Sexuality

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Sexuality
      Introduction:
Sexuality is part of a person's personality and is important for overall health. Regardless of gender, age, race, socioeconomic status, religious beliefs, physical and mental health, or other demographic factors, we express our sexuality in a variety of ways throughout our lives.
Human sexuality is difficult to define. Expression of an individual's sexuality is influenced by interaction among biological, sociological, psychological, spiritual, economic, political, religious and cultural factors (WHO 2010)
     Sexual development:           
Sexuality changes as a person grows and develops. Each stage or development brings changes in sexual functioning and role of sexuality in relationships. 
      Infancy: Birth to 18 months:
                      
·        Given gender assignment of male or female.      
·        Differentiates self from others gradually.
·        External genitals are sensitive to touch.
·        Male infants have penile erections; females, vaginal lubrication.

Toddler: 1-3 years:
·        Continues to develop gender identity.
·        Able to identify own gender.
    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.
·        Focuses love on parent of the other sex.
School Age: 6-12 years:
·        Has strong identification with parent of same gender.
·        Tends to have friends of the same gender.
·        Has increasing awareness of self.
·        Increased modesty, desire for privacy.
·        Continues self-stimulating behavior.
·        Learns the role and concepts of own gender as part of the total self-concept.
·        At about 8 or 9 years becomes concerned about specific sex behaviors and often approaches parents with explicit concerns about sexuality and reproduction.

Adolescence: 12-18 years:
·        Primary and secondary sex characteristics develop.
·        Menarche usually takes place.
·        Develops relationships with interested partners.
·        Masturbation is common.
·        May participate in sexual activity.
·        May experiment with homosexual relationships.
·        Are at risk for pregnancy and sexually transmitted disease

Young Adulthood: 18-40 years:

·        Sexual activity is common.
·        Establishes own lifestyle and values.
·        Homosexual identity usually established by mid-20s
·        Many couples share financial obligations and household tasks.

Middle Adulthood: 40-65 years:
·        Men and women experience decreased hormone production.
·        The menopause occurs in women, usually anywhere between 40 and 55 years. and direct their energies.
·        The climacteric occurs gradually in men.
·        Quality rather than the number of sexual experiences time of life becomes important.
·        Individuals establish independent moral and ethical standards.
        Late Adulthood: 65 years and over:   
·        Interest in sexual activity often continues.
·        Sexual activity may be less frequent.
·        Women's vaginal secretions diminish, and breasts atrophy.
·        Men produce fewer sperm and need more time to achieve an erection and to ejaculate
Sexual health:
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 (WHO 2010)
Characteristics of Sexual Health:
·        Knowledge about sexuality and sexual behavior
·        Ability to express one's full sexual potential, excluding all forms of sexual coercion, exploitation, and abuse
·        Ability to make autonomous decisions about one's-sexual life within a context of  personal and social ethics
·        Experience of sexual pleasure as a source of physical, psychologic, cognitive, and spiritual
·        Capability to express sexuality through communication, touch, emotional expression, and love
·        Right to make free and responsible. reproductive choices
·        Ability to access sexual health care for the prevention and treatment' of all sexual concerns, problems, and disorders
Components of sexual health:
Five critical components of sexual health are sexual self-concept, body image, gender identity, gender role behavior, and freedoms and responsibilities.
Sexual self-concept:
How one values oneself as a sexual being
It determines with whom One will have sex, the gender and kinds of people a person is attracted to, and values about when, where, with whom, and how one expresses sexuality.
A positive sexual self-concept enables people to form intimate relationships throughout life. A negative sexual self-concept may impede the formation of relationships.

    Body image:
It is a central part of the sense of self, is constantly changing. Pregnancy, aging, trauma, disease, and therapies can alter an individual's appearance and function, which can affect body image. People who feel good about their bodies are likely to be comfortable with and enjoy sexual activity. People who have a poor body image may respond negatively to sexual arousal. A major influence on body image for women is the media focus on physical attractiveness and large breasts. Likewise many men worry about penis size.
   Gender identity:
It is one's self image as a female or male. It also includes social and cultural norms. Gender identity is the result of a long series of developmental events that may or may not conform to one's apparent biologic sex. Once gender identity is established, it
cannot be easily changed.
   Gender-role behavior:
It is the outward expression of a person's sense of maleness or femaleness as well as the expression of what is perceived as gender-appropriate behavior.
Each society defines its roles for males and females; boys are given reinforcement for behaving in a "masculine" way, and girls receive reinforcement for exhibiting" feminine" behaviors.
Freedoms and responsibilities:
Sexual health people:         

·        Engage activities that are freely chosen, including both self -pleasuring and shared —  pleasuring activities
·        Ethically motivated to exercise behavioral, emotional, economic and social responsibility for themselves.

