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SEMINAR
HUMAN SEXUALITY
&
SEXUAL HEALTH

Submitted by, Submitted to,

Mrs Gayathri R Mr Aneesh
1st Year MSc Nursing Assistant Professor
Upasana College Of Upasana College Of
Nursing Kollam Nursing Kollam

Submitted on:

INDEX
HUMAN SEXUALITY
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INTRODUCTION [3]
TERMINOLOGY [3]
DEFINITION [3]
DEVELOPMENT [3-7]
BIOLOGICAL & PHYSICAL ASPECTS [7-8]
MALE REPRODUCTIVE SYSTEM [8-9]
FEMALE REPRODUCTIVE SYSTEM [9-12]
SEXUAL RESPONSE CYCLE [12-13]
EVOLUTION OF SEXUAL RESPONSE CYCLE [13-14]
SEXUAL DYSFUNCTION [14-17]
PSYCHOLOGICAL ASPECT [17-18]
SOCIOCULTURAL ASPECT [18-20]
REPRODUCTIVE SEXUAL RIGHT [20-21]

SEXUAL HEALTH
INTRODUCTION [21]
DEFINITION [21]
COMPONENTS [21-22]
FACTORS AFFECTING [22]
ALTERATIONS [23]
SEX EDUCATION [23-29]
NURSING MANAGEMENT [29]

CONCLUSION [30]
BIBLIOGRAPHY [30
HUMAN SEXUALITY
INTRODUCTION
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Human sexuality is the way people experience and express

themselves sexually. This involves biological, erotic, physical, emotional, social,
or spiritual feelings and behaviours. Because it is a broad term, which has varied
over time, it lacks a precise definition. The biological and physical aspects of
sexuality largely concern the human reproductive functions, including the human
sexual response cycle. Someone's sexual orientation can influence that person's
sexual interest and attraction for another person. Physical and emotional aspects of
sexuality include bonds between individuals that are expressed through profound
feelings or physical manifestations of love, trust, and care. Social aspects deal with
the effects of human society on one's sexuality, while spirituality concerns an
individual's spiritual connection with others. Sexuality also affects and is affected by
cultural, political, legal, philosophical, moral, ethical, and religious aspects of life.

TERMINOLOGIES
 Sex: Act of intercourse.
 Sexuality: It is everything else that goes into making as a sexual being.
 Climacteric: Decline in sexual drive.
 Gender roles: Behavior appropriate to the sex of an individual.
 Heterosexual: Sexual & emotional orientation towards person of opposite sex.
 Homosexual: Sexual & emotional orientation towards person of same sex.
 Infertility: Inability to conceive.
 Myotonia: Lack of muscle action has a prolonged.
 Orgasm: The climax of sexual entertainment.
 Sexual orientation: It describes the predominant gender preference of a
person’s sexual attraction.

DEFINITION
“Human sexuality” refers to people's sexual interest in and attraction to others, as
well as their capacity to have erotic experiences and responses. People’s
sexual orientation is their emotional and sexual attraction to particular sexes or
genders, which often shapes their sexuality.

DEVELOPMENT
Nature versus nurture
Certain characteristics may be innate in humans; these characteristics may be
modified by the physical and social environment in which people interact. Human
sexuality is driven by genetics and mental activity. The sexual drive affects the
development of personal identity and social activities An individual's normative,
social, cultural, educational, and environmental characteristics moderate the sexual
drive. Two well-known schools in psychology took opposing positions in the nature-
versus-nurture debate: the Psychoanalytic school led by Sigmund Freud and
the Behaviourist school which traces its origins to John Locke .
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Psychosexual Stages
Freud (1905) proposed that psychological development in childhood takes place in a
series of fixed psychosexual stages: oral, anal, phallic, latency, and genital.
These are called psychosexual stages because each stage represents the fixation of
libido (roughly translated as sexual drives or instincts) on a different area of the
body. As a person grows physically certain areas of their body become important as
sources of potential frustration (erogenous zones), pleasure or both.
Freud believed that life was built round tension and pleasure. Freud also believed
that all tension was due to the build-up of libido (sexual energy) and that all pleasure
came from its discharge.
Freud stressed that the first five years of life are crucial to the formation of adult
personality. The id must be controlled in order to satisfy social demands; this sets up
a conflict between frustrated wishes and social norms.
The ego and superego develop in order to exercise this control and direct the need
for gratification into socially acceptable channels. Gratification centers in different
areas of the body at different stages of growth, making the conflict at each stage
psychosexual.
Psychosexual Stages of Development

Oral Stage (0-1 year)

In the first stage of personality development, the libido is centered in a baby's mouth.
It gets much satisfaction from putting all sorts of things in its mouth to satisfy the
libido, and thus its id demands.  Which at this stage in life are oral, or mouth
orientated, such as sucking, biting, and breastfeeding. 
Freud said oral stimulation could lead to an oral fixation in later life.  We see oral
personalities all around us such as smokers, nail-biters, finger-chewers, and thumb
suckers.  Oral personalities engage in such oral behaviours, particularly when under
stress.

Anal Stage (1-3 years)

The libido now becomes focused on the anus, and the child derives great pleasure
from defecating.  The child is now fully aware that they are a person in their own right
and that their wishes can bring them into conflict with the demands of the outside
world (i.e., their ego has developed). 
Freud believed that this type of conflict tends to come to a head in potty training, in
which adults impose restrictions on when and where the child can defecate.  The
nature of this first conflict with authority can determine the child's future relationship
with all forms of authority.
Early or harsh potty training can lead to the child becoming an anal-retentive
personality who hates mess, is obsessively tidy, punctual and respectful of authority. 
They can be stubborn and tight-fisted with their cash and possessions.  This is all
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related to pleasure got from holding on to their faeces when toddlers, and their
mum's then insisting that they get rid of it by placing them on the potty until they
perform!

Phallic Stage (3 to 5 or 6 years)

Sensitivity now becomes concentrated in the genitals and masturbation (in both
sexes) becomes a new source of pleasure.  The child becomes aware of anatomical
sex differences, which sets in motion the conflict between erotic attraction,
resentment, rivalry, jealousy and fear which Freud called the Oedipus complex (in
boys) and the Electra complex (in girls). 
This is resolved through the process of identification, which involves the child
adopting the characteristics of the same sex parent.
Oedipus complex
The most important aspect of the phallic stage is the Oedipus complex.   This is one
of Freud's most controversial ideas and one that many people reject outright.
The name of the Oedipus complex derives from the Greek myth where Oedipus, a
young man, kills his father and marries his mother. In the young boy, the Oedipus
complex or more correctly, conflict, arises because the boy develops sexual
(pleasurable) desires for his mother.  He wants to possess his mother exclusively
and get rid of his father to enable him to do so.  Irrationally, the boy thinks that if his
father were to find out about all this, his father would take away what he loves the
most.  During the phallic stage what the boy loves most is his penis.  Hence the boy
develops castration anxiety.The little boy then sets out to resolve this problem by
imitating, copying and joining in masculine dad-type behaviours.  This is
called identification, and is how the three-to-five year old boy resolves his Oedipus
complex.  Identification means internally adopting the values, attitudes, and
behaviors of another
Freud (1909) offered the Little Hans case study as evidence of the Oedipus complex.
Electra complex
For girls, the Oedipus or Electra complex is less than satisfactory.  Briefly, the girl
desires the father, but realizes that she does not have a penis.  This leads to the
development of penis envy and the wish to be a boy.  The consequence of this is
that the boy takes on the male gender role, and adopts an ego ideal and values that
become the superego. The girl resolves this by repressing her desire for her father
and substituting the wish for a penis with the wish for a baby.  The girl blames her
mother for her 'castrated state,' and this creates great tension.  The girl
then represses her feelings (to remove the tension) and identifies with the mother to
take on the female gender role.

