SEXUALITY

Sexuality is a crucial part of a person's identity, it is central to the emotional well-being and to
the quality of our lives. Sexuality is influenced by the biologic, physiologic, sociologic , cultural
and spiritual aspects of the being.

Sexuality as Gender or Gender Identity

Sex as gender often times refers to the biologic identification of male and female , while
Gender identity (otherwise known as core gender identity) is the genders, or lack thereof, a
person self-identifies as. It is not necessarily based on biological fact, either real or perceived,
nor is it always based on sexual orientation. The gender identities one may choose from include:
male, female, both, somewhere in between ("third gender"), or neither.

Sex as a Behavior

The term sex is used to describe a sexual behavior in general and/or may pertain to specific
expressions that emphasizes actions which are sexually oriented. E.g. "When was the last time
you had sex ?, What is your favorite sexual activities ? Who gets to be on top ? Who does most
of the work ? How often do you have sex ?

Sex as a Cultural and Spiritual Activity

Sex often times are taboo topics with close knit communities with religious orientation. Sex is
perceived as an activity derived from an obligation to God, which is to propagate here in this
world. It has nothing to do with pleasure or satisfaction o even an integral part of a person's
well being but rather as an insidious act of greed for flesh.

Sexuality as an Integral Part of the Person's Well being

Sexuality includes how you feel about your body, you interest in sexual activities, your need for
touch, and your ability to communicate your sexual needs to your partner and the ability to
engage in a satisfying sexual activity with someone or alone. When your are experiencing erotic
pleasures you are not just having sex but also experiencing your sexuality.

Sexual Health

Sexual health does not really have a definite definition but it is a phenomenon that is not
considered until its absence or when an impairment is noticed. The four critical components of
sexual health are 1. sexual self-concept, 2. body image, 3. gender identity, and 4. sexual
orientation.
 Personal Hygiene

Personal Hygiene is the self-care by which people attend to such functions as bathing, toileting,
general body hygiene, and grooming, it involves care of skin, hair, nails, teeth, oral and nasal
cavities, eyes, ears and the perineal-genital area.

Often times, perineal area washing is a source of embarrassment among recipient of care, that
is why as a nurse we must express with clarity but less vulgar in the process of making the client
understand what is supposed to be done during perineal care.

Promotion of Health during Menstruation

Menstrual Hygiene

No woman feels completely comfortable when she has her period. If it is not pre menstrual
tension or stomach cramps it is the problem of dealing with the menstrual flow.

Technology offers sanitary pads, tampons or menstrual cups or caps to deal with the flow. The
user has to decide what suits her best. Absorbent pads may be noticeable in form fitting
clothes. They cause some soreness on the inner thighs.
Some women prefer tampon to external pads. A plug of absorbent cotton or gauze is inserted
inside. But these should not be left unchanged beyond six hours. Some brands state that
tampons left unchanged for more than 12-18 hours increases the possibility of toxic shock.

It is not clear what causes toxic shock. But there seems to be a link between tampons and Toxic
Shock Syndrome (TSS). Approximately 1% of all menstruating women carry the bacteria in
question (Staphylococcus aureus) in their vagina. Absorbent tampons provide the medium for
them to grow and spread infection. TSS cases were first reported in 1978. It is marked by high
fever, severe vomiting and diarrhea. The cases can be mild to fatal.

The menstrual cup (or cap), is inserted within and collects the flow and can be emptied, cleaned
and re used. Whatever the preference, washing is important. There need be no taboo about
bath on these days. Some people have the problem of odour during menstruation. Cleanliness
and change of pad/tampon as often as is necessary reduces this problem. It is not advisable to
use perfumed pads or tampons. In fact, using powder in the genital area is not recommended.

Painful Periods (Dysmenorrhoea)

Menstruation, or having periods, is part of the female reproductive cycle. While the average
interval between periods is 28 days, many women will have cycles that are either longer or
shorter than this. During a period, the lining of the womb, which is no longer required if a
pregnancy has not occurred, is shed and bleeding occurs through the vagina. This bleeding
usually lasts between three and seven days.
Period pains are also known as dysmenorrhoea or menstrual cramps. Some symptoms may
include:
Dull or throbbing pain in your lower abdomen.
Pain that radiates to your lower back and thighs
Nausea and vomiting
Loose stools
Sweating
Dizziness
Most teenage girls and young women suffer some degree of pain during periods. This usually
becomes a problem within two to three years of periods starting, once ovulation has become
established. This is called dysmenorrhoea and usually improves spontaneously after the age of
about 25 or after childbirth.

