SEXUALITY IN NURSING

By
Ns. Andi Buanasari M.Kep., Sp.Kep.J
Sexuality
 Refers to all aspects of being sexual
and is one dimension of personality
 It Includes more than the act of
intercourse and is integral part of
life: person appearance and in
beiefs, behaviours and relationships
with others

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 I locked myself away from you
Too long,
Tossing aside my feelings
For you.
Looking for a way out, an excuse
Not to touch you;
Because I want to,
Inciting a riot within me.
To reach out for you
Is difficult,
But less difficult
Than turning away.

Leslie Bertel
 • Genetic Identity
SEXUALITY • Gender Identity
ASPECTS
• Gender Role
• Sexual Orientation

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Freud’s Theories of
Psychosexual stage
development
 Freud believed that personality develops
through a series of childhood stages
during which the pleasure-seeking
energies of the self become focused on
certain “erotic” areas.
 This psychosexual energy, or “libido”, was
described as the driving force behind
behavior.
 If the stages are completed successfully,
the result is a healthy personality.
Theories (cnt’d)

 Ifcertain issues are not resolved at the

appropriate stage, fixation can occur. A fixation is
a continuous focus on an earlier psychosexual
stage.
 Untilthis conflict is resolved, the individual will
remain "stuck" in this stage. For example, a
person who is fixated at the oral stage may be
over-dependent on others and may seek oral
stimulation through smoking, drinking, or eating.
 During the oral stage, the infant's primary source
of interaction occurs through the mouth, so the
rooting and sucking reflex is especially important.
 Theories (cnt’d)

 During the anal stage, Freud believed

that the primary focus of the libido
was controlling bladder and bowel
movements.
 The major conflict at this stage is
toilet training, the child has to learn
to control his or her bodily needs.
 Developing this control leads to a
sense of accomplishment and
independence.
Theories (cnt’d)

 During the phallic stage, the primary focus of the

libido is on the genitals. Children also discover the
differences between males and females. Freud also
believed that boys begin to view their fathers as a
rival for the mother’s affections.
 During the latent period, the development of the
ego and superego contribute to a period of calm.
 The stage begins around the time that children
enter into school and become more concerned with
peer relationships, hobbies, and other interests.
 The latent period is a time of exploration in which
the sexual energy is still present, but it is directed
into other areas.
Theories (cnt’d)

 During the final stage of psychosexual

development, the genital stage, the individual
develops a strong sexual interest in the opposite
sex.
 Interest in the welfare of others grows during this
stage.
 If the other stages have been completed
successfully, the individual should now be well-
balanced, warm, and caring. The goal of this
stage is to establish a balance between the
various life areas.
Factors affecting
sexuality

• Culture
• Religion
• Ethics
• Lifestyle
• Health state
• Age
• Stereotypes
–Fathers more than mothers
10

Ppt purwaningsih (UNAIR)

What do U do as a Nurse?

 Awareness of your own sexual feelings and

values
 Become educated in the basic principles of
sexuality will help you to better
understand sexual neds and Problems.
 Understanding that many patients may
have different beliefs, feelings and values.

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Sexual Rights – WHO, 2002
 Sexual rights include the right of all persons, free of coercion,
discrimination and violence, to

 the highest attainable standard of sexual health, including

access to sexual and reproductive health care services
 seek, receive and impart information related to sexuality
 sexuality education
 respect for bodily integrity
 choose their partner
 decide to be sexually active or not
 consensual sexual relations
 consensual marriage
 decide whether or not, and when, to have children
 pursue a satisfying, safe and pleasurable sexual life
Continuum of sexual response

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Adaptive responses meet the following
criteria:
 Between two consenting adults
 Mutually satisfying to both
 Not psychologically or physically harmful to either
 Lacking in force or coercion
 Conducted in private

Maladaptive sexual responses are behaviors that do not meet one or more of
the criteria for adaptive responses.
The degree to which these behaviors are maladaptive varies. Some sexual
behaviors may not meet any of the criteria. For example, incest may include force
and be psychologically harmful. However, other sexual responses may meet four of
the five criteria for adaptive responses but still be maladaptive.
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14
The Sexual Response Cycle

Copyright 2009 John Wiley & Sons, NY 15

Male and Female Sexual Anatomy

Copyright 2009 John Wiley & Sons, NY 16

Stages of the sexual response cycle
 Stage 1: Desire
Sexual fantasies and the desire for sexual activity
 Stage 2: Excitement
Subjective sense of sexual pleasure along with physiological changes, including
penile erection in the male and vaginal lubrication in the female
 Stage 3: Orgasm
Peaking of sexual pleasure and the release of sexual tension accompanied by
rhythmical contractions of the perineal muscles and pelvic reproductive organs
 Stage 4: Resolution
Sense of general relaxation, muscular relaxation, and well-being
Females may be able to respond to additional stimulation almost immediately
during this stage, but most males need some time before they can be
restimulated to orgasm.

