INTRODUCTION TO SEXUALITY AND ITS ROLES.

Sexuality is about your sexual feelings, thoughts, attractions and behaviours towards other people. You can find other people physically, sexually or emotionally attractive, and all those things are a part of your sexuality.

1. SEXUALITY By – Ms. Neha Singh Nursing tutor CON, KHFH

2. INTRODUCTION Sexuality is a critical component of human identity and well-being. According to WHO - 2016, sexuality encompasses biological sex, gender identities and roles, sexual activity, and sexual orientation.

3. SEXUAL HEALTH “ 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.” Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence.

4. SEXUAL DEVELOPMENT THROUGHOUT LIFE Human being are sexual beings throughout their lifespan. Sexuality is present in one form or another from since birth. Sexual development through various stages are : Sexual development in infancy – birth to 2 years The sexual response of a person is present from birth. Infants have many sensual experience including sucking on fingers and toes. Sexual development in early childhood – age: 3-7 years Increased curiosity for sexual exploration

5. By age 3, c hildren notice that genitals play a role in gender differentiation. More social interaction Recognize gender difference Sexual development in preadolescence – age: 8-12 years The age of 8-12 reflect a transition from childhood to adolescence. For most children, it is the timeframe in which puberty occurs. Acc. Freud’s psychosexual theory, children transfer this repressed libidinal energy into asexual pursuits such as school, athletics, and same-sex friendships

6. Puberty is the physical process of sexual maturation. Sexuality in adolescence – age 13-19 years Sexual maturation Increasing hormone levels Prepare for adult roles May have sexual experience Need for sex education Sexuality in adulthood – age 21-40 years Most active sexual life Choose life partner Experiment with sexual expression

7. Sexuality in late adulthood – age more than 41 years and older Menopause in females Decreased testosterone in males Fear of loss of sexual abilities

8. SEXUAL ORIENTATION Sexual orientation is defined as romantic, affectionate, emotional or sexual attraction to other people. Sexual orientation is often culturally influenced. Commonly identified sexual orientation are :

9. SEXUAL ORIENTATION DESCRIPTION Heterosexual It refers to an individual who experiences sexual fulfillment with an individual of the opposite gender. Homosexual (gay and lesbian) Gay (males or females) or lesbian (females) refers to an individual attracted to members of the same gender, commonly known as homosexual. Bisexual Bisexual refers to an individual who is attracted to both men and women. A bisexual relationship or encounter does not necessarily mean a person is gay or lesbian.

10. SEXUAL ORIENTATION DESCRIPTION Asexual Asexual refers to an individual who lacks romantic or sexual attraction to others. Transsexual Transsexual refers to an individual who lives full-time as a member of a gender that differs from the sex and gender assigned at birth. This term sometimes specifically refers to those transitioning with hormones or confirmation surgery. Questioning It refers to a person who is unsure of his/her/their sexual orientation.

11. LGBTQ LGBT or LGBTQ (Lesbian, Gay, Bisexual, Transgender and Questioning) may refer to anyone who is non heterosexual or non- cisgender , people who are lesbian, gay, bisexual, transgender and who are questioning their sexuality.

12. SEXUAL EXPRESSION The methods by which people gain satisfaction through sexual stimulation varies from person to person . Touches , smells, sounds, sights, thoughts, feelings and fantasies can all contribute to sexual fulfilment in any form of expression chosen by a person. Sexual expression can be adaptive or maladaptive.

13. ADAPTIVE RESPONSE MALADAPTIVE RESPONSE Mutual consent and satisfaction Conducted in private and no harm involved Behaviours that do not meet one or more of the criteria for adaptive response

14. Adaptive responses : Adaptive responses of sexual expression must meet the following criteria: Between two consenting adults. Mutually satisfying to both. Conducted in private. Not physically or psychologically harmful to either . Lacking in force or coercion . Maladaptive sexual responses : According to Stuart(2013), maladaptive sexual responses are behaviors that do not meet one or more of the criteria for adaptive responses.

15. TECHNIQUES OF SEXUAL EXPRESSION Masturbation : Masturbation is a self-stimulation of genital organ . Sexual intercourse : The act of intercourse (copulation or coitus) is the insertion of the penis into the partners vagina, anus or mouth. Vaginal intercourse : The act of placing the penis in the vagina, penile-vaginal intercourse, can be achieved in various positions . Anal intercourse: Anal intercourse is the act of inserting the penis into the anus and rectum of a partner . Oral-genital stimulation : Stimulation of the genitals by the mouth and tongue, may be used during foreplay or as a way to reach orgasm.

