Sexuality and Gender

Question 1

What is sexuality?

Answer 1

As a central aspect of being human throughout life and encompasses sex, gender identities and roles, sexual orientation, eroticism, pleasure, intimacy, reproduction

Question 2

What is intersex?

Answer 2

Born with female or male anatomy either inside or outside one’s body.

Question 3

What are the sexual orientations?

Answer 3

Heterosexual
Gay man or lesbian
Bisexual or pansexual
*2SLGBTQ
2Spirit, Lesbian, Gay, Bisexual, Transgender, Queer

Question 4

What is the Sexual Response Cycle?

Answer 4

Desire phase: See person for the 1st time (club)
Excitement phase: more physiological changes in body
Orgasmic phase
Resolution phase: time to recovery and get back to pre-arousal state

Question 5

What could affect one’s person Sexual function?

Answer 5

Past and current factors (traumatic, mental, physical...)
Sexual desire disorder
Sexual arousal disorder
Orgasmic disorder
Sexual pain disorder

Question 6

Describe the Sexual Desire Disorder.

Answer 6

Hypoactive sexual desire, less sexual desire

Sexual aversion disorder

Question 7

DEscribe the Sexual Arousal Disorder.

Answer 7

Female sexual arousal disorder (painful, lubrification issues)
Male erectile dysfunction (viagra)

Question 8

Describe Erectile dysfunction.

Answer 8

Problem in ability to have sexual satisfaction
problems in maintaining/attaining an erection to allow engagement in sexual intercourse
Cause: Atherosclerosis, diabetes,HBP, Multiple sclerosis, Thyroid dysfunction, Alcoholism, Renal failure, depression, structure abnormalities, medication, psychological factors

Question 9

Describe the medication used in ED as an intervention.

Answer 9

sildenafil citrate Viagra: vasodilator maintains erection, pt needs to avoid Nitroglycerine because it is a vasodilator
tadafil Cialis
vardenafil Levitra

Question 10

Describe the sexual pain disorder.

Answer 10

Dyspareunia: Painful intercourse
Vaginismus: Spasm of vagina, shrinking of muscles around area
Vulvodynia: Vulvar pain at least 3 months
Vestibulitis: itching, burning not related to UTI

Question 11

What are the possible effect of medications and ethanol on sexuality?

Answer 11

Alcohol: increase sexual functioning, chronic-> decrease sexual desire, orgasmic dysfunction, erectile dysfunction
Alpha-blocker: Inability to ejaculate
Antianxiety agents: decrease sexual desire, orgasmic dysfunction, delay ejaculation
Anticonvulsants: Decrease sexual desire, reduce sexual response
Antidepressants: same as antianxiety w/ failed ejaculation, painful erection
Antihistamines: Decreased vaginal lub & desire
Antihypertensive: Decrease sexual desire, erectile failure, ejaculation dysfunction
Antipsychotics:
Marijuana: prolonged use reduces testosterone levels and reduces sperm production
Opioids: Inhibited sexual desire & response, erectile & ejaculatory dysfunctions

Question 12

What are the changes with aging and sex?

Answer 12

Not as much stamina
Decreased speed/power of muscles contraction: affects orgasm, limits movement, pain
Dyspnea on intense exercise: SOB during intercourse
Reduced cardiac output: Decreased blood flow to genitalia

Question 13

What are the S/S of estrogen deficiency?

Answer 13

Vasomotor: hot flashes, night sweats
Genito-Urinary: Atrophic vaginitis, Dyspareunia, Incontinence
Psychological: Sleep patterns, Decreased REM sleep, Emotional lability
Skeletal: Increased fracture rate, humerus fracture
Cardiovascular: Decreased high-density lipoproteins & Increased low-density lipoproteins
Dermatological: Breast tissue changes, Diminished collagen content of skin

Question 14

What is the treatment for Menopause?

Answer 14

Hormone Replacement Therapy (years ago)
Not recommended
Decrease risk of heart attack, colon Ca, hip Fx
Increase risk of blood clots, Breast Cancer

Implementation: Should start small dose to control S&S
Dose must be review annually

Question 15

What are the Non Hormonal Therapy for Menopause?

Answer 15

Antidepressants (SSRI’s)
Gabapentin
*SERM’s (selective estrogen receptor modulators)
*Bisphosphonates (Fosomax: osteoporosis)

Question 16

What are the S/S of decreased testosterone (andropause)?

Answer 16

loss libido
Fatigue
ED
Depression & mood swings
Sleep disturbances

Question 17

Describe the PLISST Model.

Answer 17

Permission: to initiate sexual discussion
Limited Information: limit info provided to that needed for sexual function
Specific Suggestions: offer suggestions for dealing with problems
Intensive Therapy: refers appropriate for complex problems that calls for specialist intervention

Question 18

Describe gender dysphoria.

