Sexuality Patterns, Altered - Impotence; Intimacy
Ann Filipski, RN, MSN, CS, PsyD
Jeff Zurlinden, RN,
NANDA: The state in which an individual expresses concern
regarding his or her sexuality
The patient or significant other expresses concern regarding the
means or manner of sexual expression or physical intimacy within their
relationship. Alterations in human sexual response may be related to genetic,
physiological, emotional, cognitive, religious, and/or sociocultural factors or
a combination of the factors just mentioned. The problem of altered patterns of
sexuality is not limited to a single gender, age, or cultural group; it is a
potential problem for all patients whether the nurse encounters them in the
hospital or in the community. All of these factors play a role in determining
what is normative for each individual within a relationship. It is probable
that most couples reach a point in their relationship where patterns of sexual
expression become altered to the dissatisfaction of one or both members of the
couple. The ability to communicate effectively, to seek professional help
whenever necessary, and to modify existing patterns to the mutual satisfaction
of both members are skills that enable the couple to grow and evolve in this
aspect of their relationship. The nurse is in a unique position to provide
anticipatory guidance relative to altered patterns of sexual function when the
problem is an inevitable or probable result of illness or disability. The
ability to discuss these issues openly when the patient raises concerns about
sexual expression highlights the legitimacy of the couple's feelings and the
normalcy of sexual expression as a part of intimacy, as well as emotional and
Physical changes or limitations (may be time
limited or chronic)
Fear or anxiety
- Acute illness
- Pain or discomfort
- Recent surgery or trauma
- Loss of mobility or normal range of motion (ROM)
- Decreased activity tolerance
- Hormonal change
- Alcohol or substance abuse
- Medication effects
- Concerns about pregnancy or sexually transmitted diseases
- Religious or cultural prohibitions
- Lack of privacy
- Social stigma
- Conflicting values
- Lack of education regarding sexuality
- Means of birth control
- "Safe sex" practices
- Limited social skills
- Change in body or self-image
- Recent loss or trauma
- Affective disturbances
- Low self-esteem or poor self-concept
- Discomfort with sexual orientation
- Identify disturbances
- History of traumatic experiences (rape, sexual abuse, and
- Psychosis or other psychiatric disorder
- Absence of partner
- Social isolation
- Lack of appropriate environment
- Verbalized concern(s) regarding sexual functioning
- Questions regarding "normal" sexual functioning
- Expressed dissatisfaction with sexuality (i.e., decreased
satisfaction, symptoms of sexual dysfunction, concerns about sexual preference
or orientation, difficulties in accepting self/others as sexual beings,
- Reported changes in relationship with partner(s)
- Actual/perceived limitation secondary to diagnosis or therapy
- Noncompliance with medications/treatments with associated risk
of impaired or altered sexual functioning
- Reported changes in previously established sexual patterns
- Sexual behavior inappropriate to circumstance or setting
- Frequent efforts designed to elicit affirmation of sexual
- Patient or couple verbalizes satisfaction with the way they
express physical intimacy.
- Both members of the couple exhibit behavior which is acceptable
to his or her partner.
- (i) independent
- (i) Assess level of understanding regarding
human sexuality and functioning.
- Many persons have misconceptions about facts as they relate
to sexual intimacy.
- (i) Explore current and past sexual patterns,
practices, and degree of satisfaction.
- To determine realistic approach to care planning.
- (i) Identify level of comfort in discussion
for patient and/or significant other.
- It is important for the nurse to create an environment
where the couple or patient feels safe and comfortable in discussing
- (i) Identify potential or actual factors that
may contribute to current alteration in sexual functioning. (See Related
Factors of this care plan.)
- (i) Solicit information from the patient about
the nature, onset, duration, and course of sexual difficulty.
- (i) independent
- (i) Use a relaxed, accepting manner in
discussing sexual issues. Convey acceptance and respect for patient concerns.
- Patients are often hesitant to report such concerns and/or
difficulties because sexuality remains a private, uncomfortable matter for many
within our culture.
- (i) Provide privacy and adequate time to
- Respecting the individual and treating his or her concerns
and questions as normal and important may foster greater self-acceptance and
- (i) Encourage sharing of concerns, feelings,
and information between patient and current or future partner. Whenever
possible, involve both in sexual health education and counseling efforts.
- For some sexual problems it is the couple's relationship
that provides the focus for intervention.
- (i) Discuss the multiplicity of influences on
sexual functioning (physiological, emotional). Offer opportunities to ask
questions and express feelings.
- (i) Explore awareness of and comfort with a
range of sexual expression and activities (not just sexual intercourse).
- (i) Assist patient and significant other in
identifying possible options to overcome situational, temporary, or long-term
influences on sexual functioning.
- (i) Encourage patients and significant others
to locate and read relevant educational materials regarding sexuality.
- Many excellent books are available that undo myths and
errors and promote increased knowledge and communication about sexual
Education/Continuity of Care
- (i) independent
- (i) Provide accurate and timely health
teaching regarding "normal" range of sexual expression and sexual practices
throughout the life cycle.
- Satisfying sexual functioning and practice are not
automatic and need to be learned.
- (i) Discuss range of possibilities and
consequences (both positive and negative) associated with sexual expression of
all types (change in relationship, impact on physical and/or emotional health,
possibility of pregnancy, STDs and others).
- (i) Offer information regarding birth control
methods, "safe" sex practices and others.
- (i) Explain the effects on sexual functioning
of patient's medication(s), illness or disease process, health alteration,
surgery, or therapy.
- (i) Be specific in providing instruction to
patient and significant other regarding any limitations on sexual activity
resulting from illness, surgery, or other events.
- (i) Explain alternative means or forms of
expressing intimacy and/or sexual expression, such as alternative positions for
intercourse that decrease discomfort or degree of physical exertion for those
with impaired mobility or cardiopulmonary disease. Consider concerns imposed by
patient's or significant other's health status, illness, or other
- (i) Consider referral for further work-up
and/or treatment (e.g., primary health care provider, specialized physician or
mental health consultant, substance abuse treatment program, or sexual
- The counseling needs of the couple or patient may be beyond
the skill or training of the nurse.
- (c) Consider referral to self-help and/or
support groups (i.e., Reach for Recovery, Ostomy Association, Mended Hearts,
Huff and Puff, Sexual Impotence Resolved, Us Too, HIV Support Groups, Y Me,
Survivors of Abuse, or Resolve).
- Self-help support groups are unique sources of empathy,
information, and successful role models.
Sexual Counseling; Anticipatory Guidance; Teaching:
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