FUNDAMENTALS OF NURSING-II�YEAR 1, SEM II �UNIT IX: Concept of Sexuality

At the end of this unit, learners will be able to:
Review the Anatomy and physiology of the male and female
reproductive system
Describe normal sexual pattern.
Define Sexuality and its components & basic concepts.
Describe normal sexual pattern
Relate sexuality to all stages of life cycle
Identify factors that effects sexual functioning
Describe common risks and alteration in sexuality
Understand the nursing process as it relate to sexual functioning

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2. FUNDAMENTALS OF NURSING-II YEAR 1, SEM II UNIT IX: Concept of Sexuality PREPARED BY KIRAN WARIS PRINCIPAL TACI BWP 11-Mar-25 2

3. Outlines At the end of this unit, learners will be able to: Review the Anatomy and physiology of the male and female reproductive system Describe normal sexual pattern. Define Sexuality and its components & basic concepts. Describe normal sexual pattern Relate sexuality to all stages of life cycle Identify factors that effects sexual functioning Describe common risks and alteration in sexuality Understand the nursing process as it relate to sexual functioning 11-Mar-25 3

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6. Sexuality Everything that makes one a man or woman, including the need for touch, feelings about one’s body, the need to connect with another human being in an intimate way, interest in engaging in sexual behaviors, communication of one’s feelings and needs to one’s partner, and the ability to engage in satisfying sexual behaviors. Sexuality is a physiological, psychological, and social experience It is a basic, “completely normal” part of being human. 11-Mar-25 6

7. Components of Sexuality Gender Male Female Intersexed Gender role Masculine Feminine Transgendered Sexual orientation Heterosexual (straight) Homosexual (gay or lesbian) Pansexual (bisexual) 11-Mar-25 7

8. Basic concepts Gender : is defined by the biologic sex of an individual male, female, or intersex. Intersexed: Individuals are born with a combination of male and female sex organs Gender role : Is the masculine or feminine role adopted by a person and is partially defined within the individual’s cultural and social context. 11-Mar-25 8

9. Basic concepts Sexual orientation: Refers to the affection and sexual attraction of one person to another. Heterosexual : Attracted to the opposite gender Homosexual: Attracted to persons of the same gender. Gays : Men who are sexually attracted to other men, or women who are sexually attracted to other women Lesbians : Women who are sexually attracted to women Bisexual: Equally attracted to one gender as they are to the other. Asexual : Individuals who are not particularly attracted to any sex 11-Mar-25 9

10. Development of Sexuality We are sexual beings from birth to death. Expression of our sexuality develops through the life span. The development of sexuality begins with beginning and continues throughout the lifespan 11-Mar-25 10

11. Infancy birth–18 months Differentiates self from others gradually External genitals are sensitive to touch Male infants have penile erections after As evidenced by ultrasound, Males have erections several months before birth Females, vaginal lubrication It is assumed that lubrication also occurs prior to birth. when babies find their fingers and toes. 11-Mar-25 11

12. Toddler 1–3 years Able to identify own gender 3years Genital is the focus of interest, stimulation, and excitement By the age of 3, masturbation is common Penis is organ of interest for both sexes The child identifies with the parent of the same sex Develops a balancing relationship with the parent of the opposite sex Aware of differences between the sexes Interpret the behaviors of others as behavior appropriate for a female or a male. 11-Mar-25 12

13. Preschooler 4–5 years Becomes increasingly aware of self. Explores own and playmates’ body parts. Learns correct names for body parts. Learns to control feelings and behavior 11-Mar-25 13

14. School age 6–12 years Has strong identification with parent of the same gender. Tends to have friends of the same gender. Has increasing awareness of self. Increased shyness, desire for privacy. Learns the role and concepts of own gender. At about 8 or 9 years becomes concerned about specific sex behaviors and often approaches parents with clear concerns about sexuality and reproduction. 11-Mar-25 14

15. School age 6–12 years Around age 9 or 10, the first physical changes of puberty begin The development of breast buds in girls and the growth of pubic hair. As the adrenal glands mature they produce more testosterone and estradiol, which contributes to the first experiences of sexual attraction to another person Girls need to be taught about menstruation (monthly uterine bleeding) and related self- care. 11-Mar-25 15

16. Adolescence 12–18 years Primary and secondary sex characteristics develop. Boys, the testes and scrotum increase in size Girls, the pelvis and hips broaden, the breast tissue develops. Vaginal secretions become milky and change from an alkaline to an acid pH. Menarche usually takes place. Develops relationships with interested partners. Masturbation is common. May participate in heterosexual or same- sex activity. Are at risk for pregnancy and sexually transmitted infections (STIs). 11-Mar-25 16

