sexuality and sexual health gender sensitive issue

1. SEXUALITY AND
SEXUAL HEALTH

2. INTRODUCTI
ON
Sexuality is an integral part of being
human.
 Love, affection, and sexual intimacy
contribute to healthy relationships and
individual well-being.
But along with the positive aspects of our
human sexuality, there also are illnesses,
mixed emotions and unintended
consequences that can affect our sexual
health.

3. DEFINITION
• Sexuality is the sum total of our sexual feelings
and behavior
• It is shaped from our values, attitudes, behaviors,
physical appearance, beliefs, emotions,
personality, likes and dislikes as well as the way
in which we have been socialized.

4. SEXUAL HEALTH
• Integration of the physical, emotional,
intellectual and social aspects of sexual being in
ways that positively enhance personality,
communication, pleasure, relationships and love
• Not merely the absence of disease, dysfunction
or infirmity
-WHO

5. IMPORTANCE OF SEXUAL HEALTH
• Irresponsible sexual behavior → problems like
unwanted pregnancies and STDs.
• “Promoting responsible sexual behavior” as one of
the 10 leading health indicators for nation.
-US surgeon general listed in 2001
• Fundamental rights for individual including….
“Freedom from diseases that interfere with
sexual & reproductive function” -
WHO

6. SEXUALITY

7. UNDERSTANDING
SEXUALITY
Sex :
•One’s biological characteristics
•Anatomical, physiological and genetic
(XX; XY)—as a female or as a male.
Gender :
•Refers to what a person, society, or legal
system defines as “female” or “male.”

8. UNDERSTANDING
SEXUALITY
• Gender role : set of socially or culturally
defined attitudes, behaviors, expectations,
and responsibilities that is considered
appropriate for women (feminine) and men
(masculine).
•Gender identity
It is how one chooses to view oneself as a
male or female in integration with others,

9. UNDERSTANDING
SEXUALITY
Sexual orientation –
Heterosexuality - Romantic attraction for sharing
sexual expression with opposite sex
Homosexuality - Sharing sexual expression with
one’s own sex (Gay or Lesbian)
Bisexuality - Sharing sexual expression with
both sexes

10. TERMINOLOGY OF
SEXUALITY
Sexual arousal : state of coital
readiness brought on by a variety of
stimuli.
Masturbation:sexual stimulation by
self.
• Oral sex: stimulation of genitals with
mouth.
• Anal Sex : Sexual stimulation of the
anus

11. TERMINOLOGY CONTD….
• Petting : Sexual activities other than
intercourse
• Pornography : depiction of sex or sex
organs in an erotic manner through
audiovisual stimulation.

12. TERMINOLOGY CONTD….
• Prostitution -commercial sex
• Necrophilia -sex between a living human and a
human corpse
• Incest -sex between close relatives
• Bestiality -humans having sex with non-human
animals
• Judaism -sexual intercourse during a woman's
menstrual period

13. SEXUAL DEVELOPMENT…
• Sexual development starts even before birth and
continues through out the life span.
• A variety of influences have an impact on this
development:
Genetic Influences
Hormonal Influences
Psychological Influences

14. SEXUAL DEVELOPMENT…
• Before birth, the human sexual response
cycle begins.
• The male fetus achieves erections in
utero—and some males are even born
with erections.
• The female sexual response cycle is
functional before birth.

15. DEVELOPMENT…
CONTD..
• 6 months - 1 yr: genital self-exploration &
masturbation occur for both sexes.
• When babies can touch their bodies,
they begin to explore their genitals.

16. SEXUAL DEVELOPMENT…
• By 2 years of age –
• aware of their biological sex
• show an understanding of sexual
identity.
• At 3–5 years of age –
• understand how females and males
should act as well as gender roles
• ask questions like where babies come
from.

17. SEXUAL DEVELOPMENT…
• At 5–12 years:
• begin to show romantic interest.
• The first signs of sexual orientation
(preference toward males or females or
both) characterize this phase.
• At ages 8–13 years:
• the first physical signs of puberty
• Begin slightly earlier for girls than boys.

18. SEXUAL DEVELOPMENT…
• Girls: first menstruation
between ages 9 and 16yrs
•Boys:11- 18yrs - onset of sperm
production.
•pubertal milestones depend on the child’s
nutritional status and may be delayed if
nutritional
status is severely compromised

19. SEXUAL DEVELOPMENT
AFTER PUBERTY
First sexual intercourse
•varies greatly by culture
•mid- to later adolescence is fairly common across
cultures.
First child birth
•Many factors determine when and whether a
person has a first child.
• First childbirth also varies by community and
individual

20. SEXUAL DEVELOPMENT
Menopause
• Female - mid 30s-50s.
• Physiological changes are end of ovulation,
menstruation, and the capacity to reproduce.
• Male - climacteric occurs at 45 to 65 years of
age
• decrease in testosterone production.