16. Alternative forms of Sexual Expression which are considered Maladaptive Voyeurism : It is the achievement of sexual arousal by looking at the body of a person other than one's sexual partner . Sadism : It is the practice of gaining sexual pleasure while inflicting abuse on the partner . Masochism : It is the practice of gaining sexual pleasure from the humiliation of being abused . Pedophilia : It is the practice of adults gaining sexual satisfaction by performing sexual acts with children.

17. FACTORS AFFECTING SEXUALITY FACTORS DESCRIPTIONS Developmental Factors With age, the sexuality changes and is affected in terms of biological sex as well as its expression and roles involved. Culture Sexual norms/identity is majorly influenced by the society and culture we live it. Religion Religious beliefs influence sexuality e.g., virginity signifies purity or having physical intimacy during menstruation is sin.

18. FACTORS DESCRIPTION Ethics It is about what seems right to one may be considered wrong for other. Ethically sexual expression shall be admissible to both the partners. Lifestyle Modernization has influenced sexuality and its expression, more stress and responsibilities of work and family has lead to change in sexual expression exhibited as less physical intimacy.

19. SEXUALLY TRANSMITTED INFECTIONS Sexually transmitted infections (STIs)/ sexually transmitted diseases (STDs) or venereal diseases, are infections that spread from one person to another primarily through sexual contact. C ommon types of STIs and their signs and symptoms are :

20. DISEASE/INFECTION CHARACTERSTICS Acquired immunodeficiency syndrome (AIDS) Caused by human immunodeficiency virus (HIV). Incidence is high in IV drug users, gay and bisexual men; increasing heterosexual transmission. Fatigue, weight loss, diarrhea , fever, enlarged lymph nodes, anorexia, and night sweats are common clinical manifestations. Bacterial Vaginosis (BV) Caused by imbalance of bacteria (alters flora in the genital region). Men typically asymptomatic. Symptoms in women: Foul-smelling, thin, grayish to white vaginal discharge. Chlamydia Caused by Chlamydia trachomatis-intracellular bacteria. Primarily affects 15-24 years age young people. Many people are asymptomatic. Symptoms in men : Penile discharge, pain and swelling in testicles, burning micturition. Symptoms in women : Vaginal discharge, urinary frequency, burning micturition, dysuria, and urethral soreness.

21. DISEASE/INFECTION CHARACTERSTICS Cytomegalovirus (CMV) Caused by a virus in the same family as herpes and Epstein-Barr virus (EBV). Not exclusively sexually transmitted. May be asymptomatic. A first-time infection may cause a mild illness with fever, mononucleosis, lymphadenopathy, hepatomegaly and splenomegaly. Genital Herpes Caused by herpes simplex virus type 2 (HSV-2). Can be caused by HSV-1 through oral sex. Lesions develop around the rectum, genitals or mouth. Oral herpes (cold sores) is typically caused by HSV-1. Appear as single or multiple painful vesicles, which rupture and form ulcer-like lesions; these form scabs as they heal. Recurrences are usually preceded by prodromal symptoms of tingling and fullness.

22. PREVENTION OF SEXUALLY TRANSMITTED INFECTIONS The best measure to prevent is to avoid sexual contact. If a person is sexually active, there are some measures that can reduce the risk of developing STls . Use of condom correctly and consistently. Have a mutually monogamous sexual relationship with an uninfected partner . Use sterile needles if injecting intravenous medications .

23. The risk of acquiring an STI also increases with the number of partners over a lifetime. Therefore, avoid multiple sex partners. Intravenous drug abuse should not be done. Sexually active individuals must have regular screening for STIs even in the absence of symptoms, and especially if having sex with a new partner. Indulge in natural form of intercourse (vaginal intercourse) if practiced, use a condom . If diagnosed with a STI, be treated to reduce the risk of transmission to partner or from mother to baby .

24. If diagnosed with STI, notify all recent sex partners and urge them to go for screening. Stop all sexual activity while being treated for an STI. Do not donate blood if diagnosed with STI.