Latency Stage (5 or 6 to puberty)

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No further psychosexual development takes place during this stage (latent means
hidden).  The libido is dormant.  Freud thought that most sexual impulses are
repressed during the latent stage, and sexual energy can be sublimated (re: defence
mechanisms) towards school work, hobbies, and friendships. 
Much of the child's energy is channelled into developing new skills and acquiring
new knowledge, and play becomes largely confined to other children of the same
gender.

Genital Stage (puberty to adult)

This is the last stage of Freud's psychosexual theory of personality development and
begins in puberty.  It is a time of adolescent sexual experimentation, the successful
resolution of which is settling down in a loving one-to-one relationship with another
person in our 20's.  Sexual instinct is directed to heterosexual pleasure, rather than
self-pleasure like during the phallic stage. 
For Freud, the proper outlet of the sexual instinct in adults was through heterosexual
intercourse.  Fixation and conflict may prevent this with the consequence that sexual
perversions may develop. 
For example, fixation at the oral stage may result in a person gaining sexual
pleasure primarily from kissing and oral sex, rather than sexual intercourse.
Gender differences
Psychological theories exist regarding the development and expression of gender
differences in human sexuality. A number of
them,including nonanalytic theories, sociobiologicaltheories, social learning
theory, social role theory, and script theory, agree in predicting that men should be
more approving of casual sex (sex happening outside a stable, committed
relationship such as marriage) and should also be more promiscuous (have a higher
number of sexual partners) than women. These theories are mostly consistent with
observed differences in males' and females' attitudes toward casual sex before
marriage in the United States; other aspects of human sexuality, such as sexual
satisfaction, incidence of oral sex, and attitudes
toward homosexuality and masturbation, show little to no observed difference
between males and females. Observed gender differences regarding the number of
sexual partners are modest, with males tending to have slightly more than females.
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BIOLOGICAL & PHYSIOLOGICAL ASPECTS

Like other mammals, humans are primarily grouped into either
the male or female sex, with a small proportion (around 1%) of intersex individuals,
for whom sexual classification may not be as clear. The biological aspects of
humans' sexuality deal with the reproductive system, the sexual response cycle, and
the factors that affect these aspects. They also deal with the influence of biological
factors on other aspects of sexuality, such as organic and neurological
responses, heredity, hormonal issues, gender issues, and sexual dysfunction.

Physical anatomy and reproduction

Males and females are anatomically similar; this extends to some degree to
the development of the reproductive system. As adults, they have different
reproductive mechanisms that enable them to perform sexual acts and to reproduce.
Men and women react to sexual stimuli in a similar fashion with minor differences.
Women have a monthly reproductive cycle, whereas the male sperm production
cycle is more continuous.
Brain
The hypothalamus is the most important part of the brain for sexual functioning. This
is a small area at the base of the brain consisting of several groups of nerve cell
bodies that receives input from the limbic system. Studies have shown that within lab
animals, destruction of certain areas of the hypothalamus causes the elimination of
sexual behavior.The hypothalamus is important because of its relationship to
the pituitary gland, which lies beneath it. The pituitary gland secretes hormones that
are produced in the hypothalamus and itself. The four important sexual hormones
are oxytocin, prolactin, follicle-stimulating hormone, and luteinizing
hormone. Oxytocin, sometimes referred to as the "love hormone, is released in both
sexes during sexual intercourse when an orgasm is achieved. Oxytocin has been
suggested as critical to the thoughts and behaviours required to maintain close
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relationships. The hormone is also released in women when they give birth or are
breastfeeding. Both prolactin and oxytocin stimulate milk production in women.
Follicle-stimulating hormone (FSH) is responsible for ovulation in women, which acts
by triggering egg maturity; in men it stimulates sperm production. Luteinizing
hormone (LH) triggers ovulation, which is the release of a mature egg.
Male anatomy and reproductive system

Males also have both internal and external genitalia that are responsible for
procreation and sexual intercourse. Production of spermatozoa (sperm) is also
cyclic, but unlike the female ovulation cycle, the sperm production cycle is constantly
producing millions of sperm daily.
External male anatomy
The male genitalia are the penis and the scrotum. The penis provides a passageway
for sperm and urine. An average-sized flaccid penis is about 3 3⁄4 inches (9.5 cm) in
length and 1 1⁄5 inches (3.0 cm) in diameter. When erect, the average penis is
between 4 1⁄2 inches (11 cm) to 6 inches (15 cm) in length and 1 1⁄2 inches (3.8 cm) in
diameter. The penis's internal structures consist of the shaft, glans, and the root.
The shaft of the penis consists of three cylindrical bodies of spongy tissue filled with
blood vessels along its length. Two of these bodies lie side-by-side in the upper
portion of the penis called corpora cavernous. The third, called the corpus
spongiosum, is a tube that lies centrally beneath the others and expands at the end
to form the tip of the penis (glans).[23]
The raised rim at the border of the shaft and glans is called the corona. The urethra
runs through the shaft, providing an exit for sperm and urine. The root consists of the
expanded ends of the cavernous bodies, which fan out to form the curare and attach
to the pubic bone and the expanded end of the spongy body (bulb). The root is
surrounded by two muscles; the bulbocavernosus muscle and the ischiocavernosus
muscle, which aid urination and ejaculation. The penis has a foreskin that typically
covers the glans; this is sometimes removed by circumcision for medical, religious or
cultural reasons. In the scrotum, the testicles are held away from the body, one
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possible reason for this is so sperm can be produced in an environment slightly

lower than normal body temperature.
Internal male anatomy
Male internal reproductive structures are the testicles, the duct system, the prostate
and seminal vesicles, and the gland. The testicles are the male gonads where sperm
and male hormones are produced. Millions of sperm are produced daily in several
hundred seminiferous tubules. Cells called the Leydig cells lie between the tubules;
these produce hormones called androgens; these consist
of testosterone and inhibin. The testicles are held by the spermatic cord, which is a
tube like structure containing blood vessels, nerves, the vas deferens, and a muscle
that helps to raise and lower the testicles in response to temperature changes and
sexual arousal, in which the testicles are drawn closer to the body.
Sperm are transported through a four-part duct system. The first part of this system
is the epididymis. The testicles converge to form the seminiferous tubules, coiled
tubes at the top and back of each testicle. The second part of the duct system is
the vas deferens, a muscular tube that begins at the lower end of the epididymis . The
vas deferens passes upward along the side of the testicles to become part of the
spermatic cord. The expanded end is the ampulla, which stores sperm before
ejaculation. The third part of the duct system is the ejaculatory ducts, which are 1-
inch (2.5 cm)-long paired tubes that pass through the prostate gland, where semen
is produced. The prostate gland is a solid, chestnut-shaped organ that surrounds the
first part of the urethra, which carries urine and semen. Similar to the female G-spot,
the prostate provides sexual stimulation and can lead to orgasm through anal sex.
The prostate gland and the seminal vesicles produce seminal fluid that is mixed with
sperm to create semen. The prostate gland lies under the bladder and in front of the
rectum. It consists of two main zones: the inner zone that produces secretions to
keep the lining of the male urethra moist and the outer zone that produces seminal
fluids to facilitate the passage of semen. The seminal vesicles secrete fructose for
sperm activation and mobilization, prostaglandins to cause uterine contractions that
aid movement through the uterus, and bases that help neutralize the acidity of the
vagina. The Cowper's glands, or bulbourethral glands, are two pea sized structures
beneath the prostate.
Female anatomy and reproductive system
External female anatomy