21. PSYCHOSEXUAL DEVELOPMENT
THEORY - FREUD
5 stages of psychosexual development
Libido - Freud's word for psychic and
sexual energy.
But in each stage of development there
are frustrations and if not successfully
dealt with, then the libido will be tied to
that stage of development

22. FREUD’S 5 STAGES OF DEVELOPMENT
•ORAL Stage (birth - 1 yr)
•The libido is focused on the mouth.
•Being fixated at this stage means an excessive
use of oral stimulation, such as cigarettes,
drinking or eating.
•ANAL Stage(2-3yrs)
•The libido is focused anally.
• Being fixated at this stage can result in –
stubborness, destructiveness, miserliness
messiness.

23. CONTD ….
PHALLIC Stage
• This period from 3- 6 years
• Focus of energy to genital area
Oedipus complex
• Male child have sexual desires for his mother
• Sees his father as a rival for her affections.
• The boy begins to fear that the father will punish him for
his desires- Castration anxiety
​Electra Complex
Girl’s romantic feelings toward her father
anger towards her mother.

24. CONTD ….
LATENCY Stage (6-12 yrs)
• Period with no developmental events
• Preference for same sex relations
GENITAL Stage (Begins at puberty )
• Maturation of reproductive organs &
production of sex hormones
• Genitals - major source of sexual tension
• Feelings for the opposite sex are a source of
anxiety
• Preparation for selecting a mate

25. DISORDERS
Paraphilias and Sexual
disorders:
Exhibitionism-individual exposes his or her
genitals to a stranger
Fetishism-the individual uses a nonliving object
(e.g., woman’s high heeled shoe, stockings) in a
sexual manner
Frotteurism-the individual touches or rubs
against a non-consenting person in a sexual
manner

26. PSYCHOSEXUAL DISORDERS
• Pedophilia-either intense sexually arousing
fantasies, urges, or behaviors involving
sexual activity with a prepubescent child
(typically age 13 or younger).
• Transvestic Fetishism- sexual interest or
desire to dress in clothes of the opposite sex.
more common for men to have this disorder
than women
• Voyeurism-which the individual observes
stranger who is naked, or engaging in sexual
activity.

27. REGULATION OF SEX
HORMONES
Male
Hypothalamus
↓
GnRH
↓
Pituitary
↓
LH/ICSH
↓
Testes
↓
Testosterone
Female
Hypothalamus
↓
GnRH
↓
Pituitary
↓ ↓
FSH LH
↓ ↓
Follicle Corpus luteum
↓ ↓
Estrogens Progesterone

28. SEXUAL RESPONSE &
PRACTICES
Sexuality on a continuum, ranges from adaptive-
maladaptive.
•The most adaptive responses meet the following
criteria:
Between two consenting adults, mutually satisfying
to both, not psychologically or physically harmful to
either, lacking force or coercion, and conducted in
private.
•Maladaptive sexual responses: include behaviors
that do not meet one or more of the criteria for
adaptive responses.

29. CONTINUUM OF SEXUAL
RESPONSES
Adaptive
responses
Adaptive
responses
Maladaptive
responses
Maladaptive
responses
Sexual
behaviour
that is
harmful,
forceful, non
private, or not
between
consenting
adults
Dysfunction
in sexual
performance
Sexual behaviour
that respects the
rights of others

30. MASTERS AND JOHNSON’ SEXUAL
RESPONSE CYCLE
•Phase I: Desire
•Phase II :Excitement
•Phase III :Plateau
•Phase IV :Orgasm
•Phase V :Resolution

31. SEXUAL RESPONSE CYCLE
CONTD…
Phase I Desire
sexual fantasies and the desire to have
sexual activity.
can not be identified solely through
physiology, reflects persons motivations,
drives and personality.

32. SEXUAL RESPONSE CYCLE
CONTD…
Phase II Excitement
Physiological or psychological stimulation or
both
subjective sense of pleasure.
Characterized by various physiological
changes like:
Penile Erection and Vaginal lubrication
Erection of nipples in both the sexes.
Heightened excitement lasts 30 seconds to
several minutes.

33. SEXUAL RESPONSE CYCLE
CONTD…
Phase III Platueau
•preparation stage for the orgasm/climax
•Continual increase in BP, HR, RR and
muscle tension
•Increase in size of penis and testes
•Release of pre-ejaculatory fluids: these
fluids are responsible for optimum pH for
sperm survival.

