Freud's Psychosexual Development

• Freud named the development process of the sexual instinct (libido) as "psychosexual development."
• Libido is among the life instincts of a person and it continues throughout life.

Components of the Mind

• The id, ego, and superego are layers of the human mind and although located together, they function separately

• The id is the starting point of pleasure-based desires and overly persistent basic energy

• The id is the basic and most primitive self

• The id's main source is the selfish satisfaction of needs such as sexuality and hunger

• The ego is the part that meets the id's wishes with reality

• The ego balances the id with various defense mechanisms and is the balancing element between the id and superego

• The ego's main task is to provide personal security and allow some requests of the id

• Freud linked memory to the ego with the functions of testing reality, defense, information synthesis, and intelligence

• The superego is an internalized symbol of father figures and cultural mores

• The superego is in conflict with the needs and demands of the id, is aggressive against the id, and keeps taboos alive

• The personality foundations are laid in the first years of life and are difficult to change

• Parents should shape their behavior to help children overcome the developmental tasks of each stage

• Freud divided psychosexual development into five orderly stages that cannot be strictly separated

• Each stage influences the next, and reflects the id’s search for satisfaction

• The five stages occur in age-specific areas

Psychosexual Stages

• Oral (0-1.5 years)
• Anal (1.5-3 years)
• Phallic (3-6 years)
• Latent (6-11 years)
• Genital (12-18 years)

Oral Period (0-1.5 years)

• Developments such as eating, speaking, and toilet training occur
• A child connects with the outside world mainly through the mouth
• A satisfied baby develops a sense of trust in the outside world
• A baby with a trusting relationship will establish similar relationships with other people throughout life
• It satisfies the baby’s libido orally
• Satisfaction comes from the mouth, lips, and tongue, with the teeth and jaw also adding to it
• All the baby’s needs and wishes are gathered in the mouth area
• The mouth is the focal point of arousal
• The baby's first sexual stimulation occurs during bathing and diaper changes
• The pressure and movement of the diaper on the genital area leads to pleasurable sensations
• As control is gained over hand and arm movements, the baby may accidentally touch genitals to relive pleasurable sensations
• The baby boys are more likely to attract to their penises, and baby girls are less likely to touch their genitals because they are hidden
• Sexual interest is normal and healthy

Anal Period (1.5-3 years)

• The source of satisfaction shifts from oral and feeding activities to breech and defecation processes
• Voluntary sphincter control causes a rapid change from a passive to an active state
• The anus is the focus of arousal
• It is a period of separation from addiction and gaining independence
• It involves a struggle against parental control
• The child gains the ability to make voluntary movements
• The child takes great pleasure in gaining control in opposite voluntary movements, for example, pick-throw, hold-release
• The child feels pleasure by holding or releasing feces
• The most enjoyable thing is determining whether to defecate or not
• The child gets attention and rewards for controlling their stool, however they face judgments of good, bad, right, wrong, and shameful
• Negative enforcement like shouting, getting angry, scolding or hitting the child's hands will not be effective
• The child will try again when they get the first opportunity to do so, but this time they will do it with a sense of guilt
• Allows for healthy sexuality in later years
• A healthy anal phase leads to healthy communication with their families and peace with the characteristics of their own sex
• Successful completion of the anal period provides autonomy, independence, and the ability to establish personal entrepreneurship without guilt
• Freud claims that a rigid and pressured attitude from the mother in toilet training can lead to being overly organized, stubborn and frugal, and have self-contempt

Phallic (Oedipal) Period (3-6 years)

