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Sexuality and Nursing Process: A Literature Review
Abstract
The purpose of this paper is to explore the literature on addressing sexuality and sexual health in nursing practice and using nursing care process for the assessment of sexual problems of individuals. Sexuality is a part of life and being human. Sexual function may be affected negatively owing to disease, treatment or surgery and changes may occur in the sexual function of any individual. In order to maintain the sexual function of individuals and improve the quality of life, health professionals must identify and solve sexual problems. Nurses can use nursing process in determining and addressing the sexual problems of individuals. The literature review was conducted utilizing several databases, selected because of their relevance to the subject under review and including CINAHL, Medline (PubMed) and Nursing Journals (PubMed). Results highlight the benefit of nursing care process in addressing the sexuality and sexual problems of people with various diseases. Nurses are aware that assessing sexuality, diagnosing sexuality problems, and evaluating outcomes of interventions to address patients’ sexuality concerns are part of holistic care. However, they often do not perform sexuality assessment in practice. The conclusion is nurses working in accordance with nursing procedures play a key role in achieving success and providing integrated care help individuals to express their sexual problems.
... [12]. Ayaz and Kubaily [16] have done a study among turkey patients with stoma bags. The findings of the study revealed that there is improvement observed in patient satisfaction with the PLISSIT model [16]. ...
... Ayaz and Kubaily [16] have done a study among turkey patients with stoma bags. The findings of the study revealed that there is improvement observed in patient satisfaction with the PLISSIT model [16]. Thus, above all studies showed that sexual health could be improved through sexual education. ...
... The fourth level is intensive therapy in which patients need intensive treatment and intervention. This is also called the referral phase because patients are referred in this phase [16]. Therefore, the PLISSIT model is considered effective for resolving sexual issues. ...
Objectives: To solve the sexual health problems among young women aged 20-39 years by using a PLISSIT model in rural Sindh Karachi Pakistan. Material and Methods: This Quasi-experiment will carry in the primary health care center of Sindh Karachi, Pakistan. One primary healthcare center will be randomly selected as an intervention group and another center will be selected as control from all primary healthcare centers in Karachi. Intervention and control groups both will have socio-demographic characteristics. The population will be post-married women of age 20 to 39 years. Eligible participants will be randomly selected into control or intervention groups by applying the Balanced Blocked Randomizing method. For estimating sample size a confidence level of 95%, with a power of 80%, and with a dropout rate of 15%, will be used in open epi online software. This led to about 40 participants in each group of Study Protocol 148 intervention and the control group will be the sample size. An adapted questionnaire (tool) called the female sexual functioning index (FSFI) from an Iranian study will be used in the study. Permission has been taken through email from the corresponding author. The questionnaire of FSFI is a validated and reliable measurement for assessing female sexual problems. Analysis Plan: For the statistical analysis, SPSS version 20 will be used and data will be shown in the form of mean and standard deviation. For the comparison of scores between and within the groups, the Pair T-test and repeated measure of variance (ANOVA) will be used. The results will be considered significant for all statistical analyses if P < 0.05. Conclusion: In conclusion, the PLISSIT model and using the FSFI questionnaire, this study aims to contribute valuable insights into addressing and potentially solving sexual health problems among young women in rural Sindh, Karachi, Pakistan. The findings obtained from this research have the potential to inform future interventions and strategies aimed at improving the sexual well-being of this population.
... Bien que le rôle de l'infirmière à l'égard de la santé sexuelle soit fondamental, il demeure néanmoins un domaine d'intervention dont la reconnaissance est précaire et pour lequel une réflexion collective semble nécessaire (10,11). Malgré son caractère holistique, plusieurs autres enjeux pouvant nuire à l'évolution de la pratique infirmière en santé sexuelle sont toutefois identifiés (12,13). Nommons, par exemple, une tendance à la biomédicalisation de cette question, un manque de confiance et de connaissances des infirmières à l'égard de la santé sexuelle, des attitudes conservatrices de la part de ces dernières, l'absence d'évaluation de cette dimension et le transfert de la responsabilité y étant associée à d'autres professionnels jugés plus compétents (12)(13)(14)(15)(16)(17). ...
... Malgré son caractère holistique, plusieurs autres enjeux pouvant nuire à l'évolution de la pratique infirmière en santé sexuelle sont toutefois identifiés (12,13). Nommons, par exemple, une tendance à la biomédicalisation de cette question, un manque de confiance et de connaissances des infirmières à l'égard de la santé sexuelle, des attitudes conservatrices de la part de ces dernières, l'absence d'évaluation de cette dimension et le transfert de la responsabilité y étant associée à d'autres professionnels jugés plus compétents (12)(13)(14)(15)(16)(17). ...
... Ce phénomène est paradoxal, puisque la santé sexuelle devrait normalement s'intégrer à la vision holistique de l'être humain portée par la profession (12). De manière générale, plusieurs éléments contributifs à cette situation sont identifiés au sein de la littérature, soit : une tendance à la biomédicalisation des questions associées à la sexualité, un manque de confiance et de connaissances des infirmières à l'égard de la santé sexuelle, des attitudes conservatrices de la part de ces dernières, l'absence d'évaluation de cette dimension dans la pratique courante et le transfert de la responsabilité y étant associée à d'autres professionnels jugés plus compétents (12)(13)(14)(15)(16)(17). ...
Sexual health and intellectual disability: a narrative literature review and its implications for nursing practice
Issues associated with affectivity and sexuality in the context of intellectual disability have recently been the subject of various interdisciplinary discussions in academia. In nursing, interventions in sexual health are supported with hesitation and those issues constitute a marginal field of nursing research. A narrative literature review was realized in order to establish a portrait of the knowledge produced on this topic in the last decade. This paper illustrates three specific research areas recently developed, namely issues related to sexual autonomy, contextual factors positively or negatively contributing to emotional and sexual life, and the experiences of people identified as having an intellectual disability in this regard. On the basis of these results, different issues related to sexuality and intellectual disability are discussed, including those associated with the negotiation process of affective and sexual life, parenthood as a mediator of emotional and sexual expression, and the inclusiveness issues of sexual diversity in health interventions. Implications for nursing are finally discussed in light of the recent development of its role in sexual health.
... The last step involves referring to a specialist. [26] Currently, there is no sex education in public health centers of Iran, and midwives in these centers are not capable of counseling and educating about sexual problems. In this study, we evaluate the efficacy of applying the first two steps of PLISSIT model in decreasing women's sexual problems and dysfunction. ...
... By reassuring that their feeling is acceptable, the midwife tried to create a comfortable and trusting environment. [26,32] Based on the results of sexual function assessment using the FSFI questionnaire, during permission step, the midwife tried to identify the possible conditions that altered the domain of sexual function, such as knowledge deficit (related to misinformation and sexual myths), anxiety (related to loss of sexual desire or functioning), fear (related to history of sexual abuse or dyspareunia), pain related to inadequate vaginal lubrication, body image disturbance (related to perceived sexual rejection by spouse), and interrupted family processes. Also, the midwife tried to identify the history of the problem, onset and course of the problem, precipitating factors and changes over time, women's perception of causes of the problem, and past treatment. ...
... Talking about sexuality may also give the women some reassurance to continue to engage in their choice of sexual behaviors, provided they are not harmful. [26,32] Physical examination of genital system was done anytime, if needed. In the case of desire phase disorder, the midwife evaluated reasons such as physical or emotional stress, certain drug use, diseases, body image issues, relationship quality, social isolation, and lack of communication. ...
The World Health Organization emphasizes on integration of sexual health into primary health care services, educating people and health care workers about sexuality, and promoting optimal sexual health. Despite the high prevalence of sexual problems, these problems are poorly managed in primary health care services. This study was conducted to evaluate the efficacy and feasibility of the first two steps of PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Treatment) model for handling of women sexual problems in a primary health care setting.
This was a quasi-experimental study that was carried out in Zanjan, northwest of Iran. Eighty women who had got married in the past 5 years and had sexual problem were randomly assigned to control and intervention groups. The intervention group received consultation based on PLISSIT model by a trained midwife and the control group received routine services. Female Sexual Function Index (FSFI) questionnaire was used for assessing and tracking any changes in sexual function. Data were collected at three points: Before consultation and 2 and 4 weeks after consultation. Paired t-test and repeated measures analysis of variance (ANOVA) test were used for comparison of scores within groups.