34. SEXUAL RESPONSE CYCLE
CONTD…
Phase IV Orgasm
•Peaking of sexual pleasure with release of sexual
tension
•Rhythmic contraction of perineal muscle and
reproductive organs
characterized by:
•4 – 5 rhythmic spasm of prostrate, seminal
vesicle, vas and urethra in males.
• In women characterized by 3 to 15 involuntary
contraction of lower third of vagina and by
strong sustained contraction of uterus.
• Orgasm last for 3 to 25 sec.

35. SEXUAL RESPONSE CYCLE CONTD…
Phase V Resolution:
• Disgorgement of blood from the genitalia which
brings body back to its resting state.
• Refractory period : recovery phase after
orgasm in which it is impossible for an
individual to have additional orgasms.
• Refractory period in men last several minutes to
several hours and does not exist in women.

36. SEXUAL RESPONSE AND SEXUAL
PRACTICES
Sexual Practices:
Safe
Probably Safe
Unsafe in the absence of HIV
testing ,trust and monogamy.

37. SAFE SEXUAL PRACTICES:
 Massage
 Hugging
 Body Rubbing
 Dry Kissing
 Masturbation, Mutual Masturbation
 Hand to Genital Touching
 Erotic Books And Movies
 All sexual Activities when both partners are
monogamous, trustworthy, and known by testing to
free of HIV

38. POSSIBLY SAFE SEXUAL
PRACTICES:
• Wet kissing with no broken skin, cracked lips or
damaged mouth tissues.
• Vaginal or rectal intercourse using latex or synthetic
condom correctly.
• Oral sex on men using latex or synthetic condom.
• Oral sex on women using dental dam, female condom
modified male condom, if she does not have period or
vaginal infection with discharge.
• All sexual activities when both partners are in a long
term monogamous relationship.

39. UNSAFE IN ABSENCE OF HIV
TESTING, TRUST AND
MONOGAMY:
 Any vaginal or rectal intercourse in absence of condom.
 Oral sex on men & women without condom.
 Semen in mouth & Oral anal contact.
 Sharing sex toys or douching equipments.
 Blood contact of any kind including menstrual blood,
or any sex that causes tissue damage or bleeding.

40. METHODS OF CONTRACEPTION
1. Barrier Method
a).Physical Method
b).Chemical methods
c).Combined Method
2. Intra-Uterine
Devices
3. Hormonal method
1. Male sterilization
2. Female sterilization
Spacing
Method
Terminal Methods

42. CONTRACEPTION
Reasons for non use of contraceptives among
unmarried youth:
Did not expect to have sex.
Lack of information about contraception.
Lack of access to contraceptives.
Tend not to plan ahead and think of
consequences.
Think they are not at risk.
Lack confidence and motivation to use.
Embarrassed and not assertive.
Lack power and skill to negotiate use.

43. SEXUAL HEALTH
PROBLEMS
Sexual Health Problems involve:
•Sexually Transmitted Infections
•Sexual Dysfunctions
•Infertility
•Unwanted Pregnancy
•Violence against gender and sexuality

44. SEXUALLY TRANSMITTED
INFECTIONS
Infections that are spread from person to
person through intimate sexual contact.
Older terminology
• Venereal diseases" (vds)
• Sexually transmitted diseases" (stds),

45. SEXUALLY TRANSMITTED
INFECTIONS
•The World Health Organization states that:
•“In developing countries, STDs and their
complications are amongst the top five
disease categories for which adults seek
health care.
•In women of childbearing age, STDs
(excluding HIV) are second to maternal
factors that causes disease, death and
healthy life lost".

46. COMMON STI’SCOMMON STI’S
• Syphilis
• Chlamydia
• Gonorrhea, Hepatitis B
• HIV and AIDS
• Pubic Lice
• Trichomoniasis
• Genital Herpes (HSV-2)
• Genital Warts (HPV)

47. STATISTICS OF
STI
Global trends
•Chlamydia remains the most
commonly reported infectious disease
US
•Gonorrhea is the second most
commonly reported infectious disease
in the United States.

48. STATISTICS OF STI
Current trends in India
• Syphilis is the commonest STI.
• There is significant rise in the cases
of syphilis, herpes genitalis and
genital warts and reduction in that of
chancroid, lymphogranuloma
venereum (LGV), candidiasis,
trichomoniasis and bacterial
vaginosis cases.
Regional STD Centre in New Delhi, 2008

49. SEXUALLY TRANSMITTED
INFECTIONS
Common Symptoms in women
• Sores, bumps or blisters near genitals,
anus or mouth.
• Burning or pain when urinate .
• Itching, bad smell or unusual discharge
from vagina or anus.
• Pain in lower abdomen .
• Bleeding from vagina between
menstrual periods .
• Sometimes symptoms don't show up
for weeks or months or years.

