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Table 10-7

AgeDevelopment of Sexual Behavior
First 18 mo Major source of pleasure from touch and oral exploration.
18 mo–3 yr Pleasurable and sexual feelings are associated with genitals (acts of urination and defecation). Masturbation without fantasy or eroticism.
3–6 yr Beginning resolution of Oedipus and Electra complexes; foundation for heterosexual relationships; masturbation with curiosity about genitals of opposite sex.
6–12 yr Peer relations with same sex; onset of sex play; morality and sexual attitudes taught and learned; phase of sexual tranquility.
12–18 yr (adolescence) Onset of puberty with biological development of secondary sex characteristics; menstruation and ejaculation occur.
Frequent masturbation. Intense anxiety and guilt may occur over heterosexual or homosexual behavior (petting, coitus, masturbation, STI, pregnancy, genital size).
18–23 yr (early adulthood) Maximum interpersonal and intrapsychic self-consciousness about sexuality. Issues: premarital coitus, sexual freedom.
Anxiety about: sexual competency, genital size, impotence, fear of pregnancy, rejection.
23–30 yr Focus on sexual activity in coupling and parenthood; mutual masturbation.
30–45 yr (middle adulthood) For women—peak sexuality without new sexual experiences. Conflict regarding extramarital sex may increase.
Purpose of Intercourse:
  • Need for body contact (and procreation until age 35+).
  • Physical expression of trust, love, and affection.
  • Reaffirmation of self-concept, as sexually desirable and sexually competent due to worry about effects of aging.
Sexual Dysfunctions:
  • Men: erectile dysfunction, premature ejaculation, decreasing libido.
  • Women: intermittent lack of orgasmic response, vaginismus, dyspareunia.
  • For either or both: changes or divergences in degree of sexual interest.
Causes of Sexual Dysfunction (Men):
  • Overindulgence in food or drink.
  • Preoccupation with career and economic pursuits.
  • Mental or physical fatigue.
  • Boredom with monotony of relationship.
  • Drug dependency: alcohol, tobacco, certain medications.
  • Fear of failure.
  • Chronic illness: diabetes, alcoholism → peripheral neuropathy → impotence (smoking and drinking may result in decreased testosterone production); excessive smoking → vascular constriction → decreased libido; spinal cord injuries; prostatectomy, androgen deprivation therapy (for prostate cancer).
  • Self-devaluation due to accumulation of role function losses, sexual self-image, and body image.
  • Past history of lack of sexual enjoyment in younger years.
Causes of Sexual Dysfunction (Women):
  • Belief in myths regarding “shoulds and should nots” of frequency, variations, and enjoyment.
  • Widowhood: inhibition and loyalty to deceased.
45–65 yr (later adulthood) Menopause occurs.
Little or no fear of pregnancy; evidence of sexual activity differences in men and women: women may have increased pleasure, men take longer to reach orgasm; may prefer less strenuous mutual masturbation.
Over 65 yr (old age) Activity depends on earlier sexual attitude.
May suffer guilt and shame when engaging in sex.
Can have active and enjoyable sex life with continuing sex needs.
Age is not a barrier provided there is opportunity for sexual activity with a partner or for sublimated activities.
Women in this age group outnumber men; single women outnumber single men by an even larger margin.

From © Lagerquist, S: Nursing Examination Review, ed 4. Addison-Wesley, Redwood City, CA.