Significant improvement was found in FSFI sub-domain scores, including sexual desire (P < 0.0001), arousal (P < 0.0001), lubrication (P < 0.0001), orgasm (P = 0.005), satisfaction (P = 0.005), pain (P < 0.0001), and FSFI total score (P < 0.0001) in the intervention group compared to the control group.
This study showed that PLISSIT model can meet the sexual health needs of clients in a primary health care setting and it can be used easily by health workers in this setting for addressing sexual complaints and dysfunctions.
... Sexual health is an essential part of human well-being and a highly important component of quality of life. 1 Many conditions may considerably affect sexual health; disease-related processes, psychological conditions, life events, pregnancy, childbirth, and menopause can directly or indirectly impact sexual functioning and the well-being of patients and their partners and relationships. 2,3 Pregnancy affects multiple physiological and mental functions that may inhibit sexuality. The variations in endocrine function, anatomic changes, and psychosomatic factors that occur during each trimester of pregnancy can lead to sexual dysfunction. ...
... 22 The permission, limited information, specific suggestions, intensive therapy (PLISSIT) model provides a graded framework for SHC nursing. 2,23,24 The PLISSIT model has been validated to improve sexual function in patients with various disease processes 25,26 and during pregnancy. 23 By applying the "limited information" and "specific suggestion" levels of the PLISSIT, the Nursing Intervention on Sexual Healthcare (NISH) scale can be used to further assess the extent of nursing interventions required during SHC. ...
Introduction
Infertility may negatively impact sexual function. Women with fertility problems usually prioritize treatment for infertility, but their sexual function in each trimester of pregnancy is poorly researched.
Aim
To compare the sexual function and sexual healthcare needs of women who underwent successful in vitro fertilization (IVF group) and women who conceived naturally (CN group) during each trimester.
Methods
Longitudinal prospective cohort study was conducted from August 2016 to July 2018. The IVF group (n = 100) was recruited from a leading reproductive treatment center; the CN group (n = 100), at the prenatal clinic of a medical center in central Taiwan. Questionnaires were mailed to women in the 10th–11th gestational week; 70 women in the IVF group and 75 in the CN group completed all 3 questionnaires, during the 10th–11th, 20th–21st, and 30th–31st gestational weeks.
Main Outcome Measures
Female Sexual Function Index and Nursing Intervention on Sexual Healthcare needs were compared between groups in each trimester.
Results
Most participants reported sexual dysfunction concerns during pregnancy. In the first trimester, the Female Sexual Function Index score was significantly lower in the IVF group than in the CN group (18.13 ± 6.27 vs 20.34 ± 5.87, respectively; P < .05). Sexual healthcare needs at the permission level were significantly lower in the IVF group than in the CN group (10.78 ± 2.41 vs 11.79 ± 2.67, respectively; P < .05).
Conclusion
The IVF group had lower sexual function in the first trimester than the CN group. Sexual function improved in the second trimester in the IVF group but decreased throughout pregnancy in the CN group. The CN group had a greater need for sexual healthcare nursing intervention at the permission level than the IVF group.
... Mostly in Pakistan Midwives, LHWs and LHVs are unskilled in counseling and education for sexual problems. Applying the PLSISIST model for reducing sexual problems is the right option to improve sexual health [22]. In a session of sexual education and counseling, attraction, perceive values, and behaviors are discussed openly. ...
This literature synthesis explores the topic of addressing sexual problems among women aged 20-39 years in rural primary health care centers in Karachi, Sindh, Pakistan, using the PLISSIT model. The study aims to provide an overview of relevant literature and highlight the importance of implementing the PLISSIT model in addressing sexual health issues in this specific population. The literature review was conducted through comprehensive searches using databases such as Google Scholar, PubMed, CINAHAL, and ScienceDirect. A total of 45 articles were selected for review, with a focus on research articles, review articles, reports, and books published within the past five years. The search strategy also included accessing relevant publications through the Aga Khan University library, resulting in the inclusion of 31 references for paraphrasing and inclusion in the study. The background section emphasizes the significance of reproductive health and sexual health as essential components of overall well-being. Sexual health is often considered a sensitive and taboo topic in rural communities, making it challenging to openly discuss sexual health issues. The literature review reveals those developing countries, including Pakistan, face challenges in addressing sexual health effectively. Limited awareness and information contribute to the prevalence of sexual problems and concerns among women. Specific educational programs, seminars, and workshops targeting rural communities are necessary to raise awareness and provide information about sexual behaviors and practices. The literature synthesis concludes by emphasizing the need for governments, policymakers, and public health authorities to prioritize sexual health as an integral component of overall health and well-being. The prevalence of female sexual dysfunction is found to be high in both developed and developing countries, including Iran. The review also highlights the marginalization and neglect of sexual health issues faced by women with disabilities. In conclusion, this literature synthesis provides a comprehensive overview of relevant literature related to sexual health issues among women aged 20-39 years in rural primary health care centers in Karachi, Sindh, Pakistan. This includes literature relevant to the study objectives. This synthesis starts with a drawing of the method of searching strategy to obtain data significant to the study topic. Google Scholar, PubMed, CINAHAL, and science direct were used as search databases. This whole chapter consists of six parts in which the first part is about sexual health and their perception globally, and the second part is about the prevalence of sexual problems among women globally, in Asia, and in Pakistan. Moreover, the third part is about sexual education, a counseling program for tackling sexual problems, while the fourth part is about the implementation of the PLISSIT model in primary health care centers, t h e fifth part is about a brief summary of the literature and the last part is about why my study is important and how it will contribute to the literature. SEARCH STRATEGY library. The searched literature filtered, recent publications about the past 5 years mostly selected reviews. About 45 articles were selected for the literature review and about 31 were referenced for paraphrase. Then finally the main body is paraphrased from the literature in a systematic way with resonating own ideas. BACKGROUND
... These stages are assessment, planning, implementation and evaluation. In order to give effective and qualified psychosexual care to people, nurses working in accordance with nursing process play a key role in achieving success [23] . ...
... Sexual health cannot be studied in isolation as a physical concept [59]; instead, it should be explored as a multidimensional phenomenon focused on the 'whole woman.' As such, clinicians need to assess, identify, and intervene to improve the sexual health of individual women, taking into consideration their perspective, as part of holistic care [66]. ...
Background
Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain).
Methods
This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi’s seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis.
Results
Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.
Conclusion
Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.
... As such, clinicians need to assess, identify, and intervene to improve the sexual health of individual women, taking into consideration their perspective, as part of holistic care. [66] In the Spanish context, there are ve studies reported in the literature that explore any aspect of postpartum sexuality [32][33][34][35]67], with minimal focus on sexual health. Two of the Spanish postpartum and sexuality studies used observational methods to understand the mode of birth and postpartum sexual functioning in Madrid [34] and self-esteem and self-image of women in Navarra. ...
Background: Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain).
Methods: This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi's seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis.
Results: Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.
Conclusion: Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.
... The participants also delayed seeking care, or seeking care without disclosing their lifestyle. These fi ndings support previous literature [12,[29][30][31][32][33] that highlights that HCPs receive very little education and training in sexuality in their undergraduate programmes, and even less about alternative sexual lifestyles. [34] This lack of education leads to HCPs being uncomfortable discussing sexuality, regardless of the health care setting. ...
Consensual non-monogamous parenting couples are at increased risk for health inequities, especially during the transition to parenthood. This article presents partial results of a more extensive mixed-methods study exploring the conciliation of these couples’ parenting role and their sexual lifestyle, more specifically, their perceptions of health care providers including nurses. Semi-structured interviews and online questionnaires were completed with a total of 6 participants. Positive and negative issues were identified that were clients- and health care providers-based. The Expanding the Movement for Empowerment and Reproductive Justice lens was used to discuss the positive and negative consequences. Nurses need to develop, implement and evaluate a different clinical approach with these couples, who are aware of the health risks associated with their lifestyle, yet they always put their families first. Nurse administrators need to assess their institutional policies that are based on hetero-mononormative assumptions.