The Mons veneris, also known as the Mound of Venus, is a soft layer of fatty tissue
overlaying the pubic bone. Following puberty, this area grows in size. It has many
nerve endings and is sensitive to stimulation.
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The labia menorah and labia majora are collectively known as the lips. The labia
majora are two elongated folds of skin extending from the mons to the perineum. Its
outer surface becomes covered with hair after puberty. In between the labia majora
are the labia minora, two hairless folds of skin that meet above the clitoris to form the
clitoral hood, which is highly sensitive to touch. The labia minora become engorged
with blood during sexual stimulation, causing them to swell and turn red. The labia
minora are composed of connective tissues that are richly supplied with blood
vessels which cause the pinkish appearance. Near the anus, the labia minora merge
with the labia majora. In a sexually unstimulated state, the labia minora protects the
vaginal and urethral opening by covering them. At the base of the labia minora are
the Bartholin's glands, which add a few drops of an alkaline fluid to the vagina via
ducts; this fluid helps to counteract the acidity of the outer vagina since sperm
cannot live in an acidic environment. The clitoris is developed from the same
embryonic tissue as the penis; it or its glans alone consists of as many (or more in
some cases) nerve endings as the human penis or glans penis, making it extremely
sensitive to touch. The clitoral glans, which is a small, elongated erectile structure,
has only one known function—sexual sensations. It is the main source of orgasm in
women. Thick secretions called smegma collect in the clitoris.
The vaginal opening and the urethral opening are only visible when the labia minora
are parted. These opening have many nerve endings that make them sensitive to
touch. They are surrounded by a ring of sphincter muscles called
the bulbocavernosus muscle. Underneath this muscle and on opposite sides of the
vaginal opening are the vestibular bulbs, which help the vagina grip the penis by
swelling with blood during arousal. Within the vaginal opening is the hymen, a thin
membrane that partially covers the opening in many virgins. Rupture of the hymen
has been historically considered the loss of one's virginity, though by modern
standards, loss of virginity is considered to be the first sexual intercourse. The
hymen can be ruptured by activities other than sexual intercourse. The urethral
opening connects to the bladder with the urethra; it expels urine from the bladder.
This is located below the clitoris and above the vaginal opening.
The breasts are external organs used for sexual pleasure in some cultures. Western
culture is one of the few in which they are considered erotic. ] The breasts are the
subcutaneous tissues on the front thorax of the female body. Breasts are modified
sweat glands made up of fibrous tissues and fat that provide support and contain
nerves, blood vessels and lymphatic vessel. Their purpose is to provide milk to a
developing infant. Breasts develop during puberty in response to an increase in
oestrogen. Each adult breast consists of 15 to 20 milk-producing mammary glands,
irregularly shaped lobes that include alveolar glands and a lactiferous duct leading to
the nipple. The lobes are separated by dense connective tissues that support the
glands and attach them to the tissues on the underlying pectoral muscles. Other
connective tissue, which forms dense strands called suspensory ligaments, extends
inward from the skin of the breast to the pectoral tissue to support the weight of the
breast. Heredity and the quantity of fatty tissue determine the size of the breasts
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Internal female anatomy

The female internal reproductive organs are the vagina, uterus, Fallopian

tubes, and ovaries. The vagina is a sheath-like canal that extends from the vulva to
the cervix. It receives the penis during intercourse and serves as a depository for
sperm. The vagina is also the birth canal; it can expand to 10 cm (3.9 in) during
labour and delivery. The vagina is located between the bladder and the rectum. The
vagina is normally collapsed, but during sexual arousal it opens, lengthens, and
produces lubrication to allow the insertion of the penis. The vagina has three layered
walls; it is a self-cleaning organ with natural bacteria that suppress the production of
yeast. The G-spot, named after the Ernst Gräfenberg who first reported it in 1950,
may be located in the front wall of the vagina and may cause orgasms. This area
may vary in size and location between women; in some it may be absent. Various
researchers dispute its structure or existence, or regard it as an extension of the
clitoris.
The uterus or womb is a hollow, muscular organ where a fertilized egg (ovum) will
implant itself and grow into a fetus.The uterus lies in the pelvic cavity between the
bladder and the bowel, and above the vagina. It is usually positioned in a 90-degree
angle tilting forward, although in about 20% of women it tilts backwards. The uterus
has three layers; the innermost layer is the endometrium, where the egg is
implanted. During ovulation, this thickens for implantation. If implantation does not
occur, it is sloughed off during menstruation. The cervix is the narrow end of the
uterus. The broad part of the uterus is the fundus.
During ovulation, the ovum travels down the Fallopian tubes to the uterus. These
extend about four inches (10 cm) from both sides of the uterus. Finger-like
projections at the ends of the tubes brush the ovaries and receive the ovum once it is
released. The ovum then travels for three to four days to the uterus. After sexual
intercourse, sperm swim up this funnel from the uterus. The lining of the tube and its
secretions sustain the egg and the sperm, encouraging fertilization and nourishing
the ovum until it reaches the uterus. If the ovum divides after fertilization, identical
twins are produced. If separate eggs are fertilized by different sperm, the mother
gives birth to non-identical or fraternal twins.
The ovaries are the female gonads; they develop from the same embryonic tissue as
the testicles. The ovaries are suspended by ligaments and are the source where ova
are stored and developed before ovulation. The ovaries also produce female
hormones progesterone and oestrogen. Within the ovaries, each ovum is surrounded
by other cells and contained within a capsule called a primary follicle. At puberty, one
or more of these follicles are stimulated to mature on a monthly basis. Once
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matured, these are called Graafian follicles. The female reproductive system does

not produce the ova; about 60,000 ova are present at birth, only 400 of which will
mature during the woman's lifetime.
Ovulation is based on a monthly cycle; the 14th day is the most fertile. On days one
to four, menstruation and production of oestrogen and progesterone decreases, and
the endometrium starts thinning. The endometrium is sloughed off for the next three
to six days. Once menstruation ends, the cycle begins again with an FSH surge from
the pituitary gland. Days five to thirteen are known as the pre-ovulatory stage. During
this stage, the pituitary gland secretes follicle-stimulating hormone (FSH). A negative
feedback loop is enacted when oestrogen is secreted to inhibit the release of FSH.
Oestrogen thickens the endometrium of the uterus. A surge of Luteinizing
Hormone (LH) triggers ovulation. On day 14, the LH surge causes a Graafian follicle
to surface the ovary. The follicle ruptures and the ripe ovum is expelled into the
abdominal cavity. The fallopian tubes pick up the ovum with the fimbria. The cervical
mucus changes to aid the movement of sperm. On days 15 to 28—the post-
ovulatory stage, the Graafian follicle—now called the corpus luteum—secretes
oestrogen. Production of progesterone increases, inhibiting LH release. The
endometrium thickens to prepare for implantation, and the ovum travels down the
Fallopian tubes to the uterus. If the ovum is not fertilized and does not implant,
menstruation begins.

