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SEXUALITY/SEXUAL RESPONSE
OBJECTIVES:
1. Discuss the concept of human sexuality
2. Describe the components of the human sexual response
3. Analyze the concept of feminism.
CONTENT OUTLINE:
A. Human sexuality
1. Definition: phenomenon that pervades the total person and involves a complex interplay of biologic, psychological, and sociocultural variables.
2. Our sexuality is part of out basic identity. It encompasses our total sense of self as male or female. It involves our attitudes, values, feelings, and beliefs about masculinity and feminity; how we feel about our physical selves. It is the integration of our needs for affiliation and intimacy, and our expressions of love, and affection, as well as our fears, fantasies and decisions regarding our erotic conduct. It influences and is influenced by our interpersonal relationships, our family roles, and our social life-styles. (Roberts, 1980)
a. Biologic sex. Male or female
Chromosomal sex.
Embryology.
b. Gender identity. Ones sense of being female or male; may potentially be different from biological sex. Usually solidified in children by age 3 years.
c. Gender role or sex role. Outward expression of one's gender and is learned early in life. An individual's Perception of what constitutes appropriate behavior, attitudes, beliefs, emotions for a woman or a man and how that is practiced or conveyed in relationships with others.
d. Sexual orientation. Heterosexual, bisexual, homosexual.
e. Sexual self-concept. The notion we have of ourselves as men or women, masculine or feminine. It reflects body image and evaluation of one's adequacy as a man or woman. A person's sexual self-concept can be altered dramatically as a consequence of illness.
B. Human sexual response cycle.
Human sexual response represents an opportunity for the integration of biologic aspects of sexuality with our thoughts, feelings, and interpersonal relationships.
The physical sexual response is one of vasocongestion and myotonia. It is a total body response.
1. Masters and Johnson (1966)
a. Excitement
(1) Genital response
(2) Extra genital response
- Nipple erection
- Venous engorgement of the breasts
- Increase in breast size
b. Plateau
(1) Genital response.
- Orgasmic platform.
Elevation of cervix.(2) Extra genital response
c. Orgasm.
(1) Genital response.
(2) Extragenital response.
d. Resolution
(1) Genital response
(2) Extragenital response.
2. Kaplan model
a. Desire. Neural component. Testosterone is an important component.
b. Excitement. Similar to excitement and plateau of Masters and Johnson's model.
c. Orgasm.
3. Subjective experience of sexual response.
a. Women. Three distinct stages of orgasmic experiences. First, "stoppage" or "suspension". Intense sensation oriented to clitoris. Sense of bearing down. Second, orgasmic response of feeling of warmth that pervades pelvis and spreads. Third, Involuntary contraction of the vagina followed by sensation of throbbing.
b. Men. Two stages. First, feeling of ejaculatory inevitability that develops as seminal fluid collects in the prostatic urethra. Second, sensation of contractions of the urethral sphincter and perception of volume of seminal fluid as it is expelled through the urethra.
4. Variations in sexual expression
5. Homosexuality.
6. Aging and sexuality
7. Sexual history. Clients expect health professionals to be informed, willing to discuss sexual matters openly, prepared to educate and counsel them appropriately.
a. Principles. Privacy, atmosphere of trust, assurance of confidentiality, comfort on the part of the practitioner with her or his own sexuality.
8. Brief sexual assessment. Three questions. The first deals with the person's role, the second with the affective-cognitional elements of sexuality, and the third with biologic aspects of sexual function.
a. Has your (illness, pregnancy, hospitalization) affected your being a (husband, wife, father, mother)?
b. Has your (abortion, heart attack) affected the way you see yourself as a (woman, man)?
c. Has your (colostomy, hysterectomy) affected your ability to function sexually (or your sex life)?
9. Sexual Problem History.
10. Physical assessment.
11. Nursing diagnosis: Sexuality patterns, altered r/t--
Sexual dysfunction, r/t
12. Gender disorders. Transsexualism. What is transvestism?
13. Structural changes interfering with sexual health. Refer to Table 52-1, Phipps, et al, 1991, p. 1520.
14. Physiologic interferences with sexual health. Table 52-2, Phipps, et al, 1991, p. 1522
15. Drug effects on human sexual behavior. Table 52-3, Phipps, et al, 1991 p. 1523.
16. Intervention. Annon's PLISSIT Model for sexual counseling provides four levels of approach to sexual difficulties.
a. Permission
b. Limited information
c. Specific suggestions
d. Intensive therapy.
C. Feminism. A world view that values women and confronts systematic injustices based on gender.
(Bunting and Campbell's Feminism and nursing: Historical perspectives, Annuls of Nursing Science, July 1990, Weisensee's chapter on Women's Health perceptions in a Male-Dominated Medical World, Kjervik & Martinson's, 1986, Sloanes, Biology of Women, 1993)
D. Sexism. A belief that the human sexes have a distinctive make-up that determines their respective lives, usually involving the idea that one sex is superior and has the right to rule the other.
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