Nursing Care of the Postmenopausal Woman, 3rd Edition
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vary among sources—their definitions il - lustrate the range of women’s experienc- es: Heterosexual or lesbian marital mo- nogamous, serial heterosexual or lesbian monogamous, nonmonogamous hetero- sexual or lesbian marriage, heterosexual or lesbian coupling with marriage, single, bisexual, lesbian, and celibate (Alexander et al., 2022; Kingsberg & Faubion, 2019). THE FEMALE SEXUAL RESPONSE Two major components affect sexual response: Physiological reaction and psy- chological processes. Although the theo- ry of the physiology of sexual response is widely accepted, it differs in each woman (Masters & Johnson, 1966). The physio - logical process of sexuality is complex, and it consists of the neurological, vas- cular, muscular, and endocrine systems. These systems influence the amount of blood that is delivered to and retained in the genitals. The systems work together to stimulate excitation and rhythmic mus- cular contractions. Sexual desire is the first phase of the sexual response and is influenced by the woman’s values, attitudes, behaviors, be- liefs, emotions, personality, and social and cultural orientations. Libido is depen- dent on the senses. Thoughts, dreams, visual stimulation, fantasy, erotic images, smells, and tactile sensations play an in- tegral role in a woman’s libido (Cason, 2022). Basson’s nonlinear model of sexual response describes the need for intima- cy. Basson states that intimacy may come before or after arousal. Physical sexual ac- tivity may elicit desire. Orgasm does not need to occur for a woman to experience sexual pleasure and satisfaction, and ex- ternal factors play an important role in the sexual response. These factors can include relationship dynamics, intimacy,
and the rewards and/or costs of engaging in sexual activity (Brotto & Graham, 2022). Desire or excitement , the first phase of sexual response, creates a specific sen - sation that causes the woman to seek or respond to a sexual experience (Cason, 2022; Kingsberg & Faubion, 2019). Drive is a biological component that consists of sexual thoughts and fantasies, seek- ing out sexual experiences, and genital tingling and sensitivity: It is the urge to participate in sexual activity. Desire also depends on the attitude toward sexual activity. Attitudes are shaped by culture, religious beliefs, family, and media influ - ences. Desire is also driven by motiva- tion and emotional factors (Cason, 2022). Does the woman want to have sexual ac- tivity with this person currently? Desire is, to some extent, a learned response result- ing from pleasure received from previous sexual activity, and it can vary throughout the lifetime. Feelings of pleasure, enjoyment, and satisfaction contribute to desire for sex- ual activity. Conversely, pain, disappoint- ment, guilt, and dissatisfaction negative- ly influence a woman’s libido. Although sexual desire is a biological event, it is also a social behavior that is based on prescribed, appropriate sexual behaviors. The notion of consent is a factor in will- ingness and readiness for sexual encoun- ters. A woman’s motivation to give herself sexually to another person and to receive the sexual experience is critical (Cason, 2022). Hormones play a large role in feelings of desire. Testosterone causes increased sexual desire in both males and females. Decreases in ovarian hormone levels af- fect the sexual function of the woman. A positive attitude toward sex, open di- alogue, and previous positive sexual ex-
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