Chapter 34: Sexuality and Nursing Care

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Welcome to the Deep Dive, your shortcut to being truly well -informed.

Today we're tackling a topic that's absolutely fundamental to holistic patient care,

but one that's often met with silence or, you know, misunderstanding,

sexuality in nursing.

That's right.

We're taking a deep dive into a key chapter from Fundamentals of Nursing by Potter, Perry, Stockard, and Hall, pulling out the really vital insights for you, whether you're studying or already practicing.

And our goal today really is to help equip you with the clinical judgment and maybe more importantly, the communication skills you need to confidently address this essential aspect of health.

We want to distill these sometimes complex concepts into clear, practical takeaways.

You understand not just what to do, but why it matters, you know, in real world settings, hospital, community, everywhere.

Exactly.

We'll cover the foundations, navigating sensitive talks, ethical points, lots to unpack.

Hopefully you'll have some aha moments that really sharpen your understanding and boost your patient care.

Let's get into it.

Okay, so let's start right at the beginning.

What is sexuality from a nursing standpoint?

The source defines it pretty broadly.

It covers sexual identity, intimacy,

thoughts, feelings about your body.

It's framed as a fundamental human need,

really crucial for overall health and well -being all through life.

And that's often confused with sexual health, isn't it?

If you look at the WHO definition, sexual health is more about a state of

physical, emotional, mental and social well -being related to sexuality.

Okay.

So it's way beyond just not having a disease or dysfunction.

It really requires a positive, respectful approach free from coercion or discrimination.

And the key thing for you as a nurse is realizing your own comfort level that directly impacts if a patient will open up.

That makes sense.

Yeah.

Being self away about why you might be uncomfortable and working on that's how you create a safe space.

That's such a good point about patient hesitation.

Yeah.

It's interesting, isn't it?

Even with media talking more openly, lots of patients are still reluctant to bring up sexual concerns with their doctors or nurses.

And that's where you as nurses are really uniquely placed.

You could address this in a relaxed sort of matter of fact way.

Building on that sexuality isn't some separate box.

It's deeply influenced by this whole mix of things, biological, social, psychological, spiritual, religious,

economic, political, historical, cultural factors.

It's all intertwined.

Right.

The real takeaway is you're not just treating a condition.

You're caring for a whole person whose sexuality is woven into their entire life.

Your own values, your patient's values, they all play a role.

So that self -awareness and those therapeutic communication skills are absolutely essential for truly holistic person -centered care.

It's definitely not static.

It changes throughout our lives.

So let's kind of walk through that journey starting from birth up to older adulthood.

In infancy and early childhood, there's that natural curiosity, right?

Physical differences, learning through touch, starting to get a sense of gender identity and how caregivers respond that really shapes a child's early understanding.

Yeah, absolutely.

Then moving into the school age years, puberty starts kicking in big physical and emotional changes.

This is such a critical time for kids to get accurate info from reliable sources like home and school.

Because otherwise.

Otherwise, they often turn to, well, less reliable sources, media, their friends.

And as nurses, you might be involved in helping parents or educators understand what's normal exploration versus, say, problematic sexual play.

Normal play isn't obsessive or unusually advanced or aggressive.

Got it.

Then comes puberty and adolescence.

Sexual interest ramps up.

Peer groups become hugely influential.

That whole am I normal anxiety really kicks in.

And this is when they face big decisions, sexual activity, identity, STIs, contraception, pregnancy.

And the data here is, well, it's striking.

Nearly 40 % of high schoolers report having had sex at least once.

And we see high STI rates in certain groups, but it's so important to understand this is often tied to social factors like poverty or education access, not ethnicity itself.

That's a critical point.

Yeah.

And social media.

It plays a huge, sometimes complicated role in how teens explore sexuality now.

So for you listening, what's the takeaway?

You play a key role in educating parents about giving factual info and helping teens build good decision -making skills.

Your clear, non -judgmental communication can be invaluable guidance, even though teens make their own choices.

Moving into young adulthood, the focus often shifts to emotional maturation in relationships.

Intimacy is still a basic need, and people might need support to achieve satisfying sexual relationships, whatever form that takes for them, partnerships, abstinence, being single.

And then middle adulthood hits.

This often brings new concerns, maybe about sexual attractiveness due to physical changes that are just part of aging.

