Human Sexuality/ Sexual Health

1. Human Sexuality/ Sexual Health

2. Objectives • Define sexual health including dimensions of sexual health • Explain the etiology, pathophysiology, manifestations, complications & collaborative care of clients with common sexually transmitted diseases: gonorrhea, Chlamydia, syphilis, genital herpes & HPV (warts)

3. Discuss sexual assault including risk factors, injuries, complications, collection of evidence, prevention and nursing care in cases of assault. Discuss the etiology, pathophysiology, manifestations, complications & collaborative care of clients with common female reproductive disorders: menstrual & uterine disorders, menopause. Discuss the etiology, pathophysiology, manifestations, complications & collaborative care of clients with common male reproductive disorders: BPH, prostatitis, prostate cancer, testicular disorders, penile disorders.

4. Learning Activities • In your text readings: Chapter 46, 47 & 49. • Society of Obstetricians & Gynecologists of Canada • Public Health Agency of Canada • Canadian Justice System • BPH

5. General Concepts • Human sexuality • Sexually transmitted diseases • Sexual assault & family violence • Prostatic & scrotal disorders • Testicular & penile disorders • Menstrual disorders • Menopause • Uterine disorders

6. Things to Think About…. • What is Sexuality/Sexual Health? Define • In what ways does sexuality impact health? (POSITIVE AND NEGATIVE) • What role do nurses play in sexual health? • What strategies can nurses use, individually and as a group, to ensure sexuality is part of care provided? • How good a job are nurses doing in addressing the last question? • What can we do differently? • How does the media impact on sexual health?

7. Human Sexuality • Sexuality is complex, multidimensional phenomenon, and changes that occur in one area may occur in another • A basic human drive (Oncology Nursing Society) • It involves the physical, psychological, social emotional and spiritual components of an individual • WHO defines sexuality using a holistic approach “positive integration of somatic, emotional, intellectual, & social aspects of being sexual beings in ways that are positively enriching & that enhance personality, communication & love”

8. Human Sexuality • Other components of sexuality are freedom from shame, fear, guilt & misconceptions, & other psychological factors that inhibit sexual responses. • An important component of sexuality is freedom from organic diseases & disorders that may interfere with sexual responses & reproduction (WHO).

9. Our Views About Human Sexuality Are Determined By: • Social rules • Genetic endowment • Cultural rules • Biology – sexual orientation • Psychology – upbringing, values/morals, influences

10. Human Sexuality Each society has rules governing sexual behavior & there is no universal agreement on what is considered normal.

11. Sexual Orientation • Various theories have proposed differing sources for sexual orientation, including genetic or hormonal factors & life experiences during early childhood • However many scientists share the view that sexual orientation is shaped for most people at an early age through complex interactions of biological, psychological & social factors

13. “Psychologists, psychiatrists and other mental health professionals agree that homosexuality is not an illness, mental disorder or emotional problem. Much objective scientific research over the past 35 years shows us that homosexual orientation, in and of itself, is not associated with emotional or social problems”.

15. Sexual Health • Health is not just absence of illness. It includes positive striving for wellness & taking responsibility for the early detection of potential problems & their treatment • Sexual health must be addressed by HCP • The relationship between self-esteem & body-image is involved in how we monitor our health & act promptly on signs of illness

16. Three Dimensions of Sexual Health • Sexual function • Sexual self-concept/gender identity: gender identity (psychological sense of being male or female) • Sexual relationships/social sex role: adherence to cultural norms for feminine & masculine behavior)

18. Sexual & Reproductive Health Basic Premises: • Each individual is responsible • Preventing is always better than treating a condition • Seek early diagnosis and treatment

19. Common Examinations : Sexual/ Reproductive Health When? • Breast self-examination • Breast examination by physician/nurse • Pap smear & Mammograms • Testicular self examination • Testicular examination by physician • DRE for prostate assessment When? Know how and when to perform these tests!

20. Educate! Papanicolaou (Pap) Test • Begin at age 18 (earlier if sexually active) • Schedule test for 1- 2 weeks after LMP • Abstain from sexual intercourse 24-48 hrs before test • Do not use douching, vaginal medicines or spermicidal foams, creams, or jellies 48 hrs before test • Inform HCP if HPV or STI

21. Pap Test: Saves LIVES!!!! • The pap smear test is the only screening test that causes a decrease in occurrences and deaths from cancer

23. Testicular Self Examination • Examine each testicle separately & in comparison to the other • Best to do after warm bath/shower • Be aware of the epididymus (slightly tender & tube like body behind the testicle is normal) • Should be done monthly • Most common cancer between 20-34

25. Sexually Transmitted Infections

26. Sexually Transmitted Infections • Any infection contracted through sexual activities or contact (oral, anal, vaginal) • More than 50 organisms can spread via sexual contact • 5 common STI: Gonorrhea Syphilis Chlamydia Genital Herpes Genital HPV (Warts)

