3. Basic principles of sexual-health counseling
   1. There is no universal consensus about acceptable values in human sexuality. Each social group has very definite values regarding sex.
   2. Counselors need to examine own feelings, attitudes, values, biases, knowledge base.
   3. Help reduce fear, guilt, ignorance.
   4. Offer guidance and education rather than indoctrination or pressure to conform.
   5. Each person needs to be helped to make personal choices regarding sexual conduct.
4. Counseling in sexual health
   1. General considerations:
      1. Create atmosphere of trust and acceptance for objective, nonjudgmental dialogue.
      2. Use language related to sexual behavior that is mutually comfortable and understood between client and nurse.
         1. Use alternative terms for definitions.
         2. Determine exact meaning of words and phrases because sexual words and expressions have different meanings to people with different backgrounds and experiences.
      3. Desensitize own stress reaction to the emotional component of taboo topics.
         1. Increase awareness of own sexual values, biases, prejudices, stereotypes, and fears.
         2. Avoid overreacting, underreacting.
      4. Become sensitively aware of interrelationships between sexual needs, fears, and behaviors and other aspects of living.
      5. Begin with commonly discussed areas (such as menstruation) and progress to discussion of individual sexual experiences (such as masturbation). Move from areas where there is less voluntary control (nocturnal emissions) to more responsibility and voluntary behavior (premature ejaculation).
      6. Offer educational information to dispel fears, myths; give tacit permission to explore sensitive areas.
      7. Bring into awareness possibly repressed feelings of guilt, anger, denial, and suppressed sexual feelings.
      8. Explore possible alternatives of sexual expression.
      9. Determine interrelationships among mental, social, physical, and sexual well-being.
   2. Assessment parameters:
      1. Self-awareness of body image, values, and attitudes toward human sexuality; comfort with own sexuality.
      2. Ability to identify sex problems on basis of own satisfaction or dissatisfaction.
      3. Developmental history, sex education, family relationships, cultural and ethnic values, and available support resources.
      4. Type and frequency of sexual behavior.
      5. Nature and quality of sex relations with others.
      6. Attitude toward and satisfaction with sexual activity.
      7. Expectations and goals.
   3. Nursing care plan/implementation
      1. Long-term goals
         1. Increase knowledge of reproductive system and types of sex behavior.
         2. Promote positive view of body and sex needs.
         3. Integrate sex needs into self-identity.
         4. Develop adaptive and satisfying patterns of sexual expression.
         5. Understand effects of physical illness on sexual performance.
      2. Primary sexual health interventions
         1. Goals: minimize stress factors, strengthen sexual integrity.
         2. Provide education to uninformed or misinformed.
         3. Identify stress factors (myths, stereotypes, negative parental attitudes).
      3. Secondary sexual health interventions: identify sexual problems early and refer for treatment.
   4. Evaluation/outcome criteria:
      1. Reduced impairment or dysfunction from acute sex problem or chronic, unresolved sex problem.
      2. Evaluate how client’s goals were achieved in terms of positive thoughts, feelings, and satisfying sexual behaviors.

Suggested Format for Sexual Assessment Interview

Interview Step	Rationale
Open the discussion of sexual matters subtly with an openended question: "People with your illness or stresses often experience other difficulties, sometimes with sexual functioning.”	This gentle opening lets the client know that other people have difficulties, too. It gives the client permission to talk with the nurse about sexual matters without labeling these matters as problems.
Follow up with another open-ended question about the client’s current status: “Has your illness or stresses made any difference in what it’s like for you to be a wife or husband (lover, boyfriend, girlfriend, sexual partner)?	The phrasing of this question enables the client to acknowledge a problem without admitting a shortcoming.
If the client speaks of having a dysfunction, ask about its effect: “How does this affect you?” or “How do you feel about it?”	This indicates that the nurse is willing to explore sexual matters more completely.
Ask about the severity and duration of the dysfunction: “Is it always difficult to control your ejaculation?" “Tell me when you first noticed this.”	These questions are directed at identifying the specific problem.
sk about the effects on the client’s sexual partner: “Has this affected your relationship with your partner?"	This question is directed toward exploring the interactional aspects of the identified problem.
Ask what the client has already done to alleviate the situation: “Have you made any adjustments in your sexual activity?”	This question yields data that will help the nurse to formulate an intervention plan.
Ask the client if and how he or she would like the situation changed: “How would you like to change the situation to make it more satisfying?”	This question conveys the negotiated nature of the therapeutic relationship, in which the client’s own goals play an important part.