This document discusses human sexuality, reproductive health, and sexual development. It defines sexuality as encompassing feelings, attitudes, and behaviors related to being male or female. Sexuality develops from birth through adulthood as one explores relationships and responds to cultural norms. Reproductive health involves the ability to have safe and satisfying sexual experiences and decide if and when to reproduce. Sexual health requires respecting one's own sexuality and others'. The document then outlines human sexual response and characteristics of sexual health.

1. Sexuality & reproduction
Learning objectives
After completing this chapter, you will be able
to;
• Define sexuality
• Define reproductive health
• Discuss how sexuality develops
• Define gender identity
• List components of sexual identity
• Discuss how humans respond to sexuality
• List characteristics of sexual health

2. • Sexuality is a complex human characteristic
that refers not just to genital sex but to all the
aspects of being male or female, including
feelings, attitudes, beliefs, and behavior.
• It is an essential part of one’s personality.
• Sexuality is a pervasive aspect of the total self
from birth to death and is an important aspect
of health for people of all ages.
• Sexuality includes a person’s attitudes toward
relationships with people of the same sex,
relationships with those of the opposite sex.
• The ways people dress, talk, and relate to
others are indicators of their sexuality.

3. Reproduction, process whereby all living
organisms produce offspring.
• Reproductive Health is a state of complete
physical, mental and social well-being and
not merely the absence of diseases of
infirmity, in all maters related to the
reproductive system and its functions and
processes.

4. Characteristics of RH
People are able to have:-
 a satisfying and safe sex life
capability to reproduce and the freedom
to decide
right to be informed and have access to
safe, effective, affordable and acceptable
methods for the regulation of fertility
right to access to appropriate health care
services for safe pregnancy and childbirth
and healthy infants

5. •Sexual Health is a state of complete
physical, mental and social well-being in
relation to sexuality, it is not merely the
absence of diseases dysfunction or
infirmity.
•Sexual Health needs:
– Positive and respectful approach to
sexuality and sexual relationships
– Having pleasure sexual experience that are
free of coercion, discrimination, and
violence
– Sexual rights of all individuals to be
respected, protected, and satisfied.

6. • There are no universally accepted sexual
values.
• For example, a sexual practice that is
considered normal in one culture may be
prohibited in another culture.

7. Sex roles are culturally determined patterns
associated with being male and female.
• These patterns are developed as a result of
cultural expectations, customs, norms, habits,
and traditions.
• E.g Infant boys and infant girls are talked to,
handled, and, many times, dressed
differently.
• In many cultures, the role of the man is to be
strong and protective, whereas the woman is
expected to be passive and nurturing.

8. Gender Identity
• Gender refers to the economic, social and
cultural attributes and opportunities
associated with being male or female in a
particular social setting at a particular point
in time.
• It is how the person decides to express
sexuality in behaviors with others of the same
and opposite sex.
• This perspective on one’s sexuality is not
inborn but rather evolves throughout the life
span and may vary according to cultural
expectations and preferences

9. Development of Sexuality
A. Prenatal Sexual Development
• Physiological sexual development begins
with conception.
• About six weeks after conception, if a Y
chromosome is present in the embryo's cells
(as it is in normal males), a gene on the
chromosome directs the undifferentiated
gonads to become testes.
• If the Y chromosome is not present (as in
normal females), the undifferentiated gonads
will become ovaries.

10. B. Childhood
•Infancy- period from birth to about 2
years of age.
•Childhood –period from 2 years of age
to 12-14 years of age.
•After birth, the process of sex-role
socialization begins immediately.
•It is common for children to touch or
play with their genitals or to play
games, such as “doctor” or “house,”
that include sexual exploration.

11. • Such experiences are usually not labeled
sexual by the children.
• Adults will often discourage such behavior
and respond negatively to it.
• Generally by the age of six or seven, children
develop a sense of privacy and are aware of
social restrictions on sexual expression.
• As the first bodily changes of puberty begin,
sometime from the age of 8 to the age of 12,
the child may become self-conscious and
more private.