27. STI’s STI’s share the following Characteristics: Transmitted by any sexual activity between opposite-sex or same–sex partners • Having one STI confers no immunity on future reinfection with that STI or with any other STI • Sexual partners of clients need to be assessed for treatment • STI’s affect people from all socioeconomic classes, cultures, age groups • Women bear a disproportionate number of the effects of STI’s • Frustration, anger, fear, shame & guilt are emotions associated with STI’s • STI’s frequently coexist in the same client (Gonorrhea & Chlamydial)

28. Etiology STI’s STI’s Caused by : 1. Bacteria: Gonorrhea, Chlamydia, Syphilis, Bacterial Vaginosis, Nongonococcal Urethritis 2. Viruses: AIDS, Genital herpes & genital warts, Hep A, B, C 3. Protozoa: Trichomoniasis 4. Yeast: Vulvovaginal candidiasis 5. Ectoparasites: Scabies & Pediculosis pubis

29. Risk Factors for Acquiring STI’s • – Sexual contact with an infected person • – A new sexual partner or more than two sexual partners in the past year • – Previous sexually transmitted infections (STIs) • – Vulnerable populations (e.g., injection drug users, incarcerated individuals, sex trade workers, street youth etc.)

30. STI Prevention Health promotion & prevention should focus on 5 major concepts: 1. Education 2. Early Detection 3. Effective DX & RX 4. Evaluation & treatment sexual partners 5. Pre-exposure vaccination if available

31. Prevention & Management STI’s • Assessing the reason for a consultation. • Knowing about STI risk factors and epidemiology. • Performing a brief client history and STI risk assessment. • Providing client-centred education and counselling. • Performing a physical examination. • Selecting appropriate screening/testing. • Diagnosing by syndrome or by organism and post-test counselling. • Treating. • Reporting to public health and partner notification. • Managing co-morbidity and associated risks. • Following up.

33. Assessment Assessment should consist of: • General health & examination • Sexual history, preferences & practices • Previous history STI’s • Specific complaints (60-80% asymptomatic) • Genital health practices (douching) • Contraceptive history • Infection barriers used

34. Chlamydial Infections • Most common bacterial STI • Caused by Chlamydia trachomatis (gram -) transmitted during vaginal, anal, oral sex • Underreported most people asymptomatic • Incubation period 1-3 weeks • High incidence reoccurrence due to lack of treating sexual partners infected

35. Chlamydia

36. Females Most often asymptomatic Vaginal discharge Dysuria Lower abdominal pain Abnormal vaginal bleeding Dyspareunia Conjunctivitis Proctitis (commonly asymptomatic) Males Often asymptomatic Urethral discharge Urethral itch Dysuria Testicular pain Conjunctivitis Proctitis (commonly asymptomatic) Neonates and infants Conjunctivitis in neonates Pneumonia in infants <6 months of age Manifestations

37. Chlamydia

38. Complications Chlamydial Infections Men: • Epididymo-orchitis • Reiter syndrome Women: • Pelvic inflammatory disease • Ectopic pregnancy • Infertility • Chronic pelvic pain • Reiter syndrome

39. Epididymo-Orchitis

40. Reiter’s Syndrome Reactive Arthritis

42. Diagnosis of Chlamydial Infections • Presentation • No definitive test for fast accurate dx • Tissue culture of cellular material from urethral, endocervix or rectum • Rapid non culture test- urogenital secretions to detect C. trachomatis • EIA test ( enzyme immunoassay specimen) 10-20 mls urine

43. Treatment Chlamydial Infections • Doxycycline (Vibramycin) 100mg bid X 7days • Zithromax 1g in a single dose (if ability to comply an issue) • Alternative regimes: • Erythromycin, Floxin, Levaquin Follow-up care: • Return if symptoms persist or recur • Treatment all sex partners • Use of condoms during all sexual contacts

44. Gonorrhea • Second most common STI • Highest among people under 24 yrs. Living in high-density urban areas , multiple partners & unprotected sex • Caused by Neisseria Gonorrhoeae (gram – diplococcus) • Direct physical contact with infected host • Mucosa with columnar epithelium susceptible (urethra-males; cervix, rectum, oropharynx) • Neonates can develop during delivery infected mother • Incubation period 3 to 4 days

45. Gonorrhea

46. Females Cervicitis PID Urethritis Perihepatitis Bartholinitis Males Urethritis Epididymitis Females & Males Pharyngeal infection Conjunctivitis Proctitis Disseminated gonococcal infection: arthritis, dermatitis, endocarditis, meningitis Manifestations

47. Females Vaginal discharge Dysuria Abnormal vaginal bleeding Lower abdominal pain Rectal pain and discharge if proctitis Deep dyspareunia Males Urethral discharge Dysuria Urethral itch Testicular pain, swelling or symptoms of epididymitis Rectal pain and discharge if proctitis Symptoms of Genital Tract Infection With N gonorrhoeae

48. Gonorrhea

50. Females Pelvic inflammatory disease Infertility Ectopic pregnancy Chronic pelvic pain Reiter syndrome Disseminated gonococcal infection Males Epididymo-orchitis Reiter syndrome Infertility (rare) Disseminated gonococcal infection Complications