Sexuality is an integral human function that’s inevitably colored and influenced by a host of interrelated factors. Its expression reflects the interaction of all the biological, psychological, and sociologic ingredients that affect a person’s self-image and behavior.
Depending on these complex factors, human sexuality can be healthy and enriching, or it can be the source of mental and physical distress. A sexually healthy person is commonly defined as a person who:
❑ exhibits behavior that agrees with gender identity (persistent feeling of oneself as male or female)
❑ can participate in a potentially loving or committed relationship
❑ finds erotic stimulation pleasurable
❑ can make decisions about sexual behavior that are compatible with values and beliefs.
An important group of sex-related disorders results from infection that’s transmitted through sexual contact. These disorders include human immunodeficiency virus infection, gonorrhea, syphilis, chlamydial infections, genital herpes, genital warts, trichomoniasis, chancroid, and lymphogranuloma venereum. Sexually transmitted diseases (STDs) are among the most prevalent infections around the world; gonorrhea, chlamydial infections, and genital warts are approaching epidemic proportions in the United States.
Sexual dysfunction disorders, including arousal disorders, orgasmic disorders, and sexual pain disorders (dyspareunia and vaginismus), may be caused by a general medical condition, psychological factors, or a combination of factors, or they may be substance-induced. Other disorders have a definite physical etiology.
Gender identity disorders and paraphilias are sexual disorders whose diagnostic criteria are found in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.
Physical assessment, primarily a diagnostic tool, can also serve as an excellent opportunity for patient teaching.
❑ During examination of the female, evaluate breast development, pubic hair distribution, and the development of external genitalia. With gloved hands, use a speculum to examine internal genitalia, including the cervix and vagina. Palpate the uterus and ovaries.
❑ During examination of the male, check pubic and axillary hair distribution. With a gloved hand, palpate the penis, scrotum, prostate gland, and rectum. Inspect the penis (shaft, glans, and urethral meatus) for lesions, swelling, inflammation, scars, or discharge. In the uncircumcised male, retract the foreskin to visualize the glans. Examine the scrotum for size, shape, and abnormalities, such as nodules or inflammation. Check for the presence of both testes (the left testis is typically lower than the right).
❑ Inspect and palpate the inguinal canal; you shouldn’t observe any bulging of tissues or organs. (See Male sexual anatomy, page 994.)
Careful assessment helps identify the cause of a sexual problem as psychological or physical. A sexual history provides the basis for prevention, diagnosis, and treatment.
❑ Ensure privacy, as for physical assessment. Allow sufficient time so that the patient doesn’t feel rushed.
❑ Approach a sexual history objectively. Remember, sexual health is relative; avoid making assumptions or judgments about the patient’s sexual activities.
❑ After listening to the patient, determine his level of sexual understanding and phrase your questions in language that he can understand. Avoid technical terms.
❑ Begin with the least threatening questions. Usually, a menstrual or urologic history helps lead into a sexual history.
❑ Inquire about what the patient accepts as normal sexual behavior. Ask about sexual needs and priorities and whether the patient can discuss them with a sex partner.
❑ Assess risk behavior concerning selection of sex partners and specific sexual practices.
❑ Ask about possible homosexual activity, which can influence the risk and treatment of some STDs.
❑ Ask the female patient if she has adequate lubrication during intercourse and if she has ever experienced orgasm or pain with sexual contact. Ask the male patient if he has ever had difficulties with erection or ejaculation.
❑ Ask about current or past contraceptive practices.
❑ Try to use the history therapeutically by encouraging the patient to express anxiety. Such fears may be alleviated simply by providing factual information and answering questions.
Sex therapy can be a vital therapeutic tool for treating sexual dysfunction. Before therapy begins, a history, a physical examination, and appropriate treatment must rule out organic causes of sexual dysfunction. The major forms of sex therapy include psychoanalysis, behavioral therapy, group therapy, classic (Masters and Johnson) therapy, and Kaplan’s sex therapy. The type of therapy appropriate for the patient depends on his problems, needs, and finances.
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Title: Professional Guide to Diseases (Eighth Edition)
Authors: Springhouse
Publisher: Lippincott Williams & Wilkins
Copyright: 2005
ISBN: 1-58255-370-X
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