25. PREVENTION OF UNWANTED PREGNANCY Unintended pregnancy remains a significant women's health issue as well as a critical social issue. An unintended pregnancy is a pregnancy that is either unwanted, such as the pregnancy occurred when no children or no more children were desired or the pregnancy is mistimed, such as the pregnancy occurred earlier than desired. The concept of unintended pregnancy helps in understanding the fertility of population and the unmet need for contraception, also known as birth control, and family planning.

26. Most unintended pregnancies result from not using contraception or from not using it consistently or correctly . Nurses have a responsibility to provide information to women regarding contraceptive methods . Patients choose contraception for many bases and may contact nurses specifically to obtain information about birth control. Some people use contraceptive methods for the orderly spacing of pregnancies; others may want to prevent pregnancy from occurring until a family is desired.

27. Some couple opt for a permanent method to prevent pregnancy from ever occurring . Factors that affect a person's choice of a contraceptive method include age, gender, marital status, desire for future pregnancy, religious beliefs, cost, level of education and ease of use and knowledge about available methods, perceptions of the various methods, and in many cases, previous experience with contraceptive methods.

28. All contraceptive methods have advantages as well as disadvantages. Explaining and understanding the available methods thoroughly is a must so that patients can choose the one that will best meet their situation and needs.

29. SEXUAL HARASSMENT Harassment is any distressing or annoying comment or conduct that is known or should be known to be unwelcome. Sexual harassment can be directed toward people of any gender, any age, and any sexual orientation. There are two forms of sexual harassment: quid pro quo and environmental harassment . Quid pro quo harassment : Quid pro quo means something given or withheld in exchange for something else.

30. Quid pro quo harassment occurs when an individual's employment or wellbeing 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 favours . Quid pro quo harassment is a clear abuse of power and is morally, legally and ethically inappropriate.

31. 2. Environmental harassment : Environmental harassment or hostile work environment occurs when sex- or gender-based behaviors create a hostile, intimidating environment that hurts a person's work performance, classroom performance, or general sense of well-being. Co-workers and peers can create a hostile environment for a member of the group through the following : Sexual teasing. Unwelcome sexually oriented and gender-based behaviors . Sexual jokes, sexual text messages and sexual comments . Offensive pictures and language and sexual behavior . Unwanted attention such as asking for dates constantly, physically blocking movement or creating unwanted interactions.

32. Effects of H arassment Harassment can cause feelings of worthlessness, helplessness and guilt in the victim. This can often lead to career dis-satisfaction and feelings of loss of control. Anger is commonly experienced by those who have been harassed.

33. Responding to Workplace Harassment in Nursing Inappropriate sexual behavior by a patient or coworker may cause the nurse to respond with either passive avoidance or aggressive retaliation. An assertive response that supports the nurse in maintaining self-respect and encourages the patient to accept responsibility for own behavior is recommended . Co-workers may also be a source of harassment for nurses. The objective of employers should be to create a positive work environment that is characterized by mutually respectful behavior.

34. Many institutions have taken steps to eliminate hostile work environments by educating employees, developing policies against workplace harassment and outlining guidelines for responding to sexual harassment. If harassed by a co-worker, confront the behavior immediately. An assertive statement is sometimes sufficient to stop the behavior. Consult a supervisor not involved in the harassment. If the harassment continues, document the date, time and describe the behavior. If the harassment still does not stop, file a grievance with administration . Seek legal advice if all previous efforts to stop the behavior have been unsuccessful.

35. SEXUAL ABUSE Sexual abuse, also referred to as sexual assault or sexual violence or molestation, is abusive sexual behavior by one person upon another. It includes unwanted sexual touching, forced oral sex and rape, among other sexual acts . Assistance of mental health professionals are required to help such patients, who survived sexual abuse. Therapy can often effectively address the trauma of sexual abuse.

36. DEALING WITH INAPPROPRIATE SEXUAL BEHAVIOR Steps of dealing with inappropriate sexual behavior includes : Talk about behavior : Talk to the person about their behavior and what you or others expect . Let them know if behavior is not appropriate- if they don't know, they can't change it. Let them know how the behavior makes you feel, e.g., "I feel uncomfortable when..." Let other people know what strategies to use.

37. Provide feedback about behavior: Provide the person with frequent, direct and clear feedback. Feedback should: Be direct Be immediate and early Be concrete and describe the behavior Be consistent Give direction Not reinforce / encourage unwanted behavior Help the person to learn Not be demeaning or humiliating Doesn't impose your own values

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