Learning Objectives
By the end of this section, you will be able to:
- Identify the different forms of stimulation used in sexual fulfillment
- Explain sexual behaviors and their assigned categories
- Describe the types of expression used for sexual fulfillment
The state of experiencing satisfaction, pleasure, and contentment in one’s sexual relationships, is known as sexual fulfillment and is a crucial aspect of overall health and well-being. Though discussing sexual health and habits can be uncomfortable at first, it is important for nurses to gain the experience and knowledge to be able to understand and address patient sexual concerns. By remaining open-minded and nonjudgmental regarding others’ sexual preferences, nurses can provide care that is more holistic and promotes optimal patient wellness and outcomes.
Forms of Sexual Stimulation
Every individual has unique sexual preferences. Thus, achieving sexual fulfillment may vary from person to person. There are several different forms of sexual stimulation that an individual may prefer (or require) to become sexually fulfilled. These forms of sexual stimulation can be classified as either physical or psychological and are discussed in more detail in the following sections.
Physical
Physical sexual stimulation involves physical contact, or the touching of parts of the human body (Table 33.1). Specifically, this involves touching the various erogenous zones, which are parts of the body that trigger sexual arousal (state of being physically and mentally excited by sexual stimuli, and involves physiological responses such as increased heart rate, blood flow to the genital areas, lubrication in women, and erections in men) when stimulated. These areas include the mouth/lips, ears, neck, breasts/nipples, back, genitals, and the inner thighs (Figure 33.4).
| Type of Stimulation | Description |
|---|---|
| Kissing | Kissing is direct mouth-to-mouth contact that involves pressing one’s lips against another person’s lips. |
| Breast stimulation | Other terms include “nipple stimulation,” or “nipple play.” Involves biting, sucking, touching, and/or rubbing the nipples and surrounding breast tissue. It is important to note that the amount of breast stimulation that is comfortable varies widely from person to person. |
| Manual stimulation | Manual stimulation involves the use of hands, fingers, or other parts of the body to stimulate the genitals or other erogenous zones. Examples include “fingering,” or placing one’s fingers inside a vagina, using fingers to squeeze nipples, or using hands to stroke a penis. |
| Oral stimulation | Oral stimulation, also called “oral sex,” involves using the mouth (e.g., mouth, lips, tongue) to stimulate another person’s genitals or anus. |
Psychological
In addition to physical touch, some individuals can also be sexually stimulated by other means that can be classified as psychological stimulation. This includes the use of adult movies, magazines, photographs, and certain sounds, such as moaning or sucking noises. With this kind of stimulation, there does not need to be physical contact with another individual to elicit sexual arousal. For many individuals, both physical and psychological stimulation can result in sexual arousal; however, the degree of arousal may vary depending on their specific preferences. It is important to remember that sexual stimulation preferences are specific to each individual and should be approached with an open mind by the nurse and other health professionals.
Sexual Behaviors
One’s sexual behavior refers to acts that an individual engages in to experience sexual arousal, sexual pleasure (enjoyable and satisfying physical and emotional sensations experienced during sexual activity), orgasm (peak of sexual excitement, characterized by intense physical pleasure and a series of involuntary muscle contractions in the genital area), and/or reproduction of offspring. It encompasses a wide variety of activities and interactions, both physical and psychological. Sexual behaviors can be classified as either adaptive or maladaptive, each of which is discussed in more detail in the following sections.
Adaptive
Adaptive sexual behaviors are commonly referred to as healthy sexual behaviors. This involves an individual being able to express their sexuality in ways that enrich their life and do not pose threats to their health. Some examples of adaptive sexual behaviors include the following:
- always giving and obtaining consent before participating in sexual activities
- communicating sexual needs and desires with partner
- listening to and respecting sexual boundaries of self and others
- protecting self and others from sexually transmitted infections (STIs)
- using contraceptives appropriately, if indicated
- being comfortable with sexual identity and orientation
Life-Stage Context
Sexual Behaviors in Older Adults
There is a common misconception that older adults are no longer interested in sex. However, studies have shown that older adults who engage in sexual activity have a greater quality of life (Steckenrider, 2023). With the increasing older adult population in combination with increased access to medications and devices to assist with sexual function (e.g., penis pumps, penile implants), it is important for nurses and other health professionals to understand that discussions about sex with the older adult population are warranted and necessary. It is also important to note that older adults engaging in sexual behaviors are still at risk for STIs. For this reason, it is imperative that the care of older adults involve education and discussion about safe sexual practices.
Maladaptive
Maladaptive behaviors occur when an individual does not know how to handle challenges or new situations and acts in problematic ways (Marston, 2022). In some cases, these behaviors can be sexual in nature. Examples of maladaptive sexual behaviors include the following:
- excessive or inappropriate use of pornography (materials, such as books, magazines, videos, and websites, that depict explicit sexual content primarily intended to stimulate sexual arousal)
- infidelity (cheating or being unfaithful to a committed partner)
- developmentally inappropriate sexual behavior exhibited by children, particularly under the age of 12
- touching others in inappropriate or unwanted ways
Common Types of Sexual Expression
Sexual expression refers to both the sexual activities in which individuals engage as well as how they communicate and present their sexuality. This section will discuss masturbation, sexual intercourse, oral-genital stimulation, and a few other less common types of sexual expression.
Masturbation
Self-stimulation of the genitals or other areas of the body for sexual arousal or pleasure is called masturbation. It can involve the use of hands/fingers, sex toys, or other objects and is a normal part of healthy sexual development. Masturbation can be practiced individually or with a partner, who may or may not choose to participate in the activity. Historically, there have been myths and misconceptions surrounding masturbation, with some people believing that it could lead to various side effects such as blindness, hairy palms, or infertility. In reality, masturbation is a normal and healthy sexual activity that does not cause harm to the body (Ajmera, 2022). Misinformation about masturbation has contributed to stigma and shame surrounding this natural behavior, but education and accurate information can help dispel these myths and promote a more positive understanding of masturbation and sexual health. Masturbation offers many benefits, including
- reduced stress and anxiety,
- increased focus,
- improved mood,
- better sleep, and
- enhanced sex life.
Sexual Intercourse
In traditional definitions, sexual intercourse refers to penetration of the female’s vagina by the male’s penis. This definition, however, does not account for variations in sexual orientation, so it is often expanded to also include penetration of the anus (of a male or female) by the penis. Some definitions also include penetration of the vagina or anus by a finger, tongue, or inanimate object. Although the definition of what constitutes sexual intercourse may vary, it always involves penetration of the vagina or anus.
Oral-Genital Stimulation
Also called “oral sex,” oral-genital stimulation, involves stimulation of an individual’s genitals by another individual’s mouth, lips, or tongue. The three types of oral sex are
- fellatio (oral sex involving the penis),
- cunnilingus (oral sex involving the vagina, vulva, or clitoris), and
- anilingus (oral sex involving the anus).
Oral sex often may occur before sexual intercourse in what is known as foreplay; however, it can also be performed after sexual intercourse or on its own without any intercourse at all. This kind of sexual expression can be pleasurable but is not without risk. Both giving and receiving oral sex increases the risk of obtaining STIs, as they can be spread from mouth-genital contact and vice versa.
Other Forms of Sexual Expression
There are several other, less common forms of sexual expression (Table 33.2).
| Type of Expression | Description |
|---|---|
| Voyeurism |
|
| Sadism |
|
| Masochism |
|
| Sadomasochism |
|