Pathways to pleasure: Older adult women's reflections on being sexual beings.

Older adult women make up a growing part of the population, and yet literature on the sexual activity over their life spans is lacking. This qualitative interview study explored the experience of 16 women aged 57-91 to better understand sexual pleasure over a lifetime. The participants described having to challenge cultural rules to create a supportive environment for sexual expression. Having access to Novel contexts in which to learn, cultivating Intimacy with partners and with oneself, being Creative with sexual activities, and Extending one's sense of sexual possibility into advanced age (NICE) supported sexual pleasure as women aged.

Intimacy and Sexuality in Institutionalized Dementia Care: Clinical-Ethical Considerations.

Intimacy and sexuality expressed by nursing home residents with dementia remains an ethically sensitive issue for care facilities, nursing staff and family members. Dealing with residents' sexual longings and behaviour is extremely difficult, putting a burden on the caregivers as well as on the residents themselves and their relatives. The parties in question often do not know how to react when residents express themselves sexually. The overall aim of this article is to provide a number of clinical-ethical considerations addressing the following question: 'How can expressions of intimacy and sexuality by residents with dementia be dealt with in an ethically responsible way?' The considerations formulated are based on two cornerstones: (1) the current literature on older peoples' experiences regarding intimacy and sexuality after the onset of dementia, and (2) an anthropological-ethical framework addressing four fundamental pillars of human existence namely the decentred self, human embodiment, being-in-the-world and being-with-others. The resulting considerations are oriented toward the individual sphere, the partnership sphere, and the institutional sphere. The continuous interaction between these spheres leads to orientations that both empower the residents in question and respect the complex network of relationships that surrounds them.

Managing Professional and Nurse-Patient Relationship Boundaries in Mental Health.

Caring nurse-patient relationships in mental health settings are key components in helping patients recover. These professional relationships provide a safe, trustworthy, reliable, and secure foundation for therapeutic interactions; however, nurses face challenges in setting and maintaining relationship boundaries. Although patients ask for special privileges, romantic interactions, and social media befriending, or offer expensive gifts, nurses must recognize that these boundary violations may erode trust and harm patients. These violations may also trigger discipline for nurses. Professional relationship guidelines must be applied with thoughtful consideration, and nurses must monitor their emotions and reactions in these relationships. The current article is a sharing of personal experiences about boundaries augmented by evidence in the literature, and focuses on managing potential boundary violations (i.e., social media, sexuality, over-involvement, and gift giving) in mental health settings. [Journal of Psychosocial Nursing and Mental Health Services, 55(1), 45-51.].

Sexual health and religion: a primer for the sexual health clinician (CME).

INTRODUCTION: Sexual health is an integral part of the multifaceted human experience that is driven both by biological factors and psychological facets. Religion may provide a moral code of conduct or a sexual compass as to sexual norms and behaviors. AIM: The aim of this study was to summarize the integration of sexuality and religion. METHOD: A review of published literature and religious texts was conducted. RESULTS: The integration of religion with country or state politics and laws is a complicated dilemma and will not be discussed in the scope of this article. The extent to which an individual incorporates their religious doctrine into their sexual life is a personal and individualized choice. The sexual medicine health professional will likely encounter a diverse patient population of distinct religious backgrounds, and a primer on religion and sexuality is a much needed adjunctive tool for the clinician. CONCLUSION: Because religion can influence sexuality and dictate, in part, the behavioral and medical treatments for sexual complaints, the clinician should be familiar with religious guidelines regarding sexuality, and treatment should be customized and individualized. Failure to do so can impact compliance with the therapeutic interventions. Religious awareness also solidifies the therapeutic alliance between clinician and patient as it demonstrates respect and acknowledgment for patient's beliefs and autonomy.

Eternal sunshine of the spotless mind? An anthropological-ethical framework for understanding and dealing with sexuality in dementia care.

