Human Sexuality . For Physicians

Although this section was originally developed to educate providers regarding Human Sexuality and the role of the primary care physician, most of the sections are very relevant to parents and individuals who desire introspection and understand factors that influence sex and sexuality. 

Why do providers and physicians need to talk about sex?

Sexuality is an important aspect of life - it is intimately tied to relationships & personal adjustment.  Sexual expression begins in infancy and can continue until end of life.  Sexual behavior serves numerous functions related to physiological and psychological development & well-being, in addition to procreation.  Sex is a source of pleasure & fulfillment, it also provides way to express feelings, caring, sharing & intimacy.  It also provides way to relieve stress & bonds at an intimate level.   It is a very powerful and a potent form of communication.
 
Family Physicians (FP’s) deal with Sexual Issues which has long been part of medical care.  We can counsel, guide and teach others regarding sexuality.  We need to understand & teach psychosexual development through the life cycle & become role models for students.   Sexual issues are always part of medical care.   Freud set course for physicians to be involved with sexual functioning.   Suffering comes form misinformation, ignorance, and sexual difficulties either physical or psychological.  We need to be sensitive to culture, religion, personal beliefs & attitudes, knowledge, illnesses, and sexual traumas that impact individuals & their context.
  • We can reassure mothers regarding normal anatomical arousal
  • We can be advocates of sexual abuse prevention with parents &children
  • We can address adolescent concerns re: body image, pregnancy, identity, safer sexual practices & individual choices
    contraceptive counseling, fertility, & sexual issues in pregnancy & the postpartum perio
  • We can alleviate embarrassment of older couple whose sexual functioning is affected by arthritis, disability, chronic illness and side effects of medications by addressing the issues with compassion & competency.
  • We may be first to explore gently the options for sexual expression with a widow or widower.

Family Physicians discuss sexual health concerns

  • STD prevention, contraception, altered sexual responses, impact of depression, alcohol, & SA on sexual functioning with the estrangement associated with marital/partner conflict.
  • Healthy People 2000 seeks 75% of Primary Care & mental health care providers to provide preventive HIV & other STD counseling from a baseline of 10%.
  • PCP/s need to be informed, comfortable with the context & content of human sexuality, take appropriate sexual histories & educate re: safe sexual practices, contraception & family planning.
  • PCP’s need knowledge to help patients
  • Knowledge of psychosexual development and sexual responses a/c to gender, helps PCP correct some myths prevalent in culture.
  • Illness, aging, gender, sexual orientation, sexual trauma, medications, culture & religion, impact individual’s sexual desire and response.
  • Knowledge about normal physiology and what can restore functioning when dysfunction occurs.
  • Know the myriad of behaviors which constitute range of sexual expression.
  • Confront personal issues regarding sexuality and recognize how personal issues impact patient care.
  • Use basic tools for sexual histories, PLISSIT model, sexual genograms, sexual response cycle, and diagnosis of sexual disorders, & appropriate referrals for competent & ethical interventions.

Sexual Health

  • WHO says it is the “integration of the somatic, emotional, intellectual and social aspects of sexual being, in ways that are positively enriching and that enhance personality, communication and love”.
  • Characteristics of sexual health are
    • Components of physiologic health
    • sexual self concept
    • body image
    • sexual identity
    • biologic sex
    • gender identification
    • gender role
    • sexual orientation

Stages of Sexual Development

  • At birth: Gender assigned.  It is common for 18 month old to play with genitals.
  • 3 years:  gender identification.  Kids explore and fondle.
  • 4-5 year - normal to masturbate
  • School age:  gender role behavior is learned.
  • 6-12 identification with gender parent.  Both parents & kids have concerns & questions about sexuality and reproduction.
  • Adolescence -- 12-13 primary and secondary sexual characteristics develop.
  • 12-18 - info on body changes, odor, STD, masturbation normal & heavy.
  • Young adulthood - 20 - 40 -- active sexually.  Info on prevention of PG, STD, & good communication
  • Adulthood - 40 - 65 -- less hormone production, adjust to new roles, & reevaluate & direct energies -- look @ aspects of life
  • Late adulthood - 65 + -- sexually active, counsel on adaptation

Factors That Influence Sexuality

  • Culture - dress, rule of marriage, role behavior religious values - guidelines
  • Personal ethic - unwritten code of conduct based upon ethical principles
  • Health status/disease process.
  • Problems That Interfere With Sexuality
     
    • Medication side effects: increase/decrease motivation
    • MI - anxiety, fear, depression, low libido
    • STD - results in fear of transmission = abstinence
    • Chronic pain - decreases sex motivation
    • Joint disease - R/T pain & stiffness
    • Surgery, - ostomies, breast prostatectomy
    • Spinal cord - may or may not effect
    • DBM = male- neurologic erectile dysfunction/ Female - no arousal, lubrication

Assessment of Sexuality

  • Why is patient seeking health care -- screening allows RN and patient to identify problem areas.
  • How does sexuality interact with client?
  • Review psychosexual view of sexual self-concept

  • Usually need a sexual history if:

    • PG
    • Infertility
    • Contraception
    • STD
    • Illness affects function
    • Experiencing sexual problems
  • Techniques of Assessment of Sexuality
     
    • Self awareness, comfort with sexuality
    • Acceptance of other’s expression of sexuality
    • Preparing the patient
    • Preparing the environment - communication skills - caring - rapport - trust
    • Recognize the need of the client and family to have topic of sexuality introduced
    • Lead-in questions.
    • Sexual history

AREAS INCLUDED IN TEACHING PLAN

  • Self Breast Exam
  • Self Testicular Exam
  • Sexual Health Education
  • Responsible Behavior
  • Common Misconceptions
  • Contraception
     
    • Abstinence
    • Coitus interuptus
    • Fertility awareness
    • Mechanical barriers
    • IUD
    • Hormonal
    • Surgical sterilization
    • Abortion
    • Nuvaring
  • Using the Model
     
    • By using model, will be prepared to participate in assisting patient to understand how they may have their needs met
    • Prepares & gains trust with/through good communication, caring and knowledge about the problems the patient is facing
    • Encourages Patient to open up and discuss fears/feelings r/t their specific problem
  • Sexual Harassment
     
    • Unsolicited and unprovoked mental or physical sexually-oriented advances or innuendo, especially between employers and employees. In many instances, compliance with a harasser’s wishes is a condition of continued employment or advancement.
    • Can you list examples of sexual harassment?
    • Can you think of techniques you may use to respond to sexual harassment?

Human Sexuality Quiz

  • Q1. What is the treatment of choice for premature ejaculation?
    A. Plethysmography
    B. Dilators
    C. Squeeze technique
    D. Postage stamp
  • Q2. Which of the following is the most common cause of ED due to a medical condition?
    A. Alcohol
    B. Diabetes
    C. Myocardial infarction & cirrhosis
    D. Propanolol (B-blocker)
 

 
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This service is designed for educational purposes only. You should not rely on this information as a substitute for personal medical attention, diagnosis or hands-on treatment. If you are concerned about your health or that of a child's, please consult your family's health care provider immediately.