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Sexuality & Sexual Health

This course covers the important components of sexuality and sexual health, including reproductive anatomy and physiology, conception, STDs, and the sexual response cycle. It also addresses normal sexual behaviors and changes associated with puberty and aging. The nurse's role in reproductive health education is emphasized, and expected outcomes such as reduced fear of STDs and improved sexual relationships are discussed.

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Sexuality & Sexual Health

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  1. Sexuality & Sexual Health

  2. Important Components • Reproductive A & P • Conception • STD’s • Sexual Response Cycle • Normal Sexual Behaviors – Heterosexual vs. Homosexual behaviors • Puberty Onset – Adolescent • Changes Associated with Aging

  3. The Nurses Role • Reproductive Health Education • Ongoing • Changes with circumstances and maturity

  4. Examples of Expected Outcomes • Client states he is no longer fearful of contracting a STD • Client states she better able to control symptom of PMS • Couple states they have achieved a mutally satisfying sexual relationship • Client states he is ready to tell family about gay gender identity

  5. Reproductive Development • Sex of individual determined at conception • Oocytes - female egg cells • Sex Hormones • Androgen (Testosterone)– muscular development, physical growth sebaceous gland secretions • Estrogen

  6. Reproductive Development • Puberty – 9 – 14 years • Menarche – 1st menstrual period • Secondary Sex Characteristics • Tanner’s Staging • REVIEW A & P of both male & female systems

  7. Sexual History • Questions Box 4.1 p. 65 Pillitteri

  8. Gender Identity • Sexual identity • Inner sense of person has of being male or female • Family Empowerment – p. 87 – Questions families are hesitant to ask??

  9. Guidelines for Safe Sex Practices • Box 4.3 p. 89 SO IMPORTANT!!!!!!!!!!!!!!!!!!!!!!!!!

  10. Sexual Response Cycle • Similar physiological mechanisms are involved • Vasocongestion • Increased muscle tension • Parallels of the cycle male/female • Erection of clitoris / penile erection • Reflexive muscular contractions • Increased HR, BR, RR

  11. Sexual Response Cycle • Parasympathetic Nervous System • Vasodilation • Penile erection • Vaginal lubrication • Feeling of warmth / relaxation after orgasm • Sympathetic • Increased HR & BP • Ejaculation • Vaginal Spasms

  12. Sexual Response Cycle - Phases • Excitement • Plateau • Stage of Orgasm • Resolution

  13. Disorders of Sexual Functioning • Primary (life long condition) • Secondary • Psychological factors • Physical (Biological) factors

  14. Erectile Dysfunction • Impotence • Viagra p. 95 Pillitteri • Surgical implants

  15. Premature Ejaculation • Ejaculation before penile vaginal contact • Frustration • Serotonergic antidepressants • Counseling

  16. Failure to Achieve Orgasm or Decreased Sexual Desire • Etiology • Poor sexual techniques • Concentrating too hard on achievement • Negative attitudes about sex • Perimenopause • Tx.= estrogen/testosterone

  17. Dyspareunia • Pain during intercourse • Etiology • Endometriosis • Vaginal infections • menopause

  18. Menstruation • Characteristics of Normal Menstrual Cycles • P. 81

  19. Menstruation - Physiology • 4 Body Structures Involved • Hypothalamus • Pituitary Gland • Ovaries • Uterus

  20. Menstruation - Physiology • Hypothalamus • Luteinizing hormone-releasing hormone (LHRH / GnRH) • Initiates the cycle • Presence of estrogen represses these hormones

  21. Menstruation - Physiology • Pituitary Gland • FSH – follicle-stimulating hormone (matures the ovum) • LH – luteninizing hormone (responsible for ovulation & growth of uterine lining)

  22. Menstruation - Physiology • Ovary – releases the matured ovum each month

  23. Menstrual Cycle • Cyclic process of follicular growth & development (ovarian follicle) • Ovulation • Endometrial Stabilization • Menstruation