• Begins to perceive the existence of themselves and the outside world
• A child begins to understand that there are two different genders and to seek answers as to why
• Children get to know their bodies more closely
• Positive and negative emotions are developed for their own bodies
• The pleasure area resides in the genitals and their surroundings
• Arousal is extremely interesting
• Talking about genitals as you would hands, feet, nose, eyes, and ears helps curiosity and makes the issue normal
• Names for sexual/reproductive organs should be taught
• Thoughts can come about including that if someone thinks of it, it must be known about and therefore action is taken, and therefore the person feels guilty and should be punished
• In order to avoid same sex parents the child feels a sexual affinity for the opposite sex parent. They imitate the opposite sex parent and try to be pleasing to them
• The child's sexual preferences shift as the girl tries to resemble her mother and the boy resembles his father
• The girl tries to win her father’s favor by resembling her mother, and the boy tries to win his mother's favor
• Excessive pressure can be related to the two complexes
• Boys have an Oedipus complex
• Girls have an Electra complex

Oedipus Complex

• The boy approaches his mother with love, and thus engages in a race with his father and may develop hatred for him
• A boy may love his father and want to be like him, or feel hate towards him
• There is conflict in this process
• The boy's penis gains importance not only as an organ of pleasure but also in terms of self-sense
• The penis becomes equivalent to the “whole body”
• If the complex cannot be resolved in a healthy way the Oedipus complex is suppressed into the unconscious mind until adolescence, causing feelings of distress and depression

5 Conditions that must be fulfilled for the Oedipal complex to be resolved

• The mother and father love each other and share their love with the child
• The child senses this love, steps aside and breaks the bond with the mother out of respect for the love of the mother and father
• The father values and spends quality time with his son and creates communication at an appropriate level that the son can understand
• The child can say "I can't do this to my father, he loves me very much and I love him very much" so they can willingly break the bond with the mother out of respect for his father
• The presence of new and non-threatening prospective partners come into the child's life
• Parents allow their children to detach from them
• The child does not have a parent who devalues their sexual identity

Elektra Complex

• It is when a girl admires her father and shows jealousy towards her mother
• Intensified sexual and aggressive impulses and basic security with the mother take place
• The girl both identifies with her mother and must distance herself
• Unhealthy Electra complexes are repressed until puberty with stress and depression. Is concerned with emotional and social relationships

5 Conditions that must be fulfilled for the Electra complex to be solved

• The parents love each other and share their love with the child and the daughter will do the same as the son with the Oedipus complex

• The mother cares and spends quality time with her daughter and a healthy connection is created, so the child feels better breaking the paternal connection and will say "I can't do this to my mother, she loves me very much and I love her very much"

• The presence of new and non-dangerous individuals for the child

• Parents allow their children to detach from them

• The child does not have a parent who devalues their sexual identity

• Complexes can be activated in the following situations: marriage, the wife becoming pregnant and wife giving birth, as well as changes to the behavior or appearance of a partner

Phallic stage results

• Men may experience “pay-off” attachment which may result in erectile dysfunction, premature ejaculation or sexual aversion.
• Women experience dyspareunia, asexuality, frigidity, or disorders/ phobias.

Latency Period (6-11 years)

• A phase where resolution to the Oedipus complex occurs with inactive or decreased sexual drive
• Sexual roles and identities are combined and further reinforced
• Control of instinctive impulses and sexual silence helps with the development of the self (ego) and its abilities
• Pleasure is directed towards objects other than sexual ones
• First love attempts and platonic love happens
• Admiring the opposite sex or choosing them as a partner also becomes prevalent

Genital Period (12-18 years)

• Physiological maturity and hormonal influences happen leading to increases again of sexual urges
• Previously hidden impulses come to the surface
• The genitals are again the focus of arousal

Adolescence

• It sees lots of physical and psychological variance
• Physical/ functional issues happen here

Early Adolescence

• Physical and psychosocial differences are noted
• In adolescence, feelings of confusion and anxiety against the rapid changes in the body, inability to keep up with the changes, unfamiliar bodies, and decreased self-esteem are dominant

Middle Adolescence

• Physical fluctuations are in the process of finishing with more personality autonomy
• Intense emotions are very common. Influence by peers is important
• Confusion regarding how they feel is replaced by acceptance of those feelings
• Behavioral changes occur
• Sexuality and independence increases
• Risk is often taken with increased sexual exploration