... As such, clinicians need to assess, identify, and intervene to improve the sexual health of individual women, taking into consideration their perspective, as part of holistic care. [66] In the Spanish context, there are ve studies reported in the literature that explore any aspect of postpartum sexuality [32][33][34][35]67], with minimal focus on sexual health. Two of the Spanish postpartum and sexuality studies used observational methods to understand the mode of birth and postpartum sexual functioning in Madrid [34] and self-esteem and self-image of women in Navarra. ...
Background: Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain).
Methods: This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi's seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis.
Results: Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.
Conclusion: Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.
... As such, clinicians need to assess, identify, and intervene to improve the sexual health of individual women, taking into consideration their perspective, as part of holistic care. [66] In the Spanish context, there are ve studies, reported in the literature that explore any aspect of postpartum sexuality [32][33][34][35]67], with minimal focus on sexual health. Two of the Spanish postpartum and sexuality studies used observational methods to understand the mode of birth and postpartum sexual functioning in Madrid[34] and self-esteem and self-image of women in Navarra. ...
Background: Sexual health is a multidimensional phenomenon constructed by personal, social, and cultural factors but continues to be studied with a biomedical approach. During the postpartum period, a woman transitions to mother, as well as partner-to-parent and couple-to-family. There are new realities in life in the postpartum period, including household changes and new responsibilities that can impact the quality of sexual health. This phenomenon is understudied especially in the context of Spain. The purpose of this study was to describe the lived experience of postpartum sexual health among primiparous women giving birth in Catalonia (Spain).
Methods: This was a phenomenological study with a purposive sample of primiparous women. Data was collected through semi-structured interviews until saturation. Analysis followed Colaizzi's seven-step process with an eighth translation step added to limit cross-cultural threats to validity. Also, the four dimensions of trustworthiness were established through strategies and techniques during data collection and analysis.
Results: Ten women were interviewed from which five themes emerged, including: Not feeling ready, inhibiting factors, new reality at home, socio-cultural factors, and the clinician within the health system. Returning to sexual health led women to engage in experiential learning through trial and error. Most participants reported reduced libido, experienced altered body image, and recounted resumption of sexual activity before feeling ready. A common finding was fatigue and feeling overloaded by the demands of the newborn. Partner support was described as essential to returning to a meaningful relationship. Discussions about postpartum sexual health with clinicians were described as taboo, and largely absent from the care model.
Conclusion: Evidence-based practices should incorporate the best evidence from research, consider the postpartum sexual health experiences and preferences of the woman, and use clinician expertise in discussions that include the topic of postpartum sexual health to make decisions. As such, human caring practices should be incorporated into clinical guidelines to recognize the preferences of women. Clinicians need to be authentically present, engage in active communication, and individualize their care. More qualitative studies are needed to understand postpartum sexual health in different contexts, cultures, and countries and to identify similarities and differences through meta-synthesis.
... By incorporating educational models on how to asses sexual health, (e.g. PLISSIT-model and BETTER-model) into current GPN training, skills of nurses may be improved (29). ...
Background:
Assessment of sexual health is important in chronically ill patients, as many experience sexual dysfunction (SD). The general practice nurse (GPN) can play a crucial part in addressing SD.
Objective:
The aim of this cross-sectional study was to examine to which extent GPNs discuss SD with chronically ill patients and what barriers may refrained them from discussing SD. Furthermore, we examined which factors had an association with a higher frequency of discussing SD.
Methods:
A cross-sectional survey using a 48-item questionnaire was send to 637 GPNs across the Netherlands.
Results:
In total, 407 GPNs returned the questionnaire (response rate 63.9%) of which 337 completed the survey. Two hundred and twenty-one responding GPNs (65.6%) found it important to discuss SD. More than half of the GPNS (n = 179, 53.3%) never discussed SD during a first consultation, 60 GPNs (18%) never discussed SD during follow-up consultations. The three most important barriers for discussing SD were insufficient training (54.7%), 'reasons related to language and ethnicity' (47.5%) and 'reasons related to culture and religion' (45.8%). More than half of the GPNs thought that they had not enough knowledge to discuss SD (n = 176, 54.8%). A protocol on addressing SD would significantly increase discussing during SD.
Conclusions:
This study indicates that GPNs do not discuss SD with chronically ill patients routinely. Insufficient knowledge, training and reasons related to cultural diversity were identified as most important reasons for this practice pattern. Implementation of training in combination with guidelines on SD in the general practice could improve on the discussing of sexual health with chronic patients.
... These stages are assessment, planning, implementation and evaluation. In order to give effective and qualified psychosexual care to people, nurses working in accordance with nursing process play a key role in achieving success [29]. ...
Background: Sexual health is an important aspect of Quality of life (QoL). It is a basic human right and a fundamental part of a full healthy life. Patients with Chronic kidney disease (CKD) worldwide suffer many physical dysfunctions including sexual activity. Psy
... However, addressing patient sexuality has been shown to be difficult and usually not integrated within nursing care despite the fact that nurses are aware of the importance of discussing patient sexuality [11][12][13][14]. Although barriers regarding addressing patient sexuality have already been widely reported in the past [15,16], a difference between the patients' need for information and the ability of nurses to provide information still exists in modern days. ...
Introduction: Spinal cord injury may seriously affect sexual health and sexuality, which can lead to lower self-esteem, social isolation, lower quality of life, and an increased risk of depression. Nurses play an extensive role in providing patient education. However, a gap between the patients’ need for information and the lack of information provided by nurses still exists. Therefore, knowledge about barriers and facilitators regarding discussing patient sexuality is necessary.
Methods: Semi-structured interviews were conducted with 25 nurses working in Spinal Cord Injury rehabilitation in one clinic in the Netherlands. The following themes were discussed during the interviews: (1) attitude, (2) social factors, (3) affect, (4) habits and (5) facilitating conditions.
Results: Addressing patient sexuality was difficult due to the nurses’ attitude and their environment. Sexuality was considered important but respondents were reserved to discuss the topic due to taboo, lack of knowledge, and common preconceptions. Participants expressed the need for education, a clear job description, time and privacy.
Conclusion: Nurses consider discussing patient sexuality as important but are hindered due to multiple factors. Organizational efforts targeted at knowledge expansion are needed to break the taboo and remove preconceptions. Nurses should provide opportunities to discuss the subject to intercept sexuality-related problems.
• IMPLICATIONS FOR REHABILITATION
• The specific tasks of each profession within the multidisciplinary team regarding patient sexuality should be discussed, agreed upon and protocolized.
• Adding a sexologist in the multidisciplinary team may be of benefit as well as structurally incorporating an appointment with the sexologist within the patients' schedule.
• If a sexologist is not available, opt for a nurse practitioner who is specialized – or wants to further specialize – in sexual health and sexuality.
• In order to create more awareness on patient sexuality within the nursing team, a working group can be arranged to give special attention to discussing the subject by organizing trainings and coaching fellow nurses to address sexuality.
• Create a safe and private environment for the patient when addressing sexuality.
• Educational interventions to enhance the nurses' knowledge in order to make nurses feel capable to provide basic sexuality-related patient education.
... These stages are assessment, planning, implementation and evaluation. In order to give effective and qualified psychosexual care to people, nurses working in accordance with nursing process play a key role in achieving success [23] . ...
Background: Sexual health is a basic human right and a fundamental part of a full healthy life. Patients with Chronic kidney disease (CKD) worldwide suffer many physical dysfunctions including sexual activity. Therefore, this study aims to assess the psychosexual dysfunctions experienced by hemodialysis male patients and their coping strategies. Methods: A descriptive research design is conducted in the hemodialysis units at Urology and Nephrology Center at Mansoura University. The data were collected from 100 hemodialysis male patients. The study Tools included the Arizona Sexual Experience Scale (ASEX), the Psychosexual Dysfunction Questionnaire and the Brief Cope Scale (BCS). Results: Obtained results revealed that most of the study of sample (94%) complained of many psychosexual dysfunctions while only 6% expressed no significant psychosexual dysfunctions. The studied patients used problem focused coping by 76% with total mean of (18.36) out of a possible score of (24). On the other hand, the studied patients used emotional focused coping by 57% with total mean of (50.24) out of a possible score of (88). Conclusion: The vast majority of the study sample does suffer multiple psychosexual dysfunctions. Both physical and psychological distress increase CKD male patients' psychosexual dysfunctions and indicate the necessity of introducing psychiatric liaison nursing programs to enhance their coping strategies in the hemodialysis care units.