50. SEXUALLY TRANSMITTED
INFECTIONS
Common Symptoms for Males:
•Sores, bumps or blisters near genitals,
anus or mouth.
•Burning or pain while urinating.
•Drip or discharge from penis .
•Itching, pain or discharge from anus.
• Sometimes symptoms don't show up for
weeks or months.

51. SEXUALLY TRANSMITTED
INFECTIONS
Prevention is the Key
Abstinence, or not having oral, vaginal or
anal sex, is the best way to protect.
It is possible to get an STD even without
having intercourse through skin-to-skin
contact.
Use latex condoms correctly for any type
of sex (vaginal, oral or anal) from start to
finish.

52. MANAGEMENT OF STI

53. SEXUAL
DYSFUNCTIONS
Persistent or recurrent inability to
react emotionally or physically to
sexual stimulation in a way expected
of the average healthy person or
according to one’s own standards of
acceptable sexual response.

54. SEXUAL DYSFUNCTIONS
Factors contributing to sexual
dysfunction:
Psychological/emotional factors
• Stress
• Negative body image
• Performance anxiety
• Expectation of failure
• Fear of pregnancy
• Memory of negative sexual experiences
• Fear of acquiring or transmitting a sexually
transmitted disease

55. FACTORS CONTRIBUTING TO
SEXUAL DYSFUNCTION:
Biological/physiological factors
•Changes related to aging
•Certain medical conditions (arthritis,
reproductive cancers, diabetes, cardiac
disease, hypertension)
•Physical injury (such as spinal cord injuries)
•The effects of hormonal contraceptive
methods
•Pregnancy

56. FACTORS CONTRIBUTING TO SEXUAL
DYSFUNCTION:
Interpersonal/social
factors
 Poor communication
with partner
 Sexual abuse
 Attitudes toward
sexual orientation
 Uncertainty of how to
behave
 Conflicts with one’s
partner
Environmental
factors
 Cultural influences
 Gender dynamics
 Availability of
partners (partner
ratio)
 Physical setting
(lack of privacy)

57. SEXUAL
DYSFUNCTIONS
• Sexual Desire Disorder:
• Hypoactive sexual desire disorder
• Sexual Aversion Disorders
• Sexual Arousal Disorder:
• Female sexual arousal disorder
• Male Erectile dysfunction

58. SEXUAL DYSFUNCTIONS
• Orgasmic disorders:
• Female orgasmic disorders
• Male orgasmic disorders
• Premature Ejaculation
• Sexual pain Disorders:
• Dyspareunia
• Vaginismus
• Gender identity Disorder

59. MALE ERECTILE
DYSFUNCTION
A total incapacity to achieve an erection, or the
ability to maintain them for a very short period of
time.
Causes
•Sufficient blood not enters the corpora cavernosa,
due to damage to nerves or arteries caused by a
disease like
-diabetes mellitus
-chronic alcoholism, smoking,
-vascular as well as neurological disease.

60. MANAGEMENT OF ERECTILE
DYSFUNCTION
Inflatable Penile Prosthesis
a fixed mechanical device surgically implanted
within the two corpora cavernosa of the penis,
allowing erection as often as desired
Microsurgery
Penile revascularisation
and venous ligation
Self-injection kit
Papaverine, phentolamine,
prostaglandin E1, & combinations
of these drugs

61. PREMATURE
EJACULATION
• Man ejaculates before his sex partner
achieves orgasm
Causes
• Temporary depression, stress over financial
matters
• Unrealistic expectations about performance,
• Overall lack of confidence
Treatment
• Training and improving mental habituation to
sex
• Physical development of stimulation control
• Dapoxetine (SSRI)

62. FEMALE ORGASMIC
DYSFUNCTION
A woman either can't reach orgasm, or has
difficulty reaching orgasm when she is sexually
excited.
Causes
•A history of sexual abuse or rape
•Boredom and monotony in sexual activity
•Antidepressants like fluoxetine, sertraline etc
•Hormonal disorders, hormonal changes due to
menopause, and chronic illnesses that affect
general health and sexual interest
•Negative attitudes toward sex

63. ORGASMIC DYSFUNCTION
CONTD…
Treatment
•Healthy attitude toward sex by education
about sexual stimulation and response
•Teaching orgasm by focusing on clitorial
stimulation, and directed masturbation.