SEXUAL RESPONSE CYCLE

The sexual response cycle is a model that describes the physiological responses
that occur during sexual activity. This model was created by William
Masters and Virginia Johnson. According to Masters and Johnson, the human sexual
response cycle consists of four phases; excitement, plateau, orgasm, and
resolution, also called the EPOR model. During the excitement phase of the EPOR
model, one attains the intrinsic motivation to have sex. The plateau phase is the
precursor to orgasm, which may be mostly biological for men and mostly
psychological for women. Orgasm is the release of tension, and the resolution period
is the unaroused state before the cycle begins again.
The male sexual response cycle starts in the excitement phase; two centres in the
spine are responsible for erections. Vasoconstriction in the penis begins, the heart
rate increases, the scrotum thickens, the spermatic cord shortens, and the testicles
become engorged with blood. In the plateau phase, the penis increases in diameter,
the testicles become more engorged, and the Cowper's glands secrete pre-seminal
fluid. The orgasm phase, during which rhythmic contractions occur every 0.8
seconds, consists of two phases; the emission phase, in which contractions of the
vas deferens, prostate, and seminal vesicles encourage ejaculation, which is the
second phase of orgasm. Ejaculation is called the expulsion phase; it cannot be
reached without an orgasm. In the resolution phase, the male is now in an
unaroused state consisting of a refectory (rest) period before the cycle can begin.
This rest period may increase with age.
The female sexual response begins with the excitement phase, which can last from
several minutes to several hours. Characteristics of this phase include increased
heart and respiratory rate, and an elevation of blood pressure. Flushed skin or
blotches of redness may occur on the chest and back; breasts increase slightly in
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size and nipples may become hardened and erect. The onset
of vasocongestion results in swelling of the clitoris, labia minora, and vagina. The
muscle that surrounds the vaginal opening tightens and the uterus elevates and
grows in size. The vaginal walls begin to produce a lubricating liquid. The second
phase, called the plateau phase, is characterized primarily by the intensification of
the changes begun during the excitement phase. The plateau phase extends to the
brink of orgasm, which initiates the resolution stage; the reversal of the changes
begun during the excitement phase. During the orgasm stage the heart rate, blood
pressure, muscle tension, and breathing rates peak. The pelvic muscle near the
vagina, the anal sphincter, and the uterus contract. Muscle contractions in the
vaginal area create a high level of pleasure, though all orgasms are centered in the
clitoris.

EVOLUTION OF NEUROBIOLOGICAL FACTORS IN SEXUALITY

From rodent to human, the corticalization of the brain induces several changes in the
control of sexual behaviour, including lordosis behaviour. These changes induce a
"difference between the stereotyped sexual behaviours in non-human mammals and
the astounding variety of human sexual behaviours".

Evolution of the main neurobiological factors that control the sexual behaviour of
mammals
Sexual reflexes, such as the motor reflex of lordosis, become secondary. In
particular, lordosis behaviour, which is a motor reflex complex and essential to carry
out copulation in non-primate mammals (rodents, canines, bovid ...), is apparently no
longer functional in women. Sexual stimuli on women do not trigger any more neither
immobilization nor the reflex position of lordosis. On the level of olfactory systems,
the vomeronasal organ is altered in hominids and 90% of the
pheromone receptor genes become pseudo genes in humans. Concerning hormonal
control, sexual activities are gradually dissociated from hormonal cycles. Humans
can have sex anytime during the year and hormonal cycles. On the contrary, the
importance of rewards / reinforcements and cognition became major. Especially in
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humans, the extensive development of the neocortex allows the emergence

of culture, which has a major influence on behaviour. For all these reasons, the
dynamics of sexual behaviour was modified.

Multifactorial dynamics of human sexuality

In human beings, sexuality is multifactorial, with several factors that interact (genes,
hormones, conditioning, sexual preferences, emotions, cognitive processes, cultural
context). The relative importance of each of these factors is dependent both on
individual physiological characteristics, personal experience and aspects of the
sociocultural environment.

SEXUAL DYSFUNCTION
Sexual dysfunction can be a result of a physical or psychological problem.

 Physical causes. Many physical and/or medical conditions can cause problems

with sexual function. These conditions include diabetes, heart disease,
neurological diseases, hormonal imbalances, menopause plus such chronic
diseases as kidney disease or liver failure, and alcoholism or drug abuse. In
addition, the side effects of certain medications, including
some antidepressant drugs, can affect sexual desire and function.
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 Psychological causes. These include work-related stress and anxiety, concern

about sexual performance, marital or relationship problems, depression, feelings
of guilt, or the effects of a past sexual trauma.

Both men and women are affected by sexual dysfunction. Sexual problems occur in
adults of all ages. Among those commonly affected are older adults, and they may be
related to a decline in health associated with aging.
MALE DYSFUNCTION

It is any physical or psychological problem that prevents partners from getting

sexual satisfaction. Male sexual dysfunction is a common health problem affecting
men of all ages, but is more common with increasing age. Treatment can often help
men suffering from sexual dysfunction.

The main types of male sexual dysfunction are:

 Erectile dysfunction (difficulty getting/keeping an erection)

 Premature ejaculation (reaching orgasm too quickly)
 Delayed or inhibited ejaculation (reaching orgasm too slowly or not at all)
 Low libido (reduced interest in sex).

Physical causes of overall sexual dysfunction may be:

 Low testosterone levels

 Prescription drugs (antidepressants, high blood pressure medicine)
 Blood vessel disorders such as atherosclerosis (hardening of the arteries) and
high blood pressure
 Stroke or nerve damage from diabetes or surgery
 Smoking
 Alcoholism and drug abuse

Psychological causes might include:

 Concern about sexual performance

 Marital or relationship problems
 Depression, feelings of guilt
 Effects of past sexual trauma
 Work-related stress and anxiety

The most common problems men face with sexual dysfunction are troubles with
ejaculation, getting and keeping an erection, and reduced sexual desire.

Ejaculation disorders

Problems with ejaculation are:

 Premature ejaculation (PE) — ejaculation that occurs before or too soon after
penetration
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 Inhibited or delayed ejaculation — ejaculation does not happen or takes a

very long time
 Retrograde ejaculation — at orgasm, the ejaculate is forced back into the
bladder rather than through the end of the penis

The exact cause of premature ejaculation (PE) is not known. While in many cases
PE is due to performance anxiety during sex, other factors may be:

 Stress
 Temporary depression
 History of sexual repression
 Low self-confidence
 Lack of communication or unresolved conflict with partner

Studies suggest that the breakdown of serotonin (a natural chemical that affects
mood) may play a role in PE. Certain drugs, including some antidepressants, may
affect ejaculation, as can nerve damage to the back or spinal cord.

Physical causes for inhibited or delayed ejaculation may include chronic (long-

term) health problems, medication side effects, alcohol abuse, or surgeries. The
problem can also be caused by psychological factors such as depression, anxiety,
stress, or relationship problems.

Retrograde ejaculation is most common in males with diabetes who suffer from
diabetic nerve damage. Problems with the nerves in the bladder and the bladder
neck force the ejaculate to flow backward. In other men, retrograde ejaculation may
be a side effect of some medications, or happen after an operation on the bladder
neck or prostate.

Erectile dysfunction (ED)

Erectile dysfunction (ED) is the inability to get and keep an erection for sexual
intercourse. ED is quite common, with studies showing that about one half of
American men over age 40 are affected. Causes of ED include:

 Diseases affecting blood flow such as hardening of the arteries

 Nerve disorders
 Stress, relationship conflicts, depression, and performance anxiety
 Injury to the penis
 Chronic illness such as diabetes and high blood pressure
 Unhealthy habits like smoking, drinking too much alcohol, overeating, and
lack of exercise

Low libido (reduced sexual desire)

Low libido means your desire or interest in sex has decreased. The condition is often
linked with low levels of the male hormone testosterone. Testosterone maintains sex
drive, sperm production, muscle, hair, and bone. Low testosterone can affect your
body and mood.
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Reduced sexual desire may also be caused by depression, anxiety, or relationship

difficulties. Diabetes, high blood pressure, and certain medications like
antidepressants may also contribute to a low libido.