... These stages are assessment, planning, implementation and evaluation. In order to give effective and qualified psychosexual care of people, nurses working in accordance with nursing process play a key role in achieving success [14] . ...
Background: Chronic kidney disease (CKD) is a worldwide public-health problem in which most of the physical functions of the body are affected including sexual function. Apart from physical impacts due to renal failure, there are a number of psychological impacts that may also contribute to changes in sexual functioning. Therefore, the aim of this study is to assess the prevalence of psychosexual dysfunctions experienced by hemodialysis male patients. Methods: A descriptive cross-sectional research design was conducted in the hemodialysis units at Mansoura Urology and Nephrology Center. The data were collected from 100 hemodialysis male patients who corresponded to the inclusion criteria. Arizona Sexual Experience Scale (ASEX) and Psychosexual Dysfunction Questionnaires were used to achieve the purpose of the study. Results: The results indicate that (94%) of the study sample complain of psychosexual dysfunctions. The most prevalent psychosexual dysfunctions are psychosexual discomfort, fatigue, low self-esteem during sex, difficulty in reaching orgasm, difficulty in maintenance erection and low sexual desire while suicidal ideation was the lowest prevalent psychosexual dysfunctions. Conclusion: The vast majority of the study sample has psychosexual dysfunctions. Application of psychiatric liaison nursing program in hemodialysis units is recommended.
... Additionally, poor communication techniques such as not looking directly at the client or getting out of the examination room quickly were noted. This embarrassment and discomfort by nurses is supported by earlier studies (10,11,37). Successful communication with the client and the coordination of care with health care team members including other disciplines was described as helpful to the development of the FNP's self concept. ...
Sexual and reproductive health is a global health, development, and human rights priority. In addition, universal access to sexual and reproductive health is essential. Unfortunately, many nurses feel uncomfortable talking to their patients about sexual health. The purpose of this qualitative study is to illuminate the lived experiences of family nurse practitioners in primary health care when performing sexual health assessments on their adult clients. Using van Manen’s interpretive phenomenological approach, ten interviews were transcribed and analyzed. Understanding the lived experience of these female FNPs, illuminated some of the common experiences when performing a sexual health assessment on their adult clients. Three themes were identified: self-concept, presence, and prudence. There are global nursing implications from understanding these experiences on nursing education, practice, and research.
... Although nurses play a key role in sexual health, as a field of intervention this role remains inconsistently recognised and would benefit from greater collective reflection (East and Jackson, 2013;Hayter et al., 2012). Despite the holistic nature of nursing practice, in the case of sexual health several other issues threatening its evolution have also been identified (Ayaz, 2013;Earle, 2001), including a tendency to biomedicalise the issue, nurses' lack of knowledge and confidence concerning sexual health, nurses' conservative attitudes, and the transfer of responsibility for such issues to other professionals thought to be more competent (East and Orchard, 2014;McCabe and Holmes, 2014;Macleod and Nhamo-Murire, 2016;Yildiz and Dereli, 2012). ...
Questions of sexuality and intellectual disability have now moved beyond the institutional era, and contemporary sexual health interventions have gradually been reconfigured in terms of social participation, partnership and normalising approaches. That being said, they also appear to be part of a complex negotiation process between support systems for individuals identified as having an intellectual disability. The aim of this study was to provide a better understanding of the experience of affective (sentimental and emotional) and sexual (identity and value-mediated) expression in the context of intellectual disability, as well as related factors of influence. Inspired by a critical theoretical framework and a phenomenological methodology, this research shows that these experiences are part of a negotiation process that is simultaneously systemic and intimate. It is systemic because it responds to knowledge systems specific to intellectual disability and sexuality, thus authorising a variety of interventions focused on normalising the individual. It is also intimate because these practices involve every axis of affective existence, from inhabiting restrictive spaces to reconfiguring people’s intimate relationships with themselves and others. Through these findings, nursing’s ability to recognise and advocate for this group’s sexual needs and rights is called into question.
... The changes related to sexual life that arise with the menopause are not only disorders in sexual function but are also multi-dimensional changes covering emotions, behaviour and actions (Masliza et al 2014;Kaufert et al 2008). During the decrease in oestrogen levels that occurs in the transition period of the menopause, dryness and somatic changes of the vagina, changes in the vascular and urogenital systems, bone loss, mood and sleep disorders and a decrease in cognitive functions occur (Otunctemur et al 2015;Ayaz 2013). Women complain about a decrease in libido and arousal, and of a deficiency in vaginal lubrication in connection with these changes (Kaufert et al 2008;Sehhatie-Shafaie et al 2014;Constantine et al 2015). ...
Purpose:This study was carried out in order to determine the anxiety levels of menopausal women on their sexual satisfaction.Method and material:This descriptive study. The study was carried out at a menopause clinic of a state hospital between June and August 2011. Data were collected by questionnaire: the Golombok Rust Inventory of Sexual Satisfaction (GRISS) and the State Trait Anxiety Inventory. Results:The mean age of the participants was 49.2±7.6 years old and nearly half of the women 46-50 age group. Half of the women in our sample had a chronic disease, 46.4% of women had sexual intercourse twice a week and 85.1% of them were housewives. In our research it was found that the women’s sexual satisfaction was low, and their state anxiety levels were moderate level. There was a moderate positive correlation between the women’s sexual satisfaction scores and their anxiety levels. Increased levels of both state and trait anxiety in women reduces their sexual satisfaction. Conclusion:In this study, it was shown that women’s anxiety levels were middle and their sexual satisfactions were decreased during menopause. For this reason menopausal women’s should recommended give information about sexual and psychological consultancy services.
... The World Health Organization defines sexual health as the integration of the physical, emotional, intellectual and social aspects of sexual being, in ways that enhance personality, communication and love (World Health Organization, 2014). Biological, psychological or physical conditions may have a significant impact on sexuality and sexual function (Saunamäki et al., 2010;Ayaz, 2013). Studies have demonstrated that the pelvic floor muscle (PFM) has an important role in sexuality, and strengthening the PFM improves sexual function (Bø et al., 2000;Beji et al., 2003;Dumoulin et al., 2014); this is especially true in genital arousal, stimulation and attainment of an orgasm (Rosenbaum, 2007;Mohktar et al., 2013). ...
... However, even though addressing sexuality is important, nurses have indicated in previous studies that they were reluctant to discuss sexuality with patients (e.g. Guthrie 1999, Haboubi & Lincoln 2003, Ayaz 2013. To help professionals to address the intimate topic of sexuality with patients and partners, a protocol on how and when to address sexuality should be available in every amputation department of hospitals and rehabilitation centres, in addition to making courses and training sessions available to professionals to decrease their reluctance to address this topic (Verschuren et al. 2013). ...
To describe the impact of patients' lower limb amputations on their partners' sexual functioning and well-being.
Annually, about 3300 major lower limb amputations are performed in the Netherlands. An amputation may induce limitations in performing marital activities, including expression of sexual feelings between partners. However, up until now, little attention has been paid towards this aspect in both research and clinical practice. The lack of studies on sexual activities and lower limb amputation is even more apparent with respect to partners of patients with such an amputation. Previous studies have shown, however, that the presence of a disease or disability may have a large impact not only on the patient's but also on the partner's sexual activities.
Qualitative thematic analysis.
Semi-structured interviews. The questions used in the interview were inspired by a generic framework about chronic disease and sexual functioning and well-being. In total, 16 partners of patients with a lower limb amputation who were at least 18 years old were recruited in different rehabilitation centres.
