social concerns in health care and nursing

social concerns in health care and nursing Whether clients present with sexual concerns or these concerns arise later in
treatment, it is important for therapists to appreciate contemporary sexual lexicons.
Students oft en bifurcate their experiences as “sex” and “not sex”—even
though they may disagree about what constitutes “sex” (Reinisch & Sanders,
1999). Whereas traditionally sex has been broadly defi ned as genital contact of
any kind, young people today are more likely to consider only penile–vaginal
intercourse to be sex.
Indeed, one fi ft h of college students do not consider penile–anal intercourse
to be sex and four fi ft hs don’t consider oral and manual stimulation sex
(Sanders & Reinisch, 1999). For some young people, sex’s defi nition depends
on whether there has been a date, an emotional investment, and an orgasm,
and who did what to whom. Among college students, heterosexual penile–anal
intercourse is sometimes considered sex only if the man orgasms—and oral
sex is sometimes defi ned as sex only if the recipient achieves orgasm (Bogart,
Cecil, Wagstaff , Pinkerton, & Abramson, 2000). Because active partners in
oral sex seldom achieve orgasm, many students don’t regard that act as sex.
Also of note, same-sex-attracted youth are more likely than heterosexuals to
consider use of sex toys, oral–anal contact, penile–anal intercourse, and oral
stimulation to be sex.
Sometimes students’ sexual identity does not correspond with their sexual
behavior or primary sexual attractions (Savin-Williams, 2005). A therapist
must cautiously distinguish among these sexual domains. For example,
assessing sexual behavior rather than identity is particularly important with
homoerotic male international students and North American minority races and ethnicities, who commonly engage in clandestine (“on the down-low”)
unprotected same-sex behavior while eschewing the labels “gay” or “bisexual.”
Because they ignore health messages aimed at gay and bisexual men, they are
at increased risk for contracting human immunodefi ciency virus (HIV) and
transmitting it to their female partners (Cohen & Savin-Williams, 2004).
Defi nitions of sex also have direct implications for physical safety. Whereas
broad-based sex education campaigns help students recognize the risks of
penile–vaginal intercourse, youth may ignore or underestimate the sexually
transmitted infection (STI) risks of seemingly benign “not sex” activities such
as oral–anal and penile–anal contact.
Virginity status is similarly dependent on sexual taxonomy. Th ree quarters
of respondents in one study did not consider heterosexual oral sex to constitute
loss of virginity, and less than half did not consider anal sex as virginity
loss (Carpenter, 2001). Youths who want to maintain their virginity status are
increasingly resorting to anal and oral sex to fulfi ll personal and relational
needs. Indeed, women who wish to retain their virginity but fear losing their
boyfriends may off er—or be coerced into—anal sex as placation, despite sometimes
feeling marginalized or shamed aft erward. Of course, some women
enjoy anal sex, and its practice should not necessarily generate concern.
In sum, young people with identical sexual histories may arrive at vastly
diff erent conclusions about the meaning and implications of their sexual
behavior. For therapists, imprecise taxonomy generates fl awed conceptualizations
and inappropriate interventions. When working with sexual issues, it is
imperative to ask specifi c questions about specifi c behavior.