Human Sexuality And Sexual Health

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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:

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INDEX HUMAN SEXUALITY 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

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HUMAN SEXUALITY INTRODUCTION 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-

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versus-nurture debate: the Psychoanalytic school led by Sigmund Freud and the Behaviourist school which traces its origins to John Locke . 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.

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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 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.

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Latency Stage (5 or 6 to puberty) 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 matured, these are called Graafian follicles. The female reproductive system does not produce

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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 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

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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 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.

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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. 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.

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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 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

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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. 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

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





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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), depress ion, 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. 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

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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 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.

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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 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

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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. 2. 3. 4.

The right to equality and non-discrimination The right to life, liberty and security of the person The right to autonomy and bodily integrity 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 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:

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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. 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.

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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.

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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. 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.

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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. 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.

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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. 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

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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. Selfesteem 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 daydreaming. 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,

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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 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

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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. 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

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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. 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.

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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 

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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 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.

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