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Sexual
Dysfunctions
 DSM-IV-TR four categories of sexual
dysfunction
1. Sexual desire disorders
2. Sexual arousal disorders
3. Orgasmic disorders
4. Sexual pain disorders

Copyright 2009 John Wiley & Sons, NY 18

Self-Reported Rates of Sexual Problems

Copyright 2009 John Wiley & Sons, NY 19

Sexual Dysfunctions by Phase of the
Sexual Response Cycle

Copyright 2009 John Wiley & Sons, NY 20

 Nursing Process
Assesment:
Open-ended questions are one of the most effective ways of
promoting a discussion on sexual issues, although some nurses
report that direct questions also can be helpful in opening up the
subject. Regardless, it is important to remember that questions must
be asked at the patient’s level of understanding, with sensitivity to the
patient’s cultural background because each person is unique.
Examples of questions nurses may ask related to a patient’s sexual health include the
following:
 Tell me what you understand about (menstruation, intercourse, sexual changes with
aging, menopause).
 Since you’ve been diagnosed, what questions have you had regarding your sexuality?
 Are there any changes you have noticed in your sexual patterns since becoming ill?
 Have you noticed any differences or problems in your sexual responses since taking this
medication?
 Often people have questions about masturbation, sexual frequency, safe sex, alternate
positions. Do you?
 Sometimes it is uncomfortable to talk about sexual issues with your partner. How is this
for you and your partner?
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Assesment
 Behaviours

Heterosexuality Bisexuality

Homosexuality Transvestism

Transexualism

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Assesment
Predisposing Factors
 Biological Factors
Biological factors are initially responsible for the development
of gender—whether a person is genetically male or female

Based on family studies and DNA samples of homosexual

brothers, it has been suggested that a gene may be related to
homosexuality. Early work in the field suggested that
homosexuality may be inherited from the maternal side of the
family through the X chromosome. Before such research is
accepted as definitive, however, it needs to be validated by
replication, and similar studies of lesbians have not been
completed. These findings cannot account for all cases of
homosexuality, but they do support a possible biological basis.

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Assesment
Predisposing Factors
Behavioural factors
 Behaviorists view sexual behavior as a measurable physiological and
psychological response to a learned stimulus or reinforcement event. They
specifically are interested in sexual difficulties that result from sexual
abuse in childhood. Although men and women are affected differently by
childhood sexual abuse, both can experience sexual difficulties in later
life.
 Women are more likely to report sexual inhibitions and relationship
problems. They also experience flashbacks, dissociative episodes, feelings
of shame and guilt, compulsive sexual behavior, and sexual aversion.
 Men who were sexually abused as children often demonstrate sexually
aggressive behavior, multiple sexual partners, fear of intimacy, compulsive
sexual behavior, and confusion about their sexual orientation.
 For both women and men, sexual dysfunction is more likely to be found
when the incidence of abusive episodes is high and the types of abuse are
many.

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Assesment
Precipitating Factors
Physical
Psychiatic
Illness and
Illness
Injury

Medication HIV/AIDS

The Aging
Process
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Psychological Factors in Sexual
Dysfunction
 Psychological factors can interfere with
sexual functioning: fears, stress, anxiety,
depression, guilt, anger, partner conflict,
dependency, loss of control, time pressures,
distractions
 Performance fear – excessive need to please
a partner.
 Appraisal of Stressors
Pereptions about oneself as a sexual being change throughout the
life cycle, and they are influenced by stressful situations

 Coping Resources
1. Person’s Knowledge about sexuality
2. Positive sexual experiences
3. Supprtive people for the patients
4. Social and cultural norms that encourage healthy sexual
expression

 Coping Mechanism, Example

1. Fantasy
2. Projection
3. Denia
4. Rationalization
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Nursing Process (Cont.)

 Nursing diagnosis
Sexual dysfunction
Ineffective sexuality pattern
 Outcomes identification
 Short and long term

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Nursing Process (Cont.)

 Implementation
 Pharmacological interventions
 Health teaching and health promotion
 Advanced practice interventions
 Psychoanalytic therapy
 Couples therapy
 Group therapy
 Hypnotherapy
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Her history revealed that she had been sexually inactive
for the past 5 years. At 20 years of age, Ms. A had a brief
sexual encounter with a man she had been dating for 2
years. She nded the relationship shortly afterward
because she had no interest in maintaining a sexual
relationship with the man. She recently became involved
in a relationship with a woman that was very satisfying to
her. She felt she had to end the relationship because she
would not tolerate thinking of herself as a homosexual.
During one of the initial counseling sessions, Ms. A told
the nurse that she must end the relationship before “it”
happens again. Nurse: What are you afraid will happen?
Ms. A: I’m afraid I’ll feel attracted to her again. Nurse:
What about that frightens you? Ms. A (becoming upset):
That will mean I’m homosexual!
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Nurse: What does being homosexual mean for you?
Ms. A: It means I’m sick. It’s a sin. I couldn’t go to church
anymore.
Nurse: Are all homosexuals sick?
Ms. A: Yes.
Nurse: How do you know this?
Ms. A: Everybody knows that homosexuality is morally wrong.
Homosexuals have a lot of emotional problems.
Nurse: Do you know any homosexual people?
Ms. A: Well, not exactly.
Nurse: What have you read about homosexuality?
Ms. A: Nothing. 31
Copyright 2009 John Wiley & Sons, NY 32