12. C. Adolescence
• Stage of maturation between childhood and
adulthood.
• Puberty typically begins in girls from 8 to 12
years of age, whereas boys start about two years
later.
• The first menstruation and first ejaculation are
often considered the most important events of
puberty.
• The term denotes the period from the beginning
of puberty to maturity; it usually starts at about
age 14 in males and age 12 in females.
• The transition to adulthood varies among
cultures, but it is generally defined as the time
when individuals begin to function
independently of their parents.

13. D. Adulthood
• More permanent relationships, in the form of
marriage or cohabitation, become prevalent.
• As people age, they may experience physical
changes, illnesses, or emotional upheavals,
such as the loss of a partner, that can lead to a
decline in sexual interest and behavior.

14. • In women, there is a gradual decline in the
function of the ovaries and in the
production of estrogen.
The average age at which menopause (the
end of the menstrual cycle) occurs is about
50.

15. Decreased estrogen leads to
thinning of the vaginal walls,
shrinking of the vagina and labia majora,
and
 decreased vaginal lubrication
• These conditions can be severe enough to
cause the woman pain during intercourse.

16. .
• In men, testosterone production declines
over the years, and the testes become
smaller.
Decreased testosterone lead to
Decrease volume and force of ejaculation
sperm count is reduced,
but viable sperm may still be produced in
elderly men.

17. Sexual orientation
• Describes an individual’s preference for ways
of expressing sexual feelings.
• Like all human behavior, sexual behavior is
complex.
• Sexual orientation is a dynamic lifelong
process of growth.

18. Heterosexuality, sexual orientation toward
people of the opposite sex.
Bisexuality, which is sexual orientation toward
people of either sex.
• The vast majority of women and men may be
described as heterosexual.
Homosexuality, sexual orientation toward
people of the same sex.
• Female homosexuals are frequently called
lesbians.
• In recent years, the term gay has been applied
to both homosexual men and women.

19. Transvestism, the practice of wearing the
clothing of the opposite sex for emotional or
sexual expression.
• Transvestites tend to perceive themselves
either as women with masculine
predispositions, or as men with comparable
feminine predispositions.
• Transvestism occurs among both sexes, but is
more common among men than among
women.

20. Human Sexual Response
• The human sexual response is a combination
of physiological responses and emotional
responses (thoughts and feelings).
• These four phases, listed in the accompanying
display, are experienced by both men and
women.

21. A. Excitement
• The excitement stage of sexual arousal is
characterized by increased blood flow to
blood vessels (vasocongestion), which
causes tissues to swell.
In men,
The tissues in the penis become engorged
with blood, causing the penis to become
larger and erect.
The skin of the scrotum thickens,
Tension increases in the scrotal sac, and
The scrotum is pulled up closer to the body.

22. • In women, vasocongestion occurs in the
tissue surrounding the vagina, causing
fluids to seep through the vaginal walls to
produce vaginal lubrication.
the glans of the clitoris becomes larger and
harder than usual, which is similar with male
erection.
Muscular contraction around the nipples
causes them to become erect.

23. B. Plateau
• During the plateau stage, vasocongestion peaks
and the processes begun in the excitement stage
continue until sufficient tension is built up for
orgasm to occur.
• Breathing rate, pulse rate, and blood pressure
increase.
• The man's penis becomes completely erect and
the glans swells.
• In women, the breasts continue to swell, the
lower third of the vagina swells, creating what is
called the orgasmic platform, the clitoris retracts
into the body, and the uterus enlarges.

24. C. Orgasm
• Orgasm, or climax, is an intense and usually
pleasurable sensation that occurs at the peak of sexual
arousal and is followed by a drop in sexual tension.
• Not all sexual arousal leads to orgasm, and
individuals require different conditions and different
types and amounts of stimulation in order to have an
orgasm.
• Orgasm consists of a series of rhythmic contractions in
the genital region and pelvic organs.
• Breathing rate, pulse rate, and blood pressure increase
dramatically during orgasm.
• General muscle contraction may lead to facial
contortions and contractions of muscles in the
extremities, back, and buttocks.