Right.

And understanding how normal aging affects sexuality is key.

For women, decreased estrogen can lead to less vaginal lubrication, maybe some pain during intercourse dyspereonia, maybe even less desire sometimes.

For men, you often see a longer refractory period after ejaculation, maybe delayed ejaculation.

So a crucial nursing role here is providing that anticipatory guidance, letting people know these changes are normal, and suggesting simple things like using vaginal lubrication.

And then we get to older adulthood.

This group is often overlooked by health care providers when it comes to sexuality,

but studies actually show a positive link between sexual activity and physical health in older adults.

And kind of surprisingly, maybe HIV and SDI rates are actually increasing in this group.

That's right.

Often linked to high -risk encounters, maybe because pregnancy isn't a worry anymore, so protection gets forgotten.

So it really underlines the need for nurses to stay non -judgmental and knowledgeable across the whole lifespan.

Exactly.

Physiologically, things slow down a bit with age, the excitement phase takes longer, orgasm might take longer, refractory time is longer for men, sex hormone levels decrease for both sexes.

But here's something important for you to remember.

For older women, if sex becomes infrequent, it's often related to their partner's health, not necessarily their own lack of desire or ability.

Good point.

Okay, beyond development, let's talk identity and orientation.

These are core parts of who we are.

Can we quickly define those terms?

Sure.

So sexual identity is how you think about yourself sexually.

Gender identity is your private internal sense of being male, female, or maybe somewhere else on the spectrum.

Okay.

Gender role is more about the outward behavior society associates with male or female.

And sexual orientation is about who you're attracted to, romantically or physically.

Got it.

And the bigger picture here for you as a nurse is that you'll care for patients all along the LGBTQ plus continuum.

That's lesbian, gay, bisexual, transgender, queer, questioning, asexual, and others,

plus fluid, pansexual, cisgender folks, everyone.

Your role is acceptance and helping them understand how their health status might impact their relationships and health outcomes.

Cultural competence is key here to help tackle the health disparities these populations often face due to discrimination or lack of sensitive care.

Which leads us right into stressors related to sexuality.

Everyone faces them at some point, right?

Things like contraception issues, infertility, sexual dysfunction.

Yeah.

These are pretty common.

Absolutely.

But it's also crucial to understand the unique stressors LGBTQ plus individuals often encounter.

Things like discrimination, insensitivity, even from healthcare providers sometimes, and a lack of healthcare knowledge specific to their needs.

That must create huge barriers.

It does.

It leads to higher risks for STIs, depression, suicide attempts, victimization.

Nurses are absolutely vital in trying to eliminate these disparities by providing informed, sensitive care and connecting people to the right resources.

Okay.

Let's zoom in on sexual dysfunction.

That's basically problems with desire, arousal, or orgasm, correct?

Correct.

For instance, erectile dysfunction or ED is quite common, especially in older men.

It's often linked to chronic diseases, diabetes, kidney disease, hypertension, neurological issues, and also some common medications.

Which ones?

Things like statins, some antihypertensives, antidepressants, antipsychotics can have ED as a side effect.

On the other hand, hypoactive sexual desire disorder or HSDD, which is low desire, is common in women.

It can be linked to chronic conditions like cancer, hormonal changes, pain, depression, anxiety.

So the medication link is really important.

Definitely.

It's vital that you include potential sexual side effects when teaching patients about their meds.

It's not just a minor detail.

It can really impact whether they stick to their treatment.

Makes sense.

And while we're talking meds, there are treatments for ED like sildenafil, tidalafil, those performance enhancing drugs, but they have serious contraindications, especially for men with heart disease or those taking certain cardiac drugs.

That's a key safety point, something you'd see on the NCLEX.

Good reminder.

Now another major stressor is sexual abuse.

Yes, unfortunately.

A widespread issue across all demographics affecting men and women, often perpetrated by someone they know an intimate partner, a family member.

What signs should nurses look for?

It varies.

In kids, maybe unexplained injuries, recurrent STIs, sudden behavioral changes like aggression or withdrawal.

In adults, maybe similar things, unexplained injuries, bruises at different healing stages, chronic pain, or changes in effect like being really anxious or unusually flat.

Also, relational clues like a partner who insists on answering for the patient or refuses to leave them alone with you.

Those are red flags.