Late Adolescence

• Plans are made for future
• Physical changes fade
• Sexual identity develops due to thinking

Adulthood In Women

• Responsibilities and places in people shift here
• Good partnered relationships create differences especially regarding social and sexuality choices

Female Sexuality in Adulthood

• There are the sexual activities: (in marriage), sexuality will grow with the partner, and feelings as a woman increase

Adult Female Concerns

• Sexual needs or issues during: (pregnancy, after pregnancy and infertility)

In Pregnancy

• It should not stop unless a doctor directs so, because issues such as prejudices are a problem that may not harm the baby
• Issues: ( low images of oneself, high levels of stress, not feeling the connection with others)
• Can be prejudices with sex causing harm if the mom has issues

Sexual Relations During Puerperium-Period

• Sexuality with partners during pregnancy
• A society may have varying views
• Some may accept
• But after the birth a woman and/or mom should feel safe and stable within
• The biggest reason women are not happy is a physical one. (as they get older) and it causes issues for their feelings and sex drives

Sexuality With Aging

• The main point is to focus on what could make them better, this is often physical
• Make a personal connection (as a nurse caring for them)

Impact Of Infertility On Sexuality

• Causes stress/ changes and is usually very hard to deal with
• Person may look at self in odd ways: (can become depressed or may see bad connection with marriage)
• In the couples relationships they go through the pain or dealing with issues
• Couples may feel pressure to keep "trying"
• The pressure may cause "homework feelings" or an inability to orgasm or have pain

Factors in The couple’s treatment and relationship when dealing with sexual health and sexuality: ( communication to keep relationship positive through support, a safe self imagine with others, knowing how they feel)

• Always give the couple support and care if they ever are in need

• Men can go through dysfunctions when infertile such as (ED or ejaculatory problems)

Female Factors of Low Fertility

• Sexual arousal disorders
• Orgasmic issues.
• Problems with (muscles clenching tightly or painful intercourse.) may cause stress and physical or emotional struggles
• Keep in mind it takes BOTH people to make it work

Sexuality Problems with the patient/couple dealing with infertility

• Low Self View: The patient feels or may act with "less then" behaviors
• Inability to Keep Relationships: Is the hardest thing that comes with it
• Always ask for what they want from you!

Male Sexuality

• Varicocele: The big one in that men’s testicles are not moving and are stuck near the abdomen. The vessels inside testicles are restricted,
• Common in 3-4 babies
• Most of those times they move after 6 months,
• These can affect low sperm motility and bad sperm _If it's high in the abdomen there’s risk
• The most dangerous point with this is cancer
• Do tests early, if one you can help decrease stress levels (not cancer)
• Varicose vessels cause increased temp and can be corrected by surgery

Climacterium

• Another term for menopause
• Women move from fertile to infertile
• Menopause (permeno, menopause, postmenopause)
• There should be a year with no menstrual or period without fertility aid help or drugs

Transition

• Early = hot skin flashing
• Low = osteoporosis / cardiac or emotional
• Post = these can affect the sexuality of the patient

Changes

• Low estrogen causes these to be bad: bleeding, low or no orgasm, bad sensations
• Make effort and be nice sexually with the wife
• Can cause atopy for the mom, and less arm and hair all over even in needed zones

Affects Women

• Low Desire: They become numb. Hormone issue in estrogen and testosterone is low and needs a doctors approval
• Do the procedures again/ ask about all as usual is a must
• You must do therapy and look for a better partner as the top goal for patient

Aging In Men:

• Low sperm motility.
• Treatment Options for ED Issues*
• Aiding a normal or healthy approach
• Using the correct medicine can help too
• "Use oil when needed always is best if it feels right."

Hormones shift for the men as well

• The androgynous decreases in stages
• With low hormones give men ART
• To increase strength levels and test issues
• These are all methods except Oral supplements are not best

What a caregiver is told

• To help with sexual help, be upfront with care you know
• With pain use (water meds, as this can solve problems)
• Help and love them as family