Seven major themes (i.e. importance of sexuality, thoughts about sexuality before the amputation, changes in sexual functioning and sexual well-being, amputation as the main cause of these changes, acceptance of the amputation, role confusion and communication about sexuality) were derived from the interviews. Minor changes in sexual functioning and sexual well-being were reported by the participants. Problems participants did encounter were solved by the couples themselves. For some participants, their sexual well-being improved after the amputation.
Participants in our study reported minor changes in their sexual well-being. Most of them indicated that communication about the changes expected and how to cope with these would have been helpful. It is therefore important that professionals address sexuality during the rehabilitation process with patients and partners.
Background:
Sexual health is one of the most important aspects of health. In Iran, most services associated with reproductive and sexual health are provided by midwives at health centers. As different factors are effective in providing care services associated with sexual health, the present study aims to investigate the factors affecting the provision of sexual health services by midwives.
Materials and methods:
In this qualitative content analysis study, data were collected by conducting in-depth interviews with 16 midwives, 7 key informants, and 6 stakeholders. Besides, the sampling method was purposeful, and data analysis was conducted using conventional content analysis and MAXQDA software.
Results:
After analyzing the content of the qualitative data, two themes were extracted, which included facilitators of and barriers to providing sexual health services by midwives.
Conclusions:
By modifying educational curricula, providing in-service training, and adopting appropriate policies, barriers for providing accessible sexual health services by midwives can be reduced.
Addressing sexuality can support youth to thrive with positive development. Healthcare providers (HCPs) are uniquely positioned to offer such support given their professional knowledge and relationship with youth. This paper aims to identify and summarize suggestions to support HCPs to discuss sexuality with youth. A scoping review methodology was used and 17 included studies were screened from four databases (i.e., Embase, Medline, CINAHL, PsycINFO). Six suggestions for practice were identified, including (i) establish a trusting relationship; (ii) create a safe and comfortable environment; (iii) ask for consent and keep conversation confidential; (iv) initiate the conversation; (v) use inclusive language; and (vi) discuss the psychosocial aspect of sexuality. It was also found that youth with a disability or chronic condition were under-represented in the literature. Future research should evaluate the clinical utility of these suggestions and how suggestions can be adapted to meet the sexuality needs of youth with a disability.
Sexual activities changes between partners is a common issue during pregnancy because of physical and psychological transformation. Moreover, couples who have infertility problems have more doubts and uncertainties about sexual life during pregnancy. This longitudinal study sought to understand the differences of sexual activities, information source and health status during gestation between married couples who underwent In Vitro Fertilization (IVF) and who conceived without IVF (NI). Within three time points, we mailed questionnaires to 75 couples who conceived without IVF and 70 couples with IVF. The questionnaires were completed separately by the husband and the wife. The proportion of couple’s sexual activity in the IVF group was significantly lower than that in the NI group (p < 0.05) during the first trimester. Most couples seek sexual health information from unprofessional resources. For preventing the misunderstanding of the information which may lead to inaccurate interpretations, healthcare professionals should take sexual health–related issues into considerations during the fertility treatment.
Sexual dysfunctions are prevalent disorders in psychiatric patients that too often are not addressed by psychiatric-mental health nurses. An integrative review was conducted using PubMed, Joanna Briggs Institute, SCOPUS, PsycINFO and CINAHL databases to evaluate the evidence for independent, nursing interventions for sexual dysfunction across all nursing literature that could be implemented by psychiatric-mental health nurses. Out of 2448 articles, nine papers met inclusion criteria and were synthesized. Best available evidence was found for sexual teaching interventions for female sexual dysfunction. The implications for psychiatric-mental health nursing practice and recommendations for future research are discussed.
Introduction Older adults’ sexuality has been linked with a number of factors associated with wellbeing. Despite sexual practices changing across the lifespan, sexuality remains an important part of the identity of older adults. The ageing population of the United Kingdom is placing increasing demands on care homes, yet despite the recognised benefits of older adults’ sexuality best practice guidelines for care homes either fail to comment on residents’ sexuality or provide recommendations which are too minimal or vague to operationalise. Most research exploring older adults’ sexuality in care homes has focussed on the views of health and social care practitioners who report on their lack of willingness to engage with residents about their sexuality needs. Research which attempts to explore older adults’ sexuality in care homes from the perspective of residents favours quantitative research methods, an approach which arguably fails to acknowledge the changes in sexual expression which occur with age. Furthermore, the lack of consensus regarding the conceptualisation of the term ‘sexuality’ across the literature limits the extent to which research findings can be synthesised. This research sought to contribute to understandings of older adults’ sexuality experiences in care homes from a first-person perspective by adopting a prospective planning approach to explore prognostications about how transitioning to a care home might impact upon experiences of sexuality and participants’ hopes and fears regarding care provision. To increase the interpretability of findings and contextualise responses, the definition of sexuality from the perspective of older adults was also considered. Methods Semi-structured interviews were conducted with ten participants to explore three broad questions: (1) How do older adults define ‘sexuality’? (2) What impact might a care home have on sexuality experience? (3) How would individuals like sexuality to be acknowledged by care services? Face-to-face and telephone interviews were audio recorded, transcribed, and analysed using a hybrid inductive/deductive thematic analysis approach at a mixed manifest/latent level. Results Participants defined sexuality as a multifaceted component of self-identity which held individual meaning and changed across the lifespan. Participants’ definitions of sexuality were compared with the World Health Organisation’s (WHO) working definition of sexuality, and areas of difference and similarity were identified. Participants anticipated that becoming a resident of a care home would prompt significant (and often negative) changes with regards to how they could experience sexuality. Participants wanted services to demonstrate attempts to minimise the environmental impact on sexuality and promote positive experiences in a manner that was responsive to individual need. Discussion While used as an ageless term, ‘sexuality’ has different understandings and applications across the lifespan and remains an important part of the identity of older adults. Findings from this study indicated that participants expected to embody the role of the non-sexual resident when transitioning into a care home, changes in identity which were predicated on living in an environment which was predicted to neither acknowledge nor facilitate positive sexuality experiences.
Les questions associées à la sexualité en contexte de handicap intellectuel ont historiquement été au cœur de stratégies biopolitiques alliant santé collective et contrôle populationnel. S’étant distanciées de l’époque institutionnelle et des pratiques eugéniques la caractérisant, les interventions ciblant ce domaine se sont graduellement reconfigurées sous l’angle de la participation sociale, du partenariat de soin et d’approches normalisantes. Plus que jamais, cette dimension se situe à l’intersection de valeurs personnelles et collectives, la vie affective et sexuelle étant aux racines de l’identité individuelle et mobilisant également ses représentations idéalisées par l’imaginaire collectif. Toutefois, bien que le rôle infirmier en santé sexuelle et en planification familiale soit reconnu, plusieurs recherches illustrent qu’il reste confiné à sa dimension biomédicale et qu’il répond avec grande difficulté aux besoins spécifiques des personnes identifiées comme ayant un handicap intellectuel en cette matière. Alliant un cadre théorique inspiré des écrits de Michel Foucault et de Julia Kristeva à une approche méthodologique issue de l’Analyse Phénoménologique Interprétative, cette recherche explore le processus de construction de l’identité socioaffective en contexte de handicap intellectuel. Par cet intermédiaire, elle propose une meilleure compréhension du parcours de vie des personnes ayant un handicap intellectuel à l’égard de l’expression affective et sexuelle, ainsi que celui de leurs systèmes de soutien. La collecte des données s’est déployée sur une période de 6 mois et a recueilli, par le biais d’entrevues semi-dirigées, les récits de 16 participants. De ce groupe, 5 sont des usagers de services de réadaptation spécialisés en handicap intellectuel, 5 sont des proches aidants et 6 sont des intervenants œuvrant dans ces mêmes services.Cette recherche expose que l’expression affective et sexuelle s’inscrit au sein d’un large processus de négociation systémique et identitaire. Systémique, car répondant de systèmes de savoirs propres au handicap intellectuel et à la sexualité, autorisant de ce fait diverses interventions visant à normaliser la personne et à offrir une réponse aux modes de subjectivation de la personne dite « vulnérable » ou « dangereuse ». Identitaire puisque ces pratiques investissent l’ensemble des axes de l’existence affective et sexuelle, allant de l’habitation d’espaces austères à la reconfiguration du « moi » intime. Ces constats sont une mise à l’épreuve des prétentions holistiques de la pratique infirmière, plus spécifiquement de sa capacité à participer à l’émancipation des personnes identifiées comme ayant un handicap intellectuel ainsi qu’à la reconnaissance de leurs besoins et de leur droit à l’expression affective et sexuelle.