FEMALE DYSFUNCTION

The most common problems related to sexual dysfunction in women include:

 Inhibited sexual desire. This involves a lack of sexual desire or interest in sex.

Many factors can contribute to a lack of desire, including hormonal changes,
medicalconditionsandtreatment(forexample, cancer and chemotherapy), depres
sion, pregnancy, stress, and fatigue. Boredom with regular sexual routines also
may contribute to a lack of enthusiasm for sex, as can lifestyle factors, such as
careers and the care of children.
 Inability to become aroused. For women, the inability to become physically
aroused during sexual activity often involves insufficient vaginal lubrication. This
inability also may be related to anxiety or inadequate stimulation. In addition,
researchers are investigating how blood flow problems affecting the vagina and
clitoris may contribute to arousal problems.
 Lack of orgasm (anorgasmia). This is the absence of sexual climax (orgasm).
It can be caused by a woman's sexual inhibition, inexperience, lack of
knowledge, and psychological factors such as guilt, anxiety, or a past sexual
trauma or abuse. Other factors contributing to anorgasmia include insufficient
stimulation, certain medications, and chronic diseases.
 Painful intercourse. Pain during intercourse can be caused by a number of
problems, including endometriosis, a pelvic mass, ovarian cysts, vaginitis, poor
lubrication, the presence of scar tissue from surgery, or a sexually transmitted
disease. A condition called vaginismus is a painful, involuntary spasm of the
muscles that surround the vaginal entrance. It may occur in women who fear that
penetration will be painful and also may stem from a sexual phobia or from a
previous traumatic or painful experience.

PSYCHOLOGICAL ASPECTS
Child sexuality
In the past, children were often assumed not to have sexuality until later
development. Sigmund Freud was one of the first researchers to take child sexuality
seriously. His ideas, such as psychosexual development and the Oedipus conflict,
have been much debated but acknowledging the existence of child sexuality was an
important development. Freud gave sexual drives an importance and centrality in
human life, actions, and behaviour; he said sexual drives exist and can be discerned
in children from birth. He explains this in his theory of infantile sexuality, and says
sexual energy (libido) is the most important motivating force in adult life. Freud wrote
about the importance of interpersonal relationships to one's sexual and emotional
development. From birth, the mother's connection to the infant affects the infant's
later capacity for pleasure and attachment. Freud described two currents of
emotional life; an affectionate current, including our bonds with the important people
in our lives; and a sensual current, including our wish to gratify sexual impulses.
During adolescence, a young person tries to integrate these two emotional currents.
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Alfred Kinsey also examined child sexuality in his Kinsey Reports. Children are

naturally curious about their bodies and sexual functions. For example, they wonder
where babies come from, they notice the differences between males and females,
and many engage in genital play, which is often mistaken for masturbation. Child sex
play, also known as playing doctor, includes exhibiting or inspecting the genitals.
Many children take part in some sex play, typically with siblings or friends. Sex play
with others usually decreases as children grow, but they may later possess romantic
interest in their peers. Curiosity levels remain high during these years, but the main
surge in sexual interest occurs in adolescence.
Sexuality in late adulthood
Adult sexuality originates in childhood. However, like many other human capacities,
sexuality is not fixed, but matures and develops. A common stereotype associated
with old people is that they tend to lose interest and the ability to engage in sexual
acts once they reach late adulthood. This misconception is reinforced by Western
popular culture, which often ridicules older adults who try to engage in sexual
activities. Age does not necessarily change the need or desire to be sexually
expressive or active. A couple in a long-term relationship may find that the frequency
of their sexual activity decreases over time and the type of sexual expression may
change, but many couples experience increased intimacy and love.

SOCIOCULTURAL ASPECT
Human sexuality can be understood as part of the social life of humans, which is
governed by implied rules of behaviour and the status quo. This narrows the view to
groups within a society. The socio-cultural context of society, including the effects of
politics and the mass media, influences and forms social norms. Before the early
21st century, people fought for their civil rights. The civil rights movements helped to
bring about massive changes in social norms; examples include the sexual
revolution and the rise of feminism.
The link between constructed sexual meanings and racial ideologies has been
studied. Sexual meanings are constructed to maintain racial-ethnic-national
boundaries by denigration of "others" and regulation of sexual behaviour within the
group Scholars also study the ways in which colonialism has effected sexuality today
and argue that due to racism and slavery it has been dramatically changed from the
way it had previously been understood. These changes to sexuality are argued to be
largely effected by the enforcement of the gender binary and heteropatriarchy as
tools of colonization on colonized communities as seen in nations such
as India, Samoa, and the First Nations in the Americas, resulting in the deaths and
erasure of non-western genders and sexualities. In the United States people of
colour face the effects of colonialism in different ways with stereotypes such as the
Mammy, and Jezebel for Black women; lotus blossom, and dragon lady for Asian
women; and the "spicy" Latina.
The age and manner in which children are informed of issues of sexuality is a matter
of sex education. The school systems in almost all developed countries have some
form of sex education, but the nature of the issues covered varies widely. In some
countries, such as Australia and much of Europe, age-appropriate sex education
often begins in pre-school, whereas other countries leave sex education to the pre-
teenage and teenage years. Sex education covers a range of topics, including the
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physical, mental, and social aspects of sexual behaviour. Geographic location also
plays a role in society's opinion of the appropriate age for children to learn about
sexuality. According to TIME magazine and CNN, 74% of teenagers in the United
States reported that their major sources of sexual information were their peers and
the media, compared to 10% who named their parents or a sex education course.

Religious sexual morality

In some religions, sexual behaviour is regarded as primarily spiritual. In others it is
treated as primarily physical. Some hold that sexual behaviour is only spiritual within
certain kinds of relationships, when used for specific purposes, or when incorporated
into religious ritual. In some religions there are no distinctions between the physical
and the spiritual, whereas some religions view human sexuality as a way of
completing the gap that exists between the spiritual and the physical.
Attitude by religion
According to Judaism, sex between man and woman within marriage is sacred and
should be enjoyed; celibacy is considered sinful.
The Roman Catholic Church teaches that sexuality is "noble and worthy" but that it
must be used in accordance with natural law. For this reason, all sexual activity must
occur in the context of a marriage between a man and a woman, and must not be
divorced from the possibility of conception. Most forms of sex without the possibility
of conception are considered intrinsically disordered and sinful, such as the use of
contraceptives, masturbation, and homosexual acts.
In Islam, sexual desire is considered to be a natural urge that should not be
suppressed, although the concept of free sex is not accepted; these urges should be
fulfilled responsibly. Marriage is considered to be a good deed; it does not hinder
spiritual wayfaring. The term used for marriage within the Quran is nikah, which
literally means sexual intercourse. Although Islamic sexuality is restrained via Islamic
sexual jurisprudence, it emphasizes sexual pleasure within marriage. It is acceptable
for a man to have more than one wife, but he must take care of those wives
physically, mentally, emotionally, financially, and spiritually. Muslims believe that
sexual intercourse is an act of worship that fulfils emotional and physical needs, and
that producing children is one way in which humans can contribute to God's creation,
and Islam discourages celibacy once an individual is married. However,
homosexuality is strictly forbidden in Islam, and some Muslim lawyers have
suggested that gay people should be put to death. On the other hand, some have
argued that Islam has an open and playful approach to sex so long as it is within
marriage, free of lewdness, fornication and adultery. For many Muslims, sex with
reference to the Quran indicates that – bar anal intercourse and adultery – a Muslim
marital home bonded by Nikah marital contract between husband and his wife(s)
should enjoy and even indulge, within the privacy of their marital home, in limitless
scope of heterosexual sexual acts within a monogamous or polygamous marriage.
Hinduism emphasizes that sex is only appropriate between husband and wife, in
which satisfying sexual urges through sexual pleasure is an important duty of
marriage. Any sex before marriage is considered to interfere with intellectual
development, especially between birth and the age of 25, which is said to be
brahmacharya and this should be avoided. Kama (sensual pleasures) is one of the
four purusharthas or aims of life (dharma, artha, Kama, and moksha). The
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Hindu Kama Sutra deals partially with sexual intercourse; it is not exclusively a