Contemporary bioethics pays considerable attention to the ethical aspects of dementia care. However, ethical issues of sexuality especially as experienced by institutionalized persons with dementia are often overlooked. The relevant existing ethics literature generally applies an implicit philosophical anthropology that favors the principle of respect for autonomy and the concomitant notion of informed consent. In this article we will illustrate how this way of handling the issue fails in its duty to people with dementia. Our thesis is that a more inclusive philosophical anthropology is needed that also heeds the fate of this growing population. Drawing on the tradition of phenomenology, we will chalk out an anthropological framework that rests on four fundamental characteristics of human existence: the decentered self, human embodiment, being-in-the-world and being-with-others. Our aim in this article is thus to tentatively put forward a broader perspective for looking at aged sexuality in institutionalized people with dementia. Hopefully the developed framework will mark the beginning of a new and refreshed ethical reflection on the topic at hand.

School-based gay-affirmative interventions: first amendment and ethical concerns.

Public health professionals and educators have developed effective school-based interventions to reduce prejudice and stigma against lesbian, gay, bisexual, and transgender (LGBT) students. Such interventions can reduce the harm caused to sexual minority youths by stigma and can improve health outcomes. However, critics have warned that these interventions attempt to control speech and religious beliefs protected by the First Amendment. We review this critique and assess the legal and ethical arguments. We conclude that, both legally and ethically, there is great leeway for schools to implement LGBT-affirmative interventions. Still, we recommend that interventionists attend critics' concerns using principles of community-based participatory research (CBPR). Using CBPR approaches, interventionists can achieve better community acceptance and cooperation and more successful interventions.

Social and ethical determinants of sexuality: 4. Sexuality and families.

OBJECTIVES: To investigate the evolving relationship between sexuality and family formation. New family units exist today whose impact on society needs to be explored. METHODS: For each main area researched (anthropology, biology, sociology, sexology, ethics) we identified articles dealing with family formation, sexuality and reproduction using PubMed, ScienceDirect, Google, religious websites and texts. RESULTS: The three monotheistic religions and the cultures derived from these have considered sexuality as focused on reproduction. Presently, sexuality has acquired new dimensions, independent from reproduction, as contraception and IVF have separated procreation and sexuality. Thus, the very concept of family has been expanded and so-called 'unusual families' have proved not to be a danger per se for children born and raised within them. CONCLUSIONS: Human sexuality has moved away from having a purely reproductive function, but remains a powerful bond keeping families together, irrespective of the gender identity and the biological links of their members. Even among traditional societies, different types of families exist and the situation has become more complex as technical developments have made parenthood possible for people who in the past were excluded from it.

Intellectual disability, sexuality and sexual abuse prevention - a study of family members and support workers.

BACKGROUND: People with intellectual disability experience difficulty forming intimate relationships and are prone to sexual exploitation and abuse. This study sought information from people involved in the care of adults with intellectual disability regarding how they supported them in the areas of sexuality, relationships and abuse prevention. METHODS: Semistructured interviews and focus groups were held with 28 family members and paid support workers caring for adults with intellectual disabilities. Interviews and focus groups were audio recorded, transcribed, coded and analysed qualitatively. RESULTS: Major themes emerging included views on sexuality and intellectual disability, consent and legal issues, relationships, sexual knowledge and education, disempowerment, exploitation and abuse, sexual health and parenting. DISCUSSION: People with intellectual disability were described as lonely, disempowered and vulnerable to abuse. The sex industry, internet and mobile telephones were identified as new forms of risk. While this study looked at the views of both family members and support workers, the sample was too small to identify any meaningful differences between the two groups.

Law, policy, biology, and sex: Critical issues for researchers.

Researchers should be aware of how sex-difference science is (mis)applied in legal and policy contexts.

Sexuality and consumers of mental health services: the impact of gender and boundary issues.

The importance of sexuality to humanity is clearly acknowledged. However, for consumers of mental health services, it tends to be a neglected topic. Although nurses are at the forefront of mental health service delivery, evidence suggests they are reluctant to include sexuality as part of their care. This article describes the findings from a qualitative exploratory research project that examined mental health nurses' attitudes to discussing sexuality with consumers. Fourteen mental health nurses from a service in Queensland participated in this study. Data analysis revealed two main themes: the impact of gender, and professional boundary issues. In terms of gender, participants referred to the impact of sexual dysfunction experienced by young adult male consumers. For female consumers the discussion centred on vulnerability to sexual exploitation and the need to exercise protective measures to ensure safety. Participants indicated concerns about being professionally compromised when discussing sexuality with consumers of the opposite sex. These findings highlight the need for further exploration of mental health nurses' attitudes towards discussing sexuality with consumers as part of their practice.