  24. Menstrual Cycle • Starts due to low circulating levels of estrogen • Stimulation of hypothalamus (gonad releasing hormones –GnRH) • These stimulate Pituitary to produce FSH & LH • Maturation of follicle within the ovary

  25. Menstrual Cycle • Follicles produce Estrogen which feeds back to hypothalamus/pituitary to suppress FSH • Surge of LH causes ovulation

  26. Menstrual Cycle • After ovulation the follicle becomes corpus luteum (yellow body) • Produces progesterone (thermogenic) to stabilize the uterine lining • Life span approximately 14 days • Without conception progesterone levels decrease • Uterine lining sloughs off • Bleeding occurs • Cycle starts all over again

  27. Menstrual Cycle Phases • Proliferative Phase (1st phase) • Hormonal influence estrogen • Endometrium proliferates or thickens • Days 5 - 14

  28. Menstrual Cycle Phases • Secretory Phase – 2nd phase) • Hormonal influence progesterone • Endometrium becomes corkstrew or twisted in appearance and dilated with quantities of glycogen & mucin, sugars & proteins • Lining appears like spongy velvet

  29. Menstrual Cycle Phases • Ischemic – 3rd phase • Loss to progesterone / estrogen support • Endometrium sloughs off / capillaries rupture

  30. Teaching About Menstrual Health • Exercise • Sexual Relations • Activities of Daily Life • Pain Relief • Rest • Nutrition • P. 84 Pillitteri

  31. Menorrhagia • Abnormally heavy menstrual flows

  32. Metrorrhagia • Bleeding between menstrual periods

  33. Premenstrual Dysphoric Disorder (PDD) • Mrs. E is a 26 y.o. female that comes to the clinic complaining of abdominal bloating, H/A and depression for about 8 days prior to her menstrual periods. • How would a diagnosis of PDD be established?

  34. Premenstrual Dysphoric Disorder (PDD) • Describe the current theory regarding the etiology of dysmenorrhea. • How are the pharmacologic & non-pharmacologic treatments of PDD & dysmenorrhea similar?

  35. Menopause • Time of last menses • Post menopause - one year without menstruation • Physiologic cessation of menses associated with decreased ovarian function • Perimenopause – period of irregular bleeding

  36. Menopause • Etiology = decreased estrogen • Average age 47 – 55 years

  37. Menopause - Diagnosis • Symptoms • Increased LH & FSH hormone levels

  38. Menopause – S/S • Irregular menses (Hallmark) • Hot Flushes • Triggers = eating a hot meal, hot weather, drinking alcohol, stress, warm clothing • Changes in vaginal mucosa (atrophic vaginal changes) • Thinning / decreased lubrication • Secretions become more alkaline – infection • Dyspareunia

  39. Menopause – S/S • Atrophic changes of lower urinary tract • Urethral thinning • Lowered bladder sensory threshold to void –Problems with incontinence • Loss of pelvic tone • Dysuria • Urgency/ frequencey • Suprapubic discomfort • Stress incontinence

  40. Menopause • Osteoporosis secondary to bony density loss • Muscle / joint pain • Loss of skin elasticity • Sleep deprivation • Lack of estrogen results in < time spent in REM

  41. Menopause - Management • Hormone Replacement Therapy • Conjugated estrogen • Premarin • Prempro • Evista

  42. Menopause – Health Education • Calcium – 1200 - 1500 mg / day • Lowfat dairy products • Watch intake of junk foods; raise phosphate levels and lower calcium • Vitamin E & B complex may decrease physical & emotional sx • Femininity & libido do not disappear with menopause

  43. Menopause – Health Education • Exercise 20 – 60 minutes 3 X week (strengthen bones and enhance Ca uptake) • Water soluble lubricant (Replens) • Educate HRT • Regular PAP’s / mammograms • Selective Estrogen Receptor Modulators – Evista (increases circulating estrogen thus decreasing bone loss)

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