sexual or religious work.
Sikhism views chastity as important, as Sikhs believe that the divine spark
of Waheguru is present inside every individual's body, therefore it is important for
one to keep clean and pure. Sexual activity is limited to married couples, and
extramarital sex is forbidden. Marriage is seen as a commitment to Waheguru and
should be viewed as part of spiritual companionship, rather than just sexual
intercourse, and monogamy is deeply emphasised in Sikhism. Any other way of
living is discouraged, including celibacy and homosexuality. However, in comparison
to other religions, the issue of sexuality in Sikhism is not considered one of
paramount importance.

REPRODUCTIVE & SEXUAL RIGHTS

The Platform for Action from the 1995 Beijing Conference on Women established
that human rights include the right of women freely and without coercion, violence or
discrimination, to have control over and make decisions concerning their own
sexuality, including their own sexual and reproductive health. This paragraph has
been interpreted by some countries as the applicable definition of women’s sexual
rights. The UN Commission on Human Rights has established that if women had
more power, their ability to protect themselves against violence would be
strengthened.
At the 14th World Congress of Sexology (Hong Kong, 1999), the WAS adopted
the Declaration of Sexual Rights, which originally included 11 sexual rights. It was
heavily revised and expanded in March 2014 by the WAS Advisory Council to
include 16 sexual rights.

1. The right to equality and non-discrimination

2. The right to life, liberty and security of the person
3. The right to autonomy and bodily integrity
4. The right to be free from torture and cruel, inhuman, or degrading treatment or
punishment
5. The right to be free from all forms of violence and coercion
6. The right to privacy
7. The right to the highest attainable standard of health, including sexual health;
with the possibility of pleasurable, satisfying, and safe sexual experiences
8. The right to enjoy the benefits of scientific progress and its application
9. The right to information
10. The right to education and the right to comprehensive sexuality education
11. The right to enter, form, and dissolve marriage and similar types of
relationships based on equality and full and free consent
12. The right to decide whether to have children, the number and spacing of
children, and to have the information and the means to do so
13. The right to the freedom of thought, opinion, and expression
14. The right to freedom of association and peaceful assembly
15. The right to participation in public and political life
16. The right to access to justice, remedies, and redress
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This Declaration influenced The Yogyakarta Principles (which were launched as a

set of international principles relating to sexual orientation and gender identity on 26
March 2007), especially on the idea of each person's integrity, and right to sexual
and reproductive health.
Reproductive rights are legal rights and freedoms relating
to reproduction and reproductive health. The World Health Organization defines
reproductive rights as follows:
Reproductive rights rest on the recognition of the basic right of all couples and
individuals to decide freely and responsibly the number, spacing and timing of their
children and to have the information and means to do so, and the right to attain the
highest standard of sexual and reproductive health. They also include the right of all
to make decisions concerning reproduction free
of discrimination, coercion and violence.
Special goals and targets were also created to address adolescent sexual and
reproductive health needs. Adolescents are often the most vulnerable to risks
associated with sexual activity, including HIV, due to personal and social issues such
as feelings of isolation, child marriage, and stigmatization. Governments realized the
importance of investing in the health of adolescents as a means of establishing
future well-being for their societies. As a result, the Commission on Population and
Development developed a series of fundamental rights for adolescents including the
right to comprehensive sex education, the right to decide all matters related to their
sexuality, and access to sexual and reproductive health services without
discrimination (including safe abortions wherever legal).

SEXUAL HEALTH
INTRODUCTION
 World Health Organization's (WHO) definition of health as a state of complete
physical, mental and social well-being, and not merely the absence of disease or
infirmity, reproductive health, or sexual health/hygiene, addresses the
reproductive processes, functions and system at all stages of life. UN agencies
claim, sexual and reproductive health includes physical, as well as psychological
well-being through sexuality.
Reproductive health implies that people are able to have a responsible, satisfying
and safer sex life and that they have the capability to reproduce and the freedom to
decide if, when and how often to do so. One interpretation of this implies that men
and women ought to be informed of and to have access to safe, effective, affordable
and acceptable methods of birth control; also access to appropriate health care
services of sexual, reproductive medicine and implementation of health education
programs to stress the importance of safely through pregnancy and childbirth could
provide couples with the best chance of having a healthy infant.

DEFINITION
Sexual health. According to the current working definition, sexual health is: a
state of physical, emotional, mental and social well-being in relation to sexuality; it is
not merely the absence of disease, dysfunction or infirmity.
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COMPONENTS OF SEXUAL HEALTH

 SEXUAL SELF CONCEPTS
Defined as how one values oneself as a sexual being. It determines the
gender & kinds people a person is attracted to, & the values about when,
where & with whom one expresses sexuality. A positive sexual self- concept
enables poor people to form intimate relationship throughout life. A negative
sexual concept may impede formation of relationship.
 BODY IMAGE
It’s the sense of self, it is constantly changing. Pregnancy, aging, trauma,
disease & therapies can alter an individual’s appearance & function, which
can affect body image.
 GENDER IDENTITY
Its one’s self image as a male or female. Gender role behaviour is the
outward expression of a person’s sense of maleness or femaleness as well as
expression of what is perceived as gender-appropriate behaviour.
- Transgender
-Cross-dressers
-Intersexes
-Preoperative transsexual
-Post operative transsexual
 SEXUAL ORIENTATION
Its defined as one’s attraction to people of same sex, opposite sex or both
sexes. Sexual orientation lies along with a wide range between the two
extremes of exclusively heterosexual attraction & exclusively homosexual
attraction & exclusively homosexual attraction. Individual who are attracted to
people of both genders are called bisexuals
FACTORS AFFECTING SEXUAL HEALTH
Brain

The brain triggers and regulates sexual desires and therefore is at the core of
‘sexuality fitness’. Stress and depression, on the other hand, reduce sexual activities
and it is, therefore advisable to stay free of stress. Since the brain controls sexuality,
any form of anxiety is detrimental to sexual health.

Sexually transmitted infections and diseases

STDs and STIs infect and affect the way sex organs behave. Diseases and
infections reduce the activities of the infected organs, if not of the whole body.
Infections that affect the genitals mostly result in sores and wounds around the
sexual organs. For men, the sexual desire and activity reduce largely, especially if
the sores are painful. For women, the infections are mostly internal but they affect
their sexual life.
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It is always advised to go for regular STD and STI tests to make sure of your health.
When you are infected, the bad odour that accompanies is sure to affect your social
well-being as well.

Fear and anxiety

For young adults, this is the main factor that affects sexual health. The fear of
unplanned pregnancies and contracting sexual diseases reduces sexual desires for
both men and women. Some of them end up using illegal pregnancy pills that reduce
their sexual activity.