17. Young adulthood 18–40 years Sexual activity is common. Establishes own lifestyle and values. Many couples share financial requirements and household tasks. Individuals may engage in various forms of sexual expression, including dating, casual sex, and committed relationships. 11-Mar-25 17

18. Middle adulthood 40–65 years Males and females experience decreased hormone production. Menopause occurs in females usually anywhere between ages 40 and 55. The climacteric occurs gradually in males. The quality rather than the number of sexual experiences becomes important. Individuals establish independent moral and ethical standards. 11-Mar-25 18

19. Late adulthood 65 years and older Interest in sexual activity often continues. Sexual activity may be less frequent. Female’s vaginal secretions diminish, and breasts atrophy. Males produce fewer sperm and need more time to achieve an erection and to ejaculate. 11-Mar-25 19

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21. SEXUAL HEALTH “A state of physical, emotional, mental, and social wellbeing related to sexuality; it is not merely the absence of disease, dysfunction, or infirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the openness and opportunity to have pleasurable and safe sexual experiences, free of pressure, discrimination, and violence. For sexual health to be attained and maintained, the sexual rights of all persons must be respected, protected, and fulfilled” (WHO, 2006, updated 2010). 11-Mar-25 21

22. Sexual Response Cycle The sexual response cycle is the sequence of physiological events that occur when a person becomes sexually aroused. commonly used frameworks to describe the Sexual Response Cycle and Sexual Physiology are: The Masters and Johnson Model : Based on research conducted in the 1950s, Masters and Johnson (1966) identified a four- stage The Kaplan Model : Developed by Helen Singer Kaplan in the late 1970s and early 1980s, Kaplan's model includes three phases: desire, arousal, and orgasm. 11-Mar-25 22

23. Sexual Response Cycle The Masters and Johnson Model : Based on research conducted in the 1950s, Masters and Johnson (1966) identified a four- stage Excitement Plateau Orgasm, and Resolution 11-Mar-25 23

24. Excitement Characterized by physiological changes such as: Increased heart rate, blood pressure, and muscle tension. In males : This phase often involves the erection of the penis due to increased blood flow, Appearance of a few drops of lubricant, which may contain sperm, while in In females: Erection of the clitoris, Vaginal lubrication, Labia may increase two to three times in size Breasts enlarge Inner two- thirds of vagina widens and lengthens; outer third swells and narrows Uterus elevate Excitement can be triggered by various stimuli, including physical touch, erotic thoughts, or sensory stimulation. 11-Mar-25 24

25. Plateau This phase is characterized by further increases in heart rate, muscle tension, and genital enlargement. Breathing may become more rapid, and individuals may experience sharp sensitivity to touch and other stimuli. The plateau phase represents a high level of arousal that precedes orgasm. 11-Mar-25 25

26. Orgasm Respirations may increase to 40 breaths per minute Involuntary spasms of muscle groups throughout the body Diminished sensory awareness Involuntary contractions of the anal sphincter Peak heart rate (110 to 180 beats/min), respiratory rate (40/min or greater), and Blood pressure (systolic 30–80 mm Hg and diastolic 20–50 mm Hg above normal) 11-Mar-25 26

27. Orgasm Signs Present in Males Only 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 the expulsive process) Closing of the internal bladder sphincter just before ejaculation to prevent retrograde ejaculation into bladder Orgasm can occur without ejaculation Ejaculation of semen through the penile urethra and expulsion from the urethral meatus The force of ejaculation varies from man to man and at different times but diminishes after the first two to three contractions (stage 2 of the expulsive process) 11-Mar-25 27

28. Orgasm Signs Present in Females Only Approximately 5 to 12 contractions in the orgasmic platform at 0.8- sec intervals Contraction of the muscles of the pelvic floor and the uterine muscles Varied pattern of orgasms, including minor flows and contractions, multiple orgasms, or a simple intense orgasm similar to that of the male. 11-Mar-25 28

29. Resolution Phase Following orgasm, the body gradually returns to its pre- aroused state during the resolution phase. Physiological changes such as heart rate, blood pressure, and muscle tension return to baseline levels. In males, there is typically a refractory period during which further sexual stimulation does not lead to immediate arousal and orgasm. In females, there may be variability in the duration of the resolution phase, and some women may be capable of experiencing multiple orgasms without a refractory period. 11-Mar-25 29

