Chapter 34: Sexuality and Nursing Care

Sexuality and Nursing Care distinguishes between sexuality and sexual health, defining the latter as a state of physical, emotional, mental, and social well-being requiring a positive and respectful approach to sexual relationships free from discrimination and violence. The text systematically explores sexual development across the life span, starting with gender identity formation in infancy and childhood curiosity, progressing through the physiological changes of puberty and identity exploration during adolescence, and examining the maturation of intimacy in young adulthood. It details the physiological adjustments required in middle adulthood, such as coping with perimenopause and dyspareunia, and emphasizes the continued importance of sexual expression in older adulthood despite age-related changes like the postejaculatory refractory period and decreased vaginal lubrication. Significant attention is devoted to sexual identity and orientation, defining terms within the LGBTQ+ continuum including lesbian, gay, bisexual, transgender, queer, questioning, intersex, asexual, fluid, and pansexual identities, while addressing health disparities and unique stressors faced by these populations. The chapter extensively covers reproductive health decisions, categorizing contraception into nonprescription barrier methods like condoms and diaphragms, fertility awareness-based methods, and prescription interventions such as hormonal contraceptives, intrauterine devices (IUDs), and sterilization procedures like tubal ligation and vasectomy. It also addresses complex issues surrounding infertility, abortion, and the detection and prevention of sexually transmitted infections (STIs) including HIV, HPV, chlamydia, and syphilis, highlighting the critical role of vaccinations and antiretroviral therapies. The nursing process is applied using the Ex-PLISSIT model—Permission, Limited Information, Specific Suggestions, and Intensive Therapy—to guide nurses in conducting sensitive sexual health assessments and history taking. Finally, the text outlines clinical strategies for managing sexual dysfunction caused by illnesses, trauma, or medications such as antihypertensives and antidepressants, emphasizing the nurse's role in education, counseling, and interprofessional collaboration to promote sexual well-being.