What can I do to relieve the symptoms of period pains?

Heat helps apply a covered hot water bottle or heat pad to the abdomen and lower back
region. Don not fall asleep with this in place.
A nice warm bath may also help with soothing aromatherapy salts.
Eat healthy balanced diet. Cut back on salt, sugar and caffeine intake during the week prior
to your period. Supplements such as primrose oil, zinc and B vitamins may help
symptoms of cramps and bloating.
Exercise relieves the symptoms of period pain. Regular walking is an excellent form of
exercise or yoga may be beneficial.
Try to avoid stressful situations and taking time to you. Massage and reflexology can help
relieve menstrual cramps. Ensure to speak to a trained practitioner.
Some women use pain-relieving drugs for the pain. Talk to your local pharmacy.
Many women find that the oral contraceptive pill is an excellent treatment for painful or
irregular periods. Your doctor will advise you if this is a suitable option for you.

Menopause

What is menopause?
Menopause (MEN-oh-pawz) is a normal stage in a woman's life when her monthly period
stops. It is also called the "change of life". A woman who has no periods for an entire
year after the age of 45 is considered to be in menopause. After menopause, a woman is
no longer fertile (able to become pregnant naturally). Going through menopause may
take one to two years.

Perimenopause (PER-i-men-oh-pawz) is the period of time leading up to menopause.

Perimenopause can last from two to eight years. You can have many menopause-like
symptoms during perimenopause. These symptoms, such as hot flashes, can be very
bothersome for some women.
What causes menopause to start? Menopause starts when your ovaries slowly stop making the
female hormones estrogen and progesterone . Hormones are special chemicals that your body
makes. Hormones act as messengers to help control how your body works. The hormones
estrogen and progesterone help control your monthly periods. Menopause usually starts
between the ages of 40 to 55. The average age that menopause starts is 51 years old. The age
that menopause starts can be affected by:
Cigarette smoking. Women who smoke may begin menopause about one year earlier than
other women.

Family history. Women often go through menopause at about the same age as their
mothers did.

Medical treatments. Some medical treatments, such as certain treatments for cancer, can
cause menopause to start early.

Surgery. Menopause may happen suddenly in women of any age if their ovaries are
removed during surgery. This is called surgical menopause. A hysterectomy is a surgery
where the uterus (womb) is removed. Sometimes one or both ovaries are also removed
during a hysterectomy. If both ovaries are removed, menopause will start right away.
Having a hysterectomy where just the uterus is removed will not usually cause
menopause. This is because the ovaries are still inside of the body and able to make
hormones. However, monthly periods do stop after the uterus is removed during a
hysterectomy. You can no longer get pregnant after having a hysterectomy.
What are the signs, symptoms, and body changes caused by menopause? The signs and
symptoms of menopause can be different from woman to woman. The loss of female hormones
may also cause other changes in your body. These changes and symptoms may include one or
more of the following:
Menstrual period changes. One of the first signs of menopause is a change in your monthly
period. You may skip periods or your periods may come closer together. Your flow may
be lighter or heavier than normal. Your periods may slowly decrease and then stop. This
may happen quickly, but it usually happens over a year or two.

Hot flashes. Hot flashes are brief periods of feeling very warm, flushed, and sweaty. Hot
flashes can last from a few seconds to several minutes. They may happen many times
during the day, and are common at night. Wear cotton clothing if night sweats are a
problem. Layer your clothing so that you can easily remove some clothing and cool
yourself during a hot flash.

Mood changes. Mood changes are common during menopause. You may feel nervous,
irritable (easily angered), or depressed (sad for a long time). You may also notice a
decrease in your desire to have sex. Talk to your caregiver about any changes in your
mood or sex drive that bother you. Talking to your partner or a close friend may also
help.
 Breast changes. Your breasts may change shape or not be as full. You may have breast
tenderness, especially during the early stages of menopause.