ALTERATION IN SEXUALHEALTH
Infertility is “a disease of the reproductive system defined by the failure to achieve a
clinical pregnancy after 12 months or more of regular unprotected sexual
intercourse.”… (WHO-ICMART glossary). “Infertility is the inability of a sexually
active, non-contracepting couple to achieve pregnancy in one year
“Infertility is the inability of a sexually active, non-contracepting couple to achieve
pregnancy in one year. The male partner can be evaluated for infertility or subfertility
using a variety of clinical interventions, and also from a laboratory evaluation of
semen.
Sexual abuse, also referred to as molestation, is usually undesired sexual
behaviour by one person upon another. It is often perpetrated using force or by
taking advantage of another. When force is immediate, of short duration, or
infrequent, it is called assault. The offender is referred to as a sexual abuser or
(often pejoratively) molester. The term also covers any behaviour sexually by an
adult or older adolescent towards a child to stimulate any of the involved. The use of
a child, or other individuals younger than the age of consent, for sexual stimulation is
referred to as child sexual abuse or statutory rape.
Personal & Emotional Health, Ideally, sex is a natural , spontaneous act that
passes easily through a number of recognizable physiological changes. Nurses
encounter clients who have problem with one or more stages of sexual activity.Eg:
Patient who take antidepressant have noted their ability to reach orgasm is
negatively affected.
Sexual dysfunction (or sexual malfunction orsexual disorder) is difficulty
experienced by an individual or a couple during any stage of a normalsexual activity,
including physical pleasure, desire, preference, arousal or orgasm.

SEX EDUCATION

Sex education, which is sometimes called sexuality education Dr sex and

relationships education, is the process of acquiring information and forming attitudes
and beliefs about sex, sexual identity, relationships and intimacy.

Sex education is also about developing young people's skills so that they make
informed choices about their behaviour, and feel confident and competent about
acting on these choices.
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It is widely accepted that young people have a right to sex education. This is
because it is a means by which they are helped to protect themselves against abuse,
exploitation, unintended pregnancies, exually transmitted diseases and HIV and
AIDS.

Following is a brief description of the main components of the sexual health

education :

(1) Sex Roles

The study of sex roles is vital to achieve one of the objectives of sexual health
education, namely, to enable the youth the understand and cope with changes in
their own lives. The breaking down of traditional social structures and the changing
role of men and women as a result of social change is one such example.

Studies on sex role stereotypes indicate that men and women generally hold
stereotypes of the typical characteristics of males and females. Males are logical,
dominant, independent, unemotional, and aggressive while, women are sensitive,
emotional, nurturing, and are somewhat dependent and submissive.

It is unlikely that such personality characteristics are completely in same, because in

some cultures women are aggressive and dominant, while men are found to be
emotional and sensitive. If there is inherent pre-disposition that is different for each
sex, it appears that particular cultures emphasize some and mask others.

Furthermore, literature and mass media tend to create, reinforfce and perpetuate
many sex role differentiations. Many experts agree that the pressure, anxiety and
confusion about male female roles are core issues in most concerns related to
sexuality. Stereotyped sex roles hinder people from developing their natural abilities
and personalities.

(2) Pre-marital sex and teenage pregnancies

Pre-marital sex has given rise to a range of alarming problems. Today's teenagers
are faced with new challenges. Sexual activity has become more over among the
youth and society in general. Girls and boys are reaching sexual maturity at an
earlier age. Because of their early menarche girls are able to conceive at a younger
age.

As sexual intercourse among adolescents in some countries becomes common,

teenage pregnancies are on the increase. Sexual permissiveness is encouraged by
sexual messages conveyed through the mass media. It has negative impact on the
individual and the society. Hardly any effort is made to provide moral education.

Teenage pregnancies pose many problems. Strong social pressure may lead to
illegal abortion and may also provoke the women to commit suicide. Illegitimate
children may face the problem of social and legal discrimination as well as economic
hardships. If marriage is forced on the mother, there is a high probability of marriage
failure.
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When a low level of educational attainment among the women is perpetuated from
generation to generation, their opportunities for employment also get reduced. Thus,
their continued dependence on others for their

livelihood is reinforced. In terms of health, early reproduction is usually harmful both

physically and emotionally, then one which begins late.

(3) Social relationship

The growth and development of social relationship of young people is, by and large,
centered around their interaction with siblings, parents, peer group and members of
the opposite sex. Early experience of social relationship is usually centered around
home. However, as young people enter into their teens, physical and emotional
development which takes place in them is marked by changes in the patterns of
interpersonal relationship.

Parents continue to have control over their teenage children and provide protection
and guidance. However, teenagers try to assert their independence by shifting away
from parents and trying to be on their own within their families. It is common for
young people to have more frequent conflict with their parents over the amount of
freedom they think they deserve. Some parents treat these changes in behaviour
pattern as a challenge to their authority.

Many parents tend to think their growing child is inexperienced and therefore, cannot
make right decisions. Such parents therefore, can also generate stress and strain for
their children. Social development is easier for those teenagers who feel that their
parents love and trust them. An over-protected teenager is likely to have greater
difficulty in learning to act independently.

To a great extent, peer group relationships help teenagers to learn to interact with
people in a healthy manner. It is also seen that adolescents look to their peer group
for approval. During this period there is a tendency to have fiends from both sexes.

While the peer influence helps in establishing independent identities, peer pressure
at times can generate negative orientation in teenagers. Studies indicate that most
people who indulge in drugs, alcohol and teenage sex do so under peer group
pressure or orientation.

Therefore, an appropriate sexual health education package is required for young

people which will enable them to adopt healthy behaviour pattern.

(4) Personal identity

During adolescence every child tries to establish his/her own identity. The
establishment of identify is a gradual process during this stage of development. It is
possible that the physical and psychological changes taking place during the
teenage period can interfere with the process of establishing personal identity.
However, as they grow into adulthood, they normally develop a strong sense of
personal identity.

Parents and teachers need to help and support young people to develop and
maintain a high sense of self-esteem and self-concept. Self-
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esteem is closely identified with self-respect. It is the realisation of oneself as a

human being and the identification of one's self within the society. The social
development of a person is primarily based on this self-esteem.

(5) Emotional development

Teenage period that is from the age 13 to 19 is often described as a period of great
excitement and emotional turbulence. The physical changes that take place among
people during this period may result in a sudden upsurge of sexual feeling.
Experiences of sexual excitement may occur when they are nearer to people of the
same sex and age.

At this time they may not recognise that such emotions are sexual in nature. An
increase in hormones can arouse sexual thoughts and excitement. However, due to
social control such interests are not expressed in reality and this will lead them to
day-dreaming. During the teenage period 'wet dreams' are common in many boys.

Emotional stress is a common phenomenon during adolescence due to the changes

taking place with their bodies. Hormonal imbalance can cause irritation,
restlessness, and tension. Young people need to be educated on such matters
although most adolescents manage such changes and developments on their own.

It is however, essential that authentic knowledge on the subject is provided to them

along with proper guidance and support from parents, teachers and responsible
elders in the family. It is, however, most important to offer a healthy emotional
climate for young people at home, in the school, as well as in the community where
they can conveniently express their emotions.

(6) Sex Drive or Sexual feelings in childhood and adolescence

Sexual attitudes are formed from early childhood, although sexual

urges and emotions do not become apparent until the age of puberty. During this
period, many changes occur among young boys and girls. In the male, puberty
begins with the appearance of nocturnal emissions or wet dreams. At about his time,
a young man begins to experience a distinct sexual urge that is associated with his
genitals.

This heightened sexual excitability is likely to lead to masturbation. The sexual drive
of young women, on the other hand, is less genital specific and she tends to
associate sex with romantic situations.

This awakened sexual drive among the youth, particularly young men, creates a
certain among of restlessness because of which the youth are often considered by
their elders as being different and difficult.