Social and ethical determinants of human sexuality: 1. The need to reproduce.

Aims of this study was to review the many and diverse factors conditioning human sexual behavior; starting with the first and still most important: the need to reproduce and to analyse these factors and how they have changed over time in order to better understand the interplay between the major determinants of human sexuality. For this aim the authors made a literature review of relevant scientific papers and books, including religious websites. At the dawn of humanity, sexuality was focused on reproduction; this, however, did not exclude other important meanings in sexual relationships, since non-conceptive copulations have been a constant aspect of human behavior, becoming an almost unique feature of genus homo. In this respect, the characteristics of a female continuously accessible to her male set the stage for a trend towards monogamy and created the substrate for closed families. Anthropologists have justified conceptive sexuality because sexual activity is costly in terms of energy consumption; for this reason, in the early days, restricting sexual activity made sense for the survival of the species. Traditional ethical considerations and ancient norms by the three major monotheistic religions have favored conceptive sexuality, restricting sexual activity to sanctioned unions and insisting that the major scope of sexuality is procreation. In spite of this, among humans sexuality has always had a wider meaning to the point that for millennia, humans have tried to separate its unitive and procreative meanings. Today much has changed since reproduction can be achieved without intercourse, further separating it from sexual activity. In humans sexuality always possessed multiple meanings, first and foremost reproduction and the creation of a bond between a man and one or several women.

Social and ethical determinants of human sexuality: 2. Gender-based violence.

OBJECTIVES: To describe the many forms of gender-based violence and their consequences for society and women's health, focusing on various aspects of the problem, including harassment, stalking, incapacitated rape and war-related violence. METHODS: For each main area a search was made using PubMed, Medline, ScienceDirect, Scopus, classic books, Google and religious websites. The most relevant publications were then utilised for preparing the manuscript. RESULTS: Gender-based violence persists worldwide in spite of efforts by many governments and international organisations to quench it. Men continue to exercise dominance over women, often their own or prospective partners or dates. Abuses are physical, psychological or verbal; they all aim at subduing women. Those that occur during pregnancy are associated with an increased risk of adverse outcomes. Acts of violence can take the form of aggression, coercion, harassment or trafficking; are often committed against minors; may be prompted by an ill-conceived need to defend the family honour and be widespread during armed conflicts. CONCLUSIONS: Men's violent sexual behaviour has often been interpreted as a consequence of blind sexual drive. Today, however, aggressive behaviour is considered to be sensitive to and influenced by environmental cues. Eradication is possible and efforts to eliminate gender-based violence should be intensified.

Beyond Lawrence v. Texas: crafting a fundamental right to sexual privacy.

After the watershed 2003 U.S. Supreme Court decision Lawrence v.Texas, courts are faced with the daunting task of navigating the bounds of sexual privacy in light of Lawrence's sweeping language and unconventional structure. This Note focuses on the specific issue of state governments regulating sexual device distribution. Evaluating the substantive due process rights of sexual device retailers and users, this Note ultimately argues that the privacy interest identified in Lawrence is sufficiently broad to protect intimate decisions to engage in adult consensual sexual behavior, including the liberty to sell, purchase, and use a sexual device.

Sex: we can't have it both ways.

I analyse the tension between a plausible liberal view of sex work and the similarly plausible idea that rape and other forms of sexual violence are made morally worse by their sexual nature. I find no conclusive reason to drop the liberal view of sex work, at least as long as the concept of voluntary and informed consent at the core of it is robust enough to account for the realities of prostitution around the world; nor should we abandon the idea that rape is no ordinary immoral act: reducing sexual violence to non-sexual violence would misrepresent the relevant phenomena and perpetuate injustice.

A secular perspective on 21st century ethics in human reproduction: why religious views and attitudes are becoming obsolete and possibly dangerous.

