Human Sexuality is one of the fundamental drives behind every person’s feelings, thoughts, and behaviors. It incorporates biological reproduction, psychological and sociological representations of self, and orients a person’s attraction to others whilst shaping the brain and body to be pleasure-seeking. One needs to keep in mind however that with sexual contact comes the risk for sexually transmitted infections (STIs). More than 1 million sexually transmitted infections are acquired every day across the world, most of which are asymptomatic.
Human Sexuality Definitions
- assigned gender at birth – based on biologic, genetic, and anatomic factors
- gender identity – how the person self-identifies
- gender role – based on society’s expectations of gender
- gender expression – how the person self-presents to the outside world
- sexual orientation – based on the person’s sexual preference arousal orientation
- early adolescence – puberty: 10-14 years of age where body changes occur
- middle adolescence – 14-18 years of age
- late adolescence – 18+ years of age
Adolescent Sexuality
Typically, adolescents start to experience conflicts between their emerging sexuality and their families, peers, culture, and society’s approach to human sexuality. Commonly, developing adolescents are presented with role modeling, sex education and related information based on heterosexual focus. Homosexuality is commonly still associated with social or religious taboo. This imbalance can only be lessened through family connectedness, school social support, and community support for LGBTIQ+ individuals.
Signs of Adolescent Sexual Maturity & Health
- ability to live according to their own values
- taking responsibility of their own behaviour
- practicing effective decision-making
- exhibit critical thinking skills
- understanding that sexual development with or without reproduction or sexual experiences is a part of human development
- seek to expand their knowledge in terms of sexuality and reproduction
- interact with all genders respectfully and appropriately
- understanding their own gender identity and sexual orientation whilst respecting others with different gender identities and sexual orientations
- expressing sexuality in a way which connects to their own values
- expressing love and intimacy appropriately
- developing and maintaining meaningful relationships, steering away from exploitative and manipulative relationships
- practice communication and skills in a way which enhances their relationships with others
Human Sexuality & Related Health Issues
- pregnancy – may be unplanned or leading to unfavourable outcomes
- contraception
- STIs
- HIV
- victimisation
Healthcare-Related Barriers to Human Sexuality
- inaccurate or limited sex education
- lack of confidentiality
- lack of normalisation
- lack of respect
- assumptions
- inadequate questioning
- asking without actually listening
- using jargon in patient education
- inability to link issues eg. alcohol possibly leading to unsafe sex
- lack of promotion of preventative measures
- lack of (or knowledge about) community resources
Male Sexual Dysfunction
- changes start to commonly be experienced from 40+ years of age
- decreased libido
- erectile dysfunction – risk factors include obesity, smoking, leading a sedentary lifestyle, diabetes mellitus, chronic kidney disease, cardiovascular disease, psychological factors, neurological factors, endocrine disorders, and medications such as diuretics, SSRIs, clondine, methyldopa, and illicit drug use
- ejaculatory disorders – premature or delayed ejaculation, anejaculation (complete absence of ejaculation), and male anorgasmia (inability to orgasm)
Female Sexual Dysfunction
- 40% of women worldwide report sexual health problems
- problems in relation to libido, arousal, orgasm and resolution
- problems related to the endocrine system – estrogen deficiency have been associated with sexual function changes; dryness, vulvo-vaginal mucosa thinning, lacerations, and pain
- risk factors include relationship satisfaction, fatigue and stress, work and life issues, age, menopause, psychiatric disorders, medications (SSRIs)
- gynaecological issues – pregnancy and childbirth, pelvic organ prolapse, incontinence, endometriosis, and uterine fibroids
- endocrine disorders
- hypertension
- neurologic diseases eg. Multiple Sclerosis and Parkinsons’ Disease
- obesity and body image
- medications – SSRIs, Nicotine, Alcohol, and Opioids
Diagnoses & Diagnostic Criteria
- female sexual interest and arousal disorder OR
- female orgasmic disorder OR
- genitopelvic pain OR
- penetrative disorder OR
- substance-induced disorder
- medical history
- physical exam
- hormonal testing
Sexually Transmitted Infections (STIs)
More than 1 million sexually transmitted infections (STIs) are acquired every day worldwide, the majority of which are asymptomatic. Each year there are an estimated 374 million new infections with 1 of 4 STIs: chlamydia, gonorrhoea, syphilis and trichomoniasis.
