Reproductive and Sexual Health

Lesson 2
LESSON: 2
DURATION: 3 hours

Reproductive and Sexual Health

SPECIFIC OBJECTIVES:

At the end of the lesson, the students should be able to:

1. Discuss the concept of unitive and proactive health.

2. Define sexual health
3. Discuss the varieties of sexuality
4. Give examples of how the family, culture, religion and personal expectations and ethics
influence one’s sexuality.
5. Describe physiological changes during the sexual response cycle.
6. Identify the forms of altered sexual function.
7. Identify basic sexual questions the nurse should ask during the client assessment.
8. Formulate nursing diagnoses and interventions for the client experiencing sexual problems.
9. Recognize health promotion teaching related to reproductive structures.

LESSON PROPER:

A. CONCEPT OF UNITIVE AND PROCREATIVE HEALTH

a. Unitive Health
Marriage is when a man and woman unite “as one flesh” Sex is unitive
Natural intercourse between a man and a woman
b. Procreative Health
Found only in natural intercourse
Sexual act is inherently ordered toward the creation of new human life
Marriage needs to be open to the possibility of having children. Sex is procreative
 The unitive and procreative aspects of the sexual act are inseparable.
c. Procreation: is the creation of a new human person, by the act of sexual intercourse,
by a man and a woman.
d. Creation: is the making of all things from nothing, by an act of God, at some time in
the past. God’s action could have taken a second, or 6 days, or a million years
e. Evolutionary theory: is the theory that all things came about by the repeated random
actions of natural selection.
f. Sexual identity describes how a person identifies related to their sexual orientation
g. Gender identity describes the gender with which a person identifies (i.e, whether one
perceives oneself to be a man, a woman, or describes oneself in some less
conventional way. Gender identity may be affected by a variety of social structures,
 including the person's ethnic group, employment status, religion or irreligion, and
family.
h. Gender role a set of perceived behavioral norms associated particularly with males
or females, in a given social group or system
B. HUMAN SEXUALITY
A person’s sexuality encompasses complex emotions, attitudes, preferences, and
behaviors related to expression of the sexual self and eroticism.
Sex - term used to denote biological male or female status, and it is also used to describe
specific sexual behavior.
Sexuality - is a crucial part of people’s identity. It reflects our human character, not solely
our genital nature.
Three (3) aspects of sexuality
• Biologic Sex / Biologic Gender
– Term used to denote chromosomal sexual development.
• Gender / Sexual Identity
– Is the inner sense a person has of being a male or a female, or the sense of
masculinity or femininity?
• Gender-role Behavior
– Is the way a person acts as male or female, including the expression of
what is perceived as gender appropriate behavior.
Sexual Health
According to WHO (World Health Organization):
 Sexual Health- is the integration of somatic/physical, emotional, intellectual and
social aspects of sexual well-being in ways that are positively enriching and that
enhance personality, communication and love.

Three (3) Basic Elements of Sexual Health:

1. Capacity to enjoy and control sexual and reproductive behavior in accordance with
a social and personal ethics.
2. Freedom from fear, shame, guilt, false beliefs and other psychological factors
inhibiting sexual response and impairing sexual relationship.
3. Freedom from organic disorders, diseases and deficiencies that may interfere
sexual and reproductive function.
Sexual Normalcy
• Is the state wherein a person is within the average of sexual capacity and
expression, within a framework of sexual meaning and or direction and when he
has a sense of well-being within that context.
Factors Influencing Sexuality
• Developmental level
– The development of sexuality begins with conception and changes
throughout the life span.
• Culture
– All cultural groups have their own practices and values relating to sexuality.
• Religious values
 – It provides guidelines for sexual behavior and acceptable circumstances for
the behavior, prohibited sexual behavior and the consequences of breaking
the sexual rules.

• Personal ethics/ beliefs

– Many individuals and groups have developed written or unwritten codes of
conduct based on ethical principles.
• Health status
– Some conditions or illnesses may interfere person’s expression of sexuality
such as: heart disease, diabetes mellitus, spinal cord injury, surgical
procedures, joint disease, chronic pain, sexually transmitted disease, mental
disorders, medications and even pregnancy.

 Concepts of Sexuality in the Philippines

Regarding the sexual relation of Filipino husbands and wives, the following have
been observed:
1. Objections to foreplay before coitus. Reasons vary as some women feel that
prolonged foreplay they are not treated like women anymore, not respected as wives.
2. Sexual relations generally take place at night.
3. Filipinos during the act as being naked makes them feel “embarrassed” before their
husbands.
4. Arousal of body sensations is done through embracing, caressing and sometimes
biting.
5. Females are expected to repress or restrict their interests in heterosexual relations. A
wife is not supposed to ask for sexual intercourse from her husband. Thus, non-
verbal behavior is resorted to imply their needs.

Human Sexuality Response (According to Masters & Johnson, 1998)

1. Excitement Phase
- begins with the onset of erotic feeling and sensation which occurs with physical and
psychological stimulation (i.e., sight, sound, emotion, or thought) that causes
parasympathetic nerve stimulation
Two (2) Primary Physiologic Changes:
 Vasocongestion – congestion of the blood vessels in the genital area and in a
number of different body parts.
 Myotonia – an increased muscle tension

Characterized by the following body reactions:

• Men:
- Erection of the penis and nipples of breast
- Scrotal thickening and elevation of the testes.
- Presence of clear lubricating droplets at the urethral meatus
- Increased in temperature, perspiration, RR, HR and BP
- Increased muscle tension in both smooth and skeletal muscle.
• Women:
 - Erection of the clitoris and nipples of breast
- Presence of mucoid fluid or lubrication of the vaginal walls.
- Vagina widens in diameter and increases in length
- Increase in size and change in the color of the labia, uterus and breast.
- Flushing of the skin
- Increased in temperature, perspiration, RR, HR and BP
- Increased muscle tension in both smooth and skeletal muscle.