Bone changes. After menopause starts, your bones lose calcium (a mineral needed for
strong bones). This causes your bones to become thinner. Thin bones increase your
chance of breaking a bone (bone fracture). This risk of bone fractures may increase as
you age. Bone thinning may lead to osteoporosis (os-tee-oh-poh-ROH-sis) which is also
called "brittle bone disease". You have a greater chance of getting osteoporosis if you
smoke, drink too much alcohol, or have poor eating habits. Not exercising, or using
certain medicines (such as steroids or thyroid medicine) may also increase this risk.

Hair changes. Your hair may become thinner or feel different. This may happen on your
head and elsewhere on your body. You may get more hair on your face.

Vaginal changes. The lining of your vagina (vah-JI-nah) may get thinner and less elastic
(stretchy) because of hormone changes. You may also have vaginal dryness. This may
cause you to have pain or discomfort during sexual intercourse (sex). Over-the-counter
vaginal creams and lotions can help decrease vaginal dryness and make sex more
comfortable. Only use creams and lotions that are made for vaginal use. Do not use
petroleum jelly. Talk to your caregiver if over-the-counter products do not help. You may
need an estrogen cream to put in and around your vagina. Estrogen cream may help
decrease vaginal dryness and lower your risk of vaginal infections (in-FEK-shuns).

Urinary changes. After menopause you may be more likely to have urinary problems such as
urinary tract infections (UTIs). You may feel the urge to go to the bathroom more often.
You may also feel pressure and a feeling that you need to urinate right away (urgency).
You may start to wake up at night needing to urinate. You may sometimes leak urine.

Other symptoms. You may feel like your heart is pounding at times (heart palpitations).
Headaches, trouble sleeping, and tiredness are other symptoms you may have while
going through menopause.
Can I still get pregnant while going through menopause? It is possible to get pregnant while
you are going through menopause. Continue to use birth control if you do not want to have a
baby. You may need to use birth control until you have gone about a year without having a
period. Ask your caregiver about when you can stop taking birth control to avoid pregnancy.
What are the health risks of menopause? Your bones may weaken and break more easily after
menopause. Your blood cholesterol level may increase also. High cholesterol (fat in your blood)
increases your risk of heart and blood vessel problems. You may be more likely to have a heart
attack, blood clots, or a stroke (blood clot to the brain). Menopause also increases your chance
of having sleep-disordered breathing (SDB). SDB is a condition that causes your breathing to
stop for a few moments during sleep.

What are the risks and benefits of hormone replacement therapy (HRT)?
 HRT replaces one or more female hormones in your body. HRT is used to help decrease
menopausal symptoms, such as hot flashes and vaginal dryness. HRT also has some
health benefits. The risk of bone fractures due to osteoporosis is much lower if you take
HRT. HRT may also help protect you from some kinds of cancer, including colorectal
cancer. Colorectal cancer is cancer of your colon (intestines) and rectum (rear end).

HRT may cause serious problems in some people. Other health problems, such as a history
of blood clots or certain cancers, may increase the risks of taking HRT. Talk to your
caregiver about whether HRT is right for you. If you need HRT, it is best to take it for a
short period of time. It is also best to take just enough medicine to control your
menopause symptoms. Ask your caregiver for the most up-to-date information about
the benefits and risks of HRT. It may take as long as a month on HRT before you notice
your symptoms improving.
How can I live a healthy lifestyle during and after menopause?
Control other health problems you may have. Your risk of new or worsening health
problems after menopause is increased if you have certain other medical conditions.
Work with your caregiver to control other problems, such as high blood pressure or
diabetes.

Prevent bone loss. You may need extra calcium and vitamin D to help prevent osteoporosis.
Special medicines may also help decrease your bone loss. Ask your caregiver about the
ways to prevent bone loss that are right for you.

Lower your heart disease risk. Your risk of heart disease, blood clots, and stroke increases
after menopause. The following are ways to decrease your heart disease risk.

Exercise: Getting regular exercise can help to slow down bone loss and improve your
mood. Exercise makes the heart stronger, lowers blood pressure, and keeps you
healthy. Talk to your caregiver before you start exercising. Together you can plan
the best exercise program for you. It is best to start slowly and do more as you
get stronger.