These are the first indications towards the adolescent's development an independent
personality and existence which tend to be interpreted as an emotional withdrawal
from home and family. During this stage lack of understanding on the part of elders
and youngsters for each other is common.

(7) Social Aspects

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The sociological and cultural aspects of human sexuality cover topics such as sexual
behaviour, sexuality in childhood and adolescence, love, dating, relationship,
adolescent pregnancy and moral code of ethics. Sexual adjustment is part of a
person's total development into a mature individual.

Sexual maturity helps to bring out what is best, most generous, and most
constructive in an individual's life. Sex is a basic drive upon which both race
preservation and personal happiness depend. If sexuality does not evolve properly,
the whole process of growth and development is likely to be affected negatively.

Excessive sex repression tends to impair freedom and the functioning of an

individual to the extent that mating and sexual satisfaction are not attained. On the
other hand, too much sexual freedom can interfere with normal demonstrations of
love and mating functions, to the degree that sexuality remains on an infantile level.
Disturbances in sexual development can lead to personal and social mal-
adjustments.

(8) Conception, Pregnancy and Birth

In several counties in Asia, early marriages are common. This is true for India as
well. Young couples are urged to have children as early as possible. Early
pregnancies do create a lot of health, social, and psychological risks. Complications
in pregnancies and child birth are the leading cause of death among women aged
between 15 and 19 years in developing countries.

It is important to distinguish between younger and older adolescents when

discussing the risks of pregnancies. Pregnant women of any age require good
obstetric and antenatal care and nutrition. According to UNESCO package on sex
education mortality rate among women who become pregnant before they are 15 is
60 per cent higher than for women in general. Mothers under 15 are 3.5 times more
likely to die.

Pregnancy and birth are areas of real concern for teenagers. Because of the health
risks, they will be interested to know about pre-natal and post-natal care, pregnancy
symptoms and testing, foetal growth and development and labour or delivery.

(9) Physical, Emotional and Psychological Changes During Puberty

Puberty is a time for physical and emotional change. During puberty adolescents
begin to become concerned about the physical changes they see in their bodies.
Some may be developing at a slower

pace while some other may grow at a faster rate than friends. Some may be feeling
awkward about their growth while some may become anxious over their bodily
changes and may have conflicting feelings about becoming adult. Yet some others
may feel proud and comfortable about their approach to maturity.

It is a time for adolescents to develop their esteem. Adolescence a period of high

stress for many people. Young people are much concerned about their physical
image and their relationships with their family friends. Their confusions, concern and
anxiety affects their feeling of self worth. Behaviour matches self image.
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A young person with a positive, health self image will make positive, health choices.
Efforts should be made to encourage self-awareness and self-acceptance among
the adolescents during this period of drastic change.

(10) Anatomy and Physiology of the Reproductive Systems

This part identifies the various male and female reproductive organs

and their functions. Adolescents need this information in order to understand the
successive concepts concerning conception, pregnancy and contraception. Concept
of menstrual cycle is also to be discussed.

(11) Gender Roles

The term 'gender' is derived from the French word 'genre' meaning sex. Sex refers to
binary division between a male and female in terms of physical features,
chromosomes, hormones and secondary sexual characteristics. Gender refers to
those characteristics of males and females that are shaped by social factors.

While examining gender difference in life expectancies, we refer to social influences

on survival, such as preference for male children and discrimination of women and
girl children in matters of education, healthcare, nutrition etc. In fact the differences
between males and females are derived from three sources;

(i) biology,

(ii) roles that men and women traditionally play in society, and

(iii) beliefs and opinions prevalent in society.

The existing inequalities between men and women and the subordination of women
to men is one area of distinction between sex and gender which is quite explicit.

It is important to understand the gender-based role assignment by society to male

and female. In fact, all these role stereotypes influence every aspect of human life. In
Short we may say that gender roles are a set of behaviour which is determined by
the society for men and women.

A close analysis of gender roles prevents in various cultures and societies through
various ages show considerable variation. Across the globe we find that almost all
societies have assigned different roles to men and women.

In fact, history shows that men and women hardly performed equal roles or held
equal positions except in certain exceptional cases where women inherited the
throne from their fathers. Otherwise men are valued higher than women. In short, the
females are considered weaker and males stronger.

Men are considered wage earners, heads of households and leaders of the society
in various fields. The role traditionally assigned to women include raising a family
and maintaining the home, being ideal mothers, wives, sisters, and daughters while
sacrificing their personal interests for the interest of the male members within the
family.
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The major impact on gender roles are influenced by the stereotyped sex roles which
continue in every society. Almost all stereotypes are man-made, but they are
considered to be natural.

In fact, this man- made stereotypes have been handed down from generation to
generation which has resulted in the perpetuation of the discrimination against
women. From the moment a child is born, identification of sex followed by gender-
based role assignment begins and this process continues to be an integral part of
socialization of children into adulthood.

Most of the stereotyped roles or messages are given to children from childhood days
by parents, siblings, pears, society and the mass media. In fact, these messages
communicate that certain behaviours are acceptable for body but not for girls, and
vice-versa.

As the child grows up, he/she identifies himself/herself with the parents of the same
sex. The male child starts internalizing the characteristic of his father and the female
child internalizes the characteristics of the mother.

Gender roles continue to influence the behaviour of teenagers during the formative
period. The gender identity with regard to various types or roles, such as
occupational roles, domestic roles, kinship roles, community leadership roles,
conjugal roles and parental roles continue to develop during the period of
adolescence.

The effect of such gender- defined roles results in development of attitudes,

behaviour and value orientation viewed appropriate for male and female in a given
cultural setting.-

Therefore, there is need to promote appropriate gender role development among

young people during the formative period so that discrimination of women can be
challenged and a transformation of traditional models of gender relations take place
in the society. This is required if we want to create a decent society where men and
women can live a meaningful life with dignity.

Only a consciously prepared curriculum on sexual health education can influence the
existing stereotyped gender roles.

(12) Sexually Transmitted Diseases (STD)

STD as a topic in sexual health education has become more important due to the
increased spread of STDs, and especially the dramatic rise in the incidence of HIV
and AIDS. STD education should address two area: Factual education and
inculcation of the Right social attitudes.

NURSING MANAGEMENT
 ASSESSING
Information about the client health status.Include health history & physical
examination.On history collection nurse should ask about suspicion of any
sexually transmitted disease,infertility,pregnancy.
 PLANNING
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The overall goals to meet the sexual needs include:

-Maintain,restore or improve sexual health.
-Increase knowledge of sexuality & sexual health.
-Prevent the occurance or spread of STD.
-Improve sexual self concept.
 IMPLIMENTING
-Providing sex education.
-Counselling for altered sexual function.
-Intensive therapy.
-Responsible sexual behaviour.

CONCLUSION
Sexual health promotion in teenagers is a very central matter. Social cultural and
political factors can hold back effective communication between health professionals
and young people and can put off young people from seeking professionals help
regarding sexual health issues. Sexual health promotion will reach the young people
at a level that has considerable meaning to achieve change in their sexual practice
and to help them to reach their most favourable sexual health and sexual identity.
Sexual health promotion in teenagers will assist to reduce the rate of sexually
transmitted infections, HIVs, teenage pregnancies and sexual violence.

BIBLIOGRAPHY
 Shabeer, Text Book Of AdvancedNursingPractice,2 nd edition,EMMESS
publishers,Page no:586-592
 NavdeepKaur,Text Book Of AdvancedNursingPractice,1 st edition,Jaypee
publishers,
Page no:847-884
 https://writepass.com/journal/2012/12/promoting-sexual-health/
 https://wwwnursingtimes.net/clinical-archive/sexual-health