A secondary analysis of a prospective randomized clinical trial with repeated measures was conducted to examine the effects of a standardized nursing intervention on patient and spouse depressive symptoms, sexual function, and marital interaction. Another purpose of this study was to determine if, over time, differences existed in men and their spouses' levels of depressive symptoms, sexual function, and marital interaction following radical prostatectomy. Spouses reported significantly higher levels of depressive symptoms and significantly more marital interaction distress compared to patients. Patients reported significantly more distress pertaining to sexual function than their spouses.
Sexual and reproductive health (SRH) care is often overlooked in advanced practice nursing educational programs, but advanced practice registered nurses are expected to provide care in this sensitive area. Competencies for SRH care were developed by the World Health Organization, and individual countries including the United States have adapted them to their unique health systems and populations. In this article, we discuss extant and future pathways for advanced practice registered nurses to develop competence in SRH care.
Sexual BehaviorPreschool children are curious in general and tend to actively learn about the world through listening, looking, touching, and imitating. Preschool children's general curiosity about the world manifests with questions as well as exploratory and imitative behaviors including sex body parts. These sexual behaviors often occur in public and include:
Adolescence may be conceptualized as a dramatic time of child development spanning the second ten years of life. Puberty and other significant physical, social, emotional, and intellectual changes, and sexual development, mark this ever fluctuating and sometimes emotionally unstable period of life. Significant brain development occurs during adolescence with rapid growth and related cognitive, social-emotional, and behavioral changes continuing until the early to mid-twenties.
Adolescent sexual development includes not only physical changes, but the development of oneself as a sexual being. Adolescents becoming increasingly aware of their sexual attractions and interests, including sexual orientation and gender identity.
Young AdolescentsSchool children and young adolescents ages 9 to 13 may experience a substantial increase in sexual thoughts and feelings. One's first feelings of sexual attraction may occur as early as 9 to 12 years of age with onset of sexual fantasies occurring several months to one year later. This development may be followed by a "surge" of sexual interest and attractions. The physiological changes associated with puberty include increased levels of sex hormones further impact feelings of sexual arousal, attraction, and fantasies. Nocturnal emissions and the onset of menstruation are signs that the adolescent as reproductive capability. (See here for more information on adolescent sexual pubertal and sexual development and early, mid- and late adolescent stages.)
Middle and Late AdolescenceBy middle adolescence, which generally includes youth between 13 and 16 years, physical puberty may be almost complete. During this time sexual thoughts and feelings as well as sexual behavior expand further. In late adolescence, which typically includes 17 to 19 year olds, sexual thoughts, feelings, and activities may continue to significantly increase. For example, youth may become involved in a relationship that includes sexual intimacy. Brain development does not cease at age 18 or 19 and significant social-emotional and intellectual growth relevant for healthy and pro-social behaviors can be expected to continue.
Developmental differences between young adolescents and older adolescents have been noted in brain growth, as well as in their social, emotional and behavioral repertoires. Despite these overall patterns, it also is important to consider the tremendous variation in developmental milestones among teens. Further, there may be "mismatches" in the rates of development across domains for individual youth. For example, a girl may begin puberty at 9 but not yet have developed the higher order cognitive skills necessary for managing social and sexual situations that may arise. Thus, age is not always the best indicator of social maturity and good judgement.
Professionals must keep in mind that adolescents are trying to understand the rapid sexual development of their feelings and bodies. Adolescents may have advanced sexual knowledge and experience but may be well behind in abstract thinking and understanding the impact of their behaviors on others. As adolescents mature, they are able to understand and interpret their own sexual feelings and the emotions and behaviors of others.
Sexual KnowledgeThe extent and accuracy of an adolescent's knowledge about sexual matters is determined by a variety of factors including parent-child relationship quality, family attitudes and knowledge, the availability of school-based sex education programs, Internet and publicly available written literature, and cultural factors.
The extent to which other information sources provide accurate and sufficient information varies considerably. Education and accurate information ensuring that sexual activities are consensual and consistent with relevant state laws may be limited or lacking.
Sexual BehaviorDuring early adolescence there is an increase in sexual behaviors which often involve self-exploration and masturbation. Some experimentation may involve opposite or same gender peers. While these behaviors often occur with mutual agreement, they may be motivated by self-interest more than reciprocal in nature. Same gender sexual activity may be related to curiosity, opportunity, or sexual orientation. Sexual orientations are not considered sexual behavior problems.
In contrast with early adolescence, mid adolescent sexual relationships may involve increased emotional intimacy and not be as self-focused. With late adolescents, the frequency of sexual activities increases. Most sex is within dating or romantic relationships, but much occurs outside these relationships as well. Sex outside romantic relationships generally is more likely in boys and is associated with other risk factors, although casual sex among late adolescents and young adults ranging from kissing to sexual intercourse, such as "hooking up," has become more common.
Perhaps contrary to the expectation of some, sexual intercourse and oral sex are common during adolescence. Youth often are between 15 and 17 when they first engage in intercourse with the median just over 16 years. Nearly 50% of high school students and more than 60% of 12th graders have engaged in sexual intercourse. Compared to Whites and Latinos, the onset of sexual intercourse is earlier for African-American males and later for Asian Americans. For more information, see the Center for Disease Control and Prevention survey of youth risk behavior). Most sexual activity is within dating or romantic relationships, but much occurs outside these relationships as well. Although sexual intercourse during teen years is not unusual, it is not always socially appropriate or even legal. Further, there are considerable risks and consequences to these sexual behaviors which are the topic of sex education and prevention programs (See Sex Education Resources)
Over the past several decades, advanced practice registered nurses (APRNs) have become an integral part of the health care system. APRNs, including nurse practitioners (NP), certified nurse midwives (CNM), clinical nurse specialists (CNS) and certified registered nurse anesthetists (CRNA), must have at least a Masters degree and are trained to treat a specific patient population. (CRNAs are not analyzed in this brief since they do not regularly provide sexual and reproductive health care.) APRNs provide patient assessments, diagnose diseases and conditions, order tests, prescribe medications and direct patient care. Some states allow APRNs to dispense medications under certain conditions and others permit APRNs to provide drug samples to patients. States vary in how APRNs are licensed: some states allow APRNs to practice independently, others require APRNs to work within a collaborative practice agreement with a physician and other states generally allow APRNs to work independently, but require a collaborative practice agreement with a physician in order to prescribe medications.