Aims and objectives:
This study aimed to evaluate the effectiveness of a sexual healthcare training programme for clinical nurses, with respect to knowledge, attitudes and self-efficacy concerning sexual healthcare.
Background:
Inadequate sexual healthcare can result in poor treatment and quality of life for patients. Few studies have examined the development of sexual healthcare and related interventions from nurses' perspectives.
Design:
The study included two stages involving focus groups and a quasi-experimental design.
Methods:
The first stage consisted of an exploratory, descriptive session to assess nurses' perceptions and educational needs concerning sexual healthcare via two focus groups (N = 16). The second stage involved a quasi-experimental session to evaluate the training programme, based on the results of the first stage. In total, 117 nurses were recruited from a Taiwanese hospital; the experimental group (n = 59) completed a four-week (16 hours) training programme, and the control group (n = 58) did not participate in a training programme. Data were collected at four time points over 17 weeks. Longitudinal changes that occurred over time were examined using hierarchical linear models.
Results:
The experimental group demonstrated significant improvements in knowledge (β = 0·16, p < 0·01), attitude (β = 0·18, p < 0·05), and self-efficacy (β = 0·73, p < 0·001) scores. Relative to that of the control group, the experimental group showed significantly greater improvement in knowledge (β = -0·12, p < 0·01) and attitudes regarding sexual healthcare (β = -0·25, p < 0·05), but their improvement in self-efficacy concerning sexual healthcare was limited (p = 0·179).
Conclusions:
The training programme for sexual healthcare could exert positive and beneficial effects on nurses' development of knowledge regarding sexual healthcare and clarify their values and attitudes.
Relevance to clinical practice:
The training programme could reduce challenges related to sexual healthcare issues in nursing care.
Cultural studies scholars are investigating everyday practices that deny sexual pleasure and create barriers to wellbeing and health. Human rights violations regularly happen at the level of sexuality, which has prompted discussion about formal sexual rights by feminist and disability scholars. People with disabilities often negotiate medical settings that make sexual autonomy challenging. Cultural expectations surrounding sexual pleasure contribute to oppression. Based on the professional values of social work, social workers need to consider the importance of sexual pleasure to wellbeing and advocate against cultural barriers. This analysis will use mixed method by investigating a variety of popular and professional discourses about the cultural expectations surrounding sexual pleasure that create barriers to access. Medical education discourse about approaches to training professionals about sex will be synthesized as potential models for social work education. Autoethnography will be used to support the analysis by highlighting the experience of the author in critical care, graduate education and professional training roles that include integration of sexual pleasure into social work practice. Medical educators have been dealing with reluctance and avoidance of health care professionals to discussions of sexual pleasure for decades. Health care providers, in large numbers, do not feel prepared to integrate sexual pleasure into general care and consumers of health care report insensitivity on the part of professions when pursuing assistance with sexual concerns. This paper will explore ways that social work educators can increase knowledge about sexual pleasure as a complex concept, encourage client-centered attitudes, and build communications skills.
Context While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men. Objective To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders. Design Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults. Participants A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey. Main Outcome Measures Risk of experiencing sexual dysfunction as well as negative concomitant outcomes. Results Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall wellbeing. Conclusions The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
While recent pharmacological advances have generated increased public interest and demand for clinical services regarding erectile dysfunction, epidemiologic data on sexual dysfunction are relatively scant for both women and men.
To assess the prevalence and risk of experiencing sexual dysfunction across various social groups and examine the determinants and health consequences of these disorders.
Analysis of data from the National Health and Social Life Survey, a probability sample study of sexual behavior in a demographically representative, 1992 cohort of US adults.
A national probability sample of 1749 women and 1410 men aged 18 to 59 years at the time of the survey.
Risk of experiencing sexual dysfunction as well as negative concomitant outcomes.
Sexual dysfunction is more prevalent for women (43%) than men (31%) and is associated with various demographic characteristics, including age and educational attainment. Women of different racial groups demonstrate different patterns of sexual dysfunction. Differences among men are not as marked but generally consistent with women. Experience of sexual dysfunction is more likely among women and men with poor physical and emotional health. Moreover, sexual dysfunction is highly associated with negative experiences in sexual relationships and overall well-being.
The results indicate that sexual dysfunction is an important public health concern, and emotional problems likely contribute to the experience of these problems.
This article presents the development of a brief, self-report measure of female sexual function. Initial face validity testing of questionnaire items, identified by an expert panel, was followed by a study aimed at further refining the questionnaire. It was administered to 131 normal controls and 128 age-matched subjects with female sexual arousal disorder (FSAD) at five research centers. Based on clinical interpretations of a principal components analysis, a 6-domain structure was identified, which included desire, subjective arousal, lubrication, orgasm, satisfaction, and pain. Overall test-retest reliability coefficients were high for each of the individual domains (r = 0.79 to 0.86) and a high degree of internal consistency was observed (Cronbach's alpha values of 0.82 and higher) Good construct validity was demonstrated by highly significant mean difference scores between the FSAD and control groups for each of the domains (p < or = 0.001). Additionally, divergent validity with a scale of marital satisfaction was observed. These results support the reliability and psychometric (as well as clinical) validity of the Female Sexual Function Index (FSFI) in the assessment of key dimensions of female sexual function in clinical and nonclinical samples. Our findings also suggest important gender differences in the patterning of female sexual function in comparison with similar questionnaire studies in males.
Sexuality assessment and counseling are part of the nurse's professional role, but few nurses integrate this awareness into practice. Findings of this study suggest that educational programs are needed to help nurses develop confidence and comfort in dealing with patient sexuality.
This paper is a report of a study of Registered Nurses' attitudes and beliefs towards discussing sexuality with patients.
The World Health Organization regards sexuality as an essential and integrated part of being human. Studies show that diseases and treatments can affect sexuality and that a positive and respectful attitude towards sexuality is important to achieving sexual health.
The study had a correlative and comparative design. The Sexual Attitudes and Beliefs Survey was distributed to a convenience sample of 100 Swedish nurses in 2006, with a response rate of 88%.
Over 90% of nurses understood how patients' diseases and treatment might affect their sexuality. About two-thirds felt comfortable talking about sexual issues and agreed that it was their responsibility to encourage talk about sexual concerns. However, 80% did not take time to discuss sexual concerns, and 60% did not feel confident in their ability to address patients' sexual concerns. Older nurses felt more confident in their ability to address patients' sexual concerns, and the older the nurses, the more positive were their attitudes towards discussing sexuality. Nurses with further education also had a more positive attitude towards discussing sexuality.
Education is essential to improve nurses' ability to give patients the holistic care they deserve. Studies are needed to understand fully what mechanisms underlie the barriers that clearly prevent nurses from addressing patients' sexuality.
A cancer diagnosis can have an overwhelming effect on patients' sexuality. Patients can suffer physically and emotionally from the side effects of cancer treatments. Nurses and physicians often fail to recognize the importance of the sexuality assessment to patients. The purpose of this article is to discuss sexuality from the perspectives of patients with cancer. Fifty-two patients were asked to define sexuality and its meaning to them. The results demonstrated that patients' definitions of sexuality can take on many different meanings. Only a small number of patients stated that sexuality was addressed by their nurse or physician. Many patients wished someone had asked them about or brought up the topic of sexuality. The results support the value and importance of performing a sexuality assessment in patients with cancer.
Female sexual dysfunction (FSD) is a common disorder in postmenopausal women. Currently, there is no clear "gold standard" for the diagnosis of FSD.
The aim of this study was to evaluate the interrater reliability of the Women's Sexual Interest Diagnostic Interview (WSID), a new structured clinical interview designed to diagnose hypoactive sexual desire disorder (HSDD). The reliability of additional interview questions focused on the diagnosis of other types of FSD was also evaluated.