30. Some Forms of Sexual Expression Developing Intimate Relationships Fantasies and Erotic Dreams Masturbation Shared Touching Sexual Intercourse Oral–Genital Stimulation(oral sex) Anal Stimulation or Anal Intercourse Celibacy 11-Mar-25 30

31. Common Risks in Sexuality Unprotected intercourse without male or female condom use. Unprotected mouth- to- genital contact Starting sexual activity at a young age Having multiple sex partners Having a high- risk partner (one who has multiple sex partners or other risk factors) Having unprotected anal sex & proper lubrication Having sex with a partner who injects or has ever injected drugs Sex trade work 11-Mar-25 31

32. Common alteration in sexuality/Problems Affect Sexuality Sexually Transmitted Infections Chlamydia trachomatis Gonorrhea Syphilis Genital Human Papillomavirus Dysmenorrhea Premenstrual Syndrome Negative Intimate Relationships Sexual Harassment Rape Sexual Response Cycle Disorders Low Libido Arousal Disorders Orgasmic Disorders 11-Mar-25 32

33. Factors that effects sexual functioning Biological Factors Hormonal imbalances Medical conditions Medications Psychological Factors Stress and anxiety Body image and self- esteem Past experiences Mental health disorders Interpersonal Factors Relationship quality Partner factors Relationship changes Sociocultural Factors Cultural norms and values Religion and spirituality Socioeconomic factors Lifestyle Factors Substance use Diet and exercise Sleep 11-Mar-25 33

34. Assessing A client’s sexual health status should always be an integral part of a nursing assessment. Nursing History Physical Examination Identifying Clients at Risk 11-Mar-25 34

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37. Diagnosing Unrewarding or inadequate sexual experiences alterations in sexual desire or sexual arousal or Orgasmic experiences or sexual pain or lack of satisfaction; Inadequate knowledge (e.g., about conception, STIs, contraception, or normal sexual changes over the lifespan) related to misinformation and sexual myths; Anxiety related to loss of sexual desire or functioning; and others. 11-Mar-25 37

38. Planning Overall goals to meet clients’ sexual needs include the following: Maintaining, restoring, or improving sexual health Increasing knowledge of sexuality and sexual health Preventing the occurrence or spread of sexually transmitted infections Preventing unwanted pregnancy Increasing satisfaction with the level of sexual functioning Improving sexual self- concept 11-Mar-25 38

39. Implementing Based on the sexual health history and nursing diagnoses, Interventions are directed at reducing risk of potential problems and improving sexual health. Nurses require six basic skills to help clients in the area of sexual health: Self- knowledge of and comfort with their own sexuality 11-Mar-25 39

40. Implementing Acceptance of sexuality as an important area for nursing intervention and a willingness to work with clients who express their sexuality in a variety of ways. Knowledge of sexual growth and development throughout the life cycle Knowledge of basic sexuality, including how certain health problems and treatments may affect sexuality and Sexual function and which interventions facilitate sexual expression and functioning 11-Mar-25 40

41. Implementing Effective therapeutic communication skills The ability to recognize the need for all clients and family members to have the topic of sexuality introduced not only in written or audiovisual materials but also in a verbal discussion. 11-Mar-25 41

42. Implementing Sexual Health Teaching Sex Therapy Sex Education Awareness and Self-Examination (Breast Awareness, Testicular Self-Examination) Responsible sexual behavior involves the prevention of STIs, the prevention of unwanted pregnancy, and the avoidance of sexual harassment or abuse. 11-Mar-25 42

43. Evaluating The goals established during the planning phase are evaluated according to specific desired health outcomes also established during that phase. If any outcomes have not been achieved, the nurse should explore the reasons why with such questions as the following: Were risk factors correctly identified? Did the client convey all significant fears and concerns about sexuality? Was the client more comfortable following discussions about sexual matters? Did the client understand the nurse’s teaching? Was the health teaching compatible with the client’s culture and religious values? Was the client ready to deal with sexuality problems? 11-Mar-25 43

44. Summary Sexuality is a key element of human development, self-identity, interpersonal relationships, intimacy, and love. Factors that affect sexuality include family, culture, religion, personal expectations and ethics, disease processes, medications, and relationship problems. Sexual problems include sexual dysfunction disorders, arousal disorders, orgasmic disorders, sexual pain disorders, and problems with satisfaction. Nursing interventions focus largely on teaching clients about sexual health and function, responsible sexual behavior that includes the prevention of STIs and unplanned or unwanted pregnancies, breast awareness and breast screening, and self- examination of the testicles. 11-Mar-25 44

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