25. D. Resolution
• During resolution, the processes of the
excitement and plateau stages reverse, and
the bodies of both women and men return to
the unaroused state.
• The muscle contractions that occurred during
orgasm lead to a reduction in muscular
tension and release of blood from the
engorged tissues

26. CHARACTRESTICS OF SEXUAL HEALTH
Expression of a positive body image
Congruence between biologic sex, gender
identity and gender role behavior
Behavior consistent with self-concept
Capacity for physical and psychological
responsiveness, which is enhancing to self
and others
Comfort with a range of sexual behavior and
life style
Acceptance of responsibility for pleasure
reproduction and physical safety

27. • Ability to create and maintain effective
interpersonal relation ship with both sexes
– Care providers require four basic skills to help
clients in the area of sexuality:

28. • Self- knowledge and comfort with their
own sexuality.
• Acceptance of sexuality as an important
area for intervention and a willingness to
work with clients expressing their
sexuality in a variety of ways.
• Knowledge of basic sexuality, including
how certain health problems and
treatments may affect sexuality and sexual
function and which interventions facilitate
sexual expressions and functioning.
• Communications skills.

29.  Factors Influencing Sexuality
 Developmental Level: The development of sexuality begins
with conception and changes throughout the life span.
 Culture:
• Every society develops expectations about acceptable forms
of sexual expression.
• Homo sexuality is strongly condemned in Ethiopian culture,
however in some parts of the world it becomes an integral
part of rituals.
• Because clients may differ in their approaches to sexuality,
care provider must be aware of and consider cultural factors
when approaching sexual issues in health care.
• It is also very important to identify and communicate some
harmful cultural practices related to sexuality such as
manage by abduction, polygamous marriage and other
related ones.

30. Religions Values ; Religion influences sexual
expression.
• It provides guidelines for sexual behavior and
acceptable circumstances for the behavior, as
well as prohibited sexual behavior and the
consequences of breaking the sexual rules.
Personal Ethics: Many individuals and groups
have developed written or unwritten codes of
conduct based on ethical principles.
• What one person views as bizarre, perverted,
or wrong may be completely natural and right
to another.
• Examples include masturbation, oral or anal
intercourse, and cross dressing.

31. Health Status: Healthy minds, bodies, and emotions
are necessary for sexual wellness.
• Many factors can interfere with a person’s
expression of sexuality.
• Some of the common health problems that have
influence on sexuality are:
• Heart diseases, Diabetes mellitus
• Spinal cord injury
• Surgical procedures
• Joint disease, Chronic pain
• Sexually transmitted disease (STDs)
• Mental diseases
• Medications

32. Sexual Expression
• The methods by which people gain satisfaction
through sexual stimulation are varied.
• Touch, smell, sight, sounds, feelings, thoughts, and
fantasy can all contribute to sexual fulfillment in any
form of expression chosen by individuals.
• Forms of sexual stimulation include
– kissing,
– hugging,
– striking,
– squeezing,
– breast stimulation,
– manual stimulation of the genitals, oral-genital
stimulation, and anal stimulation.
• Sexual stimulation may be physical or psychological.
• Erotic stimulation through the use of films, magazines,
and photographs is common.

33. Masturbation:
• Masturbation is a technique of sexual expression in
which an individual practices self-stimulation.
Sexual Intercourse:
• Heterosexual genital intercourse is the most common
image that comes to mind when sexuality is
mentioned.
Alternative Forms of sexual Expression
• Voyeurism is the achievement of sexual arousal or
pleasure from watching, especially secretly, other
people's bodies or the sexual acts in which they
participate.
• Sadism refers to the practice of gaining sexual
pleasure while inflicting abuse on another person.
• Pedophilia is a term used to describe the practice of
adults gaining sexual fulfillment by sexual acts with
children.

34. Nursing Process and Sexuality
• Sexuality is a significant part of health, whether
the client is sexually active or not.
• Talking and listening to clients promotes
intimacy.
• Some care providers, as well as clients, are
embarrassed to talk about sexuality.
• It is imperative to deal with one’s own feelings in
order to decrease the client’s discomfort.
• Nurses must not express shock or disapproval
regarding a client’s sexual practices.
• A question as simple as “what sexual concerns
do you have?” may be used to introduce the
topic of sexuality in a nonthreatening manner.

35. Assessment
• Discussion about sexuality must be sensitive
to cultural and religious differences.
• The sensitive care provider will establish an
atmosphere that encourages the client to
freely discuss his or her concerns.
• Some actions that are conducive to such
discussion include the following:
• Assure privacy and maintain confidentiality.
• Use simple, direct language.
• Provide explanations in terms understood by
the client.