The main outcome measure was the level of agreement in the diagnosis of FSD among clinical experts, between clinical experts and study coordinators, and between clinical experts and patients' self-reported interactive voice response system (IVRS) version of the WSID.
Two versions of WSID were developed based on current diagnostic criteria: a clinician-administered version using a structured interview guide, and a patient self-report version using an IVRS. Three sexual medicine experts developed 20 clinical scenarios portraying cases and noncases of HSDD and other FSD diagnostic subtypes. Ten actresses with experience in standardized patient interviewing rehearsed these scenarios and performed the scripted patient roles in a standardized clinical interview with clinical experts (not the author of the script) and study coordinators, on a one-on-one basis, using the WSID interview format. In addition, all actresses completed the IVRS version of the WSID. Interviews were videotaped and viewed by the expert panel. In each instance, the diagnosis that the interview was scripted to portray was considered as the "gold standard." Kappa (kappa) coefficients were utilized to assess the level of agreement among experts, between study coordinators and the "gold standard", and between the IVRS version of the WSID and the "gold standard".
All experts agreed with the gold standard diagnosis provided by the author of the script (kappa=1.0). Similarly, there was perfect agreement among the experts on the presence of depressive symptomatology (kappa=1.0). On the related diagnoses of arousal disorder, orgasmic disorder, and sexual pain disorder, kappas of 0.894, 0.966, and 0.946 were observed (P<0.0001 for all comparisons). When study coordinator's WSID diagnoses were compared with the "gold standard," kappa for HSDD was 0.851; sensitivity was 0.864, and specificity and positive predictive value (PPV) were 1.00 (P<0.001 for all comparisons). When diagnoses obtained via IVRS interviews were compared with the "gold standard", kappa for HSDD was 0.802, sensitivity was 0.818, and specificity and PPV were 1.00 (P<0.001 for all comparisons).
Agreement as estimated by kappa coefficients was consistently high in both clinician-administered and patient self-reported IVRS versions in the diagnosis of HSDD.
The Golombok-Rust Inventory of Sexual Satisfaction (GRISS) is a short 28-item questionnaire for assessing the existence and severity of sexual problems. The design, construction and item analysis of the GRISS are described. It is shown to have high reliability and good validity for both the overall scales and the subscales.
To develop a brief, reliable, self-administered measure of erectile function that is cross-culturally valid and psychometrically sound, with the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
Relevant domains of sexual function across various cultures were identified via a literature search of existing questionnaires and interviews of male patients with erectile dysfunction and of their partners. An initial questionnaire was administered to patients with erectile dysfunction, with results reviewed by an international panel of experts. Following linguistic validation in 10 languages, the final 15-item questionnaire, the international index of Erectile Function (IIEF), was examined for sensitivity, specificity, reliability (internal consistency and test-retest repeatability), and construct (concurrent, convergent, and discriminant) validity.
A principal components analysis identified five factors (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction) with eigenvalues greater than 1.0. A high degree of internal consistency was observed for each of the five domains and for the total scale (Cronbach's alpha values of 0.73 and higher and 0.91 and higher, respectively) in the populations studied. Test-retest repeatability correlation coefficients for the five domain scores were highly significant. The IIEF demonstrated adequate construct validity, and all five domains showed a high degree of sensitivity and specificity to the effects of treatment. Significant (P values = 0.0001) changes between baseline and post-treatment scores were observed across all five domains in the treatment responder cohort, but not in the treatment nonresponder cohort.
The IIEF addresses the relevant domains of male sexual function (that is, erectile function, orgasmic function, sexual desire, intercourse satisfaction, and overall satisfaction), is psychometrically sound, and has been linguistically validated in 10 languages. This questionnaire is readily self-administered in research or clinical settings. The IIEF demonstrates the sensitivity and specificity for detecting treatment-related changes in patients with erectile dysfunction.
Nursing assessment of altered sexuality.
To review salient factors affecting assessment and objective measures available for use in assessment.
Literature specific to nursing assessment of sexuality and to instruments measuring altered sexuality.
Many standards of care include the assessment of sexuality, and nurses believe it to be an important aspect of care. However, the assessment of altered sexuality does not often occur in actual practice. The use of an objective measure of sexuality is recommended for both initial and on-going assessments in acute-care and community-based settings.
Sildenafil has been demonstrated to be safe and effective in the treatment of men with erectile dysfunction. The role of sildenafil in treating women with sexual dysfunction has heretofore not been reported. The purpose of this preliminary study was to ascertain the response of postmenopausal women with self-described sexual dysfunction treated with sildenafil for 3 months.
Thirty-three consecutive postmenopausal women with sexual dysfunction based on history were entered in this open-label, nonrandomized study. All patients received 50 mg of sildenafil. Efficacy was assessed at weeks 4, 8, and 12 using a newly developed 9-item, self-administered Index of Female Sexual Function (IFSF) and a global efficacy question ([GEQ] Did treatment improve your sexual function?). The IFSF quantifies the domains of desire, quality of sexual intercourse, overall satisfaction with sexual function, orgasm, lubrication, and clitoral sensation.
Of the group, 30 women (91 %) completed the study and were available for follow-up at 3 months. Mean baseline IFSF score before therapy was 24.8+/-9.8. Mean usage of sildenafil was 3.1+/-1.4 times per week for the duration of the study. The IFSF score improved to 29.5+/-7.6, 30.3+/-8.5, and 31.4+/-10.4 at 4, 8, and 12 weeks, respectively (P = 0.25). Mean scores for questions 2 (lubrication), 8 (orgasm), and 9 (clitoral sensation) improved by 23.2%, 7.4%, and 31.3%, respectively, at 12 weeks. Seven women (21%) noted improvement on the GEQ. Overall, only 6 (18.1%) of 33 patients had a significant (more than 60% improvement in IFSF score) therapeutic response. Clitoral discomfort and "hypersensitivity" occurred in 7 women (21%), 3 of whom withdrew from the study. Other side effects, which did not result in withdrawal from the study, included headache (n = 5), dizziness (n = 4) and dyspepsia (n = 3).
The data suggest that sildenafil is well tolerated in postmenopausal women with sexual dysfunction. Overall sexual function did not improve significantly, although there were changes in vaginal lubrication and clitoral sensitivity. The role of sildenafil in treating sexual dysfunction in various cohorts of women remains to be determined.
Although sexual dysfunction is common in psychiatric patients, quantification of sexual dysfunction is limited by the paucity of validated, user-friendly scales. In order to address this problem, the authors have developed the Arizona Sexual Experiences Scale (ASEX), a five-item rating scale that quantifies sex drive, arousal, vaginal lubrication/penile erection, ability to reach orgasm, and satisfaction from orgasm. Possible total scores range from 5 to 30, with the higher scores indicating more sexual dysfunction. This study assesses the internal consistency, test-retest reliability, and convergent and discriminant validity of the ASEX.
Sexual dysfunctions are highly prevalent in today's society. Male sexual disorders have received considerable attention, leading to a multitude of treatment options. Female sexual dysfunctions, on the other hand, have gone vastly underreported and untreated. A large part of this could be attributed to social mores, resulting in an overall lack of communication. The complex interplay between psychological and physiological factors involved in sexual response requires a comprehensive understanding of the norm and deviations from it. This review of the literature attempts to bring this topic into focus by concentrating on normal female sexual response, the many levels at which these dysfunctions may occur, identification in a clinical setting, and current therapeutic modalities.
In this article the author examines the purpose of discussing relationships and sexuality at initial patient assessment. Issues such as confidentiality, referral to specialist services and, most importantly, the benefit to the patient are discussed. The article begins with a definition of sexuality and describes a problem-solving approach which, with training, would enable nurses to address a patient's sexual and relationship difficulties knowing there is appropriate help available.