64. MALE ORGASMIC
DISORDER
• Delay or absence of an orgasm
• Primary male orgasmic disorder - man
has never experienced an orgasm
• Secondary male orgasmic disorder - man
loses his ability to achieve orgasm when he
has experienced them in the past.
Causes
• Hypogonadism
• Thyroid disorders
• Diseases of the penis
• Surgery

65. DYSPAREUNIA
Painful sexual intercourse
Causes
•Injuries to the pelvic area including surgical
scarring, arthritis, fatigue, headaches,
•Menopause
• lack of lubrication in the vagina, fibroid uterus
Treatment
•Hormone therapy
•Water-based lubricant help ease discomfort and
friction

66. VAGINISMUS
When the pubococcygeus, muscles contract
suddenly and uncontrollably before anything can
enter the vagina.
Symptoms
•Burning, stinging or other pain during
penetration
•Difficult or impossible entry of objects into the
vagina
Causes
•Previous urinary tract infections and yeast
infection
•STDs, childbirth, cancer
• Fear of penetration

67. VAGINISMUS
Treatment
•Exploring the vagina through touch
•Desensitization with vaginal dilators
•A paralytic agent such as botox

69. SEXUAL AVERSION DISORDER
Etiology
Sexual trauma in childhood
Symptoms
•Persistent or recurring aversion to or avoidance
of sexual activity.
•During sexual opportunity, the individual may
experience panic attacks or extreme anxiety.
Treatment
•Discovering and resolving underlying conflict or
life difficulties.

70. FEMALE SEXUAL DYSFUNCTION IN
WOMEN ATTENDING
MEDICAL CLINIC IN SOUTH INDIA
Department of Urology, Christian Medical College,
Vellore
Aims: To determine the prevalence and risk factors
for FSD.
Materials and Methods: Administered Female
Sexual Function Index (FSFI) to 149 married women
Results: FSFI domain scores suggested difficulties
with desire in 77.2%; arousal in 91.3%; lubrication
in 96.6%; orgasm in 86.6%, satisfaction in 81.2%,
and pain in 64.4%.

71. INFERTILITY
Considers couple to be infertile if they have not
conceived after 12 months of unprotected
intercourse or after 6 months if woman is over 35
years of age.(International council on infertility
information dissemination –INCIID)
Fertility treatments:
• Fertility Medications
• Tuboplasty
• Artificial insemination
• In Vitro fertilization
• Zygote intrafallopian transfer
• Embryo transfer
• Gamete intrafallopian transfer

72. APHRODISIACS
•Aphrodisiac is a substance (plant, drug, or
food)that increases sexual desire
• The name comes from Aphrodite, the
Greek goddess of sexuality and love
•Eg: Ginseng and Yohimbine,
Bremelanotide,
Phenylethylamine

73. Fruits and
Vegetables
•Strawberries
•Apple
•Apricot
•Avocado
•Cherry
•Cranberry
•Raspberry
•Watermelon
•Pepper
•Mango
•Grapes
•Pomegranate
•Pumpkin
Herbs
•Cinnamon
•Vanilla
•Saffron
•Garlic
Drinks
•Coconut Water
•Red Wine
•Absinthe
•Coffee
Others
•Mushrooms
•Wedding
cake
•Lavender
•Turkey
•Nuts
•Oats
Natural Aphrodisiac Foods

74. DRUGS USED TO ENHANCE
SEXUAL PLEASURE
• Marijuana
• LSD (lysergic acid diethylamide)
• P-chlorophenylalanine, or PCPA
• Amphetamines and Cocaine
• Antidepressants
• Viagra

75. EFFECT OF DRUGS ON SEXUAL RESPONSE

76. EFFECT OF DRUGS ON SEXUAL
RESPONSE
Drug Category Drug Effect
Contraceptives:
• Spermicide
• Combined oral, injectable
contraceptives
• Progestin-only oral or
injectable contraceptives
•Can lower estrogen,
•diminish vaginal
lubrication
•diminish libido
•Can maintain or inhibit
erection
•Can increase spotting,
irregular bleeding;

77. THE EFFECT OF DRUGS ON SEXUAL
RESPONSE CONTD
Drug Category Drug Effect
Psychoactive agents:
• Imipramine
• Doxepin
• Major tranquilizers
• Monoamine oxidase
inhibitors
• Tricyclic
antidepressants
•Interference with desire and
ability to achieve orgasm

78. SEXUAL DYSFUNCTIONS IN OLD
AGE
Physiological changes in men:
• Diminished testosterone level, sexual organ
atrophy,
• Delay in attaining erection, erection of poor
quality,
• Decline in intensity of orgasm
• Decreased hormone levels are associated with
reduced desire.

79. SEXUAL DYSFUNCTIONS
IN OLD AGE
Physiological changes in ageing women :
• loss of elasticity in breast tissue and loss of breast
dimensions
•Cervix and uterus shrink in size
• Walls of the vaginal canal atrophy and vaginal length
and width decrease,
•Decrease in vaginal lubrication
•Sex steroid starvation may indirectly affect sex drive.