Eat a healthy diet: Eat a healthy variety of foods. Your diet should include fruits and
vegetables, breads, dairy products, and protein (such as meat, beans, and fish).
Hot flashes may be helped by avoiding spicy foods, and things that contain
caffeine or alcohol. Caffeine may be found in coffee, tea, soda, sports drinks,
chocolate, and food bars.

Quit smoking: It is never too late to quit smoking. You are more likely to have a heart
attack, lung disease, blood clots, and cancer if you smoke. Ask your caregiver for
more information about how to stop smoking if you are having trouble quitting.

Control your cholesterol and weight: Lose weight if you are overweight. Check with
your caregiver before you start any weight loss program. Decrease your
 cholesterol level if it is too high. Ask your caregiver for more information about a
low cholesterol diet. You may need medicine if diet changes and exercise do not
lower your cholesterol.
Have unusual vaginal bleeding checked by a caregiver. It is normal for your periods to
slowly taper off while you go through menopause. Tell your caregiver if your vaginal
bleeding is heavier than normal or happens too often. Medicines such as birth control
pills can help make your periods more regular, decrease bleeding, and decrease hot
flashes. If you start having vaginal bleeding after menopause, tell your caregiver right
away.

See a caregiver every year for a checkup. Have a physical exam at least once a year. You
may also need a pelvic exam at least once a year. During a pelvic exam, your caregiver
checks your vagina, cervix (SER-vicks), and uterus for problems. Other tests you may
need include blood tests, a breast exam, a mammogram, and bone density testing. A
mammogram is a special x-ray that may help your caregiver find and treat breast cancer
early. Bone density testing uses sound waves or special x-rays to check your bone
thickness.
Coping with menopause: It may be hard for you to accept that you are going through
menopause. You and those close to you may feel angry, sad, or frightened. These feelings are
normal. Talk to your caregivers, family, or friends about your feelings. Let them help you.
Encourage those close to you to talk to your caregiver about how things are at home. Your
caregiver can help your family better understand how to support a person going through
menopause.

Sex Education

Sex education, which is sometimes called sexuality education or 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 behavior, 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, sexually transmitted diseases and HIV and AIDS.

It is also argued that providing sex education helps to meet young people’s rights to information
about matters that affect them, their right to have their needs met and to help them enjoy their
sexuality and the relationships that they form.

The Reproductive System

The reproductive system or genital system is a system of organs within an organism which
work together for the purpose of reproduction. Many non-living substances such as fluids,
hormones, and pheromones are also important accessories to the reproductive system. Unlike
most organ systems, the sexes of differentiated species often have significant differences.
These differences allow for a combination of genetic material between two individuals, which
allows for the possibility of greater genetic fitness of the offspring.

The major organs of the human reproductive system include the external genetalia (penis and
vulva) as well as a number of internal organs including the gamete producing gonads (testicles
and ovaries). Diseases of the human reproductive system are very common and widespread,
particularly communicable sexually transmitted diseases,

Birth Control Planning

Birth control is a regimen of one or more actions, devices, sexual practices, or medications
followed in order to deliberately prevent or reduce the likelihood of pegnancy. There are three
main routes to preventing or ending pregnancy: the prevention of fertilization of the ovum by
sperm cells ("contraception"), the prevention of implantation of the blastocyst
("contragestion"), and the chemical or surgical induction or abortion of the developing embryo
or, later, fetus. In common usage, term "contraception" is often used for both contraception
and contragestion.
Birth control is commonly used as part of family planning.
The history of birth control began with the discovery of the connection between coitus and
pregnancy. The oldest forms of birth control included coitus interruptus, pessaries, and the
ingestions or herbs that were believed to be contraceptive or abortifacient. The earliest record
of birth control use is an ancient Egyptian set of instructions on creating a contraceptive
pessary.

Different methods of birth control have varying characteristics. Condoms, for example, are the
only methods that provide significant protection from sexually transmitted diseases.

