“Human sexuality encompasses the sexual knowledge, beliefs, attitudes, values, and behaviours of individuals. Its various dimensions involve the anatomy, physiology, and biochemistry of the sexual response system; identity, orientation, roles, and personality; and thoughts, feelings, and relationships. Sexuality is influenced by ethical, spiritual, cultural, and moral concerns.”
The above definition presented by the Sex Information and Education Council of the United States (SIECUS) demonstrates the complexity of this multi-facet concept. This complex behaviour will be analysed in an attempt to clarify its meaning, however the Nursing implications towards sexuality will further be emphasised. Aware of the limitations, it is not possible to analyse and present all the complexities and numerous attributes which this concept brings about. It is therefore the author’s intention to assign the attributes under three major categories namely the physical, social and psychological aspects of life and present model cases by using three important attributes which emerge from these same categories.
Purpose and Aims of the study
The concept of sexuality has been selected for analysis. The author believes that we need sexuality as much as we need our daily bread, however although it is considered as a natural process, many perceive sexuality as a taboo.
“Sexual behaviour, more than any other behaviour, is intimately related to our emotional and social well being; yet it is misunderstood, feared and misused” (Kuczynski 1986:60).
In this analysis the author will therefore aim at clarifying the meaning of sexuality by distinguishing the normal, ordinary language usage and its scientific use from a nursing perspective.
Uses of the concept
The Collins dictionary (1991) gives three definitions of sexuality namely:
1) The state or quality of being sexual.
2) Preoccupation with or involvement in sexual matters.
3) The possession of sexual potency.
All three definitions mention the word sexual, however one can associate each meaning with three major categories or states of our life. The first definition is closely related to the psychological being, the second definition to the social being, and the third definition to the physical being. These sexual associations have been clearly identified by several authors including Webb (1985, 1994) and Ooijen and Charneck (1994). Stuart and Sundeen (1979) encompass these three aspects in their own definition and state that:
“Sexuality is an integral part of the whole person. Human beings are sexual in every way, all the time. To a large extent human sexuality determines who we are. It is an integral factor in the uniqueness of every person” (page 2).
This definition highlights attributes such as wholeness, identity, and uniqueness. Ironically though, contrary to the wholeness attribute, the word sex is derived from the Latin word sexus which means secare or in plain English to divide (Collins dictionary 1991). However Ooijen and Charneck (1994) argue that sex relates more to the physiological act and the biological state as opposed to sexuality which, besides biological, in the broader term encompass the cultural, social, psychological, and moral behaviour of our sexual behaviour.
Up to this end, the word sexuality seems to be very closely related to sexual. A search in the Thesaurus revealed eight other closely related words to sexual and include carnal, sensual, lustful, libidinous, lascivious, lecherous, prurient, and lewd. These related words demonstrate both positive and negative meanings of sexuality, however they all address to a certain extent the physical (carnal), the psychological (lustful), and the social (prurient) attributes of sexuality.
A very interesting and quite comprehensive definition which in the author’s opinion focuses on an extensive range of sexual attributes is expressed by the Sex Information and Education Council of the United States (SIECUS) whom the author came across during an internet search. They state that:
“Sexuality is a complex aspect of our personalities and ‘Self’. Our sexuality is defined by sexual thoughts, desires, and longings, erotic fantasies, turn-ons, and experiences. In many ways sexuality is the force that empowers us to express and display strong, emotional feelings for another person and is a natural stimulus for the procreation of our species. The ‘thing’ that attracts one person to another may not always be sexual – it could be sense of humour, personality, likeability, compatibility or intelligence, with sex or sexuality being only a secondary consideration. Sometimes part of our sexuality can be suppressed – we have fantasies about particular people but don’t act or talk about them. Others have general sexual desires or fantasies about people of the same sex but don’t explore or discuss those thoughts or feelings”
Many attributes emerge from this broad definition which include complexity, personality, self, thoughts, desire, longing, fantasies, turn-ons, experiences, force, strength, emotion, natural, stimulus, attraction and feelings.
Addressing purely the biological function, Hohmann (1972) describes sexuality as:
“A biological act that involves the build-up of both autonomic nervous system and striated muscle activity that culminates in orgasm. It is a biological force that is necessary for the procreation of the human race” (page 50).
