Sexual health is the ability to form developmentally appropriate sexual relationships that are safe and respectful of one’s self and others. According to the World Health Organization, sexual health includes the capacity to enjoy and control sexual and reproductive behavior in accordance with a social and personal ethic; freedom from fear, shame, guilt, false beliefs, and other psychological factors; and freedom from disease and deficiencies that interfere with sexual and reproductive function.

Sexuality includes gender identity, gender role, and sexual orientation. Gender identity (gender) is the biologic sex of the male, female, or intersexed. Intersexed people were formerly known as hermaphrodites—people who are born with both sets of genitalia or ambiguous genitalia.

Gender role is the masculine or feminine role adopted by a person, or for the transgendered, a variety of gender role behaviors, including cross-dressers, transvestites, and transsexual people. Transvestites are transgendered people who may dress opposite from their birth gender, but identify with others within their birth gender. Transsexuals are transgendered people who believe they were born into the wrong-gendered body. Transsexuals may identify with any sexual orientation.

Sexual orientation is the affectional and sexual attraction of one person to another including heterosexual (opposite gender), homosexual (same gender), or bisexual (both genders) orientations. Other terms are straight for heterosexuals, gay for male homosexuals, lesbian for female homosexuals, and pansexual for bisexuals.

Sexual dysfunction (the inability to engage in sexual activity) can result from physical or psychological illness, interpersonal factors, or the side effects of medications. The factors affecting sexual health are physiological, emotional, psychological, cultural, societal, religious, and developmental. Physiological factors include the effects of hormones, medications, and physical disease on sexuality. Emotional and psychological factors include anxiety and depression or personality disorders or manic disorders. One aspect of depression affecting sexuality is anhedonia, the inability to get pleasure from things that are usually pleasurable.

Culture determines what is considered appropriate or inappropriate in sexual behaviors. Societal factors include attitudes toward sex education and open discussion of sexuality. Religious factors vary widely, but have a great influence on sexual behavior for many people. Developmental factors are related to physical changes, readiness, and emotional maturity.

Common threats to sexual health are childhood sexual abuse, which can cause sexual acting out and low self-esteem, and sexually transmitted infections, which can lead to pelvic inflammatory disease, infertility, and cancers. These threats to sexual health can lead to erectile dysfunction (impotence), frigidity, and infertility.

Sexual assessment begins with a complete health history and medication history. The nurse should assure the client’s privacy throughout the history and physical examination. The medication history should include the history of taking over-the-counter medications, hormones, recreational drugs, or herbal preparations. The sexual history includes sexual activities, number and genders of sexual partners, satisfaction with sex, difficulty achieving erection or orgasm, pain or bleeding with sexual activity, any high-risk behavior, or other indications of sexual dysfunction.

Nursing diagnoses related to sexual health are Altered Sexuality Patterns and Sexual Dysfunction, related to deficient knowledge, pain, anxiety, fear, body image disturbance, emotional stress, or medication side effects. Once a nursing diagnosis has been established, the nurse works with the client to establish goals, usually along with the client’s partner. The PLISSIT model can be used to plan interventions. In this model, P stands for the permission the nurse gives to the client to discuss sexual matters. LI stands for the limited information the nurse may give to open the discussion, such as explaining the concerns about sexuality that a cardiac client often experiences. SS stands for the specific suggestions the nurse offers. IT stands for intensive therapy. The nurse refers the client to intensive therapy by a certified sex therapist for specific sexual problems.

Evaluation of sexual health interventions consists of an appraisal of how well the client’s goals have been met. Sexual health is an area that is amenable to prevention and wellness practices. Public information about sexual behavior and AIDS expanded in the last half of the twentieth century. Specific wellness practices are the prevention of sexually-transmitted infections (STIs), regular screening for STIs in those who have multiple sexual partners, monthly breast self-examinations (BSE) in women, yearly breast clinical examinations (BCE) of women by a health care practitioner, and self-penile and monthly self-testicular examinations (STE) in men.