SEXUALITY

• Scope of sexual well-being and ill-being

  • Sexual well-being: state of being happy, healthy or successful (function)
  • Sexual ill-being: deficient in health, happiness or prosperity (dysfunction)
• Influencing factors on sexuality

  • Physiological: acute illness, infection, surgery, trauma, medications, loss of mobility, decreased activity tolerance, hormonal changes and alcohol or substance abuse
  • Psychological: fear, anxiety, fatigue, mental health, reproductive health concerns and adverse childhood events. Alteration in body image, role confusion, personal conflicts
  • Maturational: changes associated with aging. Lack of general social skills interfere with establishing intimate relationships
  • Environmental: Pollutants and chemicals, social isolation, absence of partner or lack of privacy
• Female sexual disorders

  • Hyposexual activity disorder
  • Sexual aversion disorder
  • Sexual arousal disorder
  • Orgasmic disorder
  • Sexual pain disorder
  • Persistent genital arousal disorder
• Male sexual disorders

  • Erectile dysfunction (ED)
  • Ejaculatory disorders
• Populations at greatest risk for sexual disorders

  • Adolescents
  • Disabilities: cognitive, development, and physical
  • Newly unpartnered
  • Sexual orientation and identification: lesbian, gay, bisexual, transgender, queer
• Individual risk factors for sexual disorders

  • Multiple and casual partners
  • Failure to practice safe-sex measures
  • Use of alcohol, marijuana, or other illicit substances
  • Underlying medical conditions and medications
• Elements of taking a sexual history

  • Partners
  • Practices
  • Protection from infection
  • Past history of infection(s)
  • Prevention of pregnancy
• Female physical examination

  • External inspection and palpation
  • Internal inspection of the vagina/cervix
  • Bimanual palpation (uterus and ovaries)
  • Collection of specimen as needed
• Male physical examination

  • External inspection and palpation of the penis, scrotum, and testicles
  • Digital rectal examination
  • Collection of specimens as needed
• Diagnostic tests

  • Specimen collection
  • Tissue biopsy
  • Aspiration
  • Ultrasound
  • X-ray
  • Laparoscopy
  • Colposcopy
  • Colonoscopy
  • Genetic testing
  • Cancer screening
  • STI testing
  • Hormonal testing
• Emotional/behavioral signals of sexual abuse in children


  • Avoidance or fear of physical contact
  • Symptoms of depression/posttraumatic stress disorder PTSD
  • Self-harm and/or suicidal behavior
  • Difficulties in school, running away from home or school
  • Changes in hygiene regressive behaviors
  • Inappropriate knowledge of sexual topics, behaviors
• Emotional/behavioral signals of sexual abuse in adults


  • Depression, anxiety, PTSD
  • Self-harm and/or suicidal behavior
  • Fear of contact
  • Disruption in personal relationships
  • Strong aversion to consensual sexual activity
• Nurses are mandatory reporters required by law to report all instances of suspected child maltreatment. Mandatory requirements for adults vary by state and by patient.
• Nursing interventions for inappropriate sexual behavior

  • Determine whether behavior is attempt to communicate a physical need
  • Communicate that the behavior is not acceptable
  • Tell the patient how the behavior makes you feel
  • Identify the behavior you expect
  • Set firm limits
  • Try to refocus the patient to the real concerns
  • Report the incident to nursing instructor, charge nurse, or clinical nurse specialist
  • Clarify the consequences of continued inappropriate behavior
• Primary prevention strategies


  • Patient education
  • Condom use
  • Safe-sex practices
  • HPV vaccine
• Secondary prevention (screening) strategies


  • Screening for sexually transmitted infection (STIs)
  • Screening for intimate partner violence
  • Cervical cytologic screening (Pap test)
  • HIV screening
  • Screening for other STIs
• Pharmacologic treatments


  • Antibiotics
  • Phosphodiesterase 5 inhibitors
  • Hormonal contraceptives
  • Male and female hormone replacement therapies
• Non-pharmacologic treatments


  • Vacuum pump for man with ED
  • Vibrator to increase woman's sensations of pleasure during sexual activity
  • Harness, wedge, or other positioning device to help patient with spinal cord injury achieve genital-to-genital contact
  • Cognitive behavioral therapy and sexual counseling
• Surgical causes and treatment options


  • Surgery for prostate cancer may result in erectile dysfunction (ED)
  • Surgery for ovarian cancer may result in early menopause
  • Spinal surgery may impede sexual function
  • Bowel surgery may lead to dysfunctional body image alterations
  • Implantation of prosthetic device for men with ED
  • Reconstructing penile arteries for men with ED
  • Blocking veins that drain blood from penis for men with ED
  • Removal of tissue around vaginal opening for women for relief of pain
• Anticonvulsants

  • decreased sexual desire
  • reduced response
• Antidepressants

  • decreased sexual desire
  • orgasmic delay/dysfunction
  • delayed/failed ejaculation
  • painful erection
• Antihistamines

  • decreased vaginal lubrication
  • decreased desire
• Beta blockers

  • decreased desire
  • erectile dysfunction
• Diuretics

  • decreased vaginal lubrication
  • decreased desire
  • erectile dysfunction
• Narcotics

  • inhibited sexual desire and response
  • erectile and ejaculatory dysfunctions
• Nitroglycerine

  • should not take ED med - vasodilation and decrease BP