Sexuality & Sexual Health

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)