And this really highlights the need for private interviews if you suspect abuse, right?

Absolutely critical.

And remember, as nurses, you are mandated reporters.

You have a legal and ethical duty to report suspected child abuse and elder abuse to the appropriate authorities.

It's a core part of patient safety and advocacy.

Okay, let's shift gears to decisional issues, starting with contraception.

The choices people make here have huge impacts on their lives, physically, personally, socially, financially.

Huge.

Non -prescription methods include things like abstinence 100 % effective if maintained, but well, that can be tough.

Sure.

Barrier methods like spermicides and condoms are over the counter.

Then there are fertility awareness methods, rhythm, tracking basal body temp, cervical mucus, but those require a good understanding of the menstrual cycle.

And it's essential for you to emphasize only latex condoms really reduce STI risk effectively.

Right.

And then there are methods needing a provider.

Yes.

Lots of hormonal options.

The pill, rings, injections, implants, patches, IUDs, also barrier methods like the diaphragm or cervical cap used with spermicide, and then sterilization, which is usually permanent tubal ligation for women, vasectomy for men.

And connecting this back to public health.

Well, the reality is teen pregnancy rates in the U .S.

are still way higher than in other comparable nations, and we still see racial and ethnic disparities.

This just hammers home how vital your role as a nurse is in discussing all the options, clearing up myths, and supporting informed choices.

That's nursing best practice.

Okay.

Another really complex topic.

Abortion.

It's estimated what one in three American women will have one by age 45.

And obviously there's a whole legal and historical context like Roe v.

Wade.

Right.

So how do you as a nurse navigate this?

The key is creating an open nonjudgmental space.

Patients need to be able to discuss their options and their feelings may be loss, grief, guilt, relief, whatever it is for them.

But what about personal values?

Nurses absolutely have personal values, but the professional standard is that those values must never compromise patient care.

If you have a conflict, your responsibility is to ensure the patient still gets the care they need, maybe through a referral or consultation.

It's about upholding patient -centered care, not promoting a specific viewpoint.

Understood.

Okay.

Finally, in this section, let's tackle prevention of sexually transmitted infections, STIs.

Yeah.

And it's sobering because STI rates are still rising significantly, particularly among men who have sex with men and young people aged 15 to 24.

And women often bear the heavier burden of long -term consequences like infertility from untreated infections.

And factors like poverty and access to care play a role here too.

Absolutely.

They contribute to these ongoing disparities.

Okay.

Let's quickly run through some common STIs.

There are bacterial ones.

Right.

Like syphilis, gonorrhea, chlamydia, trichomoniasis, and PID, pelvic inflammatory disease.

These are generally curable with antibiotics, though we are seeing some antibiotic resistance emerge, which is concerning.

And viral ones?

Those include herpes simplex virus, HSV1 and 2, human papillomavirus, HPV, and HIV.

Viral STIs currently cannot be cured.

And a big problem is that many are asymptomatic.

Right.

Especially for women.

Exactly.

That makes detection really tricky.

If symptoms do show up, it might be discharge, pain during sex, or urination, or maybe a rash or lesions.

Okay.

Let's touch on a few specific ones.

HIV.

Human immunodeficiency virus.

It's blood -borne, spread mainly through contaminated needles, sexual contacts, sometimes blood products.

It progresses through stages, an initial flu -like illness, then a long asymptomatic period called clinical latency, and eventually aids if untreated, which is debilitating.

But treatment has improved.

Massively.

Anti -retroviral therapy, RT, has dramatically increased survival, turning HIV into a manageable chronic condition for many people.

Good to know.

What about HPV?

Human papillomavirus.

The most common STI in the U .S.

Most infections clear on their own without symptoms.

But certain high -risk types can cause cervical cancer, other antigenital cancers, and genital warts in both men and women.

Can you describe the warts?

Sure.

They often appear sort of textured, maybe raised or flat, sometimes described as having a cauliflower -like appearance.

Okay.

And prevention.

The vaccine.

Yes.

Cardicil -9.

It's recommended typically for ages 11 through 26 for both males and females, ideally before sexual activity starts.

It's safe and very effective against the main cancer -causing and wart -causing HPV types.

Your role in promoting this vaccine, especially against misinformation, is huge.

Got it.

Chlamydia.

The most reported infectious disease nationally.

