1. ISSUES in sexual practices with implications for counseling:
1. Sex education—need to provide accurate and complete information on all aspects of sexuality to all people.
2. Sexual-health care—should be part of total healthcare planning for all.
3. Sexual orientation—need to avoid discrimination based on sexual orientation (such as homosexuality); the right to satisfying, nonexploitive relationships with others, regardless of gender.
4. Sex and the law—sex between consenting adults not a legal concern.
5. Explicit sexual material (pornography)—can be useful in fulfilling various needs in life, as in quadriplegia.
6. Masturbation—a natural behavior at all ages; can fulfill a variety of needs (see Masturbation, Specific Situations).
7. Availability of contraception for minors—the right of access to medical contraceptive care should be available to all ages.
8. Abortion—confidentiality for minors.
9. Treatment for sexually transmitted infections (STIs)—naming of partners as part of STI control.
10. Sex and the elderly—need opportunity for sexual expression; need privacy when in communal living setting.
11. Sex and the disabled—need to have possible means available for rewarding sexual expressions.
2. SEXUAL MYTHS^*
1. Myth: Ignorance is bliss.
   Fact: What you don't know can hurt you (note the high frequency of STI and abortions); myths can perpetuate fears and such misinformation as:
1. Masturbation causes mental illness.
2. Women don't or shouldn't have orgasms.
3. Tampons cause STI.
4. Plastic wrap works better than condoms.
5. Coca-Cola is an effective douche.
   Fact: Lack of knowledge during initial experiences may result in fear and set precedent for future sexual reactions.
2. Myths: The planned sex act is not OK and is immoral for "nice" girls. If a woman gets pregnant, it is her own fault. Contraceptives are solely a woman's responsibility.
   Fact: Sex and contraception are the prerogative and responsibility of both partners.
3. Myth: A good relationship is harmonious, free of conflict and disagreement (which are signs of rejection and incompatibility).
   Fact: Conflict can induce growth in self-understanding and in understanding of others.
4. Myth: Sexual deviance (such as homosexuality) is a sign of personality disturbance.
   Fact: No single sexual behavior is the most desirable, effective, or satisfactory. Personal sexual choice is a fundamental right.
5. Myth: A woman's sexual needs and gratification should be secondary to her partner's; a woman's role is to satisfy others.
   Fact: A woman has as much right to sexual freedom and experience as a man.
6. Myth: Menopause is an affliction signifying the end of sex.
   Fact: Many women do not suffer through menopause, and many report renewed sexual interest.
7. Myth: Sexual activity past 60 years of age is not essential.
   Fact: Sexual activity is therapeutic because it:
1. Affirms identity.
2. Provides communication.
3. Provides companionship.
4. Meets intimacy needs.
8. Myth: A woman's sex drive decreases in postmenopausal period.
   Fact: The strength of the sex drive becomes greater as androgen overcomes the inhibitory action of estrogen.
9. Myth: Men over age 60 cannot achieve an erection.
   Fact: According to Masters and Johnson, a major difference between the aging man and the younger man is the duration of each phase of the sexual cycle. The older man is slower in achieving an erection.
10. Myth: Regular sexual activity cannot help the aging person's loss of function.
    Fact: Research is revealing that "disuse atrophy" may lead to loss of sexual capacity. Regular sexual activity helps preserve sexual function.
3. BASIC PRINCIPLES OF SEXUAL-HEALTH COUNSELING
1. There is no universal consensus about acceptable values in human sexuality. Each social group has very definite values regarding sex.
2. Counselors need to examine own feelings, attitudes, values, biases, knowledge base.
3. Help reduce fear, guilt, ignorance.
4. Offer guidance and education rather than indoctrination or pressure to conform.
5. Each person needs to be helped to make personal choices regarding sexual conduct.
4. COUNSELING IN SEXUAL HEALTH
1. General considerations:
1. Create atmosphere of trust and acceptance for objective, nonjudgmental dialogue.
2. Use language related to sexual behavior that is mutually comfortable and understood between client and nurse.
1. Use alternative terms for definitions (e.g., "being intimate" vs. "having sex").
2. Determine exact meaning of words and phrases because sexual words and expressions have different meanings to people with different backgrounds and experiences.
3. Desensitize own stress reaction to the emotional component of taboo topics.
1. Increase awareness of own sexual values, biases, prejudices, stereotypes, and fears.
2. Avoid overreacting, underreacting.
4. Become sensitively aware of interrelationships between sexual needs, fears, and behaviors and other aspects of living.
5. Begin with commonly discussed areas (such as menstruation) and progress to discussion of individual sexual experiences (such as masturbation). Move from areas where there is less voluntary control (nocturnal emissions) to more responsibility and voluntary behavior (premature ejaculation).
6. Offer educational information to dispel fears, myths; give tacit permission to explore sensitive areas.
7. Bring into awareness possibly repressed feelings of guilt, anger, denial, and suppressed sexual feelings.
8. Explore possible alternatives of sexual expression.
9. Determine interrelationships among mental, social, physical, and sexual well-being.
2. Assessment parameters:
1. Self-awareness of body image, values, and attitudes toward human sexuality; comfort with own sexuality.
2. Ability to identify sex problems on basis of own satisfaction or dissatisfaction.
3. Developmental history, sex education, family relationships, cultural and ethnic values, and available support resources.
4. Type and frequency of sexual behavior.
5. Nature and quality of sex relations with others.
6. Attitude toward and satisfaction with sexual activity.
7. Expectations and goals.
3. Nursing care plan/implementation:
1. Long-term goals:
1. Increase knowledge of reproductive system and types of sex behavior.
2. Promote positive view of body and sex needs.
3. Integrate sex needs into self-identity.
4. Develop adaptive and satisfying patterns of sexual expression.
5. Understand effects of physical illness on sexual performance.
2. Primary sexual-health interventions:
1. Goals: minimize stress factors, strengthen sexual integrity.
2. Provide education to uninformed or misinformed.
3. Identify stress factors (myths, stereotypes, negative parental attitudes).
3. Secondary sexual-health interventions: identify sexual problems early and refer for treatment.
4. Evaluation/outcome criteria:
1. Reduced impairment or dysfunction from acute sex problem or chronic, unresolved sex problem.
2. Evaluate how client's goals were achieved in terms of positive thoughts, feelings, and satisfying sexual behaviors.

^* Adapted from Sedgwick, R: Myths in human sexuality: a social-psychological perspective. Nurs Clin North Am 10(3):539–550. Philadelphia, WB Saunders.