Natural Family Planning

Calendar-Rhythm Method

Average Failure Rate: 13-20%

The calendar method, or rhythm method, is the oldest and most widely practiced method of
fertility awareness. Early in the twentieth century, the rhythm method was promoted by the
Catholic Church as the only morally acceptable form of family planning. At one time the
Calendar-Rhythm Method was synonymous with natural family planning. However, since that
time many other natural methods have been developed and the modern Catholic Church
accepts all of these.
How the Calendar-Rhythm Method Works

In the 1920s, it was discovered that ovulation occurs about fourteen days before the next
menstrual period. Based on this discovery, it was possible to calculate the best times to have
intercourse to achieve or avoid pregnancy. The Calendar-Rhythm Method based on three
assumptions:

1. That ovulation occurs fourteen days before the beginning of menstruation, plus or
minus two days
2. That sperm remain alive for three days, and
3. That the ovum (egg) survives for twenty-four hours.

For a woman with very regular cycles, she needs merely to count backwards from the first day
of her period to locate the day on which she ovulated, usually the fourteenth day from the first
day of her period. Using this information, she can predict when ovulation will occur the
following month and avoid having intercourse around that time.

Efficacy of the Calendar-Rhythm Method

Most women do not ovulate at the same time every month, and no woman's cycles are
identical each time. For this reason, the rhythm method is not very effective unless your cycle is
always the same number of days. For women with very regular cycles, the failure rate is
probably closer to 13%. This method is completely ineffective if used improperly.

Basal Body Temperature or Sympto-Thermal Method

Average Failure Rate: 16%

The sympto-thermal method of natural birth control involves determining the few days out of a
woman's menstrual cycles when conception can occur, and then avoiding sexual intercourse on
those days. This method involves determining this fertile time in two ways: based on a woman's
basal body temperature (it rises after ovulation) and by recording other fertility cues (such as
mood and cervical secretions). The name "sympto-thermal" method, comes from body cues
(i.e. symptoms) and a woman's temperature (i.e. thermal or thermometer).

How It Works: The Thermo Part

The sympto-thermal method requires that a woman take her temperature every morning
before she gets out of bed and record the reading. Depending on where she is in her menstrual
cycle, there will be slight variations in her temperature.

These variations are most easily measured with a special thermometer that has a range of only
a few degrees, known as a basal thermometer Before ovulation, the temperature is likely to be
between 97.2 and 97.4 degrees F. After ovulation, it will rise by at least 0.5 degrees and is often
above 98 degrees F. When the temperature stays elevated for at least three days, a woman
may assume she has already ovulated. Intercourse for the rest of the cycle will not result in
pregnancy. To determine the infertile time before ovulation, a woman needs to look at her
pattern of previous cycles. Her last "safe" day is one week before the earliest recorded day of
temperature rise, or 5 days after the first day of her period.

How It Works: The Sympto Part

By recording other cyclic symptoms, in addition to basal temperatures, the infertile time before
ovulation can be more accurately predicted. Cervical mucus and firmness, mid-cycle cramping,
breast sensitivity, and mood swings are all symptoms which give insight into the progression of
a woman's cycle. With careful monitoring, it is not difficult to predict your fertile period, when
intercourse is to be avoided. A blank NFP chart for recording these changes is available to view,
download, or print.

Intercourse during the time before ovulation is less safe than the time after ovulation because
sperm have been known to live up to six days. For this reason, some couples choose to have sex
only after the fertile period. This practice, known as the post-ovulatory temperature method, is
the most effective of all natural methods, with a failure rate of only 1% among perfect users.
However, it is not recommended because it requires a very long period of abstinence.

Effectiveness of the Sympto-Thermal Method

Consider the sympto-thermal method if you are committed to following the rules strictly. This
method can be more difficult to use for women with small infants, as getting up frequently in
the night can make the temperature readings less accurate. Illness, travel, or alcohol
consumption can throw off the basal temperature reading as well. This is why it is important to
use as many body signs as possible to predict ovulation for maximum efficacy.

Ovulation Method

Also known as the cervical mucus method, this technique is not for every woman. It requires a
woman to be very comfortable with her body since she will need to regularly check her cervical
mucus. But it can also help a woman become much more attuned to the changes that happen
within her body every month.
This family planning technique is based on the idea that a lack of cervical mucus indicates that
an egg has not yet been released by the ovaries. Additionally, without the mucus, sperm will
not be able to survive inside a woman until the time that an egg is released.