36. • Allow time for the clients’ questions.
• Demonstrate respect by adopting a
nonjudgmental attitude.
• Use open-ended questions to elicit more
information.
• Remember that you are assessing a person, not
just a body part, and respect the client’s wishes
regarding privacy.
• Before beginning the genitalia examination,
consider your patient’s cultural background and
the beliefs that may affect the examination. For
example, some cultures forbid assessment of a
female by a male caregiver.

37. • Nursing diagnosis
Sexual Dysfunction; Change in sexual function
that is viewed as unsatisfying, unrewarding,
inadequate
– Sexual Dysfunction as the etiology
• Impaired Adjustment related to loss of sexual
partner, loss of sexual body part
• Anxiety related to fear of pregnancy, loss of
sexual functioning or desire, effects of disease
process on sexual functioning.
• Pain related to sexual positioning, penile
penetration, effects of genital surgery, lack of
vaginal lubrication.
• Ineffective individual coping related to effects of
body image on sexual expression, change in
sexual partner.

38. • Fear related to pain during sexual intercourse,
history of sexual abuse
• Knowledge deficit (specify: contraceptive
methods, spread of STDS sexual Response,
Genital Anatomy, modes of sexual
expression, Self examination, Effects of
Disease or Medications) related to
misinformation, lack of interest in learning.
• Body image disturbance (specify: surgical
excision of genital Body part, loss of or gain in
body weight) related to fear of rejection.
• Impaired social interaction related to effects
of marital separation or divorce

39. Ineffective Sexuality Patterns; Expressions of
concern regarding his/her own sexuality
Defining Characteristics
• Verbalized difficulties, limitations, or changes in
sexual behaviors or activities
Related Factors
• Lack of significant other
• Conflict with sexual orientation
• Fear of acquiring a sexually transmitted disease
• Fear of pregnancy
• Ineffective or absent role models
• Lack of privacy
• Lack of knowledge

40. Planning /Expected outcomes
• Specific patient goals/out comes will depend on
the nature of the patient’s problem or concern.
• Specific patient goals/out comes to promote
sexual health.
The patient will achieve the following;
• Define the client’s sexuality
• Establish open patterns of communication with
significant others
• Develop self awareness and body awareness
• Describe responsible sexual health self-care
practices, identifying appropriate resources
• Practice responsible sexual expression

41. • Implementing
•Establishing a Trusting care provider Patent Relation
ship
• The care provider needs to project an
objective, non-threatening, nonjudgmental
attitude and an aura of confidentiality.
• Teaching about sexuality and sexual health
– Major goals of patient teaching are a change in
behaviors. Offering information, avoiding fears,
and providing positive reinforcement are some
ways care provider can assist patients to increase
their knowledge about there bodies and sexual
functioning.
• Correcting sexual myths/false belief and
promoting body awareness.

42. • Teaching Self- Examination
– Breast-self examination (BSE). This helps
the client to be familiar with what is
normal.
– Testicular self-examination (TSE)
• Considering contraception
• Facilitation coping with special sexual
Needs
• Teaching responsible sexual expression
• Advocating sexuality needs of patients
• Counseling the patient Regarding sexuality

43. • Evaluating
– Evaluation depends on acquiring information
from the client for most goals/out comes.
– Evaluate how the patient is progressing to ward
sexuality oriented goals by appearance, level of
self confidence, and manner. The nurse needs to
question the patient about progress toward goals
– One line of questioning when evaluating a
patient’s progress is as follows: “in what ways
have you been able to achieve (orgasm, increased
desire, comfortable intercourse, erection)?” What
do you think should be next step?”

44. • Quiz (5%)
1. What is the difference between sexuality and
gender.
2. Homosexuality is universally unaccepted
sexaul orientation.(T or F)
3. Write the stages of human sexual human
response.
4. Write the CHARACTRESTICS OF SEXUAL
HEALTH(3)
5. Plateau is an intense and usually pleasurable
sensation that occurs at the peak of sexual
arousal and is followed by a drop in sexual
tension.(T or F)

45. Be the change you
want to see in the
world!!!!!
Thank you!!!