Sexuality, STIs, and Contraception

Sexuality

• Sexuality changes with each stage of development

Sexual Development

• Includes infancy, early childhood, school-age years, puberty/adolescence, young adulthood, middle adulthood, and older adulthood

Sexual Orientation

Contraception

• Methods include nonprescription and those requiring a health care provider's intervention

Nonprescription Contraceptive Methods

• Abstinence, barrier methods, spermicide, and rhythm

Methods Requiring a Health Care Provider's Intervention

• Hormonal contraception, intrauterine device (IUD), diaphragm, cervical cap, sterilization (tubal ligation or vasectomy)

Sexually Transmitted Infections (STIs)

• Approximately 20 million people in the United States are diagnosed with an STI each year
• Close to half of those diagnosed with an STI are between 15 to 24 years of age
• STIs are transmitted from infected individuals to partners during intimate sexual contact

Curable STIs

• Syphilis, gonorrhea, chlamydia, and trichomoniasis are generally curable

Viral STIs

• Human papillomavirus (HPV) and herpes simplex virus (HSV) type II, human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome are viral STIs

Symptoms of STIs

• Some people infected are unaware because symptoms may be absent or unnoticed
• Common symptoms include discharge from the vagina, penis, or anus, and pain during sex or when urinating
• Blisters or sores in the genital area or fever can also indicate STIs
• Any contact with another person's body fluids around the head or an open lesion on the skin, anus, or genitalia can transmit an STI
• Embarrassment can be a factor

HIV

• Primary routes of transmission include contaminated IV needles, anal or vaginal intercourse, oral-genital sex, and transfusion of blood or blood products

HPV

• Human papillomavirus infection is the most common STI in the United States
• HPV can spread through direct contact with warts, semen, or other fluids

Chlamydia

• Chlamydia can cause infertility, pelvic inflammatory disease (PID), and neonatal complications

Nursing Knowledge Base

• Encompasses factors influencing sexuality and the sociocultural dimension of sexuality
• Impact of pregnancy and menstruation on sexuality should be discussed
• Sexual assessment and interventions need to be included in health care
• Nurses with difficulty discussing sexuality topics need to explore their discomfort to develop a plan to address it

Decisional Issues

• Contraception effectiveness involves understanding the method, consistent use, and compliance with requirements
• When dealing with abortion, select specialties or places of employment where personal values aren't compromised
• STI prevention requires abstinence to be 100% effective

Alterations in Sexual Health

• Infertility means inability to conceive after 1 year of unprotected intercourse
• Nurses have a duty to report suspected abuse to the proper authorities
• Illnesses and medications can affect sexual dysfunction

Nursing Process

• Apply the nursing process and use a critical thinking approach in patient care
• Clinical decision-making can help to develop and implement an individualized plan of care
• Relevant factors, including physical, psychological, social, and cultural, can help determine a patient's sexual well-being

Assessment

• It's important to view the patient's experience through the patient's eyes
• Know patient's expectations and set aside personal views
• Factors affecting sexuality include physical, functional, relationship, lifestyle, developmental, and self-esteem
• Sexual health history needs to be taken
• PLISSIT Assessment of Sexuality provides an avenue for Permission to discuss sexuality issues
• Obtaining Limited Information related to sexual health problems that the patient is experiencing
• Only when the nurse is clear about the problem can the nurse offer Specific Suggestions
• Intensive Therapy with a referral to a professional with advanced training if necessary should be offered

Sexual Dysfunction

• Many illnesses, injuries, medications, and aging changes negatively affect sexual health

Physical Assessment

• Teach patients about breast and testicular self-examination
• Instruct patients on the signs and symptoms of STIs

Nursing Diagnosis

• May include anxiety, ineffective coping, social isolation, interrupted family processes, deficient knowledge (contraception/STIs), sexual dysfunction, and ineffective sexuality pattern

Planning

• Maintain the patient's dignity and identity at all times
• Planning requires developing an individualized plan of care and setting measurable goals and outcomes
• Establish a therapeutic relationship, often including resuming sexual activities
• Understand knowledge base limits needing referrals to community resources

Implementation

• Educate patients about sexual health and encourage regular health and screening examinations
• Illness and surgery create situational stressors that affect a person's sexuality
• Provide information in the home environment on how an illness limits sexual activity
• Offer suggestions for adapting or facilitating sexual activity.

Evaluation

• Ask questions about risk factors, sexual concerns, and levels of satisfaction
• When outcomes are not met, determine appropriate changes in interventions