Often infects the cervix.

If untreated in women, it can lead to PID, ectopic pregnancy, infertility, major consequences.

And often asymptomatic.

Very often.

That's why annual screening is recommended for all sexually active women, up to age 25.

That's a key point for practice.

Right.

Lastly, syphilis.

Caused by the bacterium treponema pallidum, it has distinct stages.

Starts with a painless sore,

then maybe a rash and swollen lymph nodes, then a latent stage with no symptoms, and potentially years later, tertiary syphilis affecting organs like the heart or brain.

And this is a concern now.

Yes.

Cases are increasing, which is a major public health worry, especially because of the risk of congenital syphilis passing it to a newborn, which can cause severe health problems or death.

Wow.

Okay, so summing up this whole section, what's the bottom line for nurses?

It really comes down to developing those communication skills and maintaining and accepting non -judgmental attitude.

You need to build trust to get those crucial clues about potential STIs or other sexual health concerns that patients might hesitate to bring up otherwise.

Which leads perfectly into the nursing process.

This is how you put it all together, right?

Your roadmap for handling sexual health concerns systematically.

Exactly.

And a really useful framework here is the PLICIT model, which was later expanded to EXPLICIT.

Okay.

Break that down.

So PLICIT stands for permission giving the patient permission to discuss sexuality,

limited information providing basic info related to their specific problem, specific suggestions, offering concrete advice once you understand the issue, and intensive therapy knowing when to refer to someone with more specialized training.

And the EX part.

The EXPLICIT model emphasizes that giving permission isn't just the first step, it should be explicit throughout the entire interaction.

It reinforces normalizing sexuality and encouraging open dialogue as an ongoing process, keeping it truly patient -centered.

Okay, let's make this real with that case study.

Mr.

Clements, 65, recovering from a heart attack, MI, he's on propranolol, and his wife's worried about their sex life.

Right.

So first step,

assessment.

You need to figure out the patient's expectations.

Maybe asking something like, Mr.

Clements, what would you like to know about how your heart condition or medications might affect your sexual needs?

And setting the stage is crucial.

Privacy is absolute.

Close the door, make sure the room is comfortable, watch for anxiety cues, pause if needed.

Remember, some places require a chaperone for breast or genital exams, and you always need to know the rules about parental consent for minors.

When gathering that sexual history, you're looking at a lot, aren't you?

Physical stuff, functional ability,

relationships, lifestyle, development, self -esteem.

Even things that seem small, like fatigue or stress from a new baby, can really impact desire.

And body image changes from illness.

Those can amplify feelings of rejection and decrease desire, too.

You mentioned looking for clues earlier.

Yeah, because patients often do want to talk and don't know how to start.

So you listen for things like maybe they mention worrying about their partner's reaction, or they make a seemingly off -the -cuff sexual joke.

Those can be openings.

So back to Joshua, the student nurse, and Mr.

Clements.

Joshua goes in, closes the door for privacy.

He draws on his STI clinic experience, focusing on being caring and open.

He starts with, Mr.

Clements, I know some people have concerns about their sexuality after having a heart attack.

Do you have any concerns you would like to discuss right now?

And that direct but gentle opening works.

Mr.

Clements shares his fears.

I'm worried about having sex with my wife now.

I haven't been able to since I started on my high blood pressure medicine.

What if I never am able to again?

Wow, that tells Joshua a lot.

And just a reminder, during the physical assessment piece, that's also a prime time for teaching self -exams, breast or testicular, and reviewing STI symptoms, if relevant.

Right.

So after gathering that info, Joshua moves to analysis.

He uses critical thinking.

Based on what Mr.

Clements said, he identifies two main nursing diagnoses.

First, impaired sexual functioning clearly linked to the medication side effects and maybe the physical changes post -MI.

And second, fear.

Fear of having another heart attack during sex and fear that his wife might leave him because of these issues.

And it's crucial here to confirm that the patient sees this as a problem.

The contributing factors you identify, like misinformation versus, say, abuse, will totally change your interventions.

Makes sense.

So next is planning.

Setting goals, generating solutions, always patient -centered, remembering things like using preferred pronouns, maintaining dignity.

Exactly.

What's a good outcome for Mr.

Clements?

Maybe goals like expresses renewed sexual interest within two weeks and achieves a mutually satisfying sexual relationship with his wife within a month.