Factors influencing sexuality:

Many factors influence a person's sexuality. They are
·        Family
·        Culture
·        Religion
·        Personal expectations and ethics

Family

·        It is within our families that we develop our gender identity, body image, sexual self-concept, and for intimacy.
·        Through family interactions we learn about relationships and gender roles and our expectations of others and ourselves.
·        If parents are able to share affection with one
another and other family members, children will most likely become adults who are able to give and, receive affection.
·        If parents seldom hug, hold hands, or kiss each other, their children may become adults who are very uncomfortable with romantic touch.

Culture
Sexuality is regulated by the individual's culture. Culture influences the sexual nature of dress, rules about marriage, expectations of role behavior and social responsibilities, and specific sex practices.
Premarital and extramarital sex and homosexuality may be unacceptable or tolerated. Polygamy (several marriage partners) or monogamy (one marriage partner) may be the norm
Cultures differ with regard to which body parts they find to be erotic. In some cultures, legs are erotic and breasts are not.
Body weight may also be a determinant of attractiveness. There is a great deal of  pressure in American culture to be very thin. Women would be considered to be obese in America are found highly attractive in other cultures.

The degree of public nudity ranges from women's entire bodies and faces being covered in Islamic societies to complete nudity in some cultures in New Guinea and Australia.

Religion
It provides guidelines for sexual behavior and acceptable circumstances for the behavior as well as prohibited sexual behavior and the consequences of breaking the sexual rules.
Some religions view forms of sexual expression are hold virginity before marriage, acceptance of premarital sex, unwed parenthood, homosexuality, and abortion.
       Personal expectations and ethics:
Cultures have developed written or unwritten codes of conduct based on ethical principles. Personal expectations concerning sexual behavior come from these cultural norms. 
  Altered sexual function:
         Factors contributing to sexual problem:         
1.     Socio-cultural factors:
It includes very restrictive upbringing accompanied by inadequate sex education.
Another factor may be parental punishment for normally exploring one's genitals or for normal childhood sex play
2.     Psychologic factors
It include negative feelings, such as guilt, anxiety, or fear, that interfere with the ability to experience pleasure and joy.
Adults who have been sexually abused at any time of their lives may experience overwhelming anxiety. Fears may include pregnancy, sexually transmitted infections, or pain, Fear of failure in sexual performance.
3.     Cognitive factors
It include the internalization of negative expectations and beliefs. Those with low self — esteem may not understand how another person could value and love them and also find them sexually attractive.
Relationship problems:
Conflict and anger with one's partner are not conducive to positive sexual interaction.
Some persons lose the physical attraction to another or feel more attracted to someone else.

Lack of intimacy and feeling like a sex object inhibit the feeling of communion and connection that is an important part of making love.
Disagreements in sexual frequency and/or sexual activities may lead to further relationship conflict.
    Health factors:
Physical changes brought on by illness, injury, or surgery may inhibit full sexual expression.
The presence of an STI in one partner-induces fear of transmission in the other, often resulting in abstinence of sexual contact. In some situations, the presence of an STI is unknown and transmission occurs.
Many prescription medications have side effects that affect sexual functioning. Example antidepressants may slow ejaculation.
Drugs such as marijuana, amphetamines, and cocaine enhance sexual functioning. Others, such as opioids and steroids, interfere with sexual functioning.
     Nursing assessment:
·        Are you currently sexually active? With men, women or both?
·        With one or more partner?
·        Describe positive and negative aspects of your sexual functioning?
·        Do you have difficulty with sexual desire?
·        Do you experience any pain with sexual interaction?
·        What are your partner's concerns about your future sexual functioning?
·        Nursing Diagnosis.
·        Ineffective sexuality pattern.
·        Sexual dysfunction.
·        Pain.
·        Anxiety/ fear
Nursing implemention:
    Nurses requires six basic skills to help clients in the area of sexuality
·        Self- knowledge and comfort with their own sexuality
·        Acceptance of sexuality as an important area for nursing intervention and a willingness to work with clients expressing their sexuality in a variety of ways
·        Knowledge of basic sexuality, including certain health problems and treatments may affect sexuality and sexual function and which interventions facilitate sexual expression and functioning
·        Therapeutic communication skill
·        Ability to recognize the need of the client and family members to have the topic of sexuality introduced not only in written or audiovisual materials but also in verbal discussion
·        Providing Sexual Health Teaching

Sex education: 

Teaching self - examination

Breast self - examination, Testicular Self examination:
  • STI prevention
  • Counseling For Altered Sexual Function


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Sexuality
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