The psychological perspective of sexuality is according to Webb (1985) closely related to the physiological aspect. Bee (1995) describes how Freud proposed the existence of a basic unconsciousness, instinctual sexual drive called the libido. This energy is believed by Freud as the motive force behind virtually all behaviour. According to Freud this energy (Libidinal energy) is invested in that part of the body which is most sensitive at that stage of the individual’s development. Five stages are identified by Freud which include the oral stage (new born) includes mouth, lips and tongue, the anal stage (infant) includes the anus, the phallic stage (toddler) includes the genitals, the latency stage (child) includes no specific area, and the genital stage (teenager and adult) includes the genitals.
Webb (1985) differentiates the male and female gender by associating masculine aggression to the male part and maternal instinct to the female part. These psychological attributes demonstrate the stereotyping effects perceived by man (Webb 1985).
Looking from a sociological perspective, Fransella and Frost (1977) confirm from their analysis of children’s books that boys are shown as more aggressive in sporting activities and solving problems, while women appear in homes and schools more often. This indirectly highlights what we perceive as our role in the community or what other people expect what role we play in our lives according to our gender.
Roper et al (1990) state that sexual behaviour serves both reproductive and non-reproductive functions, however much more frequently this behaviour is performed for the latter reason. Each human being is a ‘sexual’ human being and has a sexual identity namely perception of ‘self’ as a boy or girl – man or woman (Roper et al 1990). Attributes like ‘self’ and ‘identity’ are repeated however the ‘gender’ attribute is clearly demonstrated.
Sexuality and Nursing
The World Health Organisation (WHO) defines sexual health as:
“the integration of the somatic, emotional, intellectual and social aspects of sexual being, in ways that are positively enriching and that enhance personality, communication and love” (WHO 1975:6)
Attributes here surface out as somatic – of the body or physical, emotional – feelings affecting the psychology of the person, intellectual – cognitive understanding, and social – interaction with others. According to WHO (Mace et al 1974), the aim of taking sexuality into account in health care is to promote sexual health and define it as:
“1. A capacity to enjoy and control sexual and reproductive behaviour in accordance with social and personal ethic.
2. Freedom from fear, shame, guilt, false beliefs, and other psychological factors inhibiting sexual response and impairing sexual relationships.
3. Freedom from organic disorders, disease, and deficiencies that interfere with sexual and reproductive functions.” (Page 4)
Webb (1995) argues how nurses now recognise that sexuality is not just about biological functioning and reproductive behaviour but a person’s sexuality involves:
“their whole personality and is pervasive on every aspect of life. How we present ourselves to others in our body language and dress gives them messages about our sexuality, and we adopt these styles of presentation as an expression of our self-concept of ourselves as sexual beings.” (Page 1)
It can be argued therefore that even in our nursing profession, the importance of addressing all aspects of sexuality (physical, social and psychological attributes) in order to establish a full nursing diagnosis and hence apply the necessary interventions, is becoming more evident. However Thomas (1989) argues that:
“It (sexuality) is seen in terms of identity, roles, relationships, self concept and the very quality of being human with all that being human encompasses. But nurses rarely identify sexuality in this way.” (Page 50)
In an attempt to develop insight into how the concept of human sexuality has been addressed within a popular nursing medium during 1980 and 1990, Carr (1996) includes some important definitions which several authors include in their works and provide a description of the attributes of sexuality which could be matched with those identified within the concept analysis. These are:
“Sexuality is intrinsic to our being – a basic need and an aspect of humanness that cannot be divorced from life events. It influences our thoughts, actions, and interactions and is involved in aspects of physical and mental health” (Hogan 1980:201)
“Sexuality is an integral part of every human being and is lived everyday of one’s life. It is evident in the way one looks, believes, behaves and relates to other human beings. Sexuality is broadly defined as a desire for contact, warmth, tenderness or love. It incorporates far more than genital sex. Sexuality includes looking and talking, poetry and long walks, hand-holding, kissing, self-pleasuring and the production of mutual orgasms by various means. Sexuality includes one’s total sense of sex. If sexuality is part of being a human being, every day in every way, then it must be linked with health.” (Webb C 1987:202)
“Our sexuality encompasses many of our human qualities; it is constant and energetic and affects our physical, psychological, emotional, spiritual and social selves. If as a healthy person, I feel sexuality to be continuous, powerful force than as suggested by Ainslie, sexuality and sexual expression must hold very special significance for the cancer sufferer.” (Coughlan 1987:202)