WHO, 2021
Sexually Transmitted Infections’ preventative approach is based on the following 5 major strategies:
- providing accurate risk assessments along with education and counseling to individuals at risk of acquiring STIs on how these can be avoided
- vaccinating individuals at risk of acquiring STIs for vaccine-preventable STIs in the pre-exposure period
- identifying symptomatic and asymptomatic individuals with STIs
- providing efficacy in the diagnosis, treatment, counseling, and follow-up of individuals with STIs
- providing evaluation, treatment and counseling of sex partners of the individuals with STIs
Risk Factors for Sexually Transmitted Infections
- new sex partner in the past 60 days
- multiple sex partners or sex partner with multiple concurrent sex partners
- sex with partners recently treated for a STI
- inconsistent or no condom use outside a mutually monogamous sexual partnership
- having sex for money or drugs
- sexual contact with sex workers
- sexually active adolescents
- men sexually active with other men (higher risk for HIV and other viral and bacterial STIs)
- transgender men and women
- patients with HIV infections (some STIs can increase HIV transmission)
- pregnant women are not at increased risk for STIs, however, due to potential for high morbidity and poor fetal outcomes following maternal infection, pregnant women should be screened for STIs at the first prenatal visit
Counseling for Sexually Transmitted Infections Risk Reduction
- discuss risks related to sexual behaviours
- assess the patient’s understanding and beliefs in relation to STI transmission
- assess circumstances which may be affecting the patient’s sexual behaviour
- assess the patient’s willingness to change risky behaviour
- negotiate behavioural goal attainable through smaller steps
Vaccination
Hepatitis A
Hepatitis A is a liver infection caused by the hepatitis A virus, which is found in the stool and blood of infected individuals. Hepatitis A can be prevented through vaccination.
Vaccination for Hepatitis A is recommended for:
- men who have sexual contact with other men
- individuals who use injection and non-injection drugs
- individuals with chronic liver disease
- individuals with close contact to Hepatitis A infected persons
- individuals travelling to countries in which Hepatitis A is endemic
NOTE: barrier methods eg. condom use do not prevent acquisition of Hepatitis A.
Hepatitis B
Hepatitis B is a liver infection caused by the hepatitis B virus. It is spread through blood, semen, or other body fluids from an infected person to a non-infected person. Hepatitis B can be prevented through vaccination.
Vaccination for Hepatitis B is recommended for:
- sexually active adolescents
- adults having unprotected sex with infected partners
- having unprotected sex with multiple partners
- having a history of STIs
- men having sexual contact with other men
- individuals who make use of injected drugs
Human Papillomavirus
Human Papillomavirus (HPV) is the most common sexually transmitted infection. Whilst it is usually harmless, some of its type can lead to cancer and/or genital warts. Multiple HPV vaccines are available for the prevention of HPV infection in women – the types of infection which causes 70% of cervical cancers, as well as those causing most genital warts.
Human Papillomavirus Vaccination is recommended for:
- females from 9-26 years of age
- males from 9-26 years of age who are sexually active with other men
- immunocompromised individuals eg. those with HIV infection
Neisseria Species
Neisseria Meningitidis a.k.a. meningococcus, is a Gram-negative bacterium which can cause meningitis and other forms of meningococcal disease, including meningococcemia – life-threatening sepsis. Whilst Neisseria species are not STIs, Neisseria Meningitidis can be transmitted through close contact such as through kissing and sexual contact.
Vaccination for Neisseria Meningitidis is recommended for:
- men having sexual contact with other men
- HIV infected individuals
Condom Use & Antimicrobial-Based Prevention
Condoms
When used consistently and correctly, condoms are highly effective in preventing HIV and other sexually transmitted diseases such as gonorrhea, chlamydia, trichomonas, genital herpes, human papillomavirus, and syphillis.
Pre-exposure prophylaxis
Pre-exposure prophylaxis (PrEP) contains two antiretroviral medicines used to treat people who have a HIV infection: tenofovir disoproxil fumarate a.k.a. TDF, and emtricitabine a.k.a. FTC. In combination, TDF/FTC drugs suppress the virus in people living with HIV.
Post-Exposure Prophylaxis (PEP) of Bacterial STI
Post-Exposure Prophylaxis (PEP) is a short course of HIV medicines taken very soon after a possible exposure to HIV to prevent the virus. PEP should be used only in emergency situations and must be started within 72 hours after a recent possible exposure to HIV.
PEP is a combination of three drugs to be taken once or twice a day for 28 days: tenofovir, emtricitabine (one pill), and either raltegravir or dolutegravir.
suppressive therapy
Suppressive therapy for genital herpes simplex virus (HSV) can be provided through valacyclovir (500mg daily). I helps decrease the risk of transmission of HSV to an uninfected partner.
topical microbicides
HIV topical microbicides are products with anti-HIV activity incorporating a direct-acting antiretroviral agent which, when applied to the vagina or rectum, can help prevent sexual acquisition of HIV in women and men. Topical microbicides may meet the prevention needs of individuals and groups for whom oral daily forms of pre-exposure prophylaxis (PrEP) have not been acceptable.
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Claire is keen about public education on health-related subjects as well as holistic patient-centered care. She is also passionate about spreading awareness on the negative effects that domestic abuse leaves on its victims’ mental, emotional, social and physical wellbeing.
Claire aspires to continue studying following completion of her Nursing Degree, because she truly believes in lifelong education.
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