So the care plan would target those diagnoses.

Precisely.

For impaired sexual functioning and fear, interventions might include sexual counseling and building trust, discussing the actual risks post -MI, explaining the proprinatal side effects, and importantly, including Mrs.

Clements.

Also, anxiety reduction, encouraging him to voice his fears, normalizing those feelings.

And the rationale is solid.

Trust enables openness.

Education provides safety guidelines involving the partner improves outcomes.

Normalizing feelings reduces anxiety.

Right.

And you'd collaborate.

For Mr.

Clements, that means involving cardiologists, maybe physical therapy, dietician, counselors.

It's that interprofessional approach using evidence -based practice.

Okay, step four.

Implementation.

Putting the plan into action.

Your response really matters here, doesn't it?

How you talk about these changes sets the tone for how patients see themselves.

Absolutely.

And health promotion is a big part of implementation.

Educating about contraception, safe sex, STI prevention, self -exams.

For instance, explaining the HPV vaccine for young men and women, ideally before they're sexually active.

That's a key intervention.

Let's talk about teaching safe sex, like condom use.

What are the key steps you'd explain?

Okay, you'd cover the essentials, store them cool and dry, check the expiration date they do expire, never ever reuse one, put it on only when the penis is erect, squeeze the air out of the tip before rolling it down all the way to the base.

After sex, withdraw the penis while it's somewhat erect, holding the condom firmly at the base so it doesn't slip off.

And crucially,

only use water -based lubricants.

Things like petroleum jelly or oil -based lotions can damage latex and cause breakage.

These details matter for safety.

Good to know.

What about during acute illness or after surgery?

Those are huge stressors.

Never just assume sex isn't a concern because someone is older or has a serious prognosis.

Always explore it gently, addressing concerns within their own value system, focusing on their needs.

Let's check back with Joshua.

He's built trust, got a private setting, he's talking about medication side effects, and then an assistive personnel AP comes in with lunch.

What does Joshua do?

He handles it perfectly.

He pauses the conversation and asks Mr.

Clements, would you prefer to continue while you eat or should we pick this up later?

Mr.

Clements wants to continue.

It shows respect, flexibility, maintaining comfort and privacy, even with interruptions.

That's great nursing practice.

This continues outside the hospital too.

Oh yeah.

In restorative care, long -term care, home care, nurses adapt.

Maybe it's helping a couple find comfortable positions, managing a fully catheter discreetly, or even disarranging for privacy in a shared room at a nursing home.

The goal is always supporting sexual expression as part of their well -being.

Okay, final step.

Evaluation.

Seeing if it worked through the patient's eyes.

Right.

You ask directly, have your concerns been addressed?

Are you satisfied?

And you plan for follow -up.

So how did it go for Mr.

Clements?

Joshua follows up.

Yes, about two weeks after discharge.

Joshua calls and asks Mr.

Clements, sometimes patients who've had a heart attack feel anxious about resuming sexual activity.

How are things going for you and Mrs.

Clements?

Did you get a chance to talk with her about your concerns?

And the result?

It's fantastic.

Mr.

Clements says, I really appreciate what you did.

I understand now my side effects.

She understands and our relationship is so much happier.

Thank you.

Wow.

That really shows the impact, doesn't it?

Education, managing anxiety, facilitating communication, it leads to real positive outcomes.

Absolutely.

It highlights the power of addressing sexual health directly and compassionately.

What a deep dive indeed.

We've really covered a lot.

The nuances of development, identity, dealing with tough issues like STIs and dysfunction, and walking through the nursing process with Mr.

Clements, it really underscores how transformative your role as a nurse is in promoting sexual health.

Totally.

And if we zoom out to the big picture, just remember, sexual health is a vital part of overall holistic wellbeing.

Your ability to blend this knowledge with critical thinking and compassionate communication, that's what empowers your patients to address this fundamental human need and live healthier, fuller lives.

We really hope this deep dive gave you some useful facts, maybe some actionable insights, and definitely more confidence in tackling this essential area of nursing care.

Keep learning, keep asking those questions, and keep making that difference.

Last minute lecture team, thank you so much for being part of our learning community and joining us for this deep dive.

The work you're doing is incredibly important and we're here to support you on your journey.

Keep up the truly amazing work.