Like the rest of your reproductive system, your cervix is affected by the monthly changes in
your body. Just after you finish your period, your cervix produces
very little, if any, mucus causing you to have a few days where
your vagina appears to be quite dry. As you progress through your
cycle, you body will begin to produce more cervical mucus.

As you get closer to ovulation, your cervical mucus will become thinner and stickier. When
ovulation is about to occur, your cervical mucus will be clear, slippery and very stretchy, similar
to a raw egg white. This type of mucus is ideal for sperm to swim in and helps the sperm swim
up to your uterus. While this is great for women who are trying to conceive, women who are
trying to avoid pregnancy will want to abstain from sex or use another form of birth control, like
condoms or the sponge, during this time.

After ovulation, the production of mucus is slowed down again. If you do notice any mucus, it
will likely be thicker and cloudier.

Checking the Mucus

There are three ways in which you can check your cervical mucus:

 Use your finger or toilet paper to wipe across the opening of vagina and then take a look
at the mucus.
 Wear a panty liner and examine any cervical mucus that may be left on it (this can be
hard to detect, though)
 The best way: reach in and get a sample of your cervical mucus. Examine the
consistency and try to stretch the mucus between your fingers. If you can stretch it at
least three inches without it breaking, then ovulation is about to occur.

If you do not want to get pregnant, then sex should be avoided from the time you begin to
notice the slippery, stretchy mucus until at least two days after it is gone.

Effectiveness

By itself, this method is not as reliable as other methods of birth control and has an average
failure rate of 20% per year. However, using the cervical mucus method along with another
form of fertility awareness, like the symptom-thermal method, can offer you more insight as to
when you are most fertile.

Standard Days Method

Average Failure Rate: 12%

The standard days method (SDM) of natural family planning has replaced the old rhythm
method as the method of choice for a woman who wants to predict fertility based on the length
of her cycle. This method does not require the use of a calendar or charting, rather it uses Cycle
Beads.

The SDM, developed at Georgetown University, is the first new natural method of family
planning to be clinically tested and introduced on an international scale in over twenty years.
To develop the method, researchers used data from the World Health Organization to
determine the probability of pregnancy based on the menstrual cycle. Counting the first day of
menstruation as day 1, they determined that days 8 to 19 were the most likely fertile window.
For SDM, couples avoid having sex during the fertile window.

Who Can Use the Standard Days Method?

The standard days method is most effective for women who have cycles between 26 and 32
days long. It is estimated that it takes about 5 hours to properly learn to use the standard days
method, and it is recommended that you first meet with a trained counselor to be sure you
understand this technique before using it.

How to Use the Standard Days Method

To use the SDM you will need to count the days of your menstrual cycle, starting with the first
day your period begins.

1. Count the first day of your period as day 1.

2. On days 1 to 7 you are not fertile and can have unprotected intercourse. (Provided
neither partner has an STD, it is medically safe to have sex even while menstruating!)
3. On days 8 to 19 you must avoid sex or use a barrier method if you do not want to get
pregnant.
4. From day 20 until your period starts you can have unprotected sex.

Ovulation Calculator

Most women who use this method use special color-coded beads called CycleBeads to help
keep track of where they are in their cycles. The figure below shows a set of cycle beads used
for the standard days method.
Effectiveness of the Standard Days Method

Although the perfect use failure rate is only 5%, the typical failure rate is 12% per year. This rate
will be higher for women who have sex during the fertile time, even if using another method of
birth control during that interval.

Benefits and Limitations of the Standard Days Method

Because this method is completely natural it addresses the needs of diverse populations with
varied religious and ethical beliefs. It also provides an effective alternative for women who
want to use natural methods for medical or personal reasons. Other advantages of standard
days method include the ease of use, low cost, and complete lack of side-effects and health
risks. The standard days method does not offer any protection against sexually transmitted
disease.

THE END
 NCM 100

SEXUALITY
MS. RAQUEL MARIANO, RN. MN
INSTUCTOR
REPORTERS:………………
RAUL NOCETE
LEDNA SIMONA
BSN 1 NIGHTS