase: Occurs in both males and females; response cycle
3. Excitement/plateau:
•
Male and Female:
Muscle tension increases as excitement in-
creases. Sex flush, usually on chest. Nipple erection.
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UGGESTIONS FOR
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Ask the students to provide additional
examples of how family, culture, religion,
and personal ethics influence one’s sexuality.
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CTIVITIES
• Discuss appropriate responses of a nurse who
discovers a client masturbating.
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Show a DVD or VHS tape presenting the
physiologic changes in males and females
during the sexual response cycle. Discuss the
effects of various diseases on these changes.
4. Orgasmic:
•
Male and Female:
Respirations may increase to 40 breaths per
30–80 mm Hg and diastolic 20–50 mm Hg above normal).
•
Male:
Rhythmic, expulsive contractions of the penis at 0.8-sec
intervals. Emission of seminal fluid into the prostatic urethra from
contraction of the vas deferens and accessory organs (stage 1 of
5. Resolution:
•
Male and Female:
Reversal of vasocongestion in 10–30 min; dis-
appearance of all signs of myotonia within 5 min. Genitals and
breasts return to their preexcitement states. Sex flush disappears in
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Identify the forms of altered sexual function.
Concepts for Lecture
1. Many individuals experience transient problems with their ability to
respond to sexual stimulation or to maintain a response. A smaller
2. Past and current problems may be related to sociocultural factors
(very restrictive upbringing accompanied by inadequate sex educa-
tion), psychological factors (negative feelings such as guilt, anxiety,
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UGGESTIONS FOR
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•
Invite a nurse practitioner to discuss sexuality
problems encountered in his or her practice
and the interventions provided. Be certain that
both male and female issues are discussed.
3. Hypoactive sexual desire disorders refer to a deficiency in or
absence of sexual fantasies and persistently low interest or a total
4. In female sexual arousal disorder, lack of vaginal lubrication causes
5. In female orgasmic disorder, the sexual response stops before
orgasm occurs. Preorgasmic women have never experienced an
6. Sexual pain disorders include dyspareunia (pain during or immedi-
ately after intercourse), vaginismus (involuntary spasm of the outer
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Identify basic sexual questions the nurse should ask during client assessment.
Concepts for Lecture
1. Information about a client’s sexual health status should be an
integral part of nursing assessment. The amount and kind of data
collected depend on the context of the assessment, that is, the
client’s reason for seeking health care and how the client’s sexuality
interacts with other problems.
It is critical to introduce the topic of sexuality to all clients in
order to give them permission to bring up concerns or problems. All
nursing histories should at least include a question such as “Have
there been any changes in your sexual function that might be related
to your illness or medications you take?”
The assessment interview lists basic sexual questions the nurse
should ask during client assessment. They include the following:
• Are you currently sexually active? With men, women, or both?
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UGGESTIONS FOR
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Have the students practice obtaining a sexual
history on each other. Discuss feelings experi-
enced by both the “nurse” and the “client”
during this process.
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• Have the students discuss situations in which
asking questions about the sexual concerns of
a client is important (e.g., side effects of cer-
tain medications).
296 CHAPTER 40 / Sexuality
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8
Formulate nursing diagnoses and interventions for the client experiencing
sexual problems.
Concepts for Lecture
1. The NANDA nursing diagnoses relating specifically to sexuality
2. Sexual problems can also be the etiology of other diagnoses, includ-
3.
Nursing interventions to promote sexual health and function focus large-
ly on the nurse’s teaching role. In addition to teaching, the nurse can do
the following to help clients maintain a healthy sexual
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9
Recognize health promotion teaching related to reproductive structures.
Concepts for Lecture
1. Providing education for sexual health is an important component of
nursing implementation. Many sexual health problems exist because
of sexual ignorance. Many others can be prevented with effective
health teaching.
Nurses can assist clients to understand their anatomy and how
the body functions. Details about physiological changes in sexual
function that occur during major developmental crises (puberty,
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UGGESTIONS FOR
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Have the students review the defining charac-
teristics and etiology for the related NANDA
nursing diagnoses in the nursing diagnosis
textbook required by the program.
books for suggestions to assist a client with
sexuality issues.
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• Divide the students into groups and assign each
group a topic (e.g., menopause, BSE). Have each
group develop a teaching plan for the assigned
topic.
•
Invite a nurse from the local STI clinic to
discuss client teaching provided in this setting.
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Arrange for the students to attend an STI clin-
ic. Discuss observations about the education
provided for clients in this setting.