Chapter 35 Flashcards
Sexuality has many definitions
Expression of an individual’s sexuality is influenced by interaction among biological, sociological, psychological, spiritual, economic, political, religious, & cultural factors
-values, attitudes, behaviors, relationships with others, & the need to establish emotional closeness with others influence sexuality
Sexuality differs from sexual health
Sexual health: State of physical, emotional, mental, & social well-being in relation to sexuality; it is not merely the absence of disease, dysfunction, or infirmity
Sexual development in infancy and early childhood
- first 3 yrs of life crucial in development of gender identity
- child identifies w/parent of same sex & develops complementary relationship w/parent of opposite sex
- children become aware of differences between sexes & begin to perceive that they are either male or female, & interpret the behaviors of others as appropriate for a male or female
Sexual development in school-age years
- parents, educators, & peer groups serve as role models & teachers for how men & women act & relate to one another
- need accurate info about changes in their bodies & emotions during this time period & what to expect going into puberty
- knowledge decreases anxiety
Sexual development in puberty/adolescence
- emotional changes are dramatic as physical ones
- time when they explore their primary sexual orientation
- may identify w/sexual minority group (lesbian, gay, bi, trans)
- LGBT individuals at higher risk for depression, suicide, abuse of tobacco, alcohol, and drugs than the general public
- risky behavior tends to continue through life
Sexual development in young adulthood
- matured physically but continue to explore & mature emotionally in relationships
- at times young adults require support and education or therapy to achieve mutually satisfying sexual relationshiops
Sexual development in middle adulthood
-concerns about sexual attractiveness
-physical changes due to aging affect sexual functioning
-decreasing levels of estrogen in perimenopausal women lead to diminished vaginal lubrication & decreased vaginal elasticity. Both of these changes lead to dyspareunia (occurrence of pain during intercourse)
-decreased levels of estrogen may also result in a decreased desire for sexual activity
MEN: increase in the postejaculatory refractory period & delayed ejaculation
-when children leave home intimate relationships changes
Sexual development in older adulthood
- Positive correlation between sexual activity and physical health
- many are sexually active in engage in high risk sexual encounters which leads to HIV & STI rates over the past 12 years
- factors that determine sexual activity in older adults include: present health status, medications, past & present life satisfaction, status of marital or intimate relationships
- sexual activity is normal in later years but is not essential to maintain quality of life
- excitement phase prolongs in both men & women & it takes longer for them to reach orgasm.
- the refractory time following orgasm is longer
- both experience a reduce availability of sex hormones
- men often have erection that are less firm and shorter acting
- women usually do not have difficulty maintaining sexual function unless of a medical condition that impairs their sexual activity
- infrequency of sex in older women related to age, health, & sexual function of their partner
Sexual orientation
- Describes the predominant pattern of a person’s sexual attraction over time
- LGBT experience decreased access to health care & do not readily seek preventive care
Contraception
- provide varying levels of protection against unwanted pregnancies
- some require prescription, others do not
- methods that are effective for contraception do not always reduce risk of STIs
Nonprescription contraceptive methods
-abstinence
-barrier methods: OTC spericidal products & condoms, diaphragm
-timing of intercourse w/regards to the woman’s ovulation cycle: rhythm, basal body temperature, cervical mucous, fertility awareness methods
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Contraceptive methods that require a health care provider’s intervention
- hormonal contraception: several forms (pills, rings, injections, subdermal implant, transdermal skin patches, IUDS)
- IUDs: Copper or progesteron; they stop the sperm from fertilizing an egg
- diaphragm: round, rubber dome that has a flexible spring around the edge. Used with contraceptive cream/jelly & inserted into vagina. Woman needs to be refitted after significant change in weight (10lbs gain/loss) or pregnancy
- cervical cap: functions like diaphragm; but covers only cervix. May be left in longer
- sterilization or tubal ligation or vasectomy
Sexually transmitted infections: Approximately 20 million people in the united states are diagnosed with an STI each year
- Highest incidence occurring in men who have sex w/men, bisexual men, youths between ages 15-24
- blacks and hispanics are diagnosed w/STIs more frequently than whites
- women have more complications associated with STIs than men
Treatment of STIs in America costs about $16 million annually. Commonly diagnosed STIs include
Syphilis, gonorrhea, chlamydia, trichomoniasis, & infection with the human papilloma virus (HPV) & herpes simplex virus (HSV) type II (genital warts, genital herpes)
Gonorrhea, chlamydia, syphilis, and pelvic inflammatory disease (PID) are caused by?
Bacteria & are usually curable with antibiotics
HIV
-Bloodborne pathogen present in most body fluids
-sometimes spread through sexual contact
-transmission occurs when there is an exchange of body fluid
-primary routes of transmission: contaminated IV needles, anal intercourse, vaginal intercourse, oral-genital sex, transfusion of blood & blood products
Three Steps of progression
1) primary infection stages lasts 1 month after contacting virus. Flu-like symptoms
2) Clinical latency phase: no symptoms of infection. HIV antibodies appear in blood 6 weeks-3 months after infection
3) Acquired immunodeficiency syndrome (AIDS): when person shows symptoms of disease.
-Highly active antiretroviral therapy (HAART) & having an experienced HIV clinician greatly increase survival time
-if left untreated people will live about 10 years
Human Papillomavirus Infection (HPV)
- Most common STI in the states; 14 million new infections each year
- most infections asymptomatic & self-limiting
- certain types can cause cervical cancer in women & anogenital cancers & genital warts in both men & women
- spread through direct contact w/warts, semen, & other body fluids from others who have the disease
The bacteria Chlamydia trachomatis causes chlamydia
- most commonly reported infectious disease in the US affecting 3 million each year
- spread by contact with fluids from infected site
- can be transmitted during birthing process & cause conjunctivitis & pneumonia in newborns
- frequently infects cervix & if untreated can cause PID, ectopic pregnancy, & infertility from damage to female reproductive organs
- causes few symptoms so some people may not know they have it so the CDC recommends screening for all sexually active women up to age 25
- high risk populations are those with multiple sex partners or infected with other STIs & men who have sex with men
Sociocultural dimensions of sexuality
-each culture has own set of rules & norms that guide sexual behavior, sexual health, & willingness to discuss
Female sexual interest tends to fluctuate during pregnancy
- Increased interest during second trimester & decreased interest during first and third trimester
- decrease in libido during first trimester because of nausea, fatigue, & breast tenderness
- during second trimester, blood flow to pelvic area increases to supply placenta, resulting in increased sexual enjoyment & libido
- during third trimester the increased abdominal size makes finding a comfortable position diffucult
The incidence of erectile dysfunction (ED) increases with age but can occur in men under 40. Risk factors are similar to those for heart disease
- Diabetes mellitus
- hyperlipidemia
- HTN
- hypothydroidism
- chronic renal failure
- smoking
- obesity
- alcohol abuse
- lack of exercise
Illnesses that affect sexual functioning
- Diabetes mellitus
- Cancer (prostate, breast, colon, ovarian, testicular, rectal)
- Neuropathy
- Spina bifida
- Spinal cord injury
- Unstable angina
- Uncontrolled HTN
- COPD
- HIV
- Substance abuse
- Depression
Medications that affect sexual functioning
- Antihypertensives
- Antipsychotics
- Antidepressants
- Antianxiety
- Diuretics
- Oncological agents
- Recreational or illicit drugs
PLISSIT Assessment of Sexuality
Permission to discuss sexuality issues
Limited Information related to sexual health problems being experienced
Specific Suggestions- only when the nurse is clear about the problem
Intensive Therapy-referral to professional with advanced training if necessary
