Scope of Human Sexuality Throughout the Life Cycle

Human sexuality refers to all the characteristics of an individual (social, personal, and emotional) that are manifest in his or her relationships with others and that reflect gendergenital orientation.

1. Components of sexual system
   1. Biological sexuality-refers to chromosomes, hormones, primary and secondary sex characteristics, and anatomical structure.
   2. Sexual identity-based on own feelings and perceptions of how well traits correspond with own feelings and concepts of maleness and femaleness; also includes gender identity.
   3. Gender identity-a sense of masculinity and femininity shaped by biological, environmental, and intrapsychic forces, as well as cultural traditions and education.
   4. Progressive deformities due to chronic illness, burns, arthritis.
   5. Sex role behavior-includes components of both sexual identity and gender identity. Aim: sexual fulfillment through masturbation, heterosexual, or homosexual experiences. Selection of behavior is influenced by personal value system and sexual, gender, and biological identity. Gender identity and roles are learned and constantly reinforced by input and feedback regarding social expectations and demands.
2. Concepts and principles of human sexual response:
   1. Human sexual response involves not only the genitals but the total body.
   2. Factors in early postnatal and childhood periods influence gender identity, gender role, sex typing, and sexual responses in later life.
   3. Cultural and personally subjective variables influence ways of sexual expression and perception of what is satisfying.
   4. Healthy sexual expressions vary widely.
   5. Requirements for human sexual response:
      1. Intact central and peripheral nervous system to provide sensory perception, motor reaction.
      2. Intact circulatory system to produce vasocongestive response.
      3. Cultural and personally subjective variables influence ways of sexual expression and perception of what is satisfying.
      4. Freedom from guilt, anxiety, misconceptions, and interfering conditioned responses.
      5. Acceptable physical setting, usually private.

Sexual-Health Counseling

General Issues

1. Issues in sexual practices with implications for counseling:
   1. Sex education-need to provide accurate and complete information on all aspects of sexuality to all people.
   2. Sexual-health care-should be part of total health care planning for all.
   3. Sexual orientation-need to avoid discrimination based on sexual orientation (such as homosexuality); the right to satisfying, nonexploitive relationships with others, regardless of gender.
   4. Sex and the law-sex between consenting adults not a legal concern.
   5. Explicit sexual material (pornography)-can be useful in fulfilling various needs in life, as in quadriplegia.
   6. Masturbation-a natural behavior at all ages; can fulfill a variety of needs.
   7. Availability of contraception for minors-the right of access to medical contraceptive care should be available to all ages.
   8. Abortion-confidentiality for minors.
   9. Treatment for sexually transmitted disease (STD)-naming of partners as part of STD control.
   10. Sex and the elderly-need opportunity for sexual expression; need privacy when in communal living setting.
   11. Sex and the disabled-need to have possible means available for rewarding sexual expressions.
2. Sexual myths*
   Fact: What you don’t know can hurt you (note the high frequency of STD and abortions); myths can perpetuate fears and such misinformation as:
   1. Sex education-need to provide accurate and complete information on all aspects of sexuality to all people.
      1. Masturbation causes mental illness.
      2. Women don’t or shouldn’t have orgasms.
      3. Tampons cause STD.
      4. Plastic wrap works better than condoms.
      5. Coca-Cola is an effective douche.
      Fact: Lack of knowledge during initial experiences may result in fear and set precedent for future sexual reactions.
   2. Myths: The planned sex act is not OK and is immoral for “nice” girls. If a woman gets pregnant, it is her own fault. Contraceptives are solely a woman’s responsibility.
   Fact: Sex and contraception are the prerogative and responsibility of both partners.
   3. Myth: A good relationship is harmonious, free of conflict and disagreement (which are signs of rejection and incompatibility).
   Fact: Conflict can induce growth in self-understanding and in understanding of others.
   4. Myth: Sexual deviance (such as homosexuality) is a sign of personality disturbance.
   Fact: No single sexual behavior is the most desirable, effective, or satisfactory. Personal sexual choice is a fundamental right.
   5. Myth: A woman’s sexual needs and gratification should be secondary to her partner’s; a woman’s role is to satisfy others.
   Fact: A woman has as much right to sexual freedom and experience as a man.
   6. Myth: Menopause is an affliction signifying the end of sex.
   Fact: Many women do not suffer through menopause, and many report renewed sexual interest.
   7. Myth: Sexual activity past 60 years of age is not essential.
   Fact: Sexual activity is therapeutic because it:
   1. Affirms identity.
   2. Provides communication.
   3. Provides companionship.
   4. Meets intimacy needs.
   8. Myth: A woman’s sex drive decreases in postmenopausal period.
   Fact: The strength of the sex drive becomes greater as androgen overcomes the inhibitory action of estrogen.
   9. Myth: Men over age 60 cannot achieve an erection.
   Fact: According to Masters and Johnson, a major difference between the aging man and the younger man is the duration of each phase of the sexual cycle. The older man is slower in achieving an erection.
   10. Myth: Regular sexual activity cannot help the aging person’s loss of function.
   Fact: Research is revealing that “disuse atrophy” may lead to loss of sexual capacity. Regular sexual activity helps preserve sexual function.