Sexual dysfunctions and sexual problems are reviewed from the perspective of prevalence, broad etiological factors, and available treatments. Although a large percentage of individuals experience sexual problems, with estimates between 10 and 52% of men and 25 and 63% of women, the prevalence of sexual dysfunctions that meet diagnostic criteria is lower and less well established by large scale population-based studies. Sexual problems and dysfunctions are correlated with other health conditions, including cardiovascular disorders, common diseases such a s diabetes, health habits, and mental health. Adequate sexual functioning also appears to be associated with personal well-being and relationship stability, although this may be more accurate for men than women. Efficacious and effective treatments exist for some of the sexual disorders, and there is an increasing focus on medical (particularly pharmacological) treatments being tested by the pharmaceutical industry. Sexual problems and dysfunctions have been notably under-researched, particularly from the perspective on consequences to individual mental health, relationships, and family functioning.
This survey was carried out to study the views of multidisciplinary health professionals about discussing sexual issues with patients.
A questionnaire was sent to professionals (nurses, doctors, physiotherapists and occupational therapists) to return by post. A duplicate questionnaire was sent 4 weeks later to a random sample of respondents.
A total of 813 replies were analysed (61% response rate). Mean age+(SD) of respondents was 37+10. Most were female (85%). Test-retest reliability of the questions showed moderate to very good agreement. Most respondents (90%) agreed that addressing sexual issues ought to be part of the holistic care of patients. However, most staff (86%) were found to be poorly trained and most (94%) were unlikely to discuss sexual issues with their patients. The gender and age of respondents was not significantly related to their participation in such discussion. Therapists had less training, lower comfort level, and less willingness to discuss sexual issues than doctors and nurses while doctors discussed sexual issues significantly often more than others (p< or =0.001). Respondents from rehabilitation wards were equivalent to those from medical or surgical wards in their training and comfort. However, they participated in discussing sexuality with patients less often than those from medical wards.
Health professionals agreed that patients' sexual issues needed to be addressed and discussed in health services. However, they were poorly trained, ill prepared and rarely participated in such discussion. This suggests that training in sexuality and sexual issues should be implemented as part of the training of health care professionals.
Body image changes and psychological adaptation are often associated with patients who have gastrointestinal disease due to the potential alteration to physical appearance through the very nature of the disease process or treatment. This article describes some of the psychological issues highlighted by patients with gastrointestinal disease, including loss of bowel control, withdrawal and concealment. It highlights altered image difficulties and adaptation through the patients' journey and treatment with illustrations from patients' narratives. In doing so, it explores the nurse's role and stresses the necessity for nurses to seek training to become skillful in counselling this group of patients towards exploring and identifying their individual psychological problems.
Sexuality assessment and counseling are part of the nurse's professional role, but few nurses integrate this awareness into practice. Findings of this study suggest that educational programs are needed to help nurses develop confidence and comfort in dealing with patient sexuality.
Patients who have undergone invasive medical procedures requiring radical body changes often experience feelings of worthlessness and particularly negative feelings about their sexuality. Their initial contact with the healthcare team is frequently a nurse who may be poorly equipped, too busy, or too embarrassed to help address the patients' sexual issues; therefore, vital information may be lost to the healthcare team. The PLISSIT Model offers nurses or case managers a concise framework for intervention to address patients' concerns at the earliest stages of their distress, and helps assure informed feedback to the healthcare team regarding the patients' sexual issues.
PURPOSE AND OBJECTIVES: The aim of this study was to examine the barriers to addressing patient sexuality across areas of specialization.
A descriptive correlational design was used in this study.
A convenience sample of nurses (N = 302) was recruited from a large Midwestern medical center.
In this study, a survey using the Sexuality Attitudes and Beliefs Survey and a demographic questionnaire was conducted.
The number one barrier to addressing patient sexuality concerns across all areas of specialization was the nurses' perceptions that patients do not expect nurses to address their sexuality concerns. Other high-ranking barriers included a lack of comfort and confidence in addressing sexuality and failure to make time to discuss patient sexuality concerns.
Educational programs with both general and specific content are needed to help nurses across areas of specialization overcome barriers to addressing patient sexuality concerns. In addition, clinical nurse specialists are challenged to think of ways in which their practice competencies might be used creatively to overcome barriers to addressing patient sexuality concerns and promote the sexual health of individuals and groups.
Further research is needed to determine whether the assumption that patients do not expect nurses to address sexuality concerns matches the reality of patients' expectations.
Although nurses are aware that assessing sexuality, diagnosing sexuality problems, and evaluating outcomes of interventions to address patients' sexuality concerns are part of holistic care, they often do not perform sexuality assessment in practice. Understanding sexuality as patients' perceptions of body image, family roles and functions, relationships, and sexual function can help nurses improve assessment and diagnosis of actual or potential alterations in sexuality. In addition, nurses should increase their knowledge and understanding of sexuality, identify available information and resources, apply practice standards, and develop a skill set to incorporate sexuality questions routinely in clinical assessments. This article provides 10 strategies to help address and validate patients' sexuality experiences and quality-of-life concerns. By promoting sexual health, nurses can help patients regain a sense of normalcy after cancer diagnosis and treatment. Holistic care is provided when nurses acknowledge the importance of sexuality in patients' lives.
It has been well documented that most patients do not volunteer information about sexual problems, and that health care providers should incorporate at least a brief sexual assessment into routine health histories and medical evaluations. While not every nurse can be a sexual counselor, listening to concerns of patient and family, presenting factual information in a nonthreatening manner, managing noncomplex disease and treatment related symptoms, and providing appropriate referrals can be easily incorporated into routine care.
Epidemiology can be defined as the population study of the occurrence of health and disease. The knowledge of the rates of occurrence of sexual dysfunctions and the primary risk factors for these conditions is very important to assist in assessing the risk and planning treatment and prevention programs in sexual medicine.
Review modern studies of the prevalence and incidence of sexual dysfunction in an effort to establish a consensus concerning the frequency of occurrence of these conditions, and review the strengths and liabilities of design methodology in the field.
Review of peer-reviewed literature.
The findings suggest that sexual dysfunctions are highly prevalent in our society worldwide, and that the occurrence of sexual dysfunctions increases directly with age for both men and women. There is also a strong support for the finding that although the frequency of symptoms increases with age, personal distress about those symptoms appears to diminish as individuals become older. An additional uniform result was that specific medical conditions and health behaviors represent major risk factors for sexual disorders, and that many of these health conditions also have a strong positive relationship with age.
Progress has been made concerning both the number and quality of epidemiologic prevalence studies in sexual medicine; however, there is a paucity of studies of the incidence of these conditions. Because reliable incidence data are critical for prevention and treatment planning, the design and execution of the incidence trials should become a high priority for the field. In addition, repeated calls for the development of a new systematic and integrated diagnostic system in sexual medicine were also evident, because of the perception by many that the imprecision of our current diagnostic system represents the "rate-limiting step" for the epidemiology of the field. The review suggests that although much has been accomplished in the past 15-20 years, much remains to be done.
To review the literature and provide specific suggestions for assessing and addressing sexual concerns seen in those diagnosed with cancer.
Review and research articles, abstracts, books, electronic databases.
Sexuality and sexual health are integral components of overall health and essential for quality of life. Patients should have the opportunity to discuss their sexual issues and concerns with a qualified health care professional. Knowledgeable, skilled nurses are well-qualified to conduct sexual assessments and to provide options for interventions and referrals.
To provide quality cancer care, nurses need to be educated about sexual health and to learn the knowledge and skills requisite to a basic discussion and assessment of potential or actual sexual dysfunction in their patients.
Fundamentals of Nursing
- P A Potter
- A G Perry
Potter, P.A., Perry, A.G.: Fundamentals of Nursing. Mosby, St. Loise (2001)
Hemşirelik Süreci (Nursing Process)
- L Birol
World Health Organization: Sexual Health http://www.who.int./ reproductive-health/gender/sexualhealth
World Health Organization: Sexual Health. IOP Publishing PhysicsWeb. http://www.who.int./
reproductive-health/gender/sexualhealth.html. (2002) Accessed 12 Apr 2010
Hems¸irelikHems¸irelik Süreci (Nursing Process)
- L Birol
Birol, L.: Hems¸irelikHems¸irelik Süreci (Nursing Process). Etki, Izmir (2004)
Handbook of Nursing Diagnosis
- L J Carpetino-Moyet
Carpetino-Moyet, L.J.: Handbook of Nursing Diagnosis. Lippincott Williams & Wilkins, Philadelphia
(2007)