Analysing the concept of sexuality

University Degree Subjects allied to Medicine

Analysing the concept of

SEXUALITY

Vincent Saliba

Introduction

“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:

This is a preview of the whole essay

“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).

Psychological Associations

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).

Sociological Associations

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)

The table below elicits the main categories of sexuality including all the attributes which the author has identified.

It has clearly been demonstrated that the concept of sexuality is very broad, and therefore the author will limit the choice for only three attributes (one from each category) and construct the case models accordingly. These are ATTRACTION, STIMULUS, and EXPERIENCE.

Model Case

Chris was window-shopping while walking along a street. As he walked by a sweet shop he became attracted by the way the sweet cakes were displayed. This temptation stimulated him to enter the shop and buy one. He paid the shopkeeper and could not wait to take a mouthful. The cake was so good that Chris could not describe the experience he was encountering.

This model case includes all three critical attributes, attraction, stimulus, and experience. It demonstrates how in sexuality, attraction and stimulus lead to the expectation of sexual gratification and satisfaction - experience.

Borderline Case

Chris was window-shopping while walking along a street. As he walked by a sweet shop he became attracted by the way the sweet cakes were displayed. This temptation stimulated him to enter the shop and buy one. He paid the shopkeeper and could not wait to take a mouthful. To his surprise though, the cake tasted so bad that he had to throw it away.

Although both attraction and stimulus are present, in this case the expected end result is not achieved and therefore the experience is deluding.

Related Case

Sarah is fed up doing the same job everyday in a factory. She always aspires to become a supervisor but does not have the necessary qualifications. During a staff Christmas party, she uses her seductive carnal approach to convince her boss in gratifying her expectations. Her boss falls into the trap and for the New Year, Sarah starts her new job as a supervisor.

In this case, although the critical attributes are not included, the concepts of “power’ and ‘achievement’ are being closely related to the main concept.

Contrary Case

While Ronald was walking by, he met his friends who were waiting on the bus stop to go to the cinema and watch a box office breaking film. Jesmond invites Ronald to join them, however Ronald feels reluctant to go and had to come up with an excuse that the film was boring. Jesmond kept pestering Ronald up to a stage that Ronald could not refuse. It was not long before the film started that Ronald fell asleep.

This case meets none of the critical attributes which pertain to sexuality. Although the film was a box office breaker, Ronald was never attracted, his disinterest never stimulated him, and once he fell asleep he never experienced the film.

Invented Case

The computer keyboard taps on the modem and asks “Hey modem, why don’t you dive into the internet and find something attractive for us all?” Stimulated by this request, the modem immediately logged into the internet. The C.P.U. went straight into an intensive search and finally downloaded a programme. The colour monitor turned on and to everybody’s surprise, they experienced the most colourful screen saver programme they have ever encountered.

This case, though totally fictitious, demonstrates the critical attributes which relate to the main concept.

Antecedents and Consequences

Empirical referents

According to Olszewski Walker and Goalson Avant (1992), empirical referents are classes or categories of actual phenomena which by their existence or presence demonstrate the occurrence of the concept itself. Using the three main attributes applied in this analysis an empirical referent for ‘attraction’ might be ability to charm in order to achieve something; ‘stimulus’ - ability to arouse and put incentive; and ‘experience’ - ability to feel or undergo.

Conclusion

The concept of sexuality has been analysed and focused mainly on Nursing perception. Due to the vast application of this concept three categories were identified namely the physiological, psychological, and sociological aspects which many authors refer to. The numerous attributes which emerged from these three categories limited the author to directly analyse three main attributes each one coming from a different category. These were attraction, stimulus, and experience. The wide application of this concept is evident however the majority of the definitions address this concept as something pertaining to wholeness and which is present in all walks of life. The complexity of this concept further suggests thorough analysis in order to help nurses increase their knowledge in this respect with the major intention of helping patients recover even better when suffering from their unfortunate illnesses.

References

Bee H (1995) The Developing Child (7th. Edition), New York, Harper Collins.

Carr G (1996) Themes relating to sexuality that emerged from a discourse analysis of the Nursing Times during 1980-1990. Journal of Advanced Nursing, 24, 196-212.

Collins English Dictionary (1991) 3rd Edition, J.M. Sinclair (Ed) London, Harper Collins.

Coughlan U (1987) Dear Nurse Nursing Times 85 (42), 32-34. In Carr G (1996) Themes relating to sexuality that emerged from a discourse analysis of the Nursing Times during 1980-1990. Journal of Advanced Nursing, 24, 196-212.

Fransella F and Frost K (1977) On Being a Woman London, Tavistock Publications. In Webb C (1985) Sexuality, Nursing and Health Toronto, HM + M Publishers.

Hogman R M (1980) Nursing and human Sexuality Nursing Times, July 24th, 1296-1300. In Carr G (1996) Themes relating to sexuality that emerged from a discourse analysis of the Nursing Times during 1980-1990. Journal of Advanced Nursing, 24, 196-212.

Hohmann G N (1972) Considerations in management of psychosexual readjustment in the cord injured male. Rehabilitation Psychology, 19, 50-58. In Ooijen E and Charnock A (1994) Sexuality and Patient Care London, Chapman and hall.

Kuczynski J (1986) Liberal Studies Nursing Times, July 9th, 60-61. In Carr G (1996) Themes relating to sexuality that emerged from a discourse analysis of the Nursing Times during 1980-1990. Journal of Advanced Nursing, 24, 196-212.

Mace D R, Bannerman R H D, and Burton J (1974) The Teaching of Human Sexuality in Schools for health professionals Geneve, World Health Organisation. In Webb C (1985) Sexuality, Nursing and Health Toronto, HM + M Publishers.

Olszewski Walker L and Goalson Avant K (1992) Strategies for Theory Construction in Nursing (2nd Ed) Texas, Appleton and Lange.

Ooijen E and Charnock A (1994) Sexuality and Patient Care London, Chapman and hall.

Roper N, Logan W, and Tierney A (1990) The Elements of Nursing (3rd. Ed.) London, Churchill Livingstone.

Sex Information and Education Council of the United States (SIECUS) Internet Address: http:\\www.siecus.org .

Stuart G W and Sundeen S J eds (1979) Principles and Practice of Psychiatric Nursing St.Louis, CV Mosby. In Webb C (1985) Sexuality, Nursing and Health Toronto, HM + M Publishers.

Thomas B (1989) Asexual Patients Nursing Times 85, (33), 49-51. In Carr G (1996) Themes relating to sexuality that emerged from a discourse analysis of the Nursing Times during 1980-1990. Journal of Advanced Nursing, 24, 196-212.

Webb C (1985) Sexuality, Nursing and Health Toronto, HM + M Publishers.

Webb C (1987) Sexual Healing Nursing Times, 83 (32), 29-30. In Carr G (1996) Themes relating to sexuality that emerged from a discourse analysis of the Nursing Times during 1980-1990. Journal of Advanced Nursing, 24, 196-212.

Webb C (1994) Living Sexuality London, Scutari press.