Sexuality and Holism
Lisa Gregory BSN, RN-BC, CCRN
During a recent work session with the OHNA Board members, we participated in a group activity identifying modalities in specific areas of holism. The areas included mental, emotional, physical, and spiritual. As we brainstormed activities, modalities, and interests into those categories, many overlapped, one in particular I want to discuss. I have always been fascinated by sexuality and holism. For me, sexuality, sexual health, and intimacy have always intersected areas of the whole.
According to the World Health Organization (WHO):
Sexuality is a central aspect of being human throughout life, encompasses sex, gender identity and roles, sexual orientation, eroticism, pleasure, intimacy, and reproduction. Sexuality is experienced and expressed in thoughts, fantasies, desires, beliefs, attitudes, behaviors, practices, roles, and relationships…Sexuality
is influenced by the interaction of biological, psychological, social, economic, political, cultural, legal, historical, religious, and spiritual factors. (WHO,2016,para.6)
Sexual health is the state of physical, emotional, mental, and social well-being inrelation to sexuality; it is not merely the absence of infection, dysfunction, orinfirmity. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination, and violence. (WHO,2016, para.4)
Sexual well-being is also a term used by the CDC and WHO which can be interchanged for both sexual health and sexuality. (Martin & Woodgate, 2020). Holistic Nursing, Scope and Standards of Practice (3rd edition, 2019) offers no such definition or acknowledgment of sexual well-being, other than performing a sexual assessment without guidelines or scripted questions. Poor vital evidence and research has been noted with most articles being published outside of the US related to sexual well-being and nurse-patient discussions on sexuality.
Sexual well-being as a quality-of-life foundation, core value, and a form of self-care. As a healer, helping others in their goals of care is key. One must understand oneself to decrease or ideally be free of unconscious bias and remain grounded in the care the patient is looking for. Open and honest communication will facilitate a trusting rapport that is essential for the best outcomes. Clearly identified problems and goals setting by the client and healer will assist in the trusting environment and aid with potential expectations, using a trauma-informed care model. A preliminary framework for assessment should include a sexual health inventory, a self-assessment focusing on areas of self-esteem, self- efficacy and personal satisfaction, sexual preferences and desires, barriers,past experiences (positive and negative) and personal goals for sexual well-being. Sexual self-esteem is related to one’s sexuality, attraction to self and others, and physical appearance. Self-efficacy in one’s ability to achieve sexual pleasure and negotiate sexual boundaries with partner(s) (Martin & Woodgate, 2020). Sexual desires can encompass intimacy and what intimacy looks like for you, not just sexual acts. Sexuality is multi-faceted including gender/gender dysphoria, identification LGBTQQIP2SAA+ (lesbian, gay, bisexual, transgender, queer, questioning, intersex, pansexual, two-spirit, asexual, ally, demi-sexual), masturbation, kinks, fetishes, BDSM (bondage, discipline (or domination), sadism (or submission), masochism, monogamy, polyamory, open relationships, abstinence, and celibacy to name a few. Viewing sexuality and intimacy through the lifespan (past, present, and future) and finding where the client is in their journey of self is another aspect to the assessment history. Stages that can be addressed are early childhood memories and experiences, learned parental, cultural, ethnic behaviors, influenced religious concepts, primary relationships with others and self, early sexual education obtained or debunked, adolescent and young adult experiences, adulthood (relationships, marriage, pregnancy, childrearing, health related issues affecting sexual wellbeing), middle age with hormonal imbalances, older adulthood, and end of life sexual needs.
Trauma and negative past experiences are
likely to surface with these conversations and/or
will be the problems listed by the client.
Nationwide, 81% of women and 43% of men
reported experiencing some form of sexual
harassment and/or assault in their lifetime (Kearl,H.,2018). One in five women in the United States experienced completed or attempted rape during their lifetime (Smith, et al, 2018). Nearly a quarter (24.8%) of men in the U.S. experienced some form of contact sexual violence in their
lifetime (Smith, et al, 2018). One in three female victims and about one in four male victims
of completed or attempted rape experienced it for the first time between the ages of 11 and 17 (Smith, et al, 2018). This is not including the overwhelming attacks to LGBTQ+, Indigenous, and minority communities.
Incorporating sexual well-being and sexuality are foundational to holistic practice. It surrounds the whole person in physical, mental, emotional, and spiritual dimensions. Having a trusting client/healer relationship is the basis for positive outcomes. Scripted questions in the assessment process is a preferred method of gathering information. Be open to the concepts of new or unknown elements to you. Goal setting can look different at various stages of life or can remain constant for the individual. Entangling trauma and past negative experiences can take time, with being kind to yourself and self-love acknowledgement. The body remembers negativity and trauma, somatic healing and acupuncture are some of the other modalities to add to reach the individual’s goals.
Intimacy, sexuality, and sexual well-being are core elements to one’s life force and aura. Let us start this conversation that is rarely found in literature or research, especially in needs and desires through all changing stages of your life. Work through the past, be honest in your present, and look forward to manifesting your future radiating with love and light. It can all start within you and be a healer to aid others in their journey.
References:
Ahn, S-H and Kim, J-H. (2020). Healthcare Professionals’ Attitudes and Practice of Sexual Health Care: Preliminary Study for Developing Training Program. Front. Public Health 8:559851. https://doi.org/10.3389/fpubh.2020.559851
Aling, M.; Lindgren, A.; Lofall, H.; Okenwa-Emergwa, L. (2021). A Scoping Review to Identify Barriers and Enabling Factors for Nurse-Patient Discussion on Sexuality and Sexual Health. Nurs. Rep. 2021, 11, 253-266. https://doi.org/10.3390/nurserep11020025.
American Nurses Association and American Holistic Nurses Association (2019). Holistic Nursing: Scope and Standards of Practice, 3rd Edition, p. 67,190.
Higgins, A, Barker, P , & Begley, C. (2006) Sexuality: The challenge to espoused holistic care. International Journal of Nursing Practice. Vol. 12, Issue 6, p. 345-351. https:/doi.org/10.1111/j.1440-172X.2006.00593.x.
Hjalmarsson E, Lindroth M. (2020). “To live until you die could actually include being intimate and having sex”: A focus group study on nurses’ experiences of their work. https://doi.org/10.1111/jocn.15303.
Kearl, H. (2018). The facts behind the #metoo movement: A national study on sexual harassment and assault. Stop Street Harassment.
Martin, K. & Woodgate, R. (2020). Concept analysis: the holistic nature of sexual well-being. Sexual and Relationship Therapy. Vol. 35, No. 1, 15-29.
Smith, S. G., Zhang, X., Basile, K. C., Merrick, M. T., Wang, J., Kresnow, M., & Chen, J. (2018). The National Intimate Partner and Sexual Violence Survey: 2015 data brief –updated release. Centers for Disease Control and Prevention.
World Health Organization. (2016). Sexual and reproductive health. Retrieved from http://www.who.int/reproductivehealth/topics/sexual_health/sh_definitions/en/.