Answer 18

Feelings of unease and incongruence between anatomical sex and gender identity
Conflict about having it as a psychiatric disorder
Have to be diagnosed to have hormonal therapy or surgery

Question 19

A 27-year-old patient states that since her marriage ended two years ago, she has found herself lacking interest and motivation in sexual activity. Which response is most likely to be therapeutic?

a. Asking what her feelings about sex were before the divorce might lead to acquiring the information you want, but as worded here, the question is more focused on the patient’s previous feelings about sex.
b. The patient has indicated that her interest in sex has waned since the end of her marriage, suggesting a possible link. It could be that the patient has not finished grieving the loss represented by her marriage or that she is experiencing depression in response to this major change in her life circumstances. Prompting her to elaborate on what has happened since the marriage ended is likely to provide assessment data that will be needed to decide what steps to take next.
c. Although physical illness can interfere with sexual desire, the patient presentation does not suggest physical illness.
d. A lack of interest in sex is a relatively common problem and can be related to stress, but stating that stress is a common cause of loss of sexual interest could mislead the patient into focusing on stress as a cause of her problem (when, in fact, the actual causes of her loss of sexual interest have not yet been assessed).

Answer 19

b. The patient has indicated that her interest in sex has waned since the end of her marriage, suggesting a possible link. It could be that the patient has not finished grieving the loss represented by her marriage or that she is experiencing depression in response to this major change in her life circumstances. Prompting her to elaborate on what has happened since the marriage ended is likely to provide assessment data that will be needed to decide what steps to take next.

Question 20

Matthew, a 21-year old male, is meeting with the nurse for support and counselling. Matthew is questioning his sexuality. Which of the following are realistic short-term outcomes for Matthew? Select all that apply.

a. Matthew displays a clear sense of his sexual orientation.
b. Matthew accepts a negative self-image of his sexuality.
c. Matthew develops healthy coping skills.
d. Matthew shows comfort with his sexual orientation.

Answer 20

b. Matthew accepts a negative self-image of his sexuality.

c. Matthew develops healthy coping skills.

Question 21

A young male patient tells you that somehow he feels that he should not be a man, that inside he is a woman. This is likely an example of:

a. Fetishism is a preoccupation with objects (rather than people) as a source of sexual arousal or gratification.
b. Frotteurism is a disorder wherein the patient derives sexual gratification from rubbing against nonconsenting people.
c. Transsexualism is a form of gender dysphoria wherein a person feels he or she is a member of the gender opposite his or her own biological gender (e.g., a man who feels that despite his male anatomy, he is really a woman).
d. Transvestic fetishism involves deriving sexual pleasure from dressing in the clothing of the opposite gender.

Answer 21

c. Transsexualism is a form of gender dysphoria wherein a person feels he or she is a member of the gender opposite his or her own biological gender (e.g., a man who feels that despite his male anatomy, he is really a woman).

Question 22

Farah is the nurse assigned to work with Mr. Roberts, a transsexual male on a step-down unit. He is in counselling as part of the process of seeking sexual reassignment surgery and has female clothing in his hospital locker. Farah is anxious at the prospect of working with someone like Mr. Roberts and spends only the briefest periods of time possible responding to his needs. What are the best descriptions of what is occurring here? Select all that apply.

a. Farah may believe that Mr. Roberts’s behaviour is deviant and that Mr. Roberts could behave differently if he wished to do so but chooses not to.
b. As a result of Farah’s lack of empathy and her limited knowledge of Mr. Roberts’s condition, her feelings about Mr. Roberts have led her to lose objectivity and are leading her to behave in a less than professional manner.
c. It is not unusual for people to become anxious when dealing with others who are very different from themselves, particularly if they lack knowledge, understanding, and empathy for the perspectives and experiences of those other persons.
d. She may be confusing his gender dysphoria with other sexual disorders such as paraphilias, which may involve victimizing others and, as a result, may be repulsed by what she imagines “his kind” do to others (in fact, transsexuals are no more likely to offend sexually than are heterosexuals in general).
e. As a result of such feelings and misconceptions about Mr. Roberts’s gender dysphoria, Farah avoids Mr. Roberts, and her avoidance is affecting the care he is receiving. While it is generally accepted that we all have a right to hold the feelings and beliefs that we possess, as a professional health care provider, Farah does not have a right to withhold care from any patient because of her feelings about that patient or to care for such a patient in a different manner than she would care for other patients. Further, a professional nurse is expected to be able to be empathic toward patients despite his or her own beliefs and feelings. In this case, Farah is not behaving empathetically toward Mr. Roberts.
f. Farah may, in fact, see Mr. Roberts himself as deviant—seeing him as his gender dysphoria rather than as a person.

Answer 22

a. Farah may believe that Mr. Roberts’s behaviour is deviant and that Mr. Roberts could behave differently if he wished to do so but chooses not to.
b. As a result of Farah’s lack of empathy and her limited knowledge of Mr. Roberts’s condition, her feelings about Mr. Roberts have led her to lose objectivity and are leading her to behave in a less than professional manner.
c. It is not unusual for people to become anxious when dealing with others who are very different from themselves, particularly if they lack knowledge, understanding, and empathy for the perspectives and experiences of those other persons.
d. She may be confusing his gender dysphoria with other sexual disorders such as paraphilias, which may involve victimizing others and, as a result, may be repulsed by what she imagines “his kind” do to others (in fact, transsexuals are no more likely to offend sexually than are heterosexuals in general).
f. Farah may, in fact, see Mr. Roberts himself as deviant—seeing him as his gender dysphoria rather than as a person.