80. SEXUAL
DYSFUNCTIONS
Perimenopausal women
• Women fear that menopause signals the end of their
sexual desirability and pleasure.
• Older women are unattractive and asexual.
• There are associated discomfort during transition years
before menopause.

81. REPRODUCTIVE HEALTH IN ADOLESCENTS
Why adolescent reproductive health is
important?
•Adolescents are 1/5th
of world’s population;
India: 22.8%.
•Youth are assets.
Risks like:
•Unintended or too early pregnancy.
•STI including HIV/AIDS
•Unsafe abortion
•Sexual Violence and unwanted sexual
activity

82. RESEARCH INPUT
 Exposure to and opinions towards sex education
among adolescent students in Mumbai: a cross-
sectional survey.
 Benzaken T, Palep AH, Gill PS.
 BACKGROUND:
 The aim of this study was to determine students' exposure
to sex education and identify students' perceptions of
accessibility to sexual health advice and their preferences
in implementing sex education.
 METHODS:
 A cross-sectional study was carried out in junior colleges in
Mumbai in 2010. The self-administered questionnaire
investigated male and female students' (aged 15-17)
exposure and opinions towards sex education. Data was
entered into and analysed using SPSS version 17.0.

83.  RESULTS:
 The questionnaire was completed by 427
students. Almost 90% of students believed it
important to have sex education as part of school
curriculum; over 60% reported prior exposure to
sex education in school. However, only 45% were
satisfied they had good access to advice about
contraception and sexual health, particularly,
females reported more limited access.
 CONCLUSIONS:
 The majority responding indicated a desire for
more widespread implementation of school-based
sex education, particularly amongst female
respondents.

84. SEXUAL AND
REPRODUCTIVE HEALTH
ISSUES IN ADOLESCENT
• 15 millions of adolescents experience pregnancy
each year world wide. Since most of these
pregnancies are unwanted, young women tend
to have induced abortions, whether legal or not.
According to WHO projections, nearly half of
the induced abortions occur under unsafe
conditions. (RH Training in Sexual Health
Research Geneva 2005 )

85. VIOLENCE RELATED TO
GENDER AND SEXUALITY
• Sexual Abuse
• Domestic Violence
• Commercial Exploitation of sex
• Female Genital Mutilation

86. VIOLENCE RELATED TO
GENDER AND SEXUALITY
Sexual abuse
• “attempted or successful coerced intercourse”.
•The prevalence of sexual abuse deserves the
attention of parents and support staff.

87. SILENTLY BEAR SEXUAL ABUSE:
SURVEY
• KANPUR: Nearly 40 per cent of girls in the city are
victims of some form of sexual abuse, revealed a study
conducted by the home science department of Chandra
Shekher Azad (CSA) University of Agriculture and
Technology. Girls of 9-12 years and have been molested
either at schools or homes.
• Out of 249 girls surveyed, 123 reported of instances
where their private parts were touched. Whereas many
girls reported of sexual act where the abuser forced the
girl to touch his genitals.
(Archana Mishra, TNN Feb 21, 2011, 10.50pm IST)

88. VIOLENCE RELATED TO
GENDER AND SEXUALITY
Domestic Violence
•Violence within the family against the
vulnerable group that involves children ,
women and elderly.
•The abuse may include:
Physical abuse
Physical neglect
Sexual Abuse
Emotional Maltreatment

89.  Domestic violence and forced sex among the
urban poor in South India: implications for HIV
prevention.
 Solomon S, Subbaraman R, Solomon SS,
 YR Gaitonde Centre for AIDS Research and Education,
Chennai, India.
 Abstract
 This article examined the prevalence of physical and
sexual violence among 1,974 married women from 40 low-
income communities in Chennai, India. The authors found
a 99% and 75% lifetime prevalence of physical abuse and
forced sex, respectively, whereas 65% of women
experienced more than five episodes of physical abuse in
the 3 months preceding the survey.

90. CONTD…
 Factors associated with violence after
multivariate adjustment included
elementary/middle school education and
variables suggesting economic insecurity. These
domestic violence rates exceed those in prior
Indian reports, suggesting women in slums may
be at increased risk for HIV and other sexually
transmitted infections.

91. VIOLENCE RELATED TO
GENDER AND SEXUALITY
Commercial Exploitation of sex
• Prostitution
• Male prostitution
• Massage parlors
• Sex Rackets
• Pornography
• Obscenity

92. VIOLENCE RELATED TO GENDER
AND SEXUALITY
Female Genital Mutilation (FGM)
•A destructive, invasive procedure usually performed on girls before
puberty.
•Part or all of the clitoris is surgically removed.
•This leaves them with reduced or no sexual feeling.
•Orgasms are sometimes impossible to experience later in life.
•Many health problems result from the surgery.
•FGM originated in Africa.
•It remains, as a cultural, not a religious practice

93. SEXUAL RIGHTSSEXUAL RIGHTS
Sexual rights embrace human rights
•Respect for bodily integrity
•Choose their partner
•Decide to be sexually active or not
•Consensual sexual relations
•Consensual marriage
•Decide whether or not, and when, to have
children
•Pursue a satisfying, safe and pleasurable
sexual life.