2. Plateau Phase
-the period during which sexual tension increases to levels nearing orgasm, which may
last from 30 seconds to 3 minutes.
Characterized by the following body reactions
• Men:
- Vasocongestion leads to full distention of the penis.
- HR increases to 100-175 bpm and RR increases to 40/min (both sexes)
• Women:
- The clitoris is drawn forward and retracts under the clitoral prepuce.
- The lower part of the vagina becomes extremely congested (formation of the
“Orgasmic Platform”)
- Increased nipple engorgement.
3. Orgasmic Phase / Orgasm
-is the involuntary climax of sexual tension, accompanied by physiologic and
psychologic release.
- This phase last for 3-10 seconds
Characterized by the following body reactions:
• Men:
- Muscle contractions surrounding the seminal vessels and prostate project semen into
the proximal urethra.
- These contractions are followed immediately by 3-7 propulsive “ejaculatory
contractions”, occurring at the same time interval as in women, which force semen
from the penis.
• Women:
- A vigorous contraction of muscles in the pelvic area
- An average of 8-15 contractions at intervals of one (1) every 0.8 seconds

4. Resolution Phase
- is the period during which the external and internal genital organs return to unaroused
state or pre-coital stage.
Characterized by the following body reactions:
• For males, a REFRACTORY PERIOD occurs during which further orgasm is
impossible, from a few hours or days, depending on age and other factors.
• Women do not go through this period so it is possible for women to have
additional orgasm if properly stimulated.
Assessing Sexual Health
• Assessment / History taking may include:
– history, regularity, amount of menstrual flow.
 – Obstetrical/gynecological history
– Reports of discharges, pain, presence of lump, or change in color, size and
shape of genital organ.
– Changes in urinary function
– Birth control / medication taken
– Sexual practices
• Possible Nursing Diagnosis:
1. Altered Sexuality Patterns (includes sexual identity, sexuality, sexual function -
the state in which one expresses concern regarding one’s sexuality.
 Possible related factors:
• Impaired relationship with partner
• Fear of pregnancy
• Of acquiring an std
• Of coitus following heart attack
• Lack of significant other
• Lack of privacy
• Body image disturbance
• Self-esteem disturbance
• Knowledge/skill deficit
• Altered body function, illness/ medical therapy
2. Sexual Dysfunction
- the state in which an individual experiences an unsatisfactory, unrewarding, or
inadequate change in sexual function.
 Possible Related Factors:
• Pregnancy
• Altered body structure or function secondary to disease process,
trauma, medical therapy (eg, surgery, radiation)
• Recent childbirth
• Drugs
A. Orgasm Disorder
1. Erectile dysfunction (impotence) – inability of man to produce or maintain
erection long enough for vaginal penetration or partner satisfaction.
2. Premature ejaculation – ejaculation before penile-vaginal contact. Ejaculation
before partner’s satisfaction has been achieved.
B. Pain Disorders
1. Vaginismus – involuntary contraction of the muscles at the outlet of the vagina
when coitus is attempted.
2. Dyspareunia/Vestibulitis – pain during coitus.

Types of Sexual Identity

1. Heterosexual
– Is one who is sexually attracted to persons of the opposite sex (“straight”).
2. Homosexual
– One who is sexually attracted to persons of the same sex (“gay, lesbian”).
3. Bisexual
– One who is sexually attracted to persons of both sexes.
 4. Transsexual
– One’s belief that one is not the sex of one’s physical body but of the opposite
sex. (Trapped in the wrong body; sex-change surgery may be desired and
undertaken).
Types of Sexual Expression

1. Celibacy- is the abstinence from sexual activity. It is the avowed state of certain
religious orders.
2. Masturbation- is self-stimulation for erotic pleasure; it can also be a mutually
enjoyable activity for sexual partners.
3. Erotic Stimulation- is the use of visual materials such as magazines or photographs
for sexual arousal.
4. Fetishism- is sexual arousal by the use of certain objects or situations.
5. Transvestism- is an individual who dresses to take on the role of the opposite sex.
6. Voyeurism- is sexual arousal by looking at another’s body.
7. Sadomasochism- involves in inflicting pain (sadism) or receiving pain (masochism)
to achieve sexual satisfaction.

C. Responsible Parenthood
o Responsible Parenthood, as defined in the Directional Plan of POPCOM, is the will
and ability of parents to respond to the needs and aspirations of the family and
children. It is a shared responsibility of the husband and the wife to determine and
achieve the desired number, spacing, and timing of their children according to their
own family life aspirations, taking into account psychological preparedness, health
status, socio-cultural, and economic concerns (Department of Health, 2015).

REFERENCES/ADDITIONAL RESOURCES/READINGS:

Berman, Audrey, et.al (2016). Kozier and Erb’s Fundamentals of Nursing, Concepts, Process
and Practice, 10th edition, Pearson Education Limited.

Pillitteri, Adele (2018). Maternal and Child Health Nursing, Care of the Childbearing and
Childrearing Family, 8th edition.

Seeley, Rod R. (2005). Essentials of Anatomy and Physiology, 5th Edition

Wong, Donna, et.al.(2009). Maternal Child Nursing Care, 3rd edition, Elsevier (Singapore) Pte
Ltd.