The application of reproductive technologies to humans has brought about a radical change in traditional perspectives about sexuality and reproduction. In the past, the field was surrounded by an aura of mystery, which allowed religion to grasp the subject firmly. Now an explosion of knowledge, and a new capacity to control all aspects of human reproduction are beginning to modify attitudes, so that the arenas of sexuality and reproduction are apparently undergoing a process of rapid secularization. As a result, religious solutions to reproductive problems are becoming obsolete and possibly dangerous, since they no longer adequately fulfill the needs of humanity in our modern era.

What religious ethics can and cannot tell us about reproduction and sexuality.

The Religious Right movement maintains that only sexual activity open to reproduction is morally acceptable, and that violating this imperative violates God's will. Religious progressives and secular humanists deny these positions, arguing instead that the moral quality of sex is determined by how its participants treat each other. However, religious progressives (but not secular humanists) continue to believe that religion has some authority in ethics. This paper shows why no such arguments are successful, and concludes that any compelling case against the Religious Right sexual ethic and in support of a humane one must be based in secular ethics.

Advancing an Ethic of Embodied Relational Sexuality to Guide Decision-Making in Dementia Care.

Sexuality and intimacy are universal needs that transcend age, cognitive decline, and disability; sexuality is a fundamental aspect of the human experience. However, supporting sexuality in long-term residential care presents ethical challenges as this setting is both a home environment for residents and a workplace for health practitioners. This is particularly complex in the case of residents with dementia given the need to balance protection from harm and freedom of self-determination. Despite such complexity, this challenge has received limited critical theoretical attention. The dominant approach advocated to guide ethical reasoning is the bioethical four principles approach. However, the application of this approach in the context of dementia and long-term care may set the bar for practitioners' interference excessively high, restricting assentual (i.e., voluntary) sexual expression. Furthermore, it privileges cognitive and impartial decision-making, while disregarding performative, embodied, and relational aspects of ethical reasoning. With an interest in addressing these limitations, we explicate an alternative ethic of embodied relational sexuality that is grounded in a model of citizenship that recognizes relationality and the agential status of embodied self-expression. This alternative ethic broadens ethical reasoning from the exclusive duty to protect individuals from harm associated with sexual expression, to the duty to also uphold and support their rights to experience the benefits of sexual expression (e.g., pleasure, intimacy). As such it has the potential to inform the development of policies, organizational guidelines, and professional curricula to support the sexuality of persons with dementia, and thereby ensure more humane practices in long-term residential care settings.

Ethics of justice and ethics of care. Values and attitudes among midwifery students on adolescent sexuality and abortion in Vietnam and their implications for midwifery education: a survey by questionnaire and interview.

UNLABELLED: Adolescent's sexuality and related reproductive health and rights problems are sensitive issues in Vietnam. Globalisation has had an impact on the lifestyles of young people, and rising numbers of abortion and STI/HIV risks among youth are posing major health concerns in the country. These problems need to be addressed. Midwives belong to a key category of health personnel in Vietnam, whose task it is to promote adolescents' sexual and reproductive health and prevent reproductive ill health. It is important to understand future midwives' perceptions and attitudes in order to improve their education and training programmes. AIM: The aim of this study was to investigate Vietnamese midwifery students' values and attitudes towards adolescent sexuality, abortion and contraception and their views on professional preparation. METHODS: A quantitative survey including 235 midwifery students from four different secondary medical colleges in northern Vietnam was carried out in 2003. A qualitative study addressing similar questions was performed and 18 midwifery students were individually interviewed. FINDINGS: Findings revealed a general disapproval of adolescent pre-marital sexual relations and abortion-'an ethics of justice'-but also an empathic attitude and willingness to support young women, who bear the consequences of unwanted pregnancies and social condemnation-'an ethics of care'. Gender-based imbalance in sexual relationships, limited knowledge about reproductive health issues among youth, and negative societal attitudes were concerns expressed by the students. The students saw their future tasks mainly related to childbearing and less to other reproductive health issues, such as abortion and prevention of STI/HIV. CONCLUSION: Midwifery education in Vietnam should encourage value-reflective thinking around gender inequality and ethical dilemmas, in order to prepare midwives to address adolescents' reproductive health needs.