94. LAWS CONCERNING SEXUALITY
Laws in India
Article 377 of IPC calls for a maximum punishment of
life imprisonment for all sexual acts against human
nature.
Sexual Assaults
In cases where accused sexually harasses or insults the
modesty of a women by way of either obscene acts or
songs or by means of words, gesture, or acts intended to
insult the modesty of a woman, he shall be punished
under section 294 and 509 respectively

95. PROSTITUTION IN INDIA
• In 2009, the Ministry of Women and
Child Development reported the presence
of 2.8 million sex workers in India
• 35.47 % of them entering the trade before
the age of 18 years
• Mumbai alone being home to 200,000 sex
workers, the largest sex industry centre
in Asia.

96. PORNOGRAPHY
•The Information Technology Act, Chapter
XI Paragraph 67, the
Government of India clearly considers
online pornography as a punishable
offense.
•The Indian Penal Code, 1860 section 293
also specifies, in clear terms, the law
against sale of obscene objects to minors.

97. LAWS TO PROTECT WOMEN
INTEREST
 The crimes identified under the Indian Penal Code (IPC)
 Rape (sec.376 IPC)
 Kidnapping & abduction for different purposes (sec.363 – 373
IPC)
 Homicide for Dowry, Dowry Deaths or their attempts
(sec.302/304-B of IPC)
 Torture, both mental and physical (sec.498-A of IPC)
 Molestation (sec.354 of IPC)
 Sexual harassment (sec.509 of IPC) (referred to in the past
as Eve-teasing)

98. CONTD ….
• Importation of girls (upto 21 years of age)
(sec.366-B of IPC)
• The crimes identified under the Special laws,
such as
 Commission of Sati (Prevention) Act, 1987
 Dowry Prohibition Act, 1961
 Indecent Representation of Women
(Prohibition) Act, 1986
 Immoral Traffic (Prevention) Act, 1956
 Protection of Women from Domestic
Violence Act, 2005

99. RAPE LAWS IN INDIA
• Sakshi, an organisation involved in issues on women
and children.
• Section 375 of the IPC only considers forced peno-
vaginal penetration to be rape.
• The Law Commission released its Report on the
Review of Rape Laws, in 2000 changing the focus from
rape to “sexual assault”, the definition of which goes
beyond penile penetration to include penetration by
any part of the body and objects, taking into account
cunnilingus and fellatio.

100. ANTI-RAPE FEMALE CONDOM (RAPE-AXE)
 Was invented by sonnet ehlers, a south
african woman in august 2005
 Inspired to create it when a patient who
had been raped stated, "If only I had teeth
down there,"
 The rape-axe is a latex sheath embedded
with shafts of sharp,
 Worn by a woman in her vagina like a
female condom.

101. ANTI-RAPE FEMALE CONDOM
• If an attacker were to attempt vaginal rape, his penis
would enter the latex sheath
• causing the attacker excruciating pain during
withdrawal and giving the victim time to escape
• The condom remain attached to the attacker's body
when he withdrew and could only be removed surgically
which would alert hospital staff and police
(LGBT rights in India)

102. INDIA DECRIMINALISED GAY SEX
• Delhi High Court legalized homosexuality on 2
July 2009
• 49-year-old colonial-era law — Section 377 of the
IPC —was decriminalised private consensual sex
between adults of the same sex.
• It is the biggest victory yet for gays rights and a
major milestone in the country's social evolution.
• India was the 127th country to take the guilt out
of homosexuality.
(Manoj Mitta & Smriti Singh, TNN Jul 3, 2009,
01.09am IST)

103. GOVERNMENT INITIATIVE
Government initiative include following programmes
and others:
 Incorporating sex education in syllabus
 Population Council
 Reproductive and Child Health Programme
 National Sexually transmitted diseases prevention
programme
 National AIDS Control programme

104. GOVERNMENT INITIATIVE
Incorporating Sex Education In Syllabus:
•In 7th
standard syllabus, basic information on
reproductive system, its changes in puberty and
menstruation is included
•Educational module and giving training to the
secondary school teachers on sex-education and
provision of information on HIV

105. REPRODUCTIVE AND
CHILD HEALTH
PROGRAMME
•Objectives of RCH:
• Ante Natal Care (ANC) and
Immunization Services
• Extent of Safe Deliveries
• Unmet need for family planning
• Awareness about RTI/STI and
HIV/AIDS
• Utilization of Government Health
Services and user's satisfaction

106. GOVERNMENT INITIATIVES IN
CONTROL OF STDS AND HIV
STD control programme in india since 1946.
Based on diagnosis and treatment of stds and relies on
health seeking behaviour of the individual with std
Five regional STD reference centre
Skin-leprosy-std clinics in medical colleges
735 STD clinics located in district hospitals

107. NACO
• April 2002 ,the GOVT of India approved national AIDS
Control and prevention policy
• objectives include reduction of the impact of epidemic
and to bring about zero transmission rate of AIDS by year
2007.
It includes:
• Blood Safety Programme
• Counseling And HIV testing
• Condom Promotion
• HIV Surveillance
• Behavioral surveillance survey

108. VOLUNTARY ORGANIZATIONS
INVOLVED
 International organizations involve:
Population Council
Center for reproductive rights
Center for health and gender equity
 The organization in India working for awareness
about sexual issues and concerns include:
TARSHI (Talking About Reproductive and
Sexual Health Issues)
Swachetan
Snehi
Sumatri e.t.c

109. SEXUALITY AND
HEALTH SERVICES

110. SEXUALITY AND HEALTH SERVICES
Guiding principles for successful
programme interventions in sexual health:
• Affirmative approach to sexuality
• Autonomy and self-determination
• Responsiveness to changing needs
• Comprehensive understanding of
sexuality
• Confidentiality and privacy

111. CONTD …..
•Cultural diversity
•Equity
•Address violence, sexual violence
and abuse
•Non-judgmental services and
programmes
•Accessible programmes and
services
•Accountability and responsibility

112. NEWER TRENDS..
• Condom vending machines
• Increased use of female condoms
• Mechanical devices for treating erectile
dysfunction and premature ejaculation in men
• Human analogous robots as sex partners

113. ROLE OF THE NURSE
• The role of the nurse is multidimensional and varies
according to the settings, She performs different roles
varying according to the settings:
Public Health centers
Hospital setting
School health Nurse

114. ROLE OF THE NURSE
In Public health centers nurse should be able to:
• Foster comfort and trust between clients and
providers
• Explore underlying issues that affect clients’
needs
• Improve both client and provider satisfaction
• Attract new clients
• Keep the community knowledgeable and support
the community’s role in influencing sexuality and
gender dynamics for achieving and maintaining
healthy sexual and reproductive behaviors

115. ROLE OF THE NURSE
As a school health nurse she should be able to:
• Help to increase sexual and reproductive health
knowledge and promote sharing of information.
• Help to understand changes in their bodies
throughout their life cycle.
• Improve their knowledge about safe sex practice
and provide help to psychological and physical
issues involved with sex.

116. ROLE OF THE NURSE
• Role of the nurse in hospital setting:
•Along with imparting knowledge she should take
care of various sexual concerns of the client.
•Nurse should be sensitive to the cues of the
sexual needs of the clients.
•Assist in various procedures to improve sexual
health and provide family planning services to
the client
•Provide privacy to the client with his partner.

117. SUMMARY
• Definition
• Sexual Development Stages
• Terminologies
• Freud’s psychosexual development theory
• Sexual response cycle
• Sexual practices
• Sexual health problems
• Sexual rights
• Laws concerning sexuality
• Government initiative
• Role of nurse

118. CONCLUSION
• Nurses have an important role in understanding
the sexuality and concerns of the patients and
public regarding that.
• For this first they themselves have to understand
their own attitudes and feelings towards sexuality.

119. REFERENCES
 Synopsis of Psychiatry.Behaviour Sciences/ clinical psychology 9th
edition, Kaplan
& Sadocks Pages 692-730.
 Psychiatric- Mental Health nursing 4th
edition ,Barbara Scheon Johnson, Pages
187-195.
 Dr. Bir Singh, Dr.V.P. Reddiah, A Handy Guide for Good Sex & Family Life,
AIDS education and Training Cell, CCM, AIIMS, 4th
edn,2008, pages 1-84
 http://www.engenderhealth.org/res/onc/sexuality/
 Gail Wiscarz Stuart, PhD, APRN, BC, FAAN, Principles and Practice of
Psychiatric Nursing, Mosby, 8th Edition, pages : 549-561
 RH Training in Sexual Health Research Geneva 2005.
 http://www.gfmer.ch/PGC_RH_2005/pdf/Adolescent_sexual_reproductive_health.pd
 http://allpsych.com/disorders/paraphilias/index.html
 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2